Mexico’s Euthanasia Debate: Fix Palliative Care First

As the "Ley Trasciende" bill pushes for the legalization of euthanasia in Mexico, experts are raising alarms about the country's lack of infrastructure, personnel, and coverage for palliative care, as well as the ethical dilemmas surrounding its potential approval.

Active euthanasia is prohibited in Mexico under Article 166 of the General Health Law and is classified as "homicide by pity" in the Federal Penal Code. Only 14 states have a Ley de Voluntad Anticipada (Advance Directive Law), which allows patients to decide whether they wish to continue medical treatments in a terminal phase.

The "Ley Trasciende," promoted by activist and professor Samara Martínez, who suffers from a terminal kidney disease, proposes modifying Article 166 to include a new Eighth Title that establishes the conditions under which a patient could access euthanasia.

"The problem is that when euthanasia is accepted, it tends to become progressively trivialized, so euthanasia and assisted suicide increase, which is when the patient is provided with the means to apply it themselves," said physician, researcher, and bioethicist Martha Tarasco.

The specialist stated that active euthanasia does not guarantee a painless death, as the substance given to the patient "does not act instantaneously." She also warned that in countries where it is legal—such as the Netherlands, Belgium, Luxembourg, Canada, and Colombia—its application has expanded to cases that do not involve terminal suffering.

"It can currently be requested for depression, for not finding meaning in life, or for not being able to care for oneself. Pain, which is now controlled with palliative care, is no longer the limit," she indicated.

The specialist emphasized that many patients who request euthanasia "are actually asking for their pain or depression to be taken away, not for their life to be taken," and stressed that "no one wishes to die when their symptoms are adequately treated."

Lack of Infrastructure to Regulate Euthanasia

For her part, Adriana Templos, president of the Mexican College of Palliative Care, stressed that Mexico lacks the healthcare infrastructure to even discuss the regulation of euthanasia without first guaranteeing universal palliative care.

"The country is not prepared. There is not enough health budget, we have a major surge in chronic degenerative diseases, and there is not enough hospital coverage or essential medications," she asserted.

Templos detailed that between 70% and 79% of the population requiring palliative care does not receive it. Mexico has only between 120 and 140 palliative care services for more than 125 million inhabitants, with some states having only 6 to 10 specialized units.

"What people are desperately asking for is not to suffer, not to have pain. That can be achieved with universal palliative care coverage," she emphasized.

The specialist noted that access to opioids like morphine—considered essential for controlling severe pain—remains restricted, and lamented that training in palliative care "is not taught in medical schools or in healthcare area schools."

Tarasco stated that "letting die is not the same as killing. Letting die is allowing the natural course of life. Asking for a substance to cause death is something else."

In that sense, Templos questioned: "How do we assess existential suffering? What standards will we use? Healthcare personnel are not even prepared to limit futile treatments, let alone to practice euthanasia."

She also warned that 50% of those who request euthanasia present with untreated anxiety or depression and that, upon receiving care, "they no longer wish to die." Furthermore, 98% of older adults lack an advance directive plan, leading to "hospitalizations and interventions they did not want, generating avoidable suffering."

Both experts concluded that before legislating on medically assisted death, Mexico must guarantee universal palliative care.

"The first step is to cover 100% of suffering treatment. Only then can we discuss other alternatives," Templos stated.