Navigating Mexico: End of Life
By JUAN DE JESÚS BREENE
I was recently at a gathering in San Miguel de Allende in the central Mexican state of Guanajuato and I asked about so-and-so. I was told that the person died a few months ago. I knew this person had been sick for a while, so I asked what was the cause of her death.
I was told that her doctor had ended her life. I quickly responded that euthanasia was not legal in any Mexican state. Someone else was called over who corroborated the same version — her doctor had ended her life.
Since this was a social gathering, I left it at that, but as soon as I got home, I wanted to look it up myself. Could the state of Guanajuato really have passed a euthanasia law?
With a federal law prohibiting it, I knew it could not be possible. But in Mexico, one never knows anything for sure.
I am guessing that what both persons were referring to regarding this person who had passed away, was that her doctor — as per her wishes — had ordered no heroic measures to prolong her life by extraordinary means.
I dug deeper. Only 15 Mexican states have end-of-life option measures, possibly translated as an advance directive law or last will and testament. The first state to adopt such a provision was Mexico City in 2008. Additionally, the states of Coahuila, Aguascalientes, San Luis Potosí, Michoacán, Hidalgo, Guanajuato, Guerrero, Nayarit, State of Mexico, Colima, Oaxaca, Sonora, Yucatán and Tlaxcala also have variations of what are known in English as living wills, death-with-dignity provisions and end-of-life options.
A general principle of Mexican law is that that which is not prohibited, is allowed. Mexico’s General Health Law textually states, “the practice of euthanasia, understood as mercy killing, as well as assisted suicide, as stated in the Federal Penal Code, is prohibited under the protection of this law.”
Mexico uses the World Health Organization’s (WHO) definition, which defines euthanasia as an “action by a doctor that deliberately causes the death of a patient.” Some countries define this as active euthanasia. This is what is not allowed in Mexico.
So keeping in mind what is not allowed, what actually is allowed in Mexico?
First, only the previously mentioned states allow some form of the following, and, even then, the conditions vary from state-to-state.
The Advance Directive Law allows treatment that the patient no longer wants, which only prolongs life and causes suffering, to be refused. This is certainly not a verbal or even casually written agreement between patient and doctor on the back of a cocktail napkin.
In those states where such directives are permitted, the typical requirements would be that the person requesting the suspension of heroic measures must: be over 18 years old, make the request in writing before a notary with two witnesses, name a person and substitute who will inform healthcare professionals of the document and pay a filing fee.
The notary must attain that the individual: has full use of his or her faculties and be in a state of mind to make such a decision that is conscious, serious, unequivocal and a formal request, and that they are making the decision of his or her own free will with no coercion.
If necessary, it is manifested to the attending doctor, healthcare providers, hospice workers and, most importantly, family members that they must abide by the dying individual’s wishes.
Yes, the person dying must be given food and water, at least intravenously. Yes, the person dying must be administered pain medicine and treated with dignity during the palliative care leading up to the moment of death.
Where the law in the states where this is permitted becomes tricky is defining what exactly constitutes extraordinary measures.
Is leaving the hospital to die at home permitted? Many doctors, even with a notarized end-of-life document, are reluctant to release a dying patient from the hospital.
On the flip side of the argument, in Mexico it is quite easy for a doctor to make a home visit. A doctor or palliative healthcare professional could easily monitor the patient’s vitals, feeding tube and breathing assistance device, and even administer medication for infections from the patient’s home.
Can a doctor or nurse refuse to honor the request? Yes, an individual for religious or other reasons can remove themselves from the process, but the institution must provide other professionals willing to honor the patient’s request.
The key seems to be for the patient to, from early on, be very clear with the attending physician, family and others about the existence of the notarized document and expectations.
What if you do not live in one of the aforementioned states? In an informal discussion with a group of attorneys, the best work-around we could come up with was establishing residency in one of those states and notarizing the document in that state. Just as a driver’s license or marriage certificate issued in one state must be recognized in other states, so must this type of notarized document.
The practice of end-of-life provisions is relatively uncommon in Mexico, yet for foreigners the practice is well-known and considered a quasi-right.
So like most things in Mexico, the answer is yes and no, depending on the state you live in, and, most importantly, on taking the time to make for your physician understand that patients also have rights.