En busca del buen morir / In search of a good death

La muerte siempre ha generado desconcierto, por lo que acompañar en este proceso de final de vida conlleva un alto compromiso existencial. Si a esta difícil tarea se le agregan los condicionantes hospitalarios o legales que sufren los enfermos en su agonía, estamos ante una muerte aterradora, muy distante de una partida que pueda ser considerada amorosa. Como sabemos, la palabra "clínica" hace referencia a la práctica de atender al pie de la cama del paciente, aliviando el dolor del que está por partir; sin embargo, el "corsé legal" de la muerte está alejando al médico de aquel que debiera recibir toda su atención y sus cuidados, atándole el brazo para acompañarlo en el buen morir. Deberíamos debatir y acordar una estrategia que enriquezca la experiencia del momento final de la vida, de modo que ese conjunto acotado de pacientes pueda elegir su forma de partir. Es de un valor incalculable despertar la compasión en este tema tan importante que preocupa al ser humano desde los inicios de la civilización. Sería muy fructífero que aprovechemos la transmisión de sabiduría de siglos de antiguas culturas que han sabido cuidar con humildad la vida hasta el instante de morir. (AU)

Death has always implied confusion, so accompanying this end-of-life process entails a highexistential commitment. If we add to this difficult task the hospital or legal constraints suffered bypatients in their agony, we are facing a terrifying death, very far from a departure that can be considered a loving one. As we know, the word "clinical" refers to the practice of caring for the patient very close to the bed, alleviating the pain of whom is about to leave; however, the "legal corset" of death is separating the doctor from the one who should receive all his attention and care, preventing him from accompanying the pacient in his/her good dying. We should discuss and agree on a strategy that enriches the experience of the end of life, so that patients could choose the way to leave. It is of incalculable value to awaken compassion on this important issue that has concerned human since the beggining of civilization. It would be very fruitful if we take advantage of the enormous wisdom of ancient cultures that have humbly cared for life until the moment of death. (AU)

[Recent case law about the right to die]. / Desarrollos recientes en la jurisprudencia sobre el derecho a morir.

This paper reviews the sentences dictated between 1993 and 2002 by the Supreme Courts of Canada and the Unites States, the House of Lords and Supreme Court of the United Kingdom and the European Human Rights Court, about the validity of the legal prohibition of assistance for suicide. These sentences constituted a judicial consensus about the right to die. This consensus recognized the legal right of patients to reject medical treatments but did not recognize the right to be assisted by a physician to commit suicide. This exclusion is changing in the recent case law of Canada and the United Kingdom, which accepts the fundamental right of terminal patients to medically assisted suicide.

Desarrollos recientes en la jurisprudencia sobre el derecho a morir / Recent case law about the right to die

This paper reviews the sentences dictated between 1993 and 2002 by the Supreme Courts of Canada and the Unites States, the House of Lords and Supreme Court of the United Kingdom and the European Human Rights Court, about the validity of the legal prohibition of assistance for suicide. These sentences constituted a judicial consensus about the right to die. This consensus recognized the legal right of patients to reject medical treatments but did not recognize the right to be assisted by a physician to commit suicide. This exclusion is changing in the recent case law of Canada and the United Kingdom, which accepts the fundamental right of terminal patients to medically assisted suicide.

Physician-assisted death with limited access to palliative care.

Even among advocates of legalising physician-assisted death, many argue that this should be done only once palliative care has become widely available. Meanwhile, according to them, physician-assisted death should be banned. Four arguments are often presented to support this claim, which we call the argument of lack of autonomy, the argument of existing alternatives, the argument of unfair inequalities and the argument of the antagonism between physician-assisted death and palliative care. We argue that although these arguments provide strong reasons to take appropriate measures to guarantee access to good quality palliative care to everyone who needs it, they do not justify a ban on physician-assisted death until we have achieved this goal.

¿Podría ser aceptable la eutanasia infantil? / Could infant euthanasia be ever acceptable?

The recent enactment of a law that allows infant euthanasia in Belgium raises questions with varied answers. To contribute to a better understanding of the topic, euthanasia and legislation concepts are described. After a bioethical analysis, we propose as conclusion that children euthanasia could only be acceptable in very exceptional situations in which palliative measures have failed. The answer should be that it is not acceptable in our setting, not until we have public policies, protocols and palliative care services for terminally ill children.

La reciente promulgación de una ley que permite la eutanasia infantil en Bélgica plantea interrogantes que admiten respuestas diversas. Para contribuir a una mejor comprensión del tema se describen los conceptos de eutanasia y la legislación pertinente. Después de hacer un análisis bioético, se plantea como conclusión que la eutanasia de niños podría ser aceptable sólo de manera muy excepcional ante situaciones en las cuales hubiesen fracasado las medidas de cuidado paliativo. Para nuestro medio la respuesta debería ser que no es aceptable, al menos mientras no existan políticas públicas, protocolos y servicios de cuidados paliativos para niños con enfermedades terminales.

[Could infant euthanasia be ever acceptable?]. / ¿Podría ser aceptable la eutanasia infantil?

The recent enactment of a law that allows infant euthanasia in Belgium raises questions with varied answers. To contribute to a better understanding of the topic, euthanasia and legislation concepts are described. After a bioethical analysis, we propose as conclusion that children euthanasia could only be acceptable in very exceptional situations in which palliative measures have failed. The answer should be that it is not acceptable in our setting, not until we have public policies, protocols and palliative care services for terminally ill children.

Posición contraria al fallo de la Corte Constitucional que declaró la exequibilidad condicionada del artículo 326 del código penal que consagra el delito de eutanasia / Opposite position to the constitutional court sentence that declared the conditioned exequibility of the article 326 from penal code that consecrate the euthanasia crime

La Corte Constitucional colombiana determinó declarar ajustado a la Constitución Política el artículo 326 del Código Penal, bajo la condición de que en el caso de los enfermos terminales que hayan expresado libremente su consentimiento no podrá derivarse responsabilidad penal para el médico que lleve a cabo la conducta eutanásica. Este artículo resume la posición de tres magistrados que salvaron su voto y la de uno que hizo una aclaración especial de voto motivada en su convicción de que el contenido de la sentencia no reflejó lo decidido por la Sala Plena de la Corporación Judicial en la sesión correspondiente. Los magistrados discrepantes comparten con la mayoría de la Sala la decisión en cuanto a la constitucionalidad de la norma que consagra como delito la eutanasia, pero disienten en lo relativo al condicionamiento que agregó la mayoría de la corte

Instrumentos legales en la toma de decisiones medicas en cuadros cronicos terminales / Legal instruments for medical decision-making concerning terminal chronic diseases

La imposibilidad de dar el consentimiento personalmente plantea el que se requiera personas que tomem decisiones por ellos. Una forma alternativa es el uso de instrumentos escritos de validez juridica representados por los testamentos vitales y los poderes legales, llamados genericamente de directivas de futuro.

European court prevents deportation of man with AIDS.

AIDS: The European Court of Human Rights ruled that a man approaching death from AIDS-related complications cannot be deported to St. Kitts. The man, identified as D, was convicted of possessing large quantities of cocaine, and after a six-year sentence was ordered deported from the U.K. He argued that his removal to St. Kitts would deprive him of access to medical care and would, in effect, be a death sentence. The Immigration Department argued that policy did not give persons with AIDS an automatic right to remain in the country. The court found that the Convention for the Protection of Human Rights and Fundamental Freedoms protected the man's right to remain.^ieng

Direitos e deveres do paciente terminal / Rights and obligations of the terminal patient

Focaliza a questäo dos direitos e deveres do paciente terminal por meio dos três grandes princípios da bioética: autonomia, beneficência e justiça. A singularidade da situaçäo terminal faz aparecer de forma mais nítida a substância ética da relaçäo médico-paciente. Na situaçäo-limite vivida pelo paciente como pessoa, devem ser vistos como básicos e incontornáveis os direitos de saber a verdade, dialogar, decidir e näo sofrer inutilmente