Table 1 The legal status of the application of euthanasia in Colombia in 2017–2020

In 1997, the Constitutional Court stated the conditions for practicing euthanasia (defined as “murder out of mercy” in the Penal Code) and ruled that under such conditions there would not be any penalty. This was a paradoxical outcome as the Court was solving a case in which a Colombian citizen was requesting to increase the penalty for “killing out of mercy” (six months to three years) to be comparable to homicide (10+ years). In the case of euthanasia, the Court acknowledged that the active subject (the doctor) was acting within the criterion of compassion and solidarity, which is enshrined in the Constitution, for the passive subject (the patient). The Court considered that euthanasia must be requested by the patient himself, who must suffer from a terminal illness that causes intense suffering and which cannot be otherwise alleviated. It was established that euthanasia must be carried out by a physician, who would not be penalized if conditions for euthanasia were met (see below).

The treating physician must know the clinical condition of the patient to such extent that a good prediction of prognosis (using prediction scales) is possible in order to define if the patient can be considered terminally ill. A terminally ill patient is defined as a patient with a medically confirmed advanced, progressive and uncontrollable disease, characterized by the absence of reasonable treatment options, with physical and psychological suffering despite having received the best available treatment, and with a life expectancy of less than 6 months.

The following are the processes required to guarantee that patient is capable of requesting euthanasia, regulated in the Protocol for the application of the procedure of Euthanasia in Colombia [11],

1: Medical condition: terminally ill patient. Expected date of death in absence of euthanasia must be established, communicated to the patient and registered in the medical record. Physician must also record if patient is considered to understand his or her medical condition.

2: Evaluation of suffering: nature and level of suffering must be evaluated as intolerable and without perspectives of improvement. This evaluation must include the perception of the treating physician and the patients´ perception, prioritizing the latter.

3: Absence of alternative treatment or care options. Received interventions must be documented, including those related to symptom management and palliative care and the results of these interventions. The patient must have had contact with a specialist in pain and palliative care and a disease-specific specialist.

4: Persistence of the explicit request. Treating physician informs when was the first time the patient expressed the request and if this request persisted over time for at least 25 days or was repeated and if the request is voluntary, free of influence of others or if any “advance directive”, either written or documented in the medical file, exists.

5: Evaluation of the capacity to decide. A psychiatrist or clinical psychologist must establish the capacity to make decisions of the patient. This evaluation must be performed prior to the evaluation by the euthanasia committee.

6: Second evaluation. The scientific interdisciplinary committee for the right to a dignified death, is the evaluates if the anterior requisites are fulfilled. This committee must be independent from the treating physician (in particular in terms of hierarchy), must not have evaluated the patient previously, and must not have a personal or professional relation with the patient. In case of discordance between the two evaluations, the committee re-evaluates the case consulting another professional.

7: Integrity of the evaluation. The treating physician and the scientific interdisciplinary committee for the right to a dignified death must base their evaluation on the medical records, the document with the written request, the conversation with and physical examination of the patient, and the dialogue with other members of the team of physicians or the family, if the patient authorizes. The treating physician must provide a summary of these findings at the moment of presenting the request for the committee.

Patients and family members or caretakers must be informed on each step of the process and be accompanied by psychologists if needed.

Physicians or medical institutions can refuse to provide euthanasia to a terminally ill patient: physicians can take on conscientious objection and institutions can refuse arguing that their principles are violated, but they have to guide the patient towards a place or situation where their request can be met.

Both adults and children (from 6 years on, meeting certain conditions) are legally allowed to request the procedure.

It is compulsory to send a complete report of the case to the Ministry of Health and Social Protection, which will check the standards of the procedure and provide statistics about it.