Andrés Núñez Leites

// Unwanted effects (?!)

When legislating, one must always consider, whether seeking to inhibit or promote conduct, what the consequences may be in concrete material terms, beyond the explicit aims proclaimed in the norm or in the discussion prior to its production. The hypothesis of the misuse of a norm, for whatever reasons, cannot be absent when legislating, since if it becomes a useful tool for the accumulation of power of any actor, the probability of that such use is carried out. In the specific case of the bill "Euthanasia and Medically Assisted Suicide" by Ope Pasquet and others [1], the vagueness of Article 1, which I will mention below, can easily open the door to the excessive use of Medically Assisted Suicide, which depending on how it is organized in healthcare and financial terms, it may eventually lead to excessive profit around the voluntary termination of life for many people in favor of the economic benefit of some medical companies, and even to the creation of "suicide tourism" in Uruguay, if it is not specified that this type of intervention is exclusively for citizens -unlikely in circumstances of significant presence of a recent immigrant mass.

// A much too wide door to death

Article 1 of the aforementioned project says verbatim: "The doctor is exempt from liability, acting in accordance with the provisions of this law and at the express request of a person of legal age, psychically fit, ill with a terminal pathology, irreversible and incurable or afflicted by unbearable sufferings, it kills him or helps him to kill himself."

The weakness of the limits that are established is evident: "sick with a terminal pathology, irreversible and incurable" does not specify that the person is precisely in the terminal stage of the development of the pathology that is. Thus, in this situation, as the project is drafted, a person with a diagnosis of "terminal, irreversible and incurable" disease could be included, but at an early stage in the development of the pathology, such that with adequate medical and psychological assistance, lead a more or less prolonged life and in conditions held as worthy, for their own benefit, of their family and their community.

Then, "afflicted by unbearable sufferings", a phrase significantly preceded by the word "or", that is, not as a condition that adds up but as a possible variant of a series of cases that would fulfill the condition of candidates for euthanasia or assisted suicide has already given rise, in cases that are emblematic in other countries [2] to the request and execution of euthanasia and assisted suicide by young people for reasons of psychological suffering (in the absence of terminal organic pathology) whose reversibility in therapeutic terms it would have had many possibilities.

// More euthanasia?

The context and timing of this legislative initiative are, to say the least, striking. It can be argued that suicide should be a right, to the extent that each individual, in full use of his freedom, should be able to choose when to interrupt his life. The variant of assisted suicide and euthanasia, to the extent that they involve the active intervention of the State and the public and / or private medical system, require limits linked to a clinical assessment of the patient's suffering and their possibility of temporary or definitive recovery. However, other negative experiences for our country in the matter of legalization and statization of risky behaviors such as the production and commercialization of marijuana (which was accompanied, contrary to the hypothesis of its promoters, by a notable increase in the consumption of more dangerous drugs and addictive such as cocaine), can serve as an indicator of a social dynamic in which the equilibrium point of normalization, that is, the midpoint between the poles of legalization or statization on the one hand and prohibition and repression on the other, be the best option, since in those poles the collective damage tends to be greater, either by explicit or tacit promotion of behavior or by generating a response in the form of a "black market". Applied this reasoning to the specific topic of euthanasia and assisted suicide, euthanasia already occurs in fact, although not always explicitly verbalized as such ("with the doctor we decided to give him the cocktail") in the agreement between the family and the doctors, through the application of drugs to mitigate the suffering of terminally ill patients. In other words, unless we were living in a situation in which that practice was permanently persecuted by the State, the proposal to give it a positive legal status does not seem to have a practical utility and could rather bring the problems mentioned in the previous paragraph, in as for the excessive anticipation of death.

// Suicide is the message

Regarding assisted suicide in particular, there is a semiotic dimension implicit in the fact that in Uruguay, one of the countries of the world with the highest incidence of suicide (especially in young and elderly men), it is proposed that health providers (Public and private) approve suicide, teach a method for suicide, and provide the material means for suicide execution: the law would be legitimizing and accepting suicide as a legitimate way to deal with problems, beyond explicitly endorsing it only in situations of medically certified physical and / or psychic suffering. There is an abundant literature available on survivors of self-elimination attempts that tends to agree that what is actually sought in most cases is to change their life situation and not kill themselves; precisely, suicide tends to appear when the perceived personal capacity to deal with problems and the perception of belonging to the group, that is, the bases of meaning and existential purpose, decline. [3] In addition, this disturbing and negative message is endowed by the projected norm with very short execution times in relation to the seriousness of the decision taken: the time between the consultation and the approval and medical provision of means for assisted suicide is counted in a few weeks.

// Mental health, illusio

Some mental health clinicians have begun to sound the alarm regarding the outsized bill for euthanasia and medically assisted suicide [4]. Perhaps a constructive way of looking at the matter is to point in the opposite direction to that of the project and to ask ourselves how we can do, from the different spheres of society, to strengthen the individual will regarding the meaning of life. Of course, we must understand the suffering people who choose suicide (assisted or not) and those who, with the support or not of their family, seek to alleviate the suffering of the terminal stage of a painful disease through euthanasia: Tolerance and emotional support for those who walk these dark paths must be the sign of our solidarity. But the legalization of both euthanasia and medically assisted suicide generate an enormous risk of ending up causing a much higher level of human suffering than that which is sought to bring down the express text. The legitimization of suicide as a way out of personal problems is probably a clear side effect of that unsensible legalization, just when suicide is, among other things, the most radical obliteration of any way of solving problems in addition to causing emotional and bonding injuries that are long lasting in the relatives of those who take their lives and in the community they inhabited.

That a country like ours has more suicides than homicides, speaks of a very deep social crisis in terms of the meaning of life. Human society, as a space of social relationship, requires a deep predisposition to participate in the social game and believe in its meaning, to dispute its prizes, bear its sanctions, accept and modify its rules, an "illusio" situated between biological propensities and the psychic and cultural configurations. [5] It is up to thinkers, philosophers, scientists inside and outside the academy to investigate this problem of meaning and individual and collective project, also addressing - but not only - the problems of the specific population sectors that suffer the most from the incidence of depression and suicide, which, among other effects on mental health, can be read at least partially as manifestations of this collective crisis. It is the responsibility of public administrators to design intelligent and informed plans to support the development of the mental health of the population that go beyond the annual announcements that, with a circumspect gesture, are announced by the health authorities when the official suicide figures are published. It is up to the legislators to promote broad social discussions, seek the best scientific support and operate based on a principle of prudence when proposing changes that, if poorly designed, as appears to be the case we are discussing here, can bring much more suffering to our population than the one it is supposed alleviate.

// Notes

[1] Pasquet, Ope y otros - “Eutanasia y suicidio médicamente asistido”

[2] van Gelder, Henk - “Noa is 17 jaar geworden: ‘Ik word losgelaten omdat mijn lijden ondraaglijk is’ ”, AD,

[3] Joiner, Ph. D., Thomas E. - “Why do people die by suicide”

[4] Fernández, Paola - Video en vivo del miércoles 8 de julio de 2020

[5] Bourdieu P., Méditations pascaliennes, Paris, Seuil, 1997, p. 123.