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Argentina aims to provide 'dignified deaths' for terminally ill and brain-dead patients

05/09/2012 01:07 EDT | Updated 07/09/2012 05:12 EDT
BUENOS AIRES, Argentina - Terminally ill patients and their families would have more power to decide how they die in Argentina under a "dignified death" law being debated Wednesday in the Senate.

If the measure is passed as expected, families will no longer have to struggle to find judges to order doctors to end life-support for people who are dying or in a permanent vegetative state. Getting such approval can be very difficult in many countries, particularly in Latin America, where opposition from the Roman Catholic church still runs strong.

The law was being debated in the Senate after passing the lower house last year. Overwhelming approval was expected in part because the measure expressly forbids euthanasia or any other acts that actually cause a death, and instead focuses on the rights of patients and their families. It also absolves doctors of any legal responsibility when they follow the patient's wishes.

The law applies to the terminally ill as well as patients suffering from irreversible and incurable illness or injury, and says they have the right to refuse surgical procedures, hydration and nutrition, reanimation and life-support systems. Rather than seek a court order, all they need do is prepare an advanced health-care directive and sign it before a notary, with two witnesses.

The ethical challenges surrounding end-of-life issues become more difficult when the patient can no longer speak for himself and has not prepared such a formal document. In these cases, the Argentine law empowers family members or legal representatives to make the decision on the patients' behalf.

Some lawmakers expressed discomfort about withdrawing feeding tubes or life support to someone who can no longer communicate. Deputy Julian Obligo of the conservative PRO party pleaded with senators to eliminate this reference, alleging that it amounts to euthanasia by hastening death. And Sen. Sonia Escudero, a dissident member of the governing Peronist party, alleged that withdrawing nutrition and hydration could cause pain to a dying person.

Medical and bioethical experts say otherwise — that an abundance of scientific evidence shows that dying people naturally stop eating and drinking for a reason — their bodies are shutting down — and that force-feeding them at that point actually causes pain. In contrast, without food and drink, the metabolism produces substances that actually produce feelings of euphoria.

By withdrawing feeding tubes, "you make their time more comfortable, not less, when they are near death," said Dan Brock, who teaches medical ethics at Harvard University in Cambridge, Mass. "All the evidence suggests they are not suffering."

"This was highly controversial 20 years ago when it began to be debated in the United States, and the Catholic Church still officially opposes it, but here anyway it's now a matter of accepted medical practice," Brock added. "This is important because in general Latin America has been very behind on these issues and so it's nice to see Argentina leading the way."

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