In Mexico, euthanasia, defined by the World Health Organization (WHO) as "the action of a physician who deliberately causes the death of a patient", is not legal, but there is an Advance Directive Law. The practice of euthanasia and medically assisted suicide, according to Article 161 Bis 21 of the General Health Law, is prohibited. "It is prohibited, the practice of euthanasia, understood as mercy killing as well as assisted suicide as stated in the Federal Penal Code, under the protection of this law."

"Euthanasia is part of the human right to have a dignified death and there are different means to achieve it, without suffering and in accordance with the person's values; while it is legal only in seven countries in the world, in Mexico the decision to suspend or refuse life-prolonging treatments and palliative care is allowed, said Asunción Álvarez del Río, professor and researcher of the Department of Psychiatry and Mental Health of the School of Medicine.

Euthanasia is legal in only seven countries in the world: Belgium, Luxembourg, Colombia, Canada, New Zealand, Spain, and the Netherlands, the latter being the first nation to approve this procedure, in April 2002.

Advance Directive Law

The Advance Directive Act allows patients to refuse treatments that they no longer want, that only prolong their life and cause them suffering. This can be done directly or by means of an advance, directives document when the patient is unable to say so directly. The person stops receiving treatments that no longer help him/her.

Mexico City was the first state in the nation to approve the Advance Directive Law in January 2008. It was also approved in Coahuila, Aguascalientes, San Luis Potosí, Michoacán, Hidalgo, Guanajuato, Guerrero, Nayarit, Estado de México, Colima, Oaxaca, Sonora, Yucatán and Tlaxcala. According to the National Institute for the Elderly, it is not necessary to be ill or suffer an accident to sign the advance directive.

"In a preventive manner, any person of legal age can do so, accrediting his or her identity, choosing his or her representatives, and expressing his or her will. By drawing up the document, the person has the opportunity to state whether or not he or she wishes to donate his or her organs after death," says the federal government agency. In order to exercise the advance directive, there are two modalities: the document, which is processed before a notary public; and the format that is granted in public, private and social health institutions.

The advance directive document is an "instrument, executed before a Notary Public, in which a person with the capacity to exercise and in full use of his/her mental faculties, manifests the free, conscious, serious, unequivocal and reiterated request to be subjected or not to medical means, treatments or procedures, which propitiate Therapeutic Obstinacy". To process the document it is necessary to comply with the following requirements.

To be of legal age.

To be in full use of his/her mental faculties.

To go before a notary public.

To choose a representative and a substitute representative.

Sign before two witnesses.

Present valid official identification of the applicant, representatives, and witnesses.

To cover the cost.

Meanwhile, the form is a "Palliative Care Instructions document previously authorized by the Ministry of Health, signed by the terminally ill person, before the corresponding health personnel and two witnesses, in which the will to continue with life-extending treatments or the suspension of curative treatment and the beginning of palliative care is expressed, preserving the dignity of the person at all times".

To process the form it is necessary to comply with the following:

Fill out the Advance Directive Form only in the presence of health personnel.

Sign in front of two witnesses.

Appoint a representative as appropriate.

Valid official identification of the applicant, representatives, and witnesses.

Validated with a clinical note.

The Legal Advice Department of INAPAM provides legal guidance to senior citizens who are interested in making this procedure and have doubts related to this issue and can obtain information at asesoriajuridicainapam@inapam.gob.mx or by calling 55 5925 5366. Also, the Notary Association of Mexico City offers advice at 55 5511 1819.

Can doctors and nurses refuse to carry out my will?

Yes, the Law states that those persons whose religious beliefs or personal convictions are contrary to the provisions of the Law may refuse to carry out the will of the patient. In this case, it is the obligation of the Ministry of Health to make sure that the institutions have personnel willing to comply with the will indicated in terms of the Law. Private institutions are obliged to appoint a person in charge of ensuring that the necessary forms are available and that the patient's will can be carried out.

Sources: El Financiero, the National University of Mexico (UNAM), the National Commission of Medical Arbitration, and the Mexico City College of Notaries.