As reported by Veja magazine, the Uruguayan House of Representatives approved the Dignified Death Act on August 13, 2025, by a vote of 64 to 29, paving the way to legalize euthanasia in the country. The bill will now proceed to a vote in the Senate before it can take legal effect.
Uruguay, a country known for its progressive stance on various social issues, has taken the initiative to debate a topic that elicits diverse legal and ethical viewpoints, even when faced with a highly controversial subject influenced by religious conservatism. The issue of a dignified death, which encompasses euthanasia and assisted suicide, has emerged as one of the most pressing bioethical and legal debates of the 21st century.
The approval of the Dignified Death Act in Uruguay represents a significant milestone, not only for its population but for the rest of Latin America as well.
1. The Case of DJ Fabo
This issue had already garnered significant worldwide attention in 2017 due to the ordeal experienced by Italian DJ Fabiano Antoniani.
Known as DJ Fabo, Fabiano was left quadriplegic and blind after a car accident in 2014. In 2017, faced with what he considered intolerable suffering and the absence of clear legal provisions for euthanasia or assisted suicide in Italy, he sought assisted suicide in Switzerland, a country where the practice is permitted under specific conditions. Activist Marco Cappato, who assisted him, subsequently turned himself in to Italian authorities, triggering a legal process that culminated in a landmark decision by the Constitutional Court (Sentenza 242/2019).
Here are the key elements of the case and its developments in Italy:
- The case exposed a gap in Italian legislation and ignited intense public and parliamentary debate on the right to a dignified death.
- In its 2019 ruling, the Italian Constitutional Court recognized that assisted suicide could not be punished under strict conditions (including serious and irreversible illness, intolerable suffering, decision-making capacity, and monitoring by the public health system), a decision that catalyzed subsequent legislative initiatives.
The episode increased the topic's international visibility, integrating it into a broader narrative that includes Canada, the Benelux countries, Spain, Switzerland, and several U.S. states such as California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, Washington, and Washington, D.C.
2. The Fernando Sureda Case
Fernando Sureda, the former president of the Uruguayan Football Association, was diagnosed with amyotrophic lateral sclerosis (ALS), a neurodegenerative disease that gradually affects motor neurons, leading to the progressive loss of movement, speech, mobility, swallowing, and breathing. In 2019, he publicly defended his right to choose the time of his own death. Fernando died that same year, but his advocacy sparked a broad discussion on the right of terminally ill individuals to lawfully end their suffering.
Later, the country's president, Yamandú Orsi, took up the cause, openly supporting it and reinforcing Uruguay's leadership role in social issues.
3. Euthanasia vs. Orthothanasia vs. Assisted Suicide
There are three central concepts on this topic that are very similar but must be clearly understood for informed discussion. Below is a brief overview of each from ethical, legal, and medical perspectives:
Euthanasia
Definition: the intentional act of a third party (usually a healthcare professional) to directly cause the death of a patient upon their request, to alleviate irreversible and intolerable suffering.
Ethical perspective: focuses on the tension between patient autonomy (self-determination) and non-maleficence (the duty to do no harm), emphasizing proportionality and compassion in the face of refractory suffering.
Legal perspective: legal in only a few countries under strict conditions; where unauthorized, it constitutes a crime. In places where it is permitted (e.g., Netherlands, Belgium), it requires objective criteria, post-death reviews, and rigorous documentation.
Medical perspective: involves the administration of lethal drugs by a physician, strict protocols with double checks for decision-making capacity, and consent.
Orthothanasia
Definition: allowing death to occur at the “right time,” avoiding therapeutic obstinacy (futile or disproportionate treatments) and prioritizing palliative care and comfort. Includes the withdrawal of disproportionate life support when there is no clinical benefit.
Ethical perspective: defends dignity at the end of life, respects clinical limits, and avoids the undue prolongation of the dying process.
Legal perspective: lawful and even required in many legal systems, guided by patient rights, informed consent, advance directives, and standards of good palliative practice.
Medical perspective: requires multidisciplinary assessment, transparent communication, symptom management, and careful care planning.
Assisted Suicide
Definition: the patient themselves performs the lethal act (e.g., by ingesting medication), aided by a third party who provides the means, information, and monitoring.
Ethical perspective: as with euthanasia, there is an emphasis on autonomy, but transfers the final act to the patient, which for some reduces the moral weight of direct medical intervention.
Legal perspective: permitted in several jurisdictions (e.g., Switzerland, several U.S. states, Canada), always with safeguards regarding mental capacity, voluntariness, and terminality or intractable suffering.
Medical prism: healthcare professionals assess eligibility, prescribe medication, and inform of risks; the final act is performed solely by the patient.
As discussed in bioethics analyses published in specialized forums, including this blog, the fundamental distinctions revolve around three axes: who performs the final act (a doctor or the patient), the nature of the act (actively causing death versus not preventing its natural progression), and the context of informed consent and decision-making capacity. From a criminal law perspective, the element of free and informed will, along with compliance with specific legal requirements, is decisive in differentiating permitted practices from illegal ones.
4. Main Aspects of the Act
Indeed, the “dignified death” provided for by the Act establishes the right to an assisted death for mentally capable adults diagnosed with a terminal or incurable illness who are experiencing “unbearable suffering.” If the two involved doctors disagree, a medical board will review the case. The patient must formalize the request in writing in the presence of witnesses and can revoke their decision at any time.
The main stipulations of the Uruguayan Dignified Death Act are:
- The patient must be of legal age, mentally fit, have a terminal or incurable illness, and be in unbearable suffering.
- The patient must record their request in writing with witnesses and has the right to revoke it at any time.
- The request will be evaluated by two doctors. In case of disagreement, a medical board will make the final decision.
A crucial point that remains unclear is how the Act will address palliative care. For the choice of a dignified death to be truly free and informed and not the only alternative to unbearable suffering, it must be accompanied by robust palliative options. This would require investment in professional training, the expansion of services nationwide, and public awareness campaigns about the benefits of palliative care.
Another important consideration is the impact on the discussion of patient autonomy and the role of the physician, who would no longer be solely an agent of healing and preserving life at all costs, but also a potential facilitator of a dignified death based on the patient’s autonomous will and meeting specific medical conditions. This would require a reassessment of medical ethics, improved end-of-life communication training, and the development of protocols that protect both the patient and the healthcare provider.
Finally, the approval of this Act in Uruguay reinforces the position of the only other South American country where euthanasia is legal and regulated: Colombia. It is noteworthy, however, that this right in Colombia did not originate from legislation but from a series of Constitutional Court decisions. Since 1997, the Court has decriminalized euthanasia for cases of terminal illness and unbearable suffering, requiring subsequent regulation by the Ministry of Health. More recently, in 2021, the Court extended this right to patients with non-terminal illnesses that cause intense and incurable suffering. This demonstrates the judiciary's crucial role in advancing rights agendas in the context of legislative inertia.
While Chile and Argentina have been engaged in intense debates on the subject in their legislatures, euthanasia and assisted suicide are considered crimes, classified as homicide or instigation/assistance to suicide, respectively, in Brazil.
