Photograph by: Flavia Carpio
Since 2017, DescLAB has been unwavering in its mission to monitor and advocate for the right to die with dignity in Colombia and Latin America. Our researchers work continuously, collecting and analyzing data, making requests to authorities, and taking legal actions to obtain information. The data presented below, up to the December 31, 2023 cut-off date, results from this ongoing effort. These results, published in the "De Muerte Lenta" reports (2021 and 2022), testify to our team's dedication.
The right to die with dignity is an issue that has broad support among the Colombian population, whose exercise and demand have been rapidly and steadily growing since 2015 and until 2023. Euthanasia, in particular, has seen a significant and steady increase over the years, and it is exercised in a relative balance between men and women. Its access is geographically concentrated in the main Colombian cities and, in those places, it is concentrated in some specific healthcare institutions (IPS, in its Spanish acronym); it is a medical act that is not widespread in the national territory and the Colombian healthcare system.
Favorability of euthanasia in Colombia's public opinion
According to the latest results of the Colombia Opina survey by the company Invamer, 70.1% of Colombians agree with the possibility of having access to euthanasia in cases of physical and psychological suffering due to bodily injury and serious and incurable illness. The highest point of favorability was recorded in August 2021, with 72.5% in favor, and the lowest in February 2022, with 68.5% in favor. The approval rate was higher in capital cities (74.9%) than in non-capital cities (64.4%).
Based on the results of the Polimétrica survey by Cifras y Conceptos, only 19% of the Colombian population want euthanasia to be strictly prohibited, while 38% are in favor of full legalization, and 37% remain neutral on the issue.
This high level of support for euthanasia contrasts with the low levels of support for other issues that generate similarly intense debate in Colombian society, particularly marriage for same-sex couples, with 39.3% support; adoption for same-sex couples, with 29.7% support; and legalization of marijuana use, with 29.7% support.
Number of euthanasia procedures: the sustained increase in autonomous end-of-life decisions
Since 2015–the year in which euthanasia was regulated and the registration of procedures began–and until December 31, 2023, 692 euthanasia procedures were performed in Colombia.
This is only the official data for those procedures carried out according to the healthcare system's framework. Although the Health Benefits Plan covers the procedure and is free of charge, many people, professionals, and organizations continue to perform and mediate this procedure privately. It is not possible to estimate the number of euthanasias that are carried out at home, with the help of families and medical professionals who charge for them, and where compliance with the regulations is unclear.
2023 stands out as the year with the highest number of euthanasia procedures in Colombia. Until the end of last year, 271 procedures were performed, marking a substantial 49.7% increase from the previous year. This surge is particularly noteworthy compared to 2015, the first year of Resolution 1216 of 2015, when only four procedures were performed.
The practice of euthanasia has seen a 67-fold increase in 9 years. This significant rise is a testament to the growing influence of media, public opinion, and family discussions on the topic. More people are considering autonomous decisions at the end of their lives.
In 2023, an average of 22.6 procedures were performed each month, a significant increase from the 181 procedures recorded in 2022. The 271 procedures in 2023 represent 30.6% of all procedures performed since records were kept, further highlighting the rapid growth in the practice.
Requests for euthanasia in Colombia: the gateway to the procedure
Since 2015, the available information and data have been limited to the euthanasia procedures carried out. However, a significant change occurred in 2021 with the implementation of a registration system mandated by the Constitutional Court of Colombia, which was ordered in 2017. This system now allows for the comprehensive tracking of information, from the initial requests to the activation of committees, rejections, and the actual practice of the procedures.
The implementation of the system and the provision of information began on October 1, 2021. Since the introduction of the registration system, there has been a notable increase in the number of euthanasia requests. In 2023, the year with the highest number of requests, 829 were registered, averaging 69 monthly requests. This represents a significant 79.8% increase over the previous year. In 2023, 3.3 procedures were authorized for every ten requests, underscoring the growing demand.
Sex distribution of euthanasia: women and men have relatively balanced access
As of December 31, 2023, 366 men (52.9%) and 325 women (47.1%) exercised their right to die with dignity through euthanasia. Two procedures have been registered for trans persons in 2022 and 2023. No cases of intersex people were registered.
When the data are analyzed in aggregate, it is possible to find a relative balance between men and women in access to medically assisted death. However, for the first time, it is possible to report the distribution by gender.
In 2021, 55.8% of the procedures were performed on men (53 cases) and 44.2% on women (42 cases). By 2023, the gap reverses in favor of men but closes significantly to approach a relative balance. In 2023, 53.5% of the procedures were performed on men (145 cases) and 46.5% on women (126).
Geographic distribution of euthanasia: concentration of procedures in the two main cities of Colombia
As of December 31, 2023, euthanasia procedures were concentrated in Antioquia (Medellín) and Bogotá (the capital of Colombia). Antioquia had 298 procedures (43.1%), and Bogotá had 285 procedures (41.2%). Together, these two cities account for 84.3% of the procedures performed in Colombia. Four out of ten euthanasia procedures are performed in Antioquia and four out of ten in Bogotá.
The remaining 15.7% of euthanasia cases were in Valle del Cauca (Cali), with 57 cases, and 8.2% in Risaralda (Pereira), with 35 cases. In Caldas (Manizales), four cases were reported. Three cases were reported in Bolívar (Cartagena), Huila (Neiva), and Quindío (Armenia).
In 2023, there were 829 requests for euthanasia. Bogotá accounted for 51.5% (427 requests) and Antioquia for 26.8% (222 requests).
Age distribution of euthanasia: a procedure carried out exclusively on adults
The vast majority of euthanasia cases performed in Colombia (691 cases) were carried out on people over the age of 18. In 2022, the first and only case of euthanasia performed on an adolescent was registered.
According to the latest reports from the Ministry of Health, the average age of those who requested euthanasia in 2023 was 62.5 years. Therefore, it is a procedure carried out mainly on older adults who are not of advanced age. If we compare this data with the average life expectancy at birth, which in 2023 will be 77.5 years, the average age of access to euthanasia will be 15 years lower.
The concentration of procedures in people with cancer and the increase of procedures in neurodegenerative diseases
In Colombia, oncological diagnoses are the primary type of illness for which people request euthanasia. Currently, 76% of all euthanasia procedures (526 cases) are performed on people with a primary diagnosis related to cancer. Non-cancer diagnoses are the minority of causes for which people request euthanasia. Only 24% of all procedures (166 cases) are for non-cancer conditions.
Use of advance directives: lack of knowledge and use of this tool to take control over the end-of-life
Anticipated end-of-life decision-making through advance directives has increased in frequency. As of December 31, 2023, of the 692 people who accessed euthanasia, 294 (42.5%) had filed an advance directive. This represents a significant change from the data reported in the previous year when only 23% (80) of people had filed one.
Given the lack of a unified registry of advance directives and the absence of digital and integrated medical records, it is challenging to determine the number of individuals who have made advanced decisions. Implementing such records could significantly enhance our ability to track these decisions.
The completion of advance directives is higher in Bogotá, where 84% of the procedures performed had a completed advance directive (121 cases out of 144). In second place was Antioquia with 74.5% (70 cases out of 94), and in third place was Valle del Cauca with 63.2% (12 out of 19).
The network of health care providers: those responsible for making the right to die with dignity effective
According to reports from the National Superintendence of Health, 34 insurance companies reported their network of contracted providers to carry out euthanasia procedures. These networks cover Bogotá and 25 departments, where 121 individual clinics provide euthanasia. Some departments that are the furthest from the center and less socioeconomically developed have no reported coverage: Chocó, Putumayo, Vaupés, Guainía, Guaviare, Vichada, and Arauca.
The fact that clinics are hired is only a first indication of availability. However, the use of the service, its accessibility, and the actual availability of euthanasia services in these areas remain unknown.
Of the 121 clinics contracted by the insurers, 115 have detailed data, representing 95% of the providers, a figure ten percentage points higher than previously reported.
Of the 115 clinics for which detailed information is available, 110 (95.7%) reported having the institutional protocol required by the National Superintendence of Health regulatory standards. Only five clinics reported not having the protocol mentioned above. The protocol is an institutional effort ordered by the authority of health to internally organize the clinic to receive requests, process and respond to them, define the functions of the committees, determine their composition, and exercise the technical secretariat, among other legal and regulatory obligations.
Just as euthanasia procedures are geographically concentrated, requests and their practice are also concentrated in a few specific clinics. Although more than 120 clinics are contracted to provide the service and are reported in several departments and municipalities of the country, only 46 have received and reported requests from citizens for access to euthanasia; that is, only 38% of the contracted and available clinics have received requests.
Information updated as of December 31, 2023.
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