Dr Gustavo Quintana walks out of a modest, two-floor apartment building in southern Bogota. Inside his black doctor’s bag are vials containing anaesthesia and muscle relaxants, a syringe and a rubber tourniquet. The man known in Colombia as “Dr Death” has just ended the life of his 234th patient: a middle-aged woman with incurable stomach cancer.
For years, in semi-clandestine conditions, Quintana and a handful of other physicians have been performing what they consider mercy killings, at risk of prosecution and amid widespread rejection from other doctors and church officials.
But their pioneering work took a step out of the shadows on Friday when, after weeks of heated public debate and last-minute legal challenges, 79-year-old Ovidio Gonzalez became the first Colombian to die as a result of government-sanctioned euthanasia.
Gonzalez died at a hospital in the western city of Pereira after suffering from terminal mouth cancer for the past five years. His death is the first in accordance with an April decree by the country’s health ministry mandating that clinics perform the procedure when requested by terminally ill patients.
A court ruling 17 years ago made Colombia the first, and still only, country in Latin America – and one of just a handful worldwide – to allow euthanasia. The ruling was based on interpretation of a constitutional clause guaranteeing Colombians the right to live, and presumably die, with dignity.
But Congress never passed laws regulating the procedure, as the high court had ordered, leaving the issue in a state of legal limbo. In April the health ministry finally intervened, providing the regulatory guidelines for insurers and hospitals.
Religious groups and many doctors were outraged by the new rules, which require all hospitals to form medical committees to evaluate a patient’s request for euthanasia. Local Roman Catholic leaders threatened to close the dozens of hospitals the church runs in Colombia if required to carry out what it considers murder, and the country’s conservative Inspector General tried to block application of the new rules.
Controversy was further ignited by Gonzalez’s decision to make himself a public test case of the law. He was assisted by his son, Julio Cesar Gonzalez, a cartoonist for top-selling newspaper El Tiempo better known by his pen name “Matador”. On Friday, Gonzalez bade farewell to his father in a cartoon showing the grim reaper, scythe in hand, asking his father why his bags are packed.
“I’m dying to travel,” answers his father, suitcases in hand.
Dr Gabriela Sarmiento, a hospice specialist with health care provider Colsanitas, said it is unlikely there will be a flood of patients taking advantage of the new liberties. In the nearly three months since the government’s decree, the two hospitals she works at have received just five such requests, two of which were withdrawn.
Sarmiento said when given the option of living with pain or dying immediately, “most people opt for the path of palliative care”.
Members of Colombia’s right-to-die movement are nonetheless celebrating, saying the new decree provides clarity to a practice that had been going on for years in secret. Colombia is among only a handful of countries including Belgium, the Netherlands and Switzerland that have either legalised or decriminalised assisted suicide for the terminally ill. Four US states – Oregon, Washington, Montana and Vermont – also have laws on the books.
“The ambiguity of the law provoked a lot of fear among doctors,” said Carmenza Ochoa, president of Colombia’s Right to Die with Dignity foundation.
Quintana says barely a week goes by without him receiving a phone call from a patient or family member looking to end their agony. He claims to have helped more sick people die than the late Jack Kevorkian, the Detroit doctor who went to jail for murder while claiming to have helped some 130 people end their lives.
However, Quintana has never been prosecuted.
Most of the procedures he performs are in the patient’s home, with the patient surrounded by loved ones.
During the nine minutes the procedure typically lasts, he whispers the same soothing mantra while injecting a mixture of lethal drugs: “Rest, you’re going to sleep for the last time, a restorative sleep.”
Quintana worries the new regulations don’t go far enough. “If a group of doctors determine you’re not terminally ill, your personal wishes are annulled.”