From inexorable death to chosen death

Abstract

The opening of the first Colombian intensive care unit at the San Juan de Dios Hospital in Bogotá in the early 1970s was a significant step forward for the advancement of medicine in Colombia, and it highlighted the need to consider the appropriate use of technology in the medical field and critical care situations. Subsequently, the arrival of the Pro-Right to Die Foundation in 1979 - initially named the Humanitarian Solidarity Foundation - introduced the first advance directive in the country, creating a space in society to reflect on the limits of medicine in end-of-life care.
As in many other parts of the world, there was a concern about the dehumanization of dying. This meant that people were increasingly dying in the cold and controlled space of a hospital, far from their loved ones, and subjected to the dictates of highly technologized medicine that was becoming less and less aligned with the desires of the patients.
For Jesuit priest Alfonso Llano Escobar, one of the pioneers of bioethics in Colombia, the main bioethical issue in Colombia in the 1980s was the prolongation of patients’ lives thanks to the power of medicine. He cited the increase in academic events dedicated to discussing this issue. For Llano Escobar, it was evident that the enormous development of medical technology had made dying a problem in those times. The medicalization of life and death was advancing rapidly, related to the dehumanization experienced in healthcare institutions.
The question then arose about how to avoid unnecessary suffering brought about by the prolongation of life in terminally ill patients due to the unlimited use of technology and because doctors are often trained to exhaust all possibilities but not to think about when to stop or redirect their therapeutic efforts. This problem still exists more than 30 years after these reflections began in Colombia.