Mexico City's Nap-or-Nix Approach to End-of-Life

In recent years, debates surrounding euthanasia and medically assisted death have emerged as some of the most profound ethical dilemmas faced by modern societies. As medical advances continue to extend life expectancy and improve the quality of care, they have also prolonged the suffering of individuals living with incurable diseases or conditions that strip them of their dignity and autonomy.

Mexico is now grappling with these questions as it considers a groundbreaking bill that could legalize euthanasia and medically assisted suicide in Mexico City (CDMX), raising questions about autonomy, ethics, and the future of human dignity.

Who Owns Our Lives?

At the core of this proposed legislation is the principle of autonomy. The right to decide the course of one's own life, particularly in circumstances where that life has been severely compromised by disease or disability, lies at the heart of the argument for legalizing euthanasia and medically assisted death. The autonomy argument is compelling because it affirms a person’s fundamental right to self-determination, a value deeply enshrined in democratic principles. As Jorge Enrique Linares Salgado, a professor at the Faculty of Philosophy and Letters at the National Autonomous University of Mexico (UNAM), astutely observed, "The basic principle for a bill to regulate medically assisted death is that of autonomy."

Yet, autonomy is not as simple as it may seem. In practice, this right can be severely curtailed by physical or mental incapacitation. Often, those suffering from irreversible or terminal conditions may find themselves trapped in a biological shell that no longer serves their desires or well-being. Asunción Álvarez del Río, a professor of Psychiatry at UNAM, eloquently put it, "Medically assisted death is when a human being, with his or her mental capacity, but with living conditions reduced to a minimum, wishes to exercise his or her freedom to determine if he or she no longer wants to live like that." Her remarks underscore the tension between being alive in the biological sense and living in a manner that aligns with one’s conception of dignity.

A Brave New World for Medical Ethics

From a medical standpoint, euthanasia and assisted death present a significant ethical shift. Traditionally, the Hippocratic Oath binds doctors to "do no harm," often interpreted as an imperative to preserve life at all costs. But as Beatriz Vanda Cantón, a professor at the Faculty of Veterinary Medicine and a key proponent of the proposed bill, noted, this mindset can become a form of cruelty when the life being preserved is marked by pain, paralysis, or a lack of meaningful existence.

Indeed, the medical profession is not monolithic in its views on euthanasia. While many physicians are trained to prioritize life preservation, others recognize that the extension of life is not inherently humane if it prolongs suffering. This bill seeks to address such ethical tensions, with its supporters emphasizing that life’s value is not merely biological, but deeply tied to quality and dignity. Mariana Navarro Hernández, a professor and palliative care physician, posed a critical question: “How far should we extend life, and what are the long-term consequences of remaining with a diminished quality of life?”

Medical ethics must evolve to reflect contemporary realities. For centuries, the fight for life made sense because recovery, in some form, was possible. Yet, in today’s world, where life can be prolonged by technology far beyond what nature intended, new ethical frameworks are needed. As Ingrid Vargas Goicoechea, a researcher at UNAM, succinctly stated, "Death is a natural phenomenon that we will experience sooner or later, and today, thanks to technological advances and medicine, life can be prolonged. Therefore, it is important to discuss how we want to leave life."

A Right to Die?

Legally speaking, the right to die is still highly contested. In many countries, euthanasia and medically assisted death remain illegal, rooted in a moral framework that prioritizes the sanctity of life. However, as Pedro Isabel Morales Aché, a lawyer and member of the Association Freedom to Die A.C., argued, the current legal stance often reflects outdated notions of morality, and it is not the religious institutions that are the main barrier. Rather, it is the health personnel, who may lack proper education on this sensitive topic.

In contrast, Morales Aché believes that euthanasia should not be stigmatized as illegal or immoral, but recognized as a legitimate option for those who suffer with no hope of recovery. The proposed bill would enable individuals who meet specific criteria—such as having a terminal or irreversible condition that severely impairs their quality of life—to receive medical assistance to end their suffering. Importantly, this legislation would ensure that the right to conscientious objection is respected on a personal basis, allowing health professionals to refuse participation if euthanasia conflicts with their personal beliefs.

A Dignified Death: What Does It Mean?

What does it mean to die with dignity? For some, it is the ability to pass away peacefully, free from pain, surrounded by loved ones. For others, it is the ability to control the timing and circumstances of their death, particularly when facing an unbearable future. A dignified death may mean different things to different people, but the common thread is that the individual—not the disease, the doctors, or the state—should be in charge of that decision.

Many people fear death not because of the event itself, but because of the uncertainty and potential suffering that may precede it. As Navarro Hernández observed, “The ideal for everyone is to die while sleeping and not wake up, but this is not always the case." This sentiment reflects a growing desire for control over the end-of-life process, to ensure that it aligns with one's values and preferences.

While the proposal to legalize euthanasia in Mexico City represents a significant step forward in recognizing individual autonomy, it is just the beginning of a long and complex journey. There are numerous ethical, legal, and cultural factors that must be considered before such a law could be enacted. Moreover, as José Luis Mendoza Delgado pointed out, we must recognize that human life has changed drastically over time. Two hundred years ago, life expectancy was just 30 years; today, in Mexico, it is 76. Our perspectives on life—and death—must evolve accordingly.

Ultimately, the conversation about euthanasia and medically assisted death is a reflection of broader societal values. It forces us to confront the uncomfortable realities of human existence: suffering, autonomy, and the inevitability of death. But it also opens the door to new possibilities for compassion, dignity, and freedom, allowing individuals to make choices about their own lives in ways that were once unthinkable.