Jorge Iván Montoya Pérez

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There is not life without value: The Orthothanasia

“Respecto del derecho fundamental a la muerte digna la jurisprudencia

constitucional han establecido que: tiene carácter fundamental y una
íntima relación con la vida, la dignidad humana y la autonomía; obligar
a una persona a prolongar por un tiempo escaso su existencia, cuando no
lo desea y padece profundas aflicciones, equivale a un trato cruel e
inhumano”.

(Corte Constitucional de Colombia Sentencia T-721/17)

Abstract

Death is a natural and unavoidable event that ends life. In a health, system built on the model
of curative therapy, in this way, health professionals have been trained and have carried out their
activity as if the death process did not exist. Many professionals do not incorporate action in the
approach to the patient at the end of his life, such as communicating the truth of the irreversible
situation, palliative treatments and emotional support to the patient and his family in this
situation of difficult decision-making; they are even unaware of the legal and ethical implications
of the dying process.

Care for the elderly generates ethical problems more frequently than in the rest of the age
groups, and these can be magnified depending on good medical practice. Clinical ethics tries to
specify what our obligations are with the sick, and in general, with all those who are immersed in
the health system.

KeyWords: Ethics, Orthothanasia, terminal illness, dignified death, life, Death, Aged.

Resumen

La muerte es un hecho natural e inevitable, que pone fin a la vida. En un sistema sanitario
construido sobre el modelo de la terapia curativa, de esta manera, los profesionales de la salud
han sido formados y han desarrollado su actividad como si el proceso de la muerte no existiera.
Muchos profesionales no tienen incorporada la actuación en el abordaje del paciente en el final
de su vida, como comunicar la verdad de la situación irreversible, los tratamientos paliativos y el
apoyo emocional al paciente y a su familia en esta situación de difícil toma de decisiones,
incluso desconocen las implicaciones legales y éticas del proceso de la muerte.

La atención al anciano genera problemas éticos con una mayor frecuencia que en el resto de
los grupos de edad, y éstos pueden magnificarse en dependencia de una buena praxis médica. La
ética clínica intenta precisar cuáles son nuestras obligaciones con los enfermos, y en general, con
todos aquellos que estén inmersos en el sistema sanitario.

Palabras claves: Ética, Ortotanasia, enfermedad terminal, muerte digna, vida, Muerte,
Anciano.

Introduction

It is noteworthy that throughout the twentieth century, technical and scientific progress
increased the current knowledge about human physiology, and they were determining to prolong
life. Nevertheless, not always this prolongation is carried out with quality as it shows the
difficulties for taking care of palliative patients in a household environment, which supports the
institutionalized death in intensive care units (ICU).

Indisputably, the machines compose the care to the intensive therapy, due to it guaranties the
great- advanced- life support that patients in critical condition need. It is necessary to
understand, that technological resources represent the communication between the critical patient
and multidisciplinary team in different moments, because they alert about risk situations and
patient evolution through constant monitoring of vital signs. Technology by itself could be an
humanizing element, even in the most technologically intense settings of health care. As Correa
Zembrano Martha Liliana says when cites Bermejo:

Humanize is an ethic issue, that must be with the values that drive our behavior in
health field. When values lead us to design politics, programs, cares and to keep the
relations associated with human dignity, we are talking about humanization (La
Humanización de la atención en los servicios de salud: un asunto de cuidado. 2015. p.
1229).

Therefore, for the multidisciplinary team to accept that limitation it is necessary to have in
mind the human finitude as a natural and chronological process of life, furthermore of
understanding the legal issues related to this action. However, this is not an easy understanding,
because is the same death that face the medical staff in front of their own finitude, creating in
them an internal conflict, doubts about the efficacy, the objectives, and the importance of their
cares.

In this context, the treatment begins to be considered disproportionate in a lot of cases,

especially when the patient’s physic and psychology suffering is extended. Hence, the
humanization of intensive care units (ICU) must determine the performance of the team.

It should be pointed out that, the palliative cares in intensive care units (ICU) make up an
actually important issue of public health where it must work in the suffering and dignity of the
person or patient; also, in the care of human necessities and life quality of people affected by a
chronic-degenerative disease or in the final phase of life. In addition, it is necessary the worry for
helping patient’s family and friends in front of the possible loss of their loved ones.

Orthothanasia

The orthothanasia emerges as a complement of “humanizing” attention. In order with its

etymological meaning, Orthothanasia comes from the Greek Orthos, that means in Spanish
“correcto”; Thanatos, that means “Muerte”. That is to say, death in the appropriate moment with
the due respect to limits life. Orthothanasia, can also be understood as natural death, what
supports the acceptance of human circumstance in the face of death, neither prolong or
abbreviate suffering. The purpose is to give life quality and suffer relief as far as possible in a
general way.

This behavior allows the patient with no possibility of cure understand the human finitude and
die in peace, given that it guarantees dignity in the dying process. In this way Luis Correa,
research director DescLAB (Laboratorio de Derecho Económicos Sociales y Culturales),
decribes:

The right of dying with dignity, emerges in Colombia since year of 1993 and it has
consolidated as a fundamental right. It is not a small matter, different from other places
in Latin America, in Colombia we have the right that our death and the end of life
correspond to our idea of dignified life and autonomy. It is a right worth understanding
and protecting. (DescLAB, 22 de oct de 2020).

It has been an ethical discussion to think about death and the end of the life as a topic of
human rights.

According to Judeo- Christian tradition, the right of dying with dignity is a constitutive part of
the right of life. We know that this tradition rejects Euthanasia and assisted suicide. It implies
that the meaning that it is attributed to the concept of “dying with dignity” radically distinguish
from the one proposed by euthanasia advocates. Indeed, what it is understood here as “the right
to a dignified death” is the right of living the own death “humanly”. This statement implicitly
implies the idea that given the inevitability of death, a certain exercise of our freedom would be
possible. Death could not be considered as a merely passive phenomenon, that takes place in
front of us, and in front of which we stand powerless (act of man), but as a “human act”. Here, I
refer to the classic distinction which belongs to the Aristotelian-Thomistic ethical tradition.

Nevertheless, it is evident that dying does not fall within scope of freedom: Each one of us
will die inevitably. Therefore, in relation to our own death, the only thing that could be subject to
freedom is the attitude we adapt to it. In front of this questioning, it should be noted that this
article aims to understand the meaning of the process of dying with dignity in Intensive Care
Units (ICU). And the influence of the situations which Orthothanasia is applied.

The Orthothanasia is a topic that bioethics begin to question currently.

Conclusion

It is worth considering, that having loved ones and patients in final stage makes the process
complex and more delicate, because of various perceptions and consensus about death spread in
our society. Family members and professionals still have the difficulty accepting the finiteness of
life. Therefore, the life of the patients has been prolonged beyond the curative therapeutic
possibilities, increasing the suffering and sadness due to the persistent and vain attempts of cure.
There is a necessity of provide dignity to the terminal patient, and the Orthothanasia emerges as
a process oriented to death and dying with dignity.

Death with dignity is not only a debate that concerns bioethics but is also part of the concerns
of health professionals.

References

Correa Zambrano, M. L. (2015) La Humanización de la atención en los servicios de salud: un

asunto de cuidado. Revista Cuidarte, vol. 7, núm. 1, 2016, pp. 1227-1231.
https://www.redalyc.org/pdf/3595/359543375011.pdf.

Correa, L. (2020) Muerte digna en Colombia. Ideas y retos sobre un derecho emergente.
DescLAB. https://www.desclab.com/post/muerte-digna-en-colombia.