Sean Murphy*
The Portuguese parliament passed Decree No. 109/XIV on 29 January, 2021, legalizing euthanasia and assisted suicide. It has been referred by the President of Portugal for a review by Portugal’s Constitutional Court.
The law permits physicians and nurses to assist in suicide or provide euthanasia for eligible patients. Eligible patients are adult nationals or legal residents of Portugal who experience intolerable suffering as a result of an extremely severe and permanent injury or incurable terminal illness. Eligible patients must also demonstrate a serious, voluntary, informed, continuing and reiterated decision to seek euthanasia/assisted suicide. Physicians who are satisfied that a patient is eligible must obtain the approval of the Committee for the Verification and Evaluation of Clinical Procedures for Advancing Death (CVA) before providing the procedure.
The law includes a protection of conscience provision. Any health professional may decline to “practise or assist in the act of antecipação da morte de um doente“, which, literally translated, means the act of “anticipating the death of a patient.” However, from the context it appears that this is more correctly translated as “advancing the death of a patient.” To assist in “advancing the death of a patient” is broad enough to encompass diagnosis, evaluation and facilitation by referral or other means.
An objection can be based upon clinical, ethical or other grounds. An objecting professional must advise a patient of the objection and reasons for it within 24 hours, presumably within 24 hours of a request from the patient. Objectors must also give written notice to the person in charge of the health establishment where they work and to their professional orders. Such an objection is permanently and universally valid and “does not need to be justified” (e não carece de fundamentação). This appears to mean that objectors are not required to demonstrate that their clinical, ethical or other reasons for refusing to participate are correct.
The law is not clear about the freedom of health care facilities to refuse to be involved with euthanasia and assisted suicide or to prohibit the procedures on their premises. Article 12.1 states that it is up to the patient to determine the location for the procedure (“A escolha do local para a prática da morte medicamente assistida cabe ao doente.”). However, nothing in the law requires a facility to comply with a patient’s choice. The rest of Article 12 simply describes places where the services can be provided.
Lack of clarity on this point is likely to cause problems, especially if Portuguese euthanasia/assisted suicide advocates are as aggressive as those in Canada. See, for example: