The introduction of the Public Health Law (Law 165/2023), published in the Official Gazette No. 9 last Friday, marks a groundbreaking moment for Cuba. For the first time, the legislation explicitly addresses “end-of-life determinations.”
Within the document, the right to a “dignified death” is acknowledged as part of the healthcare system. This includes “valid procedures that terminate life,” a phrase that, while avoiding the explicit mention of “euthanasia,” creates a legal pathway for assisted dying practices. However, its implementation hinges on the Ministry of Public Health (MINSAP) declaring the necessary conditions and a future “specific law” to regulate it.
The pivotal change is encapsulated in Article 158, under the heading “End-of-Life Determinations.”
The Law’s Stance on End-of-Life Choices
The legislation affirms the “right to a dignified death” through the exercise of end-of-life determinations. These choices encompass a range of options, including: a) therapeutic effort adjustment; b) resuscitation; c) continuous care; d) palliative care; and e) “valid procedures that terminate life.”
These measures target individuals suffering from chronic degenerative and irreversible diseases, intractable pain, or those in terminal or agonizing stages.
Article 161 of the text explicitly states that MINSAP will determine when the conditions in the country allow for “valid procedures that terminate life,” with a requirement to establish this in a “specific law.”
In practice, this means the Law does not describe an operative procedure nor does it independently set forth a detailed mechanism for these “procedures”; it leaves their implementation contingent on subsequent regulation.
Strengthening Informed Consent Framework
This legal framework also reinforces the principle of informed consent as a prerequisite for medical procedures, documented in an official model that is part of the clinical history, with guidelines for situations where written consent cannot be obtained.
Moreover, the law grants individuals the right to refuse medical procedures, mandating that such decisions be documented according to the informed consent mechanism.
Within the chapter concerning end-of-life, the law also permits individuals to decline medical procedures, and if this decision persists, it must be recorded in the official informed consent model and proceed according to Articles 127 and 128.
Another significant point is that the execution of approved actions to fulfill the right to a dignified death does not incur civil, criminal, or administrative liability for the professionals involved, provided they act within the established guidelines.
In summary, Law 165/2023 creates a legal avenue for Cuba to potentially regulate assisted dying under the umbrella of “procedures… that terminate life,” but does not, by itself, equate to an already implemented euthanasia policy. Its development remains contingent on further regulatory action and explicit decisions by MINSAP.
The regulation is set to take effect 90 days after its publication in the Official Gazette.
Future Implications of the Law
In 2024, the regime reiterated that euthanasia remains punishable by law. Specifically, authorities declared that anyone who induces, facilitates, or assists in ending another human being's life would automatically face potential criminal charges in Cuba.
The “determinations” for the end-of-life continue to focus on “individuals with chronic degenerative or irreversible conditions, experiencing intractable suffering, who are in the terminal or agonizing stages of life, or have sustained injuries that place them in this condition.”
This scope is not limited to oncology patients but also includes individuals with other diseases, such as degenerative neurological disorders.
A new regulation will need to specify the professionals eligible to carry out these actions, and the medical professional's decision must be respected, as they may either agree or decline to perform them.
Understanding Cuba's End-of-Life Law
What is the key change introduced by Law 165/2023 in Cuba?
Law 165/2023 introduces the concept of “end-of-life determinations” and acknowledges the right to a dignified death, creating a potential legal path for assisted dying practices, contingent upon future regulation.
Does the new law immediately legalize euthanasia in Cuba?
No, the law does not immediately legalize euthanasia. It outlines potential pathways for assisted dying but requires further regulation and a decision from the Ministry of Public Health to implement such practices.
Who will be affected by the end-of-life determinations outlined in the law?
The determinations are aimed at individuals with chronic degenerative or irreversible conditions, experiencing intractable suffering, or those in terminal stages, including patients with degenerative neurological disorders.