While the euthanasia law awaits a vote in the Senate—it already has preliminary approval in the House of Representatives and majority support—the Ministry of Public Health (MSP) is working with the Presidency of the Republic to finalize the regulations for Law 20,179 on palliative care.
According to a draft obtained by El País , all health providers, both public and private, must guarantee palliative care, including the formation of specific teams within each institution.
The document establishes four obligations for providers that make up the National Integrated Health System (SNIS):
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Disseminate the right to palliative care to all users.
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Ensure clear and visible information at points of service, websites, and institutional media.
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Organize an assistance plan that ensures full coverage, regardless of where you live, and that does not apply quotas.
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Enable Palliative Care Units (PCU) and Support Teams (ST), under MSP guidelines.
The plan has already been drafted by the Ministry and is awaiting presidential approval. It defines palliative care as universal, comprehensive, timely, longitudinal, and continuous.
Universal , because it must reach all people covered by Ordinance 1965 of 2019, which includes oncological pathologies, chronic lung, cardiac, neurological, liver, kidney failure, HIV, Duchenne disease, dementia, neuromuscular or chronic metabolic disorders, among others.
Comprehensive , because it addresses biological, psychological, social, and spiritual aspects. Gabriela Píriz, director of the Palliative Care program, explained that "spirituality is an aspect of the person. It has to do with transcendence, with life having meaning. It goes beyond religious aspects." As an example, she mentioned that children can be encouraged to leave a box of gifts, record a video, or write messages for important people.
Regarding timely , we will strive to refer patients early so that they don't end up seeking palliative care only in their final days of life. Each referral must be completed within a maximum of 48 business hours. The evaluation may be in person or virtually, and may be conducted by a physician or licensed nurse. It must be recorded in the patient's medical record.
Longitudinal care will involve monitoring throughout the entire process, including support for families during their grieving process. Continuous , on the other hand, refers to ongoing follow-up at all levels of care, whether in-person or virtual.
The regulations require all providers to have a UCP and ES for both adults and children, even those with fewer than 30,000 members. In these cases, a core team consisting of a doctor and a nurse will be required. Additionally, providers may sign agreements with larger providers or hire trained external personnel.
For institutions with subsidiaries or secondary locations, the requirement is to provide the same quality of care across all their facilities. The centralized team must be familiar with all patients requiring palliative care and personally assist in complex cases.
Furthermore, each provider must have adequate diagnostic, therapeutic, and logistical resources and promote ongoing training of its staff in palliative care.
In cases of hospitalization, family members will be required to be allowed flexible access to health centers, especially in situations such as death or sedation. Visits by minors will also be authorized, provided there are no medical contraindications and considering the wishes of the child or adolescent.
Finally, the draft contemplates the approach to patients who express a desire to hasten their death. Gabriela Píriz indicated that this situation is common among people in the terminal stages, whether due to physical or emotional suffering, or the fear of becoming a burden on their families.
“It often happens, in the first consultations, that the patient says, 'I don't want to continue living like this.' We call this the desire to hasten death. Most often, this is related to pain or another type of illness,” he explained. In these cases, a team trained to evaluate physical, emotional, economic, or spiritual causes and provide a comprehensive therapeutic response is required.
