SÃO PAULO, Brazil – Since Ecuador’s Constitutional Court decided to depenalize euthanasia in the South American country on Feb. 7, Catholics have been expressing their concerns regarding the regulations that will be established.

These procedures will be made by the Ministry of Health and later by Congress. Catholic leaders hope that such rules can restrict the application of the decision to a small number of cases.

The court ruling was a response to a petition made in August 2023 by Paola Roldán, a 42-year-old woman who suffers from amyotrophic lateral sclerosis (ALS), a fatal degenerative disease.

The decision established that the Ministry of Health has two months to issue a regulation of the procedures, which will be valid until a bill is prepared and approved by the Congress within 12 months.

The court determined that the patient must manifest his or her unequivocal, free, and informed consent. In case he or she is not able to do so, a representative can do it. The request must be motivated by intense suffering caused by a grave and irreversible physical injury or by a grave and incurable disease.

Archbishop Luis Cabrera Herrera of Guayaquil is among the bishops who have been highly concerned with the decision. According to him, “there has been no broad social debate about all the legal, ethical, medical, social, and spiritual aspects involved in that matter.”

“Not even medical associations have been heard, not to mention pro-life groups,” he told Crux.

Cabrera, as well as most members of the Church, has both concrete and philosophical conflicts with the arguments employed by the advocates of euthanasia in Ecuador and with the idea of putting an end to life in those cases.

“The ruling is based on the idea that a person, especially someone who is feeling intense pain, is totally free, autonomous, and independent. But the reality is that a person who is experiencing intense emotions is not always able to make the best decisions,” he said.

Cabrera said that the Church has hospice care clinics in Ecuador, but most patients in the Andean country don’t have access to such services.

“Only 3.5 percent of the cases are adequately taken care of. That means that 96.5 percent of the terminal patients don’t have such a possibility,” he said.

He fears that the healthcare system ends up privileging the now legal possibility of euthanasia and not the necessary expansion of hospice care services.

Doctor María Dolores Suárez, an obstetrician who coordinates an ecclesiastical network of dispensaries in the Archdiocese of Guayaquil, agreed with the archbishop.

“Ecuador has legislation concerning hospice care, but the government has never really invested in it,” she told Crux.

That leads people with chronic diseases to feel extreme pain and to ignore that there are ways of mitigating it, Suárez added.

“The population is becoming older, and with age come chronic diseases. The healthcare system needs higher investment in hospice care. With legal euthanasia, some authorities may prefer to resort to it than to spending money with hospice services,” she said.

Catholic doctors, as well as many non-Catholic physicians, are worried about the consequences of the Court decision for their daily work.

“Many of us have been expressing fears concerning the right to conscientious objection,” Suárez said.

Catholic lawyers have been speaking with doctors and members of the clergy about the legal avenues that Church professionals and institutions may have at their disposal, including some form of institutional conscientious objection for Catholic hospitals.

Some of the Ecuadorian physicians Suárez knows, however, have been supporting the decision. She thinks that many of them are doing so because they know that hospice care is not available and patients will suffer.

“So, the real answer is to advance in hospice care. That’s what we need not only in Ecuador, but in Latin America as a whole. We’re importing an idea from Europe at a moment when we’re only beginning to develop hospice services,” she said.

There’s also a lack of adequate mental health attention in the country, Suárez added.

“Many times, terminal patients have severe depression. If they received appropriate psychological treatment, maybe they would not reach that point [of wanting to die],” she said.

Suárez explained that Ecuadorian TV has flooded viewers with information about Paola Roldán’s case over the past few weeks, so many people were impacted by her suffering and didn’t consider other concerns involving euthanasia.

“After the Court ruling, she decided not to ask for euthanasia now,” Suárez said.

Cabrera fears that the younger generations will be culturally influenced by a pro-death mentality, especially when they face difficult moments, and will not be able to handle the struggle for a dignified life.

“Life is a gift we receive from our parents and from God. That’s why we say that life is sacred,” the archbishop said.