URUGUAY – Assisted dying legalized after a 5-year debate
08 January 2026
Guest article by Florencia Salgueiro Rubio*
After more than five years of legislative debate, civil society advocacy, and sustained public discussion, Uruguay legalized voluntary assisted dying, becoming the first country in Latin America to adopt such a law[1]. The “Ley N° 20431, Ley de Muerte Digna; Eutanasia” came into effect on 24 October 2025.
From draft to law: the legislative process
The assisted dying bill was first introduced in March 2020, during the first month in office of the conservative president Luis Lacalle Pou, but due to the COVID-19 pandemic the parliamentary discussion had to be postponed. After an extended two-year debate, it was approved in 2022 by Uruguay’s lower house of Parliament (the Chamber of Representatives) by a majority vote. The initiative failed in the Senate, obstructed by a conservative majority, and was eventually archived when the legislature ended in 2024. The same bill was reintroduced in March 2025 when left-leaning Yamandú Orsi became president and the new legislative period opened. It once again passed in the lower chamber with 64 of 99 votes in August and obtained its final approval in the Senate on 15 October 2025, with 20 of 31 votes. By the conclusion of this process, the law had secured broad cross-party support, particularly from left- and centre-leaning lawmakers.
Throughout the legislative process, the bill reached high levels of consensus and successfully incorporated a wide range of perspectives. Testimony and opinions were heard from medical professionals, academic institutions, religious leaders, civil society organizations, and international experts. Public opinion remained consistently favourable to the legalization of voluntary assisted dying, reflecting Uruguay’s long-standing liberal orientation.
This, however, did not mean the absence of strong opponents such as the Catholic Church, evangelical organizations, and conservative political and social leaders which consistently torpedoed the legalization of assisted dying. Their arguments focused primarily on perceived shortcomings in palliative care, despite Uruguay having the most advanced standards in Latin America; the rejection of bodily autonomy for people with terminal illnesses; and the refusal to engage in discussions about whether quality of life may, in some cases, take precedence over the mere prolongation of life.
Civil society organizations such as Empatía Uruguay and MADU (Muerte Asistida Digna en Uruguay) shaped both public opinion and the political feasibility of the law. Advocacy contributed to broader public understanding of assisted dying as a regulated medical practice rather than an ethical rupture, helping to counter fears of abuse or institutional breakdown. By combining international evidence with carefully presented personal stories from patients and families, these organizations made visible the negative consequences, the price of human despair due to the existing legal framework. While the use of personal stories can be ethically sensitive, in this case it proved effective in demonstrating how the status quo generated avoidable suffering and unequal access to dignity at the end of life.
What the “Ley de Muerte Digna” establishes
Beyond political debate, the law establishes precise eligibility criteria for accessing death with dignity procedures. Applicants must be legal adults, of sound mind, and be either Uruguayan citizens or have resided in the country for at least one year. Additionally, the person must suffer from a terminal illness or a severe and incurable medical condition that causes extreme deterioration in quality of life, entails unbearable pain or suffering, and offers no reasonable prospect of recovery.
The procedure includes multiple safeguards: Two independent physicians must confirm the diagnosis and the eligibility criteria. In case of disagreement, a medical committee is convened to assess the request for assisted dying. Once the diagnosis is confirmed, two witnesses must attest that the decision is made freely, without external pressure. The process cannot be completed in less than ten days, ensuring that the patient has sufficient time for reflection. At any point, the person can withdraw their request without any formal requirements.
The law also protects freedom of conscience for healthcare professionals. Physicians and nurses may invoke conscientious objection and decline participation in assisted dying procedures. However, healthcare institutions may not deny a patient’s request on the basis of the institution’s religious or ideological affiliation.
What happens next
Despite its passage, the biggest challenges for Uruguay’s assisted dying law lie in its implementation. Enforcement depends on regulations to be issued by the Ministry of Health within 180 days of the law’s enactment, which have not yet been published. Another difficulty is to ensure equitable access across the country, particularly outside the capital of Montevideo, where healthcare resources are more limited. In addition, conservative groups have already announced their intention to challenge the law through a referendum, a process which could delay the implementation even more and discourage both patients and healthcare professionals despite continued high levels of public support.
Although the law’s practical effects will only be evident after implementation, its passage has already influenced discussions beyond Uruguay’s borders, and it has reframed regional debates on dignity, autonomy, and end-of-life decision-making, thus opening new space for thoughtful, rights-based discussions across the region.
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* Florencia Salgueiro Rubio is a campaigner for the association “Empatía Uruguay”, a group of ordinary citizens, political activists from various parties and sectors, members of civil organizations, professionals, and leaders of different ideologies and beliefs, united by a single goal: to garner as much support as possible to make dignified death a reality in Uruguay.
[1] While Colombia and Ecuador decriminalized assisted dying through judicial decisions, and Peru did so only for an individual case (Ana Estrada), Uruguay is the first country in Latin America to have an assisted dying law approved by its Congress.
