URUGUAY – Implementing the Right to Dignified Death
05 August 2026
Guest article by Florencia Salgueiro Rubio*
Since October 2025, Uruguay has had a dignified death law (Ley N° 20431, Ley de Muerte Digna; Eutanasia), which allows adults with serious and incurable illnesses or health conditions to request assistance in dying, provided they are mentally competent. For the law to take effect, it required promulgation by the Executive Branch, along with the issuance of the regulatory decree (Decreto 76/026) and the implementation protocol (Ordenanza 398/026). These regulations were essential for the law’s application and were introduced just before the legal deadline, as the Ministry of Public Health sought to build the broadest possible consensus among stakeholders in Uruguay’s health system before publishing them.
First cases
The publication of the decree and the protocol made it possible to process the first requests for assisted dying in Uruguay. The first reported case of euthanasia involved a 69‑year‑old woman with metastatic pancreatic cancer, carried out at the Military Hospital. Media coverage of the event sparked debates about its significance and the family’s right to privacy. The second case to become known was that of Pablo Cánepa, who, together with his family, had publicly shared his situation during the legislative debate. He was 39 years old and suffered from cerebellar ataxia, which left him paralyzed from the neck down. His family announced the news on social media, expressing gratitude for the legislation and to the medical team.
Challenges
However, not all cases have been positive. At Empatía Uruguay, we are aware of at least two situations in which requests for assisted dying were unjustly denied. One case involved a patient with multiple sclerosis whose request was rejected because she did not wish to end her life immediately. The original version of the protocol explicitly allowed individuals to defer the procedure for “days, months, or years” after completing the approval process. Yet, on the very day the legislation was published, this clause was removed. As a result, a legal ambiguity emerged: must the person carry out the procedure immediately after approval of the request, or can she postpone it? Since no formal answer had been provided, her request was denied because she sought approval without wanting to end her life immediately.
Another serious problem is the lack of transparency in rejection decisions. Patients are not formally informed of the reasons behind a denial. They cannot know whether the issue lies in an assessment of their mental health, the severity of their condition, or the extent of their suffering. This absence of clarity leaves them without the ability to respond or appeal.
Dubious assessors and biased objection decisions
A second case illustrates further challenges. In Uruguay, many palliative care specialists oppose assisted dying, yet not all declare themselves conscientious objectors. They still participate in medical boards, but their evaluations are often biased, as they tend to reject all requests. If they are unwilling to approve any case, they should formally object rather than undermine the process. In this particular case, the situation was aggravated by the impossibility of appealing decisions. Some assessments even contradicted the patient’s clinical history, introducing a diagnosis of dementia that had never been confirmed. Families are left with no channel to contest such inconsistencies; they must restart the process from the beginning, with no dedicated mechanism for complaints beyond the general system available to the wider population.
Further challenges and regional perspectives
Another ongoing issue is institutional conscientious objection. Religious institutions in Uruguay, such as the “Catholic Circle” and the “Evangelical Hospital”, are legally permitted to refuse to perform assisted dying procedures, redirecting patients to other hospitals instead. This mirrors the situation with voluntary pregnancy termination (abortion), where hospitals must sign agreements with other institutions to ensure access – though it remains unclear whether such agreements have been formalized in practice.
A coalition of Uruguayan organizations – including Empatía, MADU, and Tenemos ELA – is actively monitoring the situation. Our goal is to ensure effective oversight and to accompany emerging cases. The bonds forged during the struggle for legalization remain vital, both for supporting families and for continuing to spread awareness of these rights so that people can exercise them fully. Empatía Uruguay has also begun receiving inquiries from individuals interested in relocating to Uruguay. The law allows foreign nationals to access assisted dying, provided they have resided in the country for at least one year. As this is still a new development, its full impact is uncertain, but particular attention is being paid to potential cases from neighbouring countries.
Outlook: ensuring fairness and safeguarding access
The implementation of Uruguay’s dignified death law is a landmark achievement, but its success depends on constant vigilance, transparency, and collaboration. The challenges faced in the first cases reveal the importance of refining procedures, ensuring fairness, and safeguarding access. At the same time, Uruguay’s experience is inspiring regional debates (for example inside the Plataforma Dignidad framework) and offering hope to those who seek autonomy and dignity at the end of life. The work of civil society organizations will be crucial in guaranteeing that this right is not only recognized in law but truly realized in practice.
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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.
Further articles on Uruguay can be found here.
