Cancer patient faced bureaucratic red tape to obtain assisted death in Colombia

The crowd was rapt when Tatiana Andia took the microphone: she was a hero to many in the room, the woman who negotiated lower drug prices for Colombia . But that day, at a conference for politicians and academics on the right to health in Latin America , there was a more intimate topic she wanted to discuss.

"A year ago, I was diagnosed with terminal lung cancer ," she began, "one that is incurable, catastrophic, all the terrible adjectives." She gave a small laugh, recognizing that it all sounded absurd.

The air in the crowded conference room grew still.

Andia, 44, a teacher and former employee of the Colombian Ministry of Health, said she would speak not as an expert, but from a different, recently acquired perspective: that of a patient. One specific health rights issue was preoccupying her these days, she said: the right to die. No one, she continued, wants to talk to me about dying.

On that day a year ago in Cartagena, Colombia, Andia concluded her presentation without going into details about how or when she would die. But she had been making plans for months.

Colombia has allowed physician-assisted death —known there as euthanasia —for a decade. It was the first country in Latin America to do so, one of the few in the world at the time, driven by a liberal high court petitioned by a terminally ill patient seeking an early death.

In July 2023, after a hiking vacation with her husband, Andia went to a doctor in Bogotá because of acute back pain. Tests revealed the cause was tumors involving her spine—metastases of incurable lung cancer .

She found herself in the office of Andrea Zuluaga, an oncologist, who described treatment options that could prolong her life. Andia had a different question: how do people with this condition die?

Zuluaga seemed surprised. But he answered frankly: "It's lung cancer, so most of the time they suffocate."

"That didn't sound great," Andia later recounted, punctuating her understatement with a big laugh.

Preventing this became her goal. The question was how to do it. How could she die with the least amount of suffering while still being able to control the process ?

When she was recruited to the Ministry of Health in 2014, she was excited to join colleagues tackling sensitive social issues. Some were trying to expand access to abortion , a long-standing battle. Others had been tasked with something new: introducing physician-assisted death into the national health system.

Physician-assisted dying had been decriminalized in the country in 1997, but no Colombian government wanted to write the law that would allow such a controversial practice. The issue stalled until 2013, when the country's highest court—pressured by a second frustrated terminally ill patient—ordered the Ministry of Health to draft regulations immediately.

Colombia's rules for assisted dying, she knew, were among the most comprehensive in the world; the procedure is permitted for patients—even children—in unbearable suffering, whether their illness is terminal or not. So there was no doubt that she would be eligible for a doctor to end her life whenever she wished.

But that didn't mean she knew how to proceed. Few Colombians did. Because it arose by court order, not legislation, it wasn't the subject of widespread public debate. Doctors, uncomfortable with ending lives and reluctant to give patients so much control, didn't encourage it, and by 2023, only 1 in 3 hospitals had established the required review committees. And health insurance companies, which nominally are tasked with organizing assisted deaths, are so bureaucratic that people die of their illness or give up before gaining access.

As a result, assisted deaths remain rare. From 2015 to 2023, the last year for which data was released, there were a total of 692 medically assisted deaths in a country of 53 million people.

Within a month of her diagnosis, Andia decided to document her journey to death. She began writing a newspaper column and appearing regularly on podcasts and TV shows. She saw these efforts as another way to expand access to healthcare, demystify the process of assisted dying, and bring it into the public conversation.

Andia outlined her "red lines," her non-negotiables. She would not allow brain surgery . She would not undergo chemotherapy , which would weaken her without significantly prolonging her life.

She felt freer to make these decisions because she didn't have children, she said; if she had, it might have clouded her clarity. She would die before she lost her physical autonomy, before she lost her ability to think clearly, before she had no choice but to depend on others.

But there was one treatment she agreed to try: an immunotherapy that might buy her some time. It was a daily pill with limited side effects. It cost the Colombian health service $1,700 a month (about R$9,369)—she checked, of course—instead of the $10,000 it costs in the United States, because of the drug pricing reform she helped implement.

For seven months, this medication kept the cancer under control. Andia took a leave of absence from teaching, as did her husband, Andrés Molano, also a teacher. They traveled to see friends, threw parties, drank wine on their terrace, and danced salsa, pressed against each other.

In February 2024, she began experiencing headaches so excruciating that she couldn't say her own name. The vision in her left eye began to narrow. Tests confirmed that the therapy had stopped working, and there were now tumors in her brain.

A year after her illness, Andia had to rely increasingly on Molano. On the morning of her speech in Cartagena, she tried to put on a favorite jumpsuit and became hopelessly tangled in it because her left leg was increasingly numb. She threw it across the room in a fit of rage and cried for a while.

Andia was now deep in the bureaucracy of dying. She had requested that her health insurance company arrange her assisted death, but no one was returning her calls or emails. She found the phone number of a senior executive she knew from her ministry work and told him bluntly that her request to die was being delayed.

After that, her case moved quickly. She wrote in a column that she knew most patients wouldn't have her connections, her profile, or her knowledge of the system.

In August, Andia had a severe seizure . At the hospital, doctors told Molano and her father they would need to intubate her, or she would die. The two men were distressed: she had a clear "do not resuscitate" request and was in the process of requesting assisted dying. But this kind of advance planning was so rare in Colombia that the doctors began the intervention. They only stopped at the last moment when Andia's oncologist burst into the room and insisted.

For a tense half hour, it seemed like the end, but Andia regained consciousness. A psychiatrist was called to evaluate her. She was profoundly weakened, but she managed to show him, on Molano's phone, that she had been writing about her intention to die for over a year.

He authorized her right to refuse treatment—and, almost as an afterthought, to have an assisted death, one of three approvals she needed from independent experts (the others were from a lawyer and an oncologist).

Andia's recovery from the seizure was painful and slow; she felt trapped in a deep sac, she said, and unable to participate in conversations. "There are no good days, only bearable days," she said. Still, she didn't set a death date.

Andia published her final column on February 26th, titled "Se Acabó La Fiesta"—the party is over. "I myself oversimplified euthanasia," she wrote. "But it's not that easy, it's not just a formality. Like many other fundamental rights, it's good and comforting that it exists on paper, but exercising it in practice is another story."

By now, tens of thousands of Colombians were following her story, watching her navigate the shifting red lines. She wanted them to know she was tracing the last one.

"The party is over, precisely because it stopped being a party and became torture. And I don't have to show anyone how much I suffer," he wrote. "I say goodbye with dignity."

That night, her death was reported in Colombia's national newspaper. It was all over the papers. Her career was celebrated. None of the stories mentioned that she had died by assisted death.

This article was originally published in The New York Times .