Dignified death or institutional resignation?

On January 23, 2026, the government of Cuba published in the Official Gazette the new Public Health Law, which for the first time recognizes the right to a dignified death and defines the circumstances under which euthanasia may be applied, although its implementation remains pending a specific regulation.

The announcement has been presented as a breakthrough in rights, but in the current context of the Cuban healthcare system, characterized by shortages, the collapse of care services, and the fragility of palliative care, this measure cannot be understood solely in legal terms; it must be viewed as a deeply ethical issue.

As a doctor, discussing euthanasia and dignified death can never be separated from the context in which these words are spoken. In Cuba, where the healthcare system is undergoing a deep structural crisis, characterized by a shortage of medications, hospital collapse, the massive emigration of professionals, and the erosion of palliative care, this debate takes on a morally unsettling dimension.

In countries where euthanasia is legal, it does not apply to just any suffering or any illness. It is reserved for individuals with severe, irreversible conditions in advanced stages, when medicine can no longer provide healing or significant improvement. Moreover, it is only considered after the patient has had real access to palliative care, pain management, psychological support, and companionship. In other words, when the suffering is due to the disease itself rather than a lack of care.

Cuba está muy lejos de ese escenario. Aquí muchos pacientes no sufren porque su enfermedad sea intratable, sino porque no reciben analgésicos, no hay recursos, no hay personal, no hay condiciones mínimas. En ese contexto, hablar de “elegir morir” puede ocultar algo mucho más grave: estar siendo empujado a esa elección por el abandono.

A patient who wishes to die because they cannot manage their pain or because they do not want to be a burden in a system that does not take care of them is not exercising true freedom; they are responding to structural violence.

Legalizing euthanasia, without first ensuring that everyone has access to pain relief, palliative care, and dignified attention until the end, would turn assisted death into a dangerous shortcut. It would not be a victory for rights, but rather an elegant way to manage scarcity.

The uncomfortable question is not whether someone has the right to die, but why so many no longer have the assurance of the right to live with dignity until their last day.