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On August 8, 2023, Paola Roldán, an Ecuadorian citizen, filed an unconstitutionality action in Ecuador’s Constitutional Court against Article 144 of the Comprehensive Organic Criminal Code (COIP), which defines simple homicide. Having suffered from ALS for several years, she sought euthanasia and expressed her desire to “die with dignity.” 

After several months of deliberation, the Constitutional Court ruled in her favor, supported by 7 out of 9 judges present. There, in ruling No. 067-23-IN, the Court declared that Article 144 would only remain constitutional if an exception for euthanasia were created: 

This article will remain constitutional provided that (i) the doctor who performs the conduct typified in Article 144 of the COIP is not sanctioned in the case where (ii) a person, expressing their unequivocal, free, and informed consent (or through their representative when they cannot express it), requests to access an active euthanasia procedure; (iii) due to intense suffering from a serious and irreversible bodily injury or a serious and incurable disease.

More broadly, the Court ruled that, in this context, the norm of always preserving life was incompatible with the rights to dignity and personal development (autonomy), and that Ecuador’s laws protecting life must allow exceptions to protect other rights. Additionally, the Court highlighted that doctors’ conscience objections should be respected in active euthanasia procedures. 

The ruling also stated that: 

The Ministry of Public Health, within a maximum period of 2 months from the notification of this ruling, must issue regulations governing the procedure for the application of voluntary and involuntary active euthanasia, considering technical criteria and in line with this ruling. These regulations will be in effect until a new law is approved. The regulations must be submitted to this Court, which will verify their compliance. The National Assembly is mandated to, within a maximum of 12 months from the presentation of the bill, discuss and enact a law regulating euthanasia procedures with the highest standards as established in this ruling. The National Assembly must report quarterly on the progress and compliance with this measure from the receipt of the bill prepared by the Ombudsman’s Office.

In her dissenting opinion, Judge Teresa Nuques Martínez argued that the majority ruling exceeded the Court’s jurisdiction, encroaching on legislative powers. Judge Corral Ponce also dissented. He argued that, while the petitioner’s feelings and thoughts should be respected, Article 144 of the COIP “is not unconstitutional; that the Constitutional Court exceeds its jurisdiction by creating, with manifest and contradictory conceptual errors, an exception to the criminal law ; that the presumption of constitutionality is not broken; that this ruling was not the appropriate action; that human dignity is tied to life, not to living conditions; that the freedom to develop oneself should not undermine human dignity; that active euthanasia is not the solution, but the opposite: euthanasia opens the door to a culture of death, instead of a culture of life.” 

As Judge Nuques Martínez outlined, the Constitutional Court not only exceeded its scope but also mandated the Ministry of Health to do the same. Thus, on April 12, the Ministry of Health published the Procedural Rule for the Application of Voluntary and Involuntary Active Euthanasia. 

The rule contains an extensive list of considerations, none of which justifies the need for euthanasia. The rule also contains numerous errors that confirm that the rule is unconstitutional, that it violates the rule of law, and that it will lead to systematic human rights violations:  

  1. The rule regulates an act still penalized by the COIP, without a law permitting or decriminalizing euthanasia. (This violates the basic principle of legality.) 
  1. The rule includes involuntary euthanasia, as required by the Court. Involuntary euthanasia is when a patient cannot express their will, and their legal representative does so on their behalf, provided the patient previously expressed a desire for euthanasia through a will or advance directive. This could lead to situations where the patient, if conscious but unable to express it, cannot revoke their decision to be euthanized (This violates the right to life). 
  1. The rule denies conscience objection rights to professionals required to provide supplies for euthanasia (Violation of the right to conscience and the right to equality). 
  1. The rule classifies deaths from euthanasia as “natural deaths,” thus misleading and misrepresenting death statistics and records (Violation of the right to access public information). 

Paola Roldán, the original patient who requested euthanasia in this case, died on March 11, 2024, from “natural causes” according to press reports. 

Following the ruling, Ecuador faces numerous challenges that could be addressed through coordinated action. Martha Cecilia Villafuente, founder of Familia Ecuador, mentioned in an interview that until July 2025, the deadline for the euthanasia law, several political changes should happen that could favor this cause. By then, there will be a new government, a new National Assembly, and three new constitutional court judges. 

Read a Spanish version of this coverage here.

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