A Time to Die: Mexican Life Debates and the Paradox of Choice in Palliative Care.

Abstract

Enduring contests between church, state, and individual control over the body in Mexico have recently manifested in a contentious "life debate" over the definition and ethics of "dignified death" (Roberts in God's laboratory: assisted reproduction in the Andes. University of California Press, 2012). In 2008, Mexico City passed the Advance Directive Law, authorizing the right to refuse or withdraw life-sustaining treatment and affording palliative care services to the terminally ill through public hospitals. While these measures have ostensibly ameliorated end-of-life suffering, a growing movement of activists argues that the law falls short. They advocate for the legalization of assisted dying as central to "dignified death" despite resistance from the Catholic hierarchy and its political allies. Drawing on one year of research in Mexico's National Cancer Institute, we analyze the place of public palliative care clinicians in this fraught debate, parsing their model of care, which is predicated on surrendering to the body's preordained rhythms of life and death. We argue that this orientation gives rise to a paradox at the heart of public palliative care, which simultaneously expands end-of-life choices while making certain choices inconceivable. Our argument has implications for anthropological theories of human agency and choice, provoking complex questions about who is authorized to draw boundaries around life and death.