I want to die when the day declines, in the middle of the sea and looking to the sky, where the agony seems like a dream, like a bird that soars up into the air.… 

—Manuel Gutiérrez Nájera 

Hospice Contact Information Hospice San Miguel Manuel Rocha 35 Colonia La Lejona San Miguel de Allende 154-4287,  www.hospicesma.org

The concept of palliative care has sometimes been misunderstood or confused with euthanasia, so educating the public and health-care workers is important. At the beginning of this year, a new law, Ley General de Salud en Materia de Cuidados Paliativos (General Health Law Regarding Palliative Care), went into effect in Mexico. Hospice San Miguel, in a joint effort with state health authorities, organized the First Congress on Palliative Care for doctors, nurses, social workers and staff involved in palliative care. More than 100 doctors and 200 nurses attended the congress held August 13 and 14 at Hotel Real de Minas. 

The challenges for Hospice

Hospice held the First Congress on Palliative Care to train doctors and nurses from the state health department in palliative care for terminal patients.

According to Dr. Roberto Maxwell, Hospice’s medical director, Hospice’s challenge is to spread palliative care. “There is a certain opposition to it, and what Hospice has been doing for a year-and-a-half is to educate people, doctors and nurses, so that they are able to change their perception about the patients’ deaths. In medicine, we see death as a failure, but the only thing we have for sure in life is death,” he said. 

Dr. David McGrew, president of Hospice International and a participant in the congress, said that euthanasia has been a point of confusion in palliative care, not only in Mexico but also in the US. “Twenty-five years ago in the States, a lot of people thought we were performing some kind of euthanasia, partly because there had not been enough discussion about the reasonable and right things to do. This is how things are here right now in Mexico. We went through this process, and it will work here. We can share the lessons we learned, but they are not necessarily the same for the Mexicans. Ethics have to be developed a bit more. It has to involve a discussion among religious and government leaders, and doctors and nurses will have to work on these issues.”

Lee Carter said that hospice has nothing to do with euthanasia. “Hospice is about allowing people to have the best quality of life for as many days as they live, and letting them have a natural death. We do nothing to make death come faster and nothing to prolong life. The idea is that patients be comfortable, in their homes with their families, for as long as their lives last.

The Congress

At the First Congress on Palliative Care hospice experts such as Dr. McGrew and Dr. Roger Strong spoke on subjects such as “Expectations of the Quality of Life” and “Introduction to Palliative Care.”

The state health secretary, Jorge Armando Aguirre Torres, attended the congress and said that it will help Mexican doctors and nurses to “better understand and be more sensitive to patients’ rights to be treated with love and respect, to be free from physical pain, to receive moral and spiritual comfort, and to die in peace, with dignity, surrounded by their loved ones, without accelerating or prolonging the natural process of dying.” 


Letty González, Hospice’s Mexican services director, said it was not easy to organize the congress because they had to follow procedures established by the state health authorities. “We had talk about organizing the congress even before the new law was issued, but when the law appeared, we decided it was the right moment,” she said. “Mexican health authorities received the idea of the congress with open arms, since, with this law, every public or private hospital or clinic must have a palliative care unit.”

Dr. Maxwell explained that, according to the new law, all terminal patients have the right to have free medical services and equipment at home so that they can have a good death. “The law only includes terminal patients who have been diagnosed as having six months or less to live (at Hospice, 12 months). Chronically ill or disabled patients are not yet included in the law,” he said.

Hospice stories

Lee Carter, co-founder and director of Hospice San Miguel, took care of a very close friend who had Parkinson’s disease in 2005. “During the course of taking care of him, I realized how few resources we had in San Miguel.

We had to run from drugstore to drugstore to find the right medicine, and it was very difficult to find appropriate hospital services. I spent a lot of time looking for things—time I wanted to spend with my friend who was dying,” said Carter. “A year later, my father died in Virginia, and I went back to the US to take care of him during the last three months of his life. Since we had hospice, every medication we needed arrived within an hour: if we needed a bed, it arrived in an hour; if we needed to talk with a social worker because we were worried about something, the social worker was there in an hour. The nurse came when we needed, and the people from hospice came to talk to us as a family, as well as to my father. They were the most wonderful months of my life, and I feel honored to h
ave spent my time with my father during his last moments and grateful that he had such a wonderful ending.”

The other Hospice San Miguel co-founders, Milou de Montferrier and Joanie Barcal had similar experiences with loved ones. 

“We all knew what hospice was and we all knew that we need a hospice here, not because we planned to live the rest of our lives here, but because we had lived here over 25 years and had a lot of Mexican friends,” said Carter. “I can go back to the US and have hospice care. But none of my Mexican friends have the resources. The biggest motivation for me was to make this wonderful service available to everybody here.” 

Thanks to the initiative of Carter, Montferrier and Barcal, Hospice San Miguel, the first full-service hospice in Mexico, opened its doors on November 16, 2007. In less than two years, they have provided a dignified end for 46 terminally ill people, 75 percent of them from the Mexican community.

Ana Ramírez received hospice services when she was taking care of her dying husband. “Hospice arrived when I needed it the most,” said Ana. “There is always a person from Hospice who will be by our side. Hospice did not end when my husband died. I still receive Hospice’s therapy to help me deal with the loss of my husband.”

Milou de Montferrier said that Hospice is taking the lead in palliative care in Mexico, and she expects San Miguel to become the headquarters of hospice in Mexico. “Puerto Vallarta is already interested in opening a hospice, and they have asked for our help,” she said.