Historic First: Ana Estrada becomes the first woman in Peru to legally access euthanasia

Journalist’s notes

interview subject

Josefina Miró Quesada Gayoso is a lawyer from the Pontificia Universidad Católica del Perú (PUCP) and holds an MPhil in Criminology from the University of Cambridge, UK, where she was also a visiting scholar at the Institute of Criminology. She has served as an assistant professor and head of practice at the Faculty of Law at PUCP.

She is a member of both the Research and Study Group on Criminal Law and Criminology (GRIPEC) and the Research Group on International Protection of the Rights of Persons and Peoples (PRIDEP). Additionally, she is a journalist and has previously worked as an advisor to the Senior Management of the Ombudsman’s Office.

background information

Ana Estrada Ugarte, suffering from the degenerative disease polymyositis, became the first person in Peru to undergo a legal euthanasia procedure on April 21, 2024. After losing her autonomy in 2015 and requiring permanent nursing care, she started the blog “Ana Seeks Dignified Death” in 2019, advocating for legal access to assisted death. Her unprecedented case, supported by the Ombudsman’s Office, led to a landmark ruling in February 2021 by the Lima Superior Court of Justice, which was upheld by the Supreme Court in July 2022. The procedure followed the “Plan and Protocol of Dignified Death,” approved by EsSalud. More details can be found in this BBC article.

LIMA, Peru — As a lawyer and a friend, I accompanied Ana Estrada, the first woman in Peruvian history to access euthanasia legally, to the very end. Standing by her side, I witnessed her last days of life and, simultaneously, her immortalization. At the moment she passed, she triumphed in her struggle. She left a legacy that empowers people in my country to choose a dignified death.

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Demanding euthanasia in conservative Peru: a revolutionary act

My profound connection with Ana’s story began long before I imagined meeting her in person. Every Sunday, I sat in front of the television to watch the news. When Ana showed up on my screen and shared her story, I felt profoundly moved. Her ability to normalize her demand for euthanasia in a conservative society like Peru struck me as powerful and revolutionary.

The following day, I approached my boss at the Peruvian Ombudsman’s Office, where he had been working for just three weeks. Nervous yet determined, I suggested the institution intervene in Ana’s case. I envisioned supporting her cause with our institutional backing. “We need to pursue the litigation ourselves,” my boss replied, raising the stakes. With his endorsement, I immediately reached out to Ana.

The day I met Ana felt magical. I arrived at her house and discovered it was her birthday. Taken aback and unprepared, I improvised: “I didn’t bring you anything, but I can give you a song,” I told her, and began to sing. As I sang, she watched me with attentive and emotional eyes. Despite her illness and desire to end her life, she seemed genuinely happy. At that moment I forged a bond with Ana, marked by tenderness and collaboration.

Entering her room felt like stepping into the most beautiful Intensive Care Unit I ever saw. While it had the usual 24-hour nursing care and medical equipment, it was far from a cold hospital room. Beautiful photos adorned the turquoise walls, including a photo of a little blue bird in flight. I saw symbols of freedom everywhere.

The room seemed infused with her very essence, personalized in every detail. This was her world, molded to her liking. The nurses shared a remarkable symbiosis with Ana, like an extension of her person.

Taking on Ana’s euthanasia case

In our early conversations, I grasped the magnitude of Ana’s struggle. No cure existed for her illness, and she knew it. Ana understood her death would be filled with suffering. She recounted the months she spent hospitalized, stating clearly: “I died at that moment, and then I was reborn to conquer this right.” Her voice and gestures conveyed her full determination.

These last three years, through continuous leaning, I came to be fully aware of the right to a dignified death. Over time, Ana became my friend, confidant, and accomplice. I loved her dearly. Empathizing with Ana forced me to let go of certain selfish tendencies. I learned not to cling to a person and to savor the beautiful moments without possessing them. I never saw her imminent departure as a loss. Instead, I viewed it as helping someone find the freedom they yearned for but were denied.

A year after taking on Ana’s case, I moved to New York to pursue a master’s degree I dreamed of my whole life. Despite the distance, we stayed in close contact, sending thousands of messages on WhatsApp and Facebook, and exchanging stickers and memes. “You’ve always been the one closest to me,” Ana told me more than once. On every trip to Lima, I visited her.

While in the same room together, I felt a special magic. We drank wine and chatted for hours. Though we discussed her case as lawyer and client, we also engaged as friends. Our connection strengthened when she asked me to sing for her. I would stand before Ana and sing her favorite songs, such as “Volver,” “Alfonsina y el mar,” or “La Llorona.” These songs were part of a playlist she curated for her passing.

A judge delays the process, but we emerged victorious in January 2024

One of the hardest moments of the case came in January 2023. We won the trial in all instances, but it ended up with a judge who refused to comply with the sentence due to her personal beliefs. This hit Ana like a bucket of ice water. Her infections flared up again, and her mood turned gloomy. “They are winning,” she said, her voice cracking. I saw her as more vulnerable than ever in that moment, emotionally broken.

From then on, we fought for a year to get the necessary protocol approved for the State to definitively sanction access to euthanasia. It finally happened in January 2024. After that, Ana only had to choose the date for her death and submit the final request. The following month, I was invited to Lima to give a talk on the right to a dignified death. Ana and I always considered ourselves agnostic, but we believed in certain signs from the universe. When she found out I would be traveling to Peru, she organized everything for her passing, so I could accompany her.

On April 21, 2024, at 10:00 a.m., I arrived at Ana’s house. It was the beginning, in theory, of her last hour of life. In the living room, her parents, other relatives, and friends waited anxiously, not daring to enter the room. In Ana’s room – in her world – there were about six of us with her. I was the first to go in and see Ana. She remained calm, though everything was delayed because they couldn’t find a suitable vein for the IV. It felt like a special moment because it would be the last one with my friend. We all know we are going to die, but usually, we do not know when it will happen. This time, Ana had chosen the exact moment.

Ana’s eyes closed and she passed away peacefully

Alone with Ana in the room, we had an intimate chat, laughing out loud like so many other times. Whenever a hint of tension arose, Ana dispelled it with a joke. She seemed at peace, and that felt contagious. The room looked different; many objects that once decorated it were no longer in their places. Ana gave significant items to various people. She handed me a bag with my name on it.

Inside I found the painting of the little blue bird I fell in love with the first time I entered the room. In the background, music played, featuring about seven songs Ana selected for the occasion. As the minutes ticked by, I felt the weight of what was about to happen, but I refused to allow my sadness to ruin Ana’s moment. An excerpt from “La Fiesta,” one of the chosen songs, says, “When I go, I don’t want flowers; and my friends, don’t let them cry for me.” Listening to it, I told myself not to cry.

At one moment, I looked into Ana’s eyes, holding back the flood of emotions. Despite my best efforts, a tear fell down my cheek. “It’s okay, you’re allowed to cry,” the psychologist reassured me. At that point, I stepped back to let the doctors do their work but kept my gaze on Ana, singing the songs that continued to play. Nothing else existed in the world but that room. In a few seconds, Ana’s eyes closed, her breathing began to slow, and then it finally stopped.

Walking with Ana: the fight for a dignified death changes attorney’s perspective on dying

When Ana died, everyone in the room embraced and cried. I felt sad but mostly relieved. I recall the movie “Mar Adentro,” where the main character dreams of getting out of bed, flying out of the window, and crossing fields until he reaches the sea. That is how I imagined Ana, flying across the landscape. I felt great admiration for what my friend accomplished and pride in the struggle she faced.

Accompanying Ana in her search for the right to a dignified death redefined my thoughts about the end of life. I no longer see it in grim or violent terms, nor in terms of loneliness, abandonment, or eviction. Thanks to this struggle, I now view death as an act of liberation, of emancipation. The person takes control over that end. Ultimately, life is never about the destination but about how one moves toward that destination.