Palliative care, refusing treatment and dying with dignity in Peru: what does the law say?

Three different things that get mixed up

When people talk about “dying with dignity” in Peru, they may mean three things the law treats very differently:

1. Receiving palliative care: care to relieve pain and suffering in a serious illness. It is a right.
2. Refusing treatment, or asking that the natural process of death be respected when you are terminally ill. Also a right, with limits.
3. Another person causing death at the patient’s request (euthanasia). It is a crime under the Penal Code. The Ana Estrada case was a court exception for one person.

This page explains each one with the text of the law.

Palliative care: what the law says it is

Ley 30846 created a national palliative care plan in 2018. Article 3 sets its aim:

“El Plan Nacional de Cuidados Paliativos para Enfermedades Oncológicas y No Oncológicas tiene como objetivo general asegurar la inclusión de los cuidados paliativos en el Sistema Nacional de Salud, a fin de lograr la máxima calidad de vida posible para el paciente y para su entorno familiar y cuidadores.”

(The plan aims to include palliative care in the national health system, to achieve the best possible quality of life for the patient, their family and carers.)

The name matters: it is not only for cancer. It also covers non-cancer illnesses.

The law’s regulation (Supreme Decree 015-2026-SA, published in September 2026) defines palliative care:

“Cuidados paliativos: Es la atención que se ofrece a pacientes de toda edad y sus familias, que sufren por alguna enfermedad severa, generalmente crónica, progresiva, incurable e intratable, que limita o acorta la vida, con el objeto de mejorar su calidad de vida, a través de la prevención y el alivio del sufrimiento […]. Los cuidados paliativos no terminan con la muerte de la persona, sino que continúan con el soporte del duelo a la familia. Los cuidados paliativos son una intervención sanitaria, la cual puede ser complementaria al tratamiento específico de la enfermedad del paciente.”

(Palliative care is care for patients of any age and their families facing a severe, usually chronic, progressive and incurable illness that limits or shortens life, to improve quality of life by preventing and relieving suffering. It does not end with death but continues with bereavement support for the family, and it can be given alongside treatment of the illness.)

Three points that correct common mistakes:

• It is not only for the last days. It can go alongside treatment of the illness.
• It is for patients of any age, children included.
• It includes the family, also after death, with bereavement support.

What the national plan covers, and whom it binds

The regulation lists the forms of care the plan covers, including hospital care, telemedicine and care at home:

“8.5. Para la atención de los CP, el PLANCP considera intervenciones en las IPRESS, según su categorización y nivel de atención. Pueden ser las siguientes: […] e. Atención domiciliaria en CP.”

(The plan covers care at health facilities according to their level, and may include home palliative care.)

Two limits to know. First, article 8.2 says the plan applies to public providers (IPRESS), insurers (IAFAS) and management units. Second, article 9 says the plan «se aprueba mediante Decreto Supremo» (is approved by supreme decree): the regulation is not the plan itself. In practice, the care you get depends on what your facility already offers.

Your right to refuse treatment

The General Health Law (Ley 26842), article 15.2, literal g), says everyone has the right:

“A ser informada sobre su derecho a negarse a recibir o continuar el tratamiento y a que se le explique las consecuencias de esa negativa. La negativa a recibir el tratamiento puede expresarse anticipadamente, una vez conocido el plan terapéutico contra la enfermedad.”

(To be told of your right to refuse to start or continue a treatment and to have the consequences explained. The refusal can be expressed in advance, once the treatment plan for the illness is known.)

The regulation (Supreme Decree 027-2015-SA, article 17) adds how it is recorded and when it does not apply:

“El médico tratante debe registrar en la historia clínica del paciente que lo informó sobre este derecho, las consecuencias de su decisión, así como su aceptación o negativa en relación al tratamiento, consignando además la firma o huella digital del paciente o de su representante, según corresponda. […] La negativa a recibir o continuar el tratamiento no procede cuando la persona usuaria del servicio de salud se encuentre en estado de emergencia o esta decisión ponga en riesgo la salud pública.”

(The treating doctor must record in your medical record that you were informed, the consequences, and your acceptance or refusal, with your or your representative’s signature or fingerprint. Refusal does not apply in an emergency or when it puts public health at risk.)

What this means for you:

• You can refuse to start a treatment and also to continue one.
• Your decision must be in writing, with your signature or fingerprint. Article 24 of the regulation requires written consent when a patient refuses treatment and when a patient receives palliative care.
• You can change your mind: article 24 says consent «puede ser revocado» (can be withdrawn).
• Limit: in an emergency, or when public health is at risk, the refusal does not apply.

Respect for the natural process of death

Ley 26842, article 15.3, literal e), recognizes the right:

“A que se respete el proceso natural de su muerte como consecuencia del estado terminal de la enfermedad. El Código Penal señala las acciones punibles que vulneren este derecho.”

(To have the natural process of your death respected when your illness is terminal. The Penal Code sets out the punishable acts that violate this right.)

The regulation links it to palliative care in article 23:

“Toda persona tiene derecho a que se respete el proceso natural de su muerte y a recibir los cuidados paliativos que correspondan como consecuencia del estado terminal de la enfermedad, previa firma del consentimiento informado.”

(Everyone has the right to have the natural process of their death respected and to receive palliative care when terminally ill, after signing informed consent.)

In plain terms: if you are terminally ill, you have the right not to have your life prolonged against your will and to receive pain relief. This does not authorize anyone to cause your death.

Does Peru have living wills or advance directives?

We found no general Peruvian law on advance directives or living wills. But two rules do part of that job:

• Refusal in advance. As shown above, Ley 26842 lets you refuse a treatment in advance, «una vez conocido el plan terapéutico contra la enfermedad» (once the treatment plan for the illness is known). That means for an illness already diagnosed, not as a general instruction for any future situation.
• A representative appointed in advance. Article 5, literal a), of the regulation says:

“a. Cuando la persona usuaria tenga capacidad de ejercicio podrá delegar su representación a cualquier persona capaz, a través de una carta poder con firma certificada por fedatario institucional o notario o juez de paz, en forma anticipada a la situación que le impida manifestar su voluntad.”

(While you have legal capacity, you can hand your representation to any capable person through a carta poder with a signature certified by a fedatario, a notary or a justice of the peace, ahead of any situation that stops you from expressing your wishes.)

If you worry about losing the ability to decide, these two tools are the closest the law offers today: have your refusal recorded in your medical record, and appoint someone you trust with a certified carta poder. We explain the types of power of attorney in power of attorney in Peru.

Euthanasia is still a crime

Article 112 of the Penal Code says:

“El que, por piedad, mata a un enfermo incurable que le solicita de manera expresa y consciente para poner fin a sus intolerables dolores, será reprimido con pena privativa de libertad no mayor de tres años.”

(Anyone who, out of mercy, kills an incurable patient who expressly and consciously asks for it to end unbearable pain faces up to three years in prison.)

That article remains in the Penal Code. The difference from the rights above is who acts: refusing treatment is your decision about your own body; article 112 punishes the person who causes the death, even at the patient’s request.

The Ana Estrada case: an exception for one person

The case went to court as an amparo (constitutional protection) action brought by the Ombudsman’s Office (Defensoría del Pueblo) and another party against EsSalud and others. In 2022 the Supreme Court (Consulta N.° 14442-2021 Lima) partly approved the lower-court ruling. The decision says:

“APROBARON EN PARTE la sentencia consultada, […] en el extremo que, aplicando el control constitucional difuso, inaplica al caso concreto de la ciudadana Ana Milagros Estrada Ugarte el artículo 112 del Código Penal vigente, PRECISÁNDOSE, que la inaplicación de la norma indicada, es únicamente en forma parcial, respecto a los miembros del personal médico y sanitario […] siempre que los actos se practiquen de manera institucional y sujeta al control de legalidad conforme al Protocolo de Actuación que se establezca previamente por la Comisión Interdisciplinaria.”

(The court partly approved the ruling that set aside article 112 for Ana Estrada’s specific case, and only for the medical and health staff, provided they acted institutionally under a protocol set in advance by an interdisciplinary commission.)

What it says and what it does not:

• It applied to Ana Estrada’s «caso concreto» (specific case). It did not repeal article 112 or create a general right to euthanasia.
• It protected the medical staff carrying out the ruling under a prior protocol.
• The Court also urged the Ministry of Health to strengthen palliative care and make it available «al alcance de todos los pacientes que lo requieran» (to all patients who need it).

Anyone seeking a similar outcome would have to bring their own court case. That requires a lawyer.

What this page does not cover

We did not review the supports-and-safeguards system of Legislative Decree 1384, which changed how someone who cannot decide is represented; another page covers it. We do not cover palliative care for children in detail, organ donation, palliative care coverage by SIS, EsSalud or private insurers, or the content of the national plan, which is approved by a separate supreme decree. We also do not describe bills on euthanasia or advance directives.