When No Will Can Be Interpreted or Communicated: Paediatric Euthanasia in a Case of a Never-Competent Minor with Profound Cognitive Disability in a Latin American Context

Abstract Colombia’s Constitutional Court ruling T-057 of 2025 addresses one of the most morally demanding questions in contemporary bioethics: whether surrogate-requested euthanasia can ever be justified for a patient who has never possessed decisional and communicational capacity. The case concerned Mateo, a sixteen-year-old adolescent with refractory epilepsy, severe dystonia, and profound cognitive disability, whose mother requested euthanasia on his behalf. The Court denied the specific request while disapplying as unconstitutional the blanket exclusion of minors with intellectual disabilities from euthanasia access and ordered comprehensive palliative care and regulatory reform. This article examines the case within Colombia’s unique judge-made assisted death framework—one of the few systems globally constructed entirely through judicial decisions without enabling legislation—and surveys the comparative international landscape through six ethical lenses: principlism, care ethics, disability rights, Catholic bioethics, secular liberalism, and human rights law. The paper also briefly reviews the new Resolution 813 of 2026 that has since excluded never-competent patients from euthanasia despite the Constitutional Court orders. It concludes with a nuanced assessment: a legal order committed to human dignity cannot indefinitely condemn a minor to immense observable suffering without therapeutic prospects, yet such a position demands extraordinary procedural protection for human rights and patients’ rights.