Regulation of aid to die: the Spanish case.

By Tamara Raquel Velasco Sanz, Pilar Pinto Pastor, Beatriz Moreno-Milán, Lydia Frances Mower Hanlon, Benjamín Herreros.

Since its entry into force, on 25th June 2021, euthanasia and medically assisted suicide are part of the portfolio of services of the Spanish National Health System. In this way, Spain has become the fourth European country, after the Netherlands, Belgium and Luxembourg, to pass a law to regulate euthanasia; the eighth in the world (Colombia, Canada, Australia and New Zealand also have this regulated), and the ninth, if we also consider medically assisted suicide regulated in ten states of the United States. In Switzerland and Germany, although there is no specific regulation, assisted suicide is decriminalised. In recent years, moreover, other countries are considering regulating medical aid for dying.

The trend in recent years is for more countries to regulate and create legislation on medical aid to die. This trend reflects the growing support for help to die among professionals and among citizens, as is the case in Spain. The Spanish case is paradigmatic from many points of view, but above all because in Europe the regulation or decriminalisation of aid to die seemed something specific to countries in central and northern Europe. Spain has broken this trend. The importance of religion in the debate on euthanasia is well known and certainly in Spain the most conservative groups related to the Catholic Church have expressed their opposition to the law. However, Spain is an increasingly secular country and public debate is not the space of religious beliefs, which should be restricted to the private sphere.

The fact that there are more and more regulations on euthanasia is linked to the fact that we live in increasingly secular societies, to the recognition of the citizens’ and patients’ autonomy to decide (to which the international movement of Bioethics has contributed enormously); as well as to the extension of patients’ rights. However, euthanasia and medically assisted suicide put many health professionals in an ethical dilemma, because for many they are practices that violate their deepest ethical values. For this reason, it is important that any law on euthanasia clearly recognises the professionals’ right to a Conscientious Objection.

The article “Spanish regulation of euthanasia and physician-assisted suicide” does not carry out an ethical analysis of the arguments for and against helping to die. It instead compares the Spanish law with the legislation of the other European countries where aid to dying is regulated and, after that, highlights the strengths and weaknesses of the Spanish law. A substantial difference is that the Spanish procedure could be considered more guaranteeing, as the Evaluation Commission must review each case before and after carrying out the aid to die (in other European countries it only does so afterwards). The steps of the Spanish procedure make up a complex and long procedure (more than 40 days). This can make it a procedure with more guarantees, but it can also make it excessively long and complex, especially if we take into account that most of the patients who will request help to die will find themselves in an end-of-life situation.

The debate on euthanasia has not disappeared in Spanish society, nor among healthcare professionals. If we add to this the complexity of the procedure and the haste with which the law has been implemented in Spain (only 3 months after the approval in Parliament), we can understand the uncertainty that the law is generating in the public and, especially among healthcare professionals. At this time, a patient can request help to die, but most doctors and nurses are not trained or know how to act, health centres do not know the procedure, not all the Evaluation Commissions have yet been formed and the protocols and guidelines for action are still being worked out. As if that were not enough, several parliamentary groups have raised the possibility of taking the law before the Constitutional Court, which generates even more uncertainty about how this law and its application will evolve. Once again, the haste and the consequent improvisation are present in “the Spanish case.”

In the article “Spanish regulation of euthanasia and physician-assisted suicide” we analyse these and other aspects of a controversial law since its inception (it has been drawn up and approved in the midst of a pandemic), but which responds to a demand from many Spanish citizens. How the law is put into practice remains to be seen.

 

Paper title: Spanish regulation of euthanasia and physician-assisted suicide.

Author(s): Tamara Raquel Velasco Sanz (1,2), Pilar Pinto Pastor (2,3), Beatriz Moreno-Milán (2,4), Lydia Frances Mower Hanlon (2,5), Benjamín Herreros (2,6).

Affiliations:

(1) Departamento Enfermería, Facultad de Enfermería. Fisioterapia y Podología, Universidad Complutense de Madrid.

(2) Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid.

(3) Departamento de Medicina Legal, Psiquiatría y Patología. Facultad de Medicina, Universidad Complutense de Madrid.

(4) Departamento de Psicología Clínica. Facultad de Psicología, Universidad Complutense de Madrid.

(5) Unidad de Oncología, Hospital Universitario Puerta de Hierro de Majadahonda.

(6) Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón.

Competing interests: The authors have no conflicts of interests to disclose.

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