Spanish regulation of euthanasia and physician-assisted suicide

Abstract

In March 2021, the Spanish Congress approved the law regulating euthanasia, that regulates both euthanasia and physician-assisted suicide (PAS). In this article, we analyse the Spanish law regulating euthanasia and PAS, comparing it with the rest of the European laws on euthanasia and PAS (Netherlands, Belgium and Luxembourg). Identified strengths of the Spanish law, with respect to other norms, are that it is a law with many safeguards, which broadly recognises professionals’ right to conscientious objection and the specification that it makes on the prior comprehensive care of the patient, including the approach to care dependency. Regarding its shortcomings, the law does not differentiate well between euthanasia and PAS; it barely assigns a role to the healthcare team as a whole (similar to other regulations); it does not clarify the functions of the different professionals involved; it does not detail the specific composition and duration of theevaluation commission; it has not been accompanied by a prior or simultaneous regulation of palliative care; and, lastly, the period of time to implement the law is too short.

Opinions of nurses regarding Euthanasia and Medically Assisted Suicide

“…It establishes its purpose and scope of application, the requirements for people to be able to request the provision of aid in dying and the conditions for its exercise (Figure 1), using criteria very similar to previous international regulations, especially European ones; by highlighting the need to be an autonomous, repeated decision, in a context of terminally ill or chronic, advanced illness with unbearable suffering. 21

Figure 1.Requirements for the application of Euthanasia or MAS in Spain.

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“…It should be noted that this multidisciplinary commission is created at regional level as a body with pre- and post-verification functions, which is one of the main differences with the rest of the approved regulations of other countries, where the commissions only have functions after the service has been provided, not before. 21

Figure 2.Procedure for the regulation of Euthanasia and MAS in Spain.

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“…In this aspect, the main differences with European regulations are that the Netherlands and Luxembourg only contemplate the possibility of CO for doctors, while Belgium includes, in addition to doctors, that no professional will be obliged to provide assistance in a euthanasia procedure, and nurses can be included in this sense. 21…”

“…Organic Law 10/1995, of 23 rd November 1995, of the Penal Code 18 was amended with the aim of decriminalising all Euthanasia related conducts to be carried out in the specific cases established in the law, including all professionals involved, unlike in Holland, Belgium and Luxembourg, where only the doctor is exempt from criminal liability. 21…”

“…It establishes its purpose and scope of application, the requirements for people to be able to request the provision of aid in dying and the conditions for its exercise (Figure 1), using criteria very similar to previous international regulations, especially European ones; by highlighting the need to be an autonomous, repeated decision, in a context of terminally ill or chronic, advanced illness with unbearable suffering. 21 The Spanish law sets out the procedure to be followed for the provision of aid in dying and the guarantees to be observed, stipulating three mandatory prior verification filters: the responsible doctor, the consultant doctor and the Guarantee and Evaluation Commission (GEC) (Figure 2). It should be noted that this multidisciplinary commission is created at regional level as a body with pre-and post-verification functions, which is one of the main differences with the rest of the approved regulations of other countries, where the commissions only have functions after the service has been provided, not before.…”