Dr. Carlos Centeno, Professor of Palliative Medicine
Euthanasia, by law, in Spain: Is everything clear?
In Spanish political life there has recently been quiet celebration at Congress’ approval of the Euthanasia Bill. There has hardly been any social reaction in the media, either in favour or against, as if the fact had left citizens somewhere between surprised and perplexed. From my point of view as a medical doctor and university lecturer, there are aspects of the bill that need to have a bit more light shed upon them, that need greater clarification,.
1. Support for euthanasia is not by any means unanimous
Not everybody considers legalisation for euthanasia to be an advance or a social triumph. Individuals, societies, cultures and also the main religions think that it goes against the common good and is a step backwards.
Those with this critical profile draw attention to the consequences in countries where euthanasia was legalized to accommodate terminally ill patients requesting release from their unbearable suffering. In the end, the law has become applied to the seriously ill, to the mentally ill, to children with dementia, to those that are tired of living… Under the umbrella of the law of euthanasia, numerous deaths are brought about that are not declared (up to one in four in Holland). Even those laws that apparently most guarantee to limit euthanasia to restricted and well-controlled situations tend to broaden their criteria. It is as if these laws have a life of their own; they keep growing and create necessity. This slippery slope is real, as warned by the American Medical Association.
Approval of euthanasia puts social and moral pressure on the most fragile, such as, ALS patients, old people and people who are dependent on others. How should they react, especially during hard times, given the social and family resources they consume? The availability of easy relief can influence the decisions of even the most committed health professionals. For example, will a team providing palliative care maintain the same intensity of care if there exists the option of euthanasia, which might also reduce the physical and emotional demands on them?
As a whole, the attitude of doctors has been one of rejection and, above all, of disinterest and of avoiding getting involved. Doctors do not consider euthanasia as their “thing”. In fact, in Switzerland, euthanasia and assisted suicide are carried out outside the field of medicine.
2. Was it necessary to legislate in a hurry?
The way of going about getting approval for euthanasia in Spain has invited criticism because, with the apparent backing of social demand (influenced by the design and ambiguity of surveys), the usual process for laws of weight and import has been bypassed. Why, this time, were experts not asked to inform Parliament, as is customary in debated matters? Why was there no request for a report from the National Committee on Bioethics? How can it be that the collective organization of regional medical colleges (Organización Médica Colegial) was not consulted? Is the last month of a year in which 50,000 people died of COVID the best moment to approve a law about the right to die?
3. Big changes in the concepts of what a human being is and how to organize a society
Although it is presented as a law that does not oblige anybody, the reality is that it modifies essential social values. Previously, a doctor was there to heal and look after people and provide relief from pain. After approval of the euthanasia law, a doctor will also be there to terminate the life of whoever, in certain conditions, asks for it. Previously, we as a society were taught to look after and accompany a person who was suffering at the end of their life. After approval of the euthanasia law, this person can be shown the exit in case they want it. Where caring was regarded as the most pure human activity, now – if a person wants to die –caring would be a waste of time and would go against the rights of the person concerned.
The new law responds to the idea that dignity resides essentially in autonomy, not to the idea that a person has value simply because they are a person. The value of human life ends up being conditioned by the will and desire of the patient. Now, liberty is stripped of social value and is understood as a reflection of the isolated will of the individual: pure individualism in which society is merely an instrument to carry out the individual’s commands.
4. Concern about suffering at the end of life can be addressed by making the field of palliative care more central
Palliative care is not an alternative to euthanasia. Palliative care is not an alternative, period. It is for all citizens. Palliative care is able to provide relief from physical, moral, and social suffering at the end of life. This is achieved with the human, personal company of expert health professionals and also by means of palliative sedation if necessary. Although good palliative care would not resolve all petitions for euthanasia, it is able to provide relief from a very significant amount of suffering at the end of life.
Palliative care should be regarded as essential and of universal necessity and made accessible to everybody. With or without a euthanasia law for those who ask for it, training in palliative care should be provided for all health professionals and built into university studies. Similarly, palliative care teams should be present in hospitals and available for people in their homes; workers in the area of palliative care should be given due recognition for their specific expertise.