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[Euthanasia in Spain #2] The process from application to completion, as seen from the contents of the Spanish Euthanasia Bill; Safeguards to avoid the risk of coercion

  • Writer: リップディー（RiP:D)
    リップディー（RiP:D)
  • 2 days ago
  • 7 min read

[The process from application to completion, as seen in the Spanish Euthanasia Bill, and safeguards to avoid the risk of coercion]


This paper focuses on the euthanasia law in Spain.

・"The specific process from requesting euthanasia to its completion"

- "Safety measures in place to prevent harm to patients"

--I will explain this while focusing on the above two points.


Spanish government website, site image about Ankor

*This is a website that explains euthanasia in Spain. It is a very easy-to-understand website aimed at the general public , so please use it as a reference.


By the way, in Spain (and other Spanish-speaking countries and South America), euthanasia is expressed as "Eutanasia," which is the same as the English word "Euthanasia . "



*The actual PDF of the Spanish Euthanasia Law can be found here

Cover of the Spanish Euthanasia Law


[Name of law] (The process from application to completion as seen from the contents of the Spanish Euthanasia Bill)


"Ley Orgánica 3/2021, de 24 de marzo, de regulación de la eutanasia"


"Organic Law No. 3 Euthanasia Law of March 24, 2021"



[Eligibility conditions]


• Age and place of residence:

Anyone over 18 years of age, of Spanish nationality or legal residence in Spain, or who holds a residence certificate proving residence in Spain for at least 12 months.


• Decision-making ability:

Be competent and conscious at the time of application.


• Understanding information provided:

I have received and understand all written information about my condition, available treatments, options including palliative care, and support for addictions (if any).


Medical conditions:

By the attending physician,


" Severe and chronic physical dysfunction,

A condition involving intolerable physical or mental pain "


or


" Serious and irreversible illness, unbearable physical or

A condition accompanied by mental distress and with a limited life expectancy


It has been certified as such.


• Free will and no coercion:

The applicant has applied twice , in writing or by other recordable means, voluntarily and not as a result of external pressure .

The two applications must be separated by at least 15 days , but if the attending physician determines that the patient is about to lose their capacity to consent, a shorter period may be permitted depending on the circumstances.


• Informed consent:

Provide informed consent before receiving assisted euthanasia, which will be recorded in the patient's medical record.


*Special exception

Even if a patient has completely lost the capacity to comply with the above requirements, if they have previously created an advance directive (living will) or equivalent legal document that requests assistance in euthanasia, assistance may be provided based on that document.



*Points to note

According to Article 3 (Definitions) and Article 5 (Requirements) of the Spanish Euthanasia Bill, the diseases covered are:

They fall into two categories .


1. "Serious and incurable illness"

Physical or mental pain is "unbearable" and continues without any hope of improvement.

Life prognosis is "limited" (not limited to within a few months).


2) "Severe, chronic, and incapacitating condition"

Severe impairments or dysfunctions that prevent independent living and make a person dependent on others or devices.

There is no prospect of long-term improvement.

It involves "persistent and unbearable physical or mental suffering."



In other words , it is acceptable even if you are not terminally ill .

Being "terminal" is not a requirement. As in the Netherlands and Belgium,

If you have a chronic illness or progressive disability that causes unbearable pain, you fall within the eligibility criteria.

(Examples: incurable neurological diseases, complete paralysis, ALS, etc.)

⇩

In other words, the range of conditions is wide.


Applications based solely on mental illness are also permitted.

The Spanish euthanasia bill explicitly states "padecimiento físico o psíquico (physical or mental suffering)" in its text.

However, of course, the strict conditions of "chronic and with no prospect of improvement" and "unbearable pain" must be met.

In practice, cases based on mental illness are reviewed very carefully (as in the Netherlands and Belgium).



To sum up...

- Euthanasia in Spain is not limited to terminal illnesses .

→ Also covers ALS, progressive intractable diseases, and severe chronic disabilities.


Mental illness is not legally excluded.

→ However, strict screening and multiple checks by the Assurance and Evaluation Committee are essential.



[Review process]


[Application stage 1]


First application:

The patient makes an initial application in writing or by other recordable means that clearly indicates their desire to seek assistance.


The document must be signed and dated by the patient, and if the patient is unable to sign, it may be signed and dated in the patient's presence by another adult, stating the reason for the signature.


This document is signed in front of a medical professional who then submits it to the treating physician and it is incorporated into the medical record.



[Application stage 2]


Physician review process:

After receiving the initial application, the responsible physician (médico responsible) will verify the patient's eligibility within two days and begin a discussion with the patient about the diagnosis, treatment options, expected outcomes, and palliative care.

The doctor will ensure that the patient understands the information provided and will provide the information in writing.


Second application:

After 15 days have passed since the first request (or such shorter period as the treating physician deems appropriate) and a second request is received, the treating physician will resume the deliberation process with the patient within two days to address any questions or requests for additional information.


Confirmation of intent to continue and consent:

24 hours after the end of the deliberation process , the attending physician confirms with the patient whether they wish to continue receiving assistance .

If the patient wishes to continue, the attending physician will inform the medical team (especially the nurses) and, if the patient so wishes, the family and relatives.

Also, obtain signed informed consent from the patient.



[Evaluation stage]


Consulting physician's evaluation:

The doctor in charge must determine whether the patient has a "severe and chronic physical disability" or

If you are diagnosed with a "serious and irreversible illness,"


Consulting physician (médico consultor)

(a physician trained in the patient's pathology and not on the same team as the treating physician )

The written report is obtained, and the consulting physician evaluates the patient's condition and potential for treatment.

If the consulting physician's report is not acceptable, the patient can appeal to the Compensation and Evaluation Committee.



[Discussion stage]


Review by the Review Committee


1. Notification by the treating physician:

After the above steps are completed, the attending physician must:

The Chair of the Review Committee (original translation: Guarantee and Evaluation Committee) will be notified within a maximum of three business days.


2. Committee Verification:

Within two days, the chairman will appoint one doctor and one legal officer from the committee to verify whether the requirements and conditions for euthanasia are met.


3. Access to information and interviews:

The appointed committee members will have access to medical records and will be able to interview the treating physician, medical team, and the patient themselves.


4. Reporting and Decision:

The committee will submit a report within seven days. If the report is in favor, the process will continue, but if it is not, an appeal can be filed.

If the two committee members disagree, the matter will be referred to the full committee for a final decision.


5. Appealing a denial:

If a request for euthanasia is denied by the attending physician, the patient has 15 days to appeal to the Compensation and Evaluation Committee.

If the committee refuses, the patient can file an administrative lawsuit.



[Implementation and reporting stage]


Euthanasia


1. After a positive decision:

After a positive decision has been made, medical personnel will carry out the assisted euthanasia with the utmost care and professionalism, applying the appropriate protocols.


2. Patient Selection:

If the patient is conscious, they can choose how they wish to receive assisted dying. The options are:


- Direct administration by healthcare professionals

The doctor administers the medication directly to the patient, and the doctor and other medical personnel are present until the patient dies.


Self-administration by patients

The patient is given the medication by a doctor who prescribes it and provides it to the patient for self-administration. In this case, the doctor and other medical professionals monitor and support the patient after self-administration until death.



Post-implementation procedures and monitoring


1. Notification to the Security and Evaluation Committee:

After assisted euthanasia is performed, the attending physician will send two documents to the Compensation and Evaluation Committee within five business days containing specific patient information and details of the procedure.


2. Committee Post-mortem Review:

The Guarantee and Evaluation Committee will conduct a follow-up review within two months to determine whether the assisted dying was carried out in accordance with the procedures set out in the law.


3. Legal Considerations of Death:

Death through euthanasia is for all purposes legally considered a natural death.


4. Conscientious Objection:

Medical professionals directly involved in assisting euthanasia can exercise the right of conscientious objection if it conflicts with their own beliefs . Medical institutions should establish a register of conscientious objectors (a global rule).


5. Support for people with disabilities:

People who are deaf, hard of hearing and deafblind are guaranteed resources and means to assist them in accessing information, forming and expressing their wishes, consenting and communicating.


6. Annual report:

The Guarantee and Evaluation Committee (Review Committee) is required to prepare and publish an annual evaluation report on the application of the Euthanasia Law.


* [Protective measures (safety guards)]

・Two separate applications + consideration period

- Confirmation of the patient's free will (eliminating external pressure)

・Check by a third-party doctor

・Preliminary and post-review by the Guarantee and Evaluation Committee (Review Committee)



remarks


[Spain's euthanasia process]

①Apply to your doctor (usually your primary care physician) (first check)

⇩

② Evaluation by a consulting physician (a completely independent physician from the first one) (second check)

⇩

③ Nominated by the Euthanasia Review Committee (Guarantee and Evaluation Committee: a third-party external organization)

Evaluation by one new doctor and one legal professional (third check)

⇩

④ Implementation


*Modeled after the format of countries surrounding the Netherlands.



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