In the last 40 years, many people have opened the debate on euthanasia by ending their lives by their own means, without achieving a dignified end. With their actions, they have achieved greater social awareness about the need to address a dignified farewell to this life, when living means continuous agony due to the great physical or psychological suffering that an incurable and irreversible disease can cause.
To this deliberation, on the right to die with dignity, the Right to Die with Dignity Association joined in 1984. This movement has promoted, and promotes, the right to euthanasia for a dignified death.
In 1986, through the General Health Law, patients are allowed to be autonomous to consent to or reject treatment and request voluntary discharge. Gone are the days of paternalism, to give way to a time in which the autonomy of the person prevails and frees them from any medical imperative.
Later in 2001, Law 41/2002 Regulating Patient Autonomy and Rights and Obligations in Matters of Information and Health Documentation, reaffirms the autonomy of patients by allowing them to reject treatments, and thereby achieve an end of life with terminal sedation - always authorized by the patient and/or family - if symptoms of suffering occur or they are in a situation of last days.
Terminal illness, or any type of incurable process, requires reflection on decision-making in relation to quality of life and its end. These will be conditioned by a large emotional component - in the patient, family and professionals - given the variability of signs and symptoms produced by the end-of-life process.
The human being is born free, grows, develops and shapes their personality in relation to their living environment, beliefs and culture. They are the owner of their life and their actions, as well as their body in its free expression. Both life and death form an individual binomial, in which one does not exist without the other.
Each existence is lived according to the individual project of each person, and thus we must understand and accept the possibility of ending said vital project. The ability to decide on aspects of the evolution of the disease, as well as reject studies or treatments, is protected by legislation to date, but the person has not been allowed to decide on the end of their life how, when and where. Allowing to determine this end of life means respecting the maximum expression of the autonomy of the human condition, since each person knows the extent of their suffering to decide their vital limit and agree on how and when they want to end their life.
Societies, which contribute to building a dignified end of life for the human being, achieve a greater degree of humanity, are more free and supportive, by not allowing their members to die in solitude and uprooted, and offering them all the necessary means to avoid the suffering produced by the progression of a chronic and irreversible disease process.
Social support for the decriminalization of euthanasia has been growing over the last 30 years. This social demand has led to the political debate on the dignified end of life of the human condition, in such a way that on March 24, 2021, the BOE publishes the Organic Law on the Regulation of Euthanasia - LORE - approved by the Congress of Deputies of the XIV Spanish legislature.
The LORE arrives to free the human being from uncertainty about their end. It is a law that does not oblige, each person will recognize in their inner self the request for application of the same, when the time they consider appropriate arrives, provided that their suffering is intolerable with their life.
Previously, it is necessary for the requesting person to have a comprehensive palliative approach to their suffering in all its aspects - pain control, mood, socio-family aspects, equal access to benefits, support for disability - in order to mitigate them. These untreated aspects produce great suffering and uncertainty and, therefore, can lead to an imminent desire to end life. If with all the resources available and treatments applied, the person fails to live with dignity, in the absence of suffering in the face of their irreversible disease process, they must have the right to request to end their life in a dignified manner through the established legislative channels.
This Law requires high guarantees and respect for the conscientious objection of professionals. Very important and necessary aspects because we are talking about life, conscience and values to be respected before the end. No one imposes or decides if the person or their representative has not requested it within the legislative framework. Likewise, the conscientious objection of the assigned professionals must be safeguarded and respected, without this conditioning their care and personal activity.
Even so, we must ensure the right of the person to end their life without delay, in the context of severe chronic and disabling suffering, or severe and incurable disease, given the bureaucratization and deadlines that may exist in the application of the law. In this area, the Healthcare Ethics committees are the ones that must be available to citizens and users of the health system, to clarify doubts, accompany in the reflection and assert their rights at the end of life.
The Healthcare Ethics Committee of the Lanzarote Health Area invites all people to carry out the document of Anticipated Wills (MAV). This legal document gives us the opportunity to express the instructions that we want to be followed by the healthcare personnel in charge of our care, when the capacity to grant consent on medical acts to be performed in an irreversible disease process has been lost. Also, through it, it enables the request for the application of euthanasia, in anticipation of the loss of factual capacity in the cases contemplated by the Law.
The end of life is an inexorable vital reality that should invite reflection, so that it occurs in a dignified manner respecting individual values. For this, it is necessary to define some concepts that will be raised at this end of life, in order to opt for the option that is closest to the values of each person, and those concepts are:
- Dignified death: All accepted and agreed death is considered.
- Assisted suicide: It is the voluntary death caused by oneself after the administration of a lethal substance, prescribed by their doctor. It must be a conscious and voluntary request.
- Living will or Anticipated Will Manifest (MAV): It is a declaration prior to the events - loss of consciousness or inability to decide or express in the face of an irreversible deterioration of their health -, in which the person indicates how they want to be treated. This declaration can be reviewed as many times as necessary, if the person so wishes.
- Palliative care: Comprehensive treatment for the care of discomfort, symptoms and stress caused by a serious illness and the side effects of its treatments, in order to improve the quality of life as long as possible.
- Palliative sedation: is the administration of drugs, in the minimum necessary doses and combinations to reduce the consciousness of the patient with advanced or terminal illness, in order to alleviate difficult-to-control symptoms.
- Terminal sedation: Pharmacological induction for a sufficiently deep and irreversible decrease in the level of consciousness of the person, in order to alleviate physical and/or psychological suffering around death, which is not achieved with other measures. It must be agreed with the patient and/or family.
- Adequacy of therapeutic effort: It consists of not establishing or withdrawing all those therapeutic or diagnostic measures that do not contribute benefit to the clinical situation of the patient. It is a technical decision, proposed by the care team and agreed with the patient and/or family.
- Rejection of treatment: It is the possibility that the patient has to reject, consciously and voluntarily, the therapeutic options that are available to them even though it may mean a shortening of their life or immediate death.
- Euthanasia: Death without pain, discomfort or physical suffering, intentionally caused by the healthcare professional, upon request of the free, conscious and autonomous person.
*Elisa Corujo, geriatrician
