The right to die with dignity, a conquest decades behind schedule

BarcelonaAntoni Monguilod died on October 2019 of Parkinson's disease after 12 years of fighting for a dignified death. The same fight that Maribel Tellaetxe had undertaken, who had Alzehimer and wanted to leave before ceasing to recognise her children; as well as Montserrat Voltà, who had ALS and criticised in a letter that the system forced her to live "in an undignified way"; and José Antonio Arrabal, also with ALS, who recorded his "death in clandestinity" in 2017 so that no one would bring his family to justice. The same fight of Ángel Hernández, the man accused of male violence for having helped his wife, María José Carrasco, to die with dignity. And so many others, starting with Ramón Sampedro, the Galician sailor and writer, a quadriplegic since the age of 25, who fought a hard legal battle to be able to die with dignity, reflected in cinema. Their cases would not have to be repeated as of Friday, after the entry into force of the new law regulating euthanasia, which makes Spain the sixth country in the world to legalise assisted dying - after the Netherlands, Belgium, Luxembourg, Canada and Colombia.

With the new law, a patient of legal age affected by a serious, chronic, disabling or incurable illness can request euthanasia in hospitals or at home. His or her condition must be associated with "constant and intolerable physical or psychological suffering" and there must be "certainty" or a high probability that there is no possibility of cure or improvement. The Ministry of Health ensures that it is a "guarantor" standard that "responds to a social demand". The aim is that the patient can be accompanied by the family until the end, can decide how to leave and do so assisted by a team of health professionals. The text has the consensus of the government and the endorsement of the medical community. 92% of the 15,000 health professionals who took part in a survey by the Department of Health on the law were in favour of it. Despite the fact that the law reserves the possibility for a doctor to make use of conscientious objection if he or she does not agree with assisting in the death of a patient, only 11% of those surveyed said they would exercise this power.

"Only for cases such as those of Ramon Sampedro or Maria Jose Carrasco it already seems a good law", said the coordinator of the Association Dret a Morir Dignament (Right to a Dignified Death), Cristina Vallès, from the Casa Orlandai in Barcelona, where members of the organisation have toasted to celebrate the legislation's entry into force. In Madrid, tenths of people have gathered at the Puerta del Sol. Ángel Hernández, who is awaiting his trial for having helped his wife to die with dignity, was missing. The prosecution accuses him of a crime of cooperation in suicide, frames the cause within male violence and asks for six months in prison. "It was an act of solidarity and compassion", says Vallès, who finds the comparison "offensive" towards victims of gender violence and hopes that justice will take into account the new legal framework and exonerate Hernandez.

Some patients, excluded from a law with interpretable issues

His trial has obscured the entry into force of a law that the organisations welcome but will be closely monitored. Vallès explains that the new text is so "guaranteeing" that it does not cover all cases. From the outset, the new law excludes minors from the possibility of dying with dignity - although "it has been shown that at 16 a minor can be competent", says Vallès - or those affected by a mental illness. The procedures to request assisted death can take up to 45 days, a period of time that organisations also consider too long. But above all, Vallès explains that one of the weaknesses of the new law is that it has interpretable issues.

In parallel to the new legal text, the Ministry of Health has approved an action protocol to assess the disability status of patients. It requires a clinical interview with a health professional to assess whether the person understands what the procedure means, reasons coherently, is able to take the decision for him or herself and expresses it voluntarily and without coercion. Vallès warns that in practice this leaves it up to doctors to "decide on the competence of the person and the assessment of the patient".

The coordinator of the entity considers that in territories with a strong bioethics community, such as Catalonia -where the Generalitat has developed a commission of guarantees and a register for conscientious objector doctors-, there should be no problems, but she believes that the interpretative nature of the regulation may cause problems in other more conservative territories or ones without such a strong medical tradition. Vallès also warns that it will be necessary to ensure that hospitals governed by religious entities do not "pressure" their professionals to make conscientious objection. In fact, with the law in place, the aim of the organisation is now to become a tool to defend the rights of people who are left out of it, to "continue to break taboos" and to "ensure that the development of the law is done without differences and without excuses" both in big cities and in smaller towns.