Since 2021, euthanasia has been legal in Spain. Euthanasia is a controversial issue in Spain and, even after the passing of this law, it arouses emotions among patients as well as caregivers and doctors.
In addition to the application of this law, there are more issues surrounding the dignified end of our lives that, regardless of our age, really need our attention. We list them all here and have divided the text into the following sections:
- Advance Directives
- Euthanasia and sedation
- Application for euthanasia
Important:
The information below is a compilation from various sources (as mentioned in the text) and is intended solely to inform our patients about a dignified end in Spain. This text has been written in response to patient queries and is not based on any ideology or personal preference. We cannot be held responsible in any way, nor can we be held liable for any damages suffered as a result of the following text. We are not responsible for any future changes to the procedure, terms and conditions, and refer to our sources for the most current and complete information. We also ask everyone to consult the sources first in case of doubt. If you are still unclear by then, you can direct your questions to SAIP Denia: hd*********@*va.es (only patients from the Denia region). It is absolutely not our intention that patients from other practices come to us with a request for euthanasia. If you have questions about euthanasia, do not hesitate to make an appointment with your own general practitioner. Euthanasia is a serious matter and guidance should be provided by your own doctor.
Advance directives
Advance directives ensure that we do not find ourselves in a situation where we can no longer have recourse to euthanasia or other forms of care in the last phase of life, simply because we can no longer express ourselves (coma, dementia, etc.). It is therefore important to resolve this before anything happens.
There are two situations:
1) Due to an accident or a sudden illness, I suddenly find myself in a situation where I can no longer assess my situation myself or have a say in my treatment. In fact, my family and my doctors have to make very essential decisions without being able to consult with me. In particular, it is a question of the decision whether or not to undergo active treatment.
2) Due to a serious illness that cannot be cured, I am deteriorating very badly and I am in a situation of unbearable suffering. Therefore, it is above all a question of whether or not to actively end one's life.Â
The difference between these situations is not always so clear-cut, sometimes they even overlap.
In a will, or living will, you write down your medical wishes in this type of situation. This lets your family and your doctor know what you have or have not decided. This is important if you can no longer tell them yourself, for example, because of dementia or because you have fallen into a coma. Anyone can make their own will in writing, and there are several ways to do this. In Spain, they have simplified this with an online register of advance directives. The advantage of a centralised registry is that it can be accessed from multiple locations. In Spain, the law on Euthanasia is the same for the whole of Spain and follows the recommendations of the Ministry of Health. But the application of the law is in the hands of the authorities of each autonomous community. So in our case, we follow the rules of the Valencian Community.
In the Valencian Community, there is also the possibility of completing and registering so-called advance directives. If necessary in the future, all medical staff responsible for your care can consult the register and read your advance directives. If necessary, a copy can be printed out for clarification for family members.
It is intended that an adult or emancipated minor with sufficient legal capacity and without external pressure should express his or her will when he or she finds himself or herself in a situation in which circumstances do not allow it. He or she must decide on:
1) Instructions on medical procedures affecting you.
2) The decision on the donation of their organs for therapeutic, educational or research purposes. In this case, consent is not required for the removal or use of the donated organs.
3) The request for the application of euthanasia in a situation where the circumstances do not allow him/her to express his/her free will.
The document can be formalised in three ways:
1) In writing before two witnesses (to be provided by yourself) in one of the following ways Patient information and care services (SAIP). They are usually located in public hospitals, such as in Denia, for example.
(2) By public deed before a notary. This costs money and you can arrange it yourself directly with a notary in your municipality. Prepare it well. For example, check the suggestions for additional texts below.
3) On the Internet. This requires digital identification of all persons signing: you and the two witnesses. You can find the direct link here.
The document Advance Directives talks about the two situations mentioned above and about organ and/or body donation to science. There is also space for personal comments. Here are some examples and their explanations.
Declaration of Willingness in the Valencian Community at the Patient Care and Information Service (SAIP)
The following text is based on the instructions of the "Right to die with dignity" foundation. You can also follow the official instructions at this page of the Generalitat.
Download here the model of declaration of wills of the Valencian Community and fill it in with your details and preferences. Copies are also available at our clinic.
Find out about the contents of the will and think about it carefully and calmly. Remember that your will is yours alone and should reflect your wishes and decisions, as you wish to express them.
Under "Other instructions you can add the following pointsThese are suggestions from the foundation "Right to die with dignity":
1) I request that my life be ended as soon as possible by euthanasia.
2) I consider it constant and intolerable physical or psychological suffering, incompatible with my personal dignity, that certain serious chronic and disabling illnesses such as neurodegenerative diseases (dementia such as Alzheimer's or any other) cause such a deterioration of my personality and my mental faculties that I am incapable of being aware of my own illness and my scheme of values. Therefore, even if I do not express it, do not remember it or, in the opinion of others, do not show outward signs of suffering, as soon as I am unable to look after myself or do not recognise my relatives or friends, or am in a clinical situation comparable to moderate dementia (GDS-FAST 5, according to the Reisberg scales), I wish that my wish to end my life as soon as possible by euthanasia be respected.
3) During the period of time required to process my request for euthanasia, or in the event that it is denied, I refuse any life support measure, treatment, intervention or procedure that would contribute to keeping me alive (antibiotics, nutrition-hydration with fluids, nasogastric tube or gastrostomy, pacemaker or defibrillator, etc.). I also request that my suffering be alleviated by all available means and, if I am in an advanced or terminal condition, I wish to die under deep palliative sedation, maintained until my death. Should there be any doubt about the irreversibility of my de facto incapacity to decide, I wish to make it clear that such a possibility does not alter my firm decision not to endure a life in which I am dependent on others for the activities of daily living.
4) If any health professional should declare themselves to be a conscientious objector with respect to any of these instructions, I request that they be replaced by another professional, guaranteeing my right to decide freely about my life and death.
Provides witnesses. One of them must have no family or property relationship with you and must certify that you make the will freely and with full mental capacity. You will need a photocopy of their identity documents. Patients registered at our clinic who have problems finding the second witness can ask one of our doctors who knows them to do so. Witnesses do not need to be present at the delivery of Advance Directives at the SAIP.
(Optional) Designates a representative. Their role is to defend your wishes to the medical team. We recommend that it be a trusted and younger person. Have this person sign your document and provide a photocopy of their ID card. Any person of legal age, who has not been legally incapacitated, may be a representative, with the exception of the following persons:
- The notary who is the authorising notary of the deed.
- The civil servant or public employee in charge of the Centralised Registry of Advance Directives of the Valencian Community.
- The witnesses before whom the document is executed.
- The healthcare personnel who must implement advance directives.
- In the field of private health care, staff with a contractual relationship, service or similar, with the private health insurance company.
It is not obligatory to register your will, but it is advisable. In case of an emergency or if you have mobility problems, you can fill in the Advance Directive in the presence of witnesses. It must be possible to show the signed advance directives to the health care staff.
If you wish to update or revoke your will, you can do so with these documents.
2. Euthanasia and sedation
Sedation and euthanasia are two approaches used in the context of alleviating suffering in critically ill patients, but they differ in their purpose and method:
1)Â EuthanasiaEuthanasia refers to the deliberate termination of a patient's life by a physician, usually at the patient's own request, to end intolerable suffering. Euthanasia is carried out by administering drugs that interrupt consciousness and then shut down the respiratory system, resulting in the patient's death.
2)Â SedationSedation is the administration of medication to render the patient unconscious in order to alleviate severe suffering that cannot be effectively controlled by other means, such as analgesics. Sedation can be used in palliative care to provide comfort to terminally ill patients without the goal of ending their life.
Thus, the main difference between the two is that euthanasia aims to actively end the patient's life to alleviate suffering, whereas sedation aims to reduce consciousness to provide comfort and alleviate suffering without the specific purpose of ending life.
Sedation is part of palliative care and can be performed as a treatment. It is not covered by the euthanasia law. Most doctors in the region have extensive experience in home sedation and can organise it at short notice if necessary.
People who are eligible to request euthanasia and want to ask for assistance in dying must follow a series of steps. These steps, which if all goes well take between 30 and 40 days, aim to demonstrate that the request is personal, firm, free, deliberate and in accordance with the euthanasia law.
3. Request euthanasia
Organic Law Regulating Euthanasia (LOR)
The steps are well explained in the following link:Â https://derechoamorir.org/eutanasia-en-espana/
The information you have just read is a compilation from various sources (as mentioned in the text) and its sole purpose is to inform our patients about a dignified end in Spain. This text has been written in response to patient queries and is not based on any ideology or personal preference. We are not responsible in any way, nor can we be held liable for any damages suffered as a result of this text. We are not responsible for any future changes to the procedure, terms and conditions, and refer to our sources for the most current and complete information. We also ask everyone to consult the sources first in case of doubt. If you are still unclear by then, you can direct your questions to the SAIP Denia: hd*********@*va.es (only patients from the region of Denia, for other SAIPs please see this list). It is by no means our intention that patients from other practices come to us with a request for euthanasia. If you have questions about euthanasia, do not hesitate to make an appointment with your own general practitioner. Euthanasia is a serious matter and guidance should be provided by your own doctor.
