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Spain: Bill on Dignified Death

(Feb. 2, 2011) The Government of Spain, through its Ministry of Health, is preparing a new bill on “death with dignity” that is expected to be ready to be submitted to the Council of Ministers by March 2011. (Pajín Asegura que la Futura Ley de Muerte Digna no Regulara la Eutanasia, LA VANGUARDIA (Jan. 26, 2011),
.) The bill will regulate the rights of patients, family members, and their doctors during the end-of-life period. (I. Rojo & C. de Martos, El Gobierno Anuncia una Ley de Muerte Digna, EL MUNDO (Nov. 20, 2010),

The law will provide for the rights of terminally ill patients facing death in order to help them to die without suffering. The government has assured those concerned that the new law will not legalize euthanasia, but will regulate the palliative care of the terminally ill. Spanish patients have since 2002 had the right to refuse medical treatment, such as a respirator that keeps the patient alive, chemotherapy for cancer patients, or a blood transfusion. (María Valerio, ¿Como se Regula en España el Derecho a Morir? EL MUNDO (Mar. 15, 2007), The Law of Patient Autonomy (LPA, Law 41/2002, Nov. 14, 2002, arts. 8-9, 274 BOLETíN OFICIAL DEL ESTADO 40126-40132 (Nov. 15, 2002), reaffirms the autonomy of the patient and the patient's right to refuse medical treatment without giving any justification. Under the 2002 law, a Jehovah's Witness may refuse a blood transfusion based on religious beliefs or a patient on dialysis may refuse to continue with it even if death may follow. (Valerio, supra.)

Experts in bioethics differentiate between two situations: the refusal of medical treatment, as in the above-mentioned cases, and euthanasia or assisted suicide, which is criminally sanctioned under Spanish law. (Id.) When the rejected treatment brings about death within a short time, it is not considered a crime; the patient dies because of his or her illness. Euthanasia, on the other hand, is taking an action to kill a person, such as administering a lethal injection that would kill even a healthy individual. When someone refuses medical treatment and then dies, it is as a result of not fighting against the illness, by the patient's own will. (Id.)

Two physicians' organizations – Organización Médica Colegial and Sociedad Espanola de Cuidados Paliativos – have proposed that economic assistance and medical leave benefits for caregivers of the terminally ill be included in the new law. (Los Médicos Piden Ayudas Exprés Para Enfermos Terminales, ABC DE SEVILLA (Jan. 29, 2011), ht
.) Both entities believe that this is a historic opportunity to address problems that the LPA left unresolved. One is the timely access to economic assistance, especially when the patient's life expectancy is very short. The current bureaucratic procedure should be replaced, the two organizations contend, by a means of rapid recourse to economic assistance, bearing in mind the urgent character of the situation. (Id.) To prevent fraud, the proposal would limit the assistance to six months only, to be used to hire caregivers or acquire special equipment, such as special mattresses, that would improve the quality of life during the patient's last days. (Id).

The physicians' groups suggest it is also important to allow for medical leave for a family member who is providing care to a terminally ill relative. This measure would also be cost efficient for the government, according to the doctors' associations, because it would allow the patient to die at home, with family members, without the high cost of hospital care. (Id.) Doctors also believe it would be timely to add to the new law a simple and fast process to access morphine medication to alleviate the most severe pain. Under the current law, morphine medication may only be prescribed by specific doctors through a “narcotics prescription” and may take up to three days to process if the doctor is not available, for instance over a weekend. (Id.)

Another recommendation from the physicians' associations is that all doctors should take a mandatory course in medical school on palliative care and attention to patients in the final stages of life. (Id.)

The actual text of the bill is still open for debate, but the Ministry of Health has already declared that the new law will give priority to the regulation of palliative care and that the government is also willing to including euthanasia in the debate. (N. Ramírez de Castro, Un Debate No Cerrado en España, ABC DE SEVILLA (Jan. 26, 2011),