(Feb. 9, 2021) On December 17, 2020, Bill No. 46-7 on the Organic Law to Regulate Euthanasia was approved by the Plenary of the Spanish Congress of Deputies (lower house) with 198 votes in favor, 138 against, and two abstentions. The bill will now move to the Senate for consideration, where it is likely to pass.
Contents of the Bill
The bill would regulate “active euthanasia,” which it defines as the action by a medical professional to deliberately end the life of patients at their request when they are afflicted with a serious, chronic, and incapacitating condition or serious and incurable disease that causes intolerable suffering.
The bill also characterizes euthanasia as including medically assisted suicide, in which the physician prescribes the medicine and guides the procedure for ending the patient’s life, but it is the patient and not the doctor who carries out the procedure.
Only Spanish nationals, legal residents, or holders of a registration certificate that proves a stay in Spanish territory of more than 12 months would qualify for the procedure.
The bill would also require that the person be of legal age and have the capacity to understand the actions to be undertaken at the time of application. If the person were incapacitated at that time but had previously signed a living will, advance directive, or equivalent legally authentic acceptable document, the procedure could also proceed.
If the patient has appointed a representative in that document, the representative would be deemed the valid spokesperson of the patient in communicating with the intervening physician.
If the patient has made a living will without designating a legal representative, the intervening physician could submit the request for the euthanasia procedure.
Under the bill, minors would not be allowed to apply for the procedure.
To ascertain and ensure that the patient clearly and undoubtedly wished to proceed, the bill would require that the request for euthanasia be submitted twice in writing, with a 15-day interval between each request. The request would have to include a statement by the patient affirming that his or her decision is free from any external pressure.
Once the request has been submitted, the physician in charge of the procedure would be required to carry out a thorough process of verifying the diagnosis of the patient’s illness, the therapeutic possibilities and expected results, and the possibilities for palliative care, making sure that the patient fully understands the information provided. The patient would then have to confirm his or her intention to move forward with the procedure. A second round of consultations between the patient and physician would also be required following the patient’s second request.
The bill would thus require that the patient confirm his or her wishes four times, which would be documented in the patient’s medical history, and allow the patient to stop the process at any time.
Regarding the advice of health care professionals, the patient’s physician would be required to agree to the procedure, and another physician with expertise and training in the pathologies suffered by the patient would also have to provide an opinion.
The bill would also create a Commission of Guarantee and Evaluation that would operate in each autonomous community and be in charge of the final evaluation of the patient’s petition. The commission would include a minimum of seven members, including medical staff and lawyers.
Once the patient and his or her physician had concluded the consent process, the evaluation commission would appoint two experts—one a lawyer and the other a physician—to evaluate the matter. If both experts agreed, the process could go ahead. If both experts were not in agreement, the full commission would have to decide. Once the commission decided that the request was justified, the intervening physician could proceed with the euthanasia or facilitate the suicide. If at any stage the request were rejected, the applicant could appeal before the commission. If the commission rejected the appeal, the applicant could submit a petition for review before the court of contentious administrative jurisdiction.
The whole process, from the time the patient filed the first request until the time the doctor received the final approval, could take up to 40 days, to which would be added a few unspecified days for the act of euthanasia itself.
The act of euthanasia could be carried out in public, private, or subsidized healthcare centers, or at the patient’s home.
Healthcare professionals directly involved in providing assistance to die would be allowed to exercise their right to conscientious objection. This objection would have to be expressed in advance and in writing.
Public Support for the Bill
According to the latest Metroscopia poll from 2019, 87% of the population in Spain supports the passing of the law, with a favorable majority in all groups surveyed, including right-wing voters and practicing Catholics. Among health care workers, the latest surveys indicate support above 65%. In contrast, the Collegiate Medical Organization has spoken out against the bill, as have the Catholic Church and the Spanish Bioethics Committee. Patient associations do not have a defined position and leave it to the individual decision of each affected person.