The Observatory of Bioethics and Law presents a Document on Euthanasia - COMUNICACIONS UB

What are the arguments in favour of euthanasia? Under what circumstances? To what extent is euthanasia accepted by the general public? What is its exact definition? Who is involved? Should the law contain provisos? Which? Should the conscientious objection of health care workers be respected?

These are some of the issues addressed in the latest document drawn up by the Opinion Group of the Observatory of Bioethics and Law (OBD) of the UB, based in the Parc Científic de Barcelona (PCB, Barcelona Science). In producing this document, the Group wishes to participate in the debate on euthanasia; a long-standing discussion and one that is rekindled after each new case reported in the media. The document coincides with intense debate about the case of a 19-year-old French youth, Vicent Humbert, and emphasizes that, in addition to media debates, surveys show that a clear majority of the public favours specific legislation on euthanasia. This majority has been increasing over decades.

Entitled "The Patient's Right to end his or her life under certain circumstances: Declaration on Euthanasia", this document is the result of consensus between numerous specialists from a range of disciplines. It aims to establish the guidelines to clarify some of the aspects that lead to confusion and imprecision regarding terminology, and presents conclusions and possible aspects to qualify in future specific legislation.

This document has been presented today during a press conference held in the Fèlix Serratosa Room of the PCB. The act included the participation of Maria Casado, jurist and director of the OBD, and Albert Royes, specialist in medical ethics, both coordinators of the document. The official presentation will be held today in the auditorium of the PCB and will be presided by the rector of the UB, Joan Tugores.

The Opinion Group upholds that the progressive recognition of the autonomy of individuals, which they consider a key element in health care relations, must lead to the acceptance of the individual's right to end his/her life under certain circumstances, and that these circumstances must be regulated by specific legislation.

At present, Law 41/2002, deontological codes of medical practice, and several statements issued by the Catholic Church support the so-called passive euthanasia, which involves suspending or not undertaking treatment in certain circumstances, even though this may lead to the death of the patient. These kinds of measures are common practice in all hospitals; decisions are taken by doctors, with the knowledge and consent of the patient's family.

The basic rights of those in healthcare and particularly the right to take decisions concerning one's own health were introduced by the General Health Law of 1986. Since then, concretion has advanced gradually, through the introduction of obligatory informed consent, through recognition that competent persons can exercise their right to refuse medical treatment or intervention, including life support, and through the introduction of laws on living wills -an issue addressed in another document drawn up by the Group. The present document emphasizes that this development must also provide concrete content to the provisions already in place and recognize that free exercise of personal autonomy may also entail the right to decide to end one's life under certain circumstances; that is, accepting voluntary active euthanasia.

The Group also holds that conceptual ambiguity regarding the term "euthanasia" further impedes debate. The document clarifies that euthanasia comprises two actions. The first is an ethically legitimate decision to end his/her life in a dignified, peaceful manner, taken by a patient suffering from a grave illness which will irrevocably lead to death or entail permanent unbearable suffering. This patient is either in a position to express his or her free will or else has done so previously by completing a living will. The second action involves medical intervention that leads to a rapid, effective and painless death for the patient. This act cannot be legitimate without the existence of the first. However, if the first exists, then the second act is necessary since it gives effect to the patient's freely taken decision. The doctor's help is called for to fulfil the patient's desire for a good death, since prescription and correct administration of certain drugs will be required to ensure a peaceful and dignified death.

Finally, bearing in mind that medical practice aims to alleviate the suffering of patients through applying adequate means for each case, the document stresses the following points:

-. Legislation against euthanasia implies the immoral lengthening of suffering.

-. Euthanasia is a question of human solidarity and compassion for the person requesting it.

-. The State should protect life but not impose the obligation to continue living in undignified conditions and against the will of the patient.

The Opinion Group of the OBD therefore proposes:

1. The introduction of specific legislation to legalize euthanasia in Spain, thereby permitting euthanasia as a medical practice in cases of serious, express, unequivocal and repeated requests by the patient.

2. That the law clearly specifies the doctor's role in each request for euthanasia which meets the legal requirements. It should also regulate the practice of euthanasia, a procedure that may be carried out by the doctor, by the patient or by family or close friends, but always under the supervision of the doctor.

The right of the doctor or other health professionals that are directly involved to exercise conscientious objection to euthanasia must be respected. However, the law must guarantee the patient the right to euthanasia in the circumstances specified.

3. Recognition of the validity of the request for euthanasia by means of a living will or expressed by the patient's representative, as designated in this will.

4. That the law respects the autonomy of minors, bearing in mind their relative maturity.

It is necessary to accept -as has already occurred on various occasions and in various places- that persons over 16 years can make their own decisions, on condition that parents are heard and are involved in the decision; in the case of minors between the age of 12 and 16 years, parental consent is required for the minor's decision to be valid.

5. That public authorities seek to extend the availability of specific intensive care services, thus ensuring universal access to these services and to the right to die with dignity.

This entails an improvement in palliative and home care so as to make these services available to the entire population, thereby establishing access as a patient's right. It is pertinent to remark that requests for euthanasia will continue to be made and should be attended.

• Document [PDF]