Jaume Vives wanted to be direct about the reality of euthanasia, but he had to settle for “Euthanasia? #Hijacked debate.” The residents’ association of the apartment building told him his initial message for a 500-square meter banner he got permission to hang from the building was too explicit.
“We’re legislating euthanasia, but when we wanted to talk about it, to show what it is, we were told it was too aggressive,” he said.
Mr. Vives, a member of the Association of Catholic Activists and leader of Vividores (“The Living”), a campaign to fight the legalization of euthanasia in Spain, was also denied space on public transportation by the private company that manages bus advertising.
“Hijacked debate” may be the best description of how euthanasia will become legal in Spain.
A bill to legalize euthanasia and physician-assisted suicide for adults facing incurable illness, irreversible disability and even mental illness as a “subjective right” is expected to pass Spain’s Senate by the end of March, the final hurdle before it becomes law. The lower chamber of the Spanish Parliament approved the law on Dec. 17, rushed through in a special session of the Congress of Deputies without expert testimony and over the objections of both the country’s bioethics committee and its doctors’ association.
A bill to legalize euthanasia and physician-assisted suicide for adults facing incurable illness, irreversible disability and even mental illness as a “subjective right” is expected to pass Spain’s Senate by the end of March
Spain is not the only country in Europe that has taken significant steps toward the decriminalization or legalization of euthanasia. Portugal’s Congress approved a euthanasia bill in February 2020, and its Senate voted it into law at the end of January.
Ireland has also taken steps to legalizing euthanasia, and courts in Germany, Italy and Austria recently handed down decisions that could that open the way for its legalization. Last October, New Zealand became the first country to legalize euthanasia through referendum. Physician-assisted suicide is also legal in Luxembourg, The Netherlands, Belgium, Switzerland, Canada, Colombia, the Australian state of Victoria and eight U.S. states.
In response to the growing legal acceptance of euthanasia, the Congregation of the Doctrine of the Faith reiterated church teaching in September in the letter “Samaritanus Bonus.” Spanish bishops published their own letter on the issue last December, “Sowers of Hope,” in which they reminded Catholics that “there is no one that can’t be cared for even if they are incurable.” The bishops called for a day of prayer and fasting on the eve of the law’s vote and have encouraged the faithful to include explicit instructions in their advanced directives that they do not wish to be euthanized.
The recent rash of pro-euthanasia legislation and court decisions suggest that euthanistic notions of a dignified death have gained acceptance in politics, courts and among the general public in Europe. But most physicians and bioethicists still oppose euthanasia, according to Léopold Vanbellingen, a researcher at the European Institute of Bioethics.
Bioethicists and political observers say public opinion in Spain has been groomed over the course of decades to consider euthanasia a medical treatment for pain. They add that an ideology of personal autonomy converging with the sensibilities of a consumerist culture have changed expectations of the role of doctors in attending to suffering.
Asking the right questions
“The Spanish law was approved with very little social debate beforehand,” said Montserrat Esquerda of the Borgia Institute of Bioethics in Barcelona. “There have been various cases exploited in the media that have [helped promote acceptance of euthnasia] and some public opinion polls in which there wasn’t clarification and verification of what the person understood as euthanasia.”
Spanish bishops called for a day of prayer and fasting on the eve of the law’s vote and have encouraged the faithful to include explicit instructions in their advanced directives that they do not wish to be euthanized.
Those polls find consistent support for euthanasia from Spaniards, but according to experts, the circumstances detailed in many survey questions better describe palliative care, not euthanasia.
“There’s a very clear confusion in terms, and many people equate euthanasia with a death without pain,” Ms. Esquerda explained.
Euthanasia broke into the public consciousness in Spain in the 1990s, when Ramón Sampedro, a quadriplegic, began a series of lawsuits seeking assistance to end his life, reaching up as far as the European Commission on Human Rights. He lost in every court.
In 1998, his family and friends helped him carry out a plan to end his life with cyanide so that no one could be convicted of assisting in his suicide. His story was turned into the Oscar-winning 2004 movie The Sea Inside.
Since then, almost a dozen attempts to decriminalize euthanasia have come through the Spanish parliament without becoming law. During the 2019 national elelctions, the Socialist presidential candidate, Pedro Sánchez, pledged to make euthanasia legal should he be elected.
That campaign followed on the heels of the highly publicized death of María José Carrasco. Ms. Carrasco, 61, had suffered from multiple sclerosis for 30 years. Her husband, Ángel Hernández, filmed her asking him to help her end her life several days in a row and then gave her a drink laced with a lethal dose of medication.
Mr. Sánchez and his party won the November 2019 elections. After he consolidated his government with the support of far-left parties, the euthanasia bill went before the parliament again in January 2020.
The Spanish Medical Organization had come out against legalizing euthanasia in May 2018, stating that it contradicted the Hippocratic oath. The Spanish Society for Palliative Care also announced its opposition.
In a unanimous decision, the Bioethics Committee of Spain, an independent consultative body attached to the Ministry of Health, advised against the law in March 2020. “There exist solid health, ethical, legal, economic, and social reasons to reject the transformation of euthanasia into a personal right and a public service,” the committee concluded.
“Is medicine still the art of curing and, if not possible, of healing, or has medicine become a commercial service like everything else, at everyone’s disposal, according to his or her wishes?”
But that credentialed opposition to euthanasia was ignored. In parliament, supporters of the bill blocked expert testimony.
Customer service providers or professionals of the healing arts?
The Bioethics Committee of Spain’s 74-page opinion addressed how recent changes in the expectations of patients are affecting medicine. The committee noted that there has been an evolution in the clinical relationship that has put “the patient at the epicenter of health care.”
But, it continued, “It is essential to emphasize that even if the patient is the center of the clinical relationship, the doctor is responsible for indications and contraindications and is co-responsible in making decisions.”
“Is medicine still the art of curing and, if not possible, of healing, or has medicine become a commercial service like everything else, at everyone’s disposal, according to his or her wishes?” Mr. Vanbellingen asked.
The committee found neither a medical indication for euthanasia to alleviate suffering nor a legal and ethical justification for deriving a right to physician-assisted suicide from an individual desire to die. “We do not think that such compassion ethically or legally legitimizes a request that, not finding support in true autonomy either, can be attended to within the present context of palliative care, social support and health care,” it stated.
Mr. Vanbellingen pointed out that although euthanasia laws intend to limit the context of the practice, the criteria established in the laws are too subjective, leading to “death on demand.”
Palliative care versus euthanasia
Spain also highlights the difficulty of countering enthusiasm for euthanasia with the benefits of palliative care alone. In the 2019 Atlas of Palliative Care in Europe, published by the European Association of Palliative Care, Spain ranked 31st of 51 countries in capacity for palliative care, landing alongside Georgia and Moldavia. It estimated that 80,000 people a year die in Spain without receiving the palliative care they need.
Bioethics Committee of Spain: There are “solid health, ethical, legal, economic, and social reasons to reject the transformation of euthanasia into a personal right and a public service.”
According to Ms. Esquerda, there is a parallel capacity gap in care for people who are disabled or who are suffering long-lasting degenerative illnesses. Both doctors and politicians know that Spain’s public health care system lags in care for the very infirm.
Four proposals to strengthen palliative care have come before the parliament, according to Mr. Vives, but none became law. Politically, palliative care “isn’t attractive,” he said, especially compared to the splash of granting citizens the apparent autonomy to free themselves from suffering.
“Samaritanus Bonus” also reminds Catholics that at the individual level, palliative care alone is not enough to overcome the desire to end suffering through death.
“Palliative care cannot provide a fundamental answer to suffering or eradicate it from people’s lives. To claim otherwise is to generate a false hope, and cause even greater despair in the midst of suffering,” it states. “Terminal illness causes a profound suffering in the sick person, who seeks a level of care beyond the purely technical.”
To assuage their suffering, they need the “wine of hope” that comes through faith in God and “to experience a solidarity and a love that takes on the suffering, offering a sense of life that extends beyond death,” and “someone who ‘remains’ at the bedside of the sick to bear witness to their unique and unrepeatable value,” the document teaches.
Politically, palliative care “isn’t attractive,” especially compared to the splash of granting citizens the apparent autonomy to free themselves from suffering.
Ms. Carrasco’s story suggests both the gaps of medical support in Spain and the necessity of human and spiritual accompaniment of the terminally ill and disabled. She had been on a waiting list to enter a residential care facility since 2007 to offer a respite to her husband, who had been her sole caretaker and was in his late fifties. In 2018, her husband, then 68, suffered a herniated disk from lifting Ms. Carrasco.
She was granted a temporary placement in a facility, but that was delayed in a snaggle of bureaucracy. Her husband’s surgery had to be postponed because there was no one else to care for Ms. Carrasco. In September 2018, her health declined further and she could barely eat or talk.
She was offered both a feeding tube and palliative care, including partial sedation, but refused all additional treatment, reportedly stating, “I don’t want to sleep, I want to die.” Her husband had said he recorded his wife’s death to show their “suffering and abandonment.”
The desire for a good death and life
Besides influencing public policy, the Vividores campaign seeks “to reach the people who are suffering and looking for meaning in their lives,” Mr. Vives said. He believes that most people do not want to answer suffering with death.
The campaign’s website includes a series of interviews with people living with joy despite disabilities and degenerative diseases. Those interviews have generated the most positive response to the anti-euthanasia campaign.
“We have the example of many people who have written us and called [to tell us] that they saw the interviews, that listening to the interviews [changed] their understanding of life and their problems,” Pablo Velasco, another organizer, said. “Even if the law passes, the campaign was not a failure.”
Vividores organizers say they are going to keep the campaign going as the law proceeds through the Senate, and if it passes, they plan to continue with a deeper educational and public opinion campaign over the next five years to try to overturn it.
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