If Maricarmen had opened the door that day, her daughter would be dead now—euthanized under Spain’s statutes on medical assistance in dying.
The elderly Spanish woman lives with her 54-year-old daughter in Santiago de Compostela. When staff from the local hospital told Maricarmen that her daughter, who suffers from multiple sclerosis, was scheduled for euthanasia, she was shocked. Unable to stop the process already set in motion, Maricarmen reached out to Abogados Cristianos, the Foundation of Christian Lawyers, for help—just in time.
As the nonprofit legal defense group put in motion legal measures to halt her daughter’s assisted death, the appointed day arrived and staff from the public health system stood on Maricarmen’s doorstep, ready to transport her daughter to the hospital for her “procedure.” In a panic, she called Polonia Castellanos, president of the foundation.
“Just don’t open the door. They can’t enter without a court order,” Ms. Castellanos recalled her advice to Maricarmen. “If she had opened the door that day her daughter would be dead,” she told America, describing the experience of Maricarmen, who asked not to be identified by her full name.
Today, both mother and daughter are alive and better than ever, according to Ms. Castellanos. She succeeded in getting a judge to temporarily stop the euthanasia. With time now on her side, Maricarmen convinced her daughter to get psychological treatment for depression. Her daughter has since rescinded her request for medical assistance in dying.
But the case and the close call Maricarmen and her daughter experienced is more than alarming. Maricarmen’s daughter should not have been a candidate for death, Ms. Castellanos said. Though she was feeling significant psychological effects because of her condition, she took no pain medications and carried out normal and enjoyable regular activities.
“This woman sent us emails,” Ms. Castellanos said. “She told us that she liked Japanese cinema. She was showing us the movies she liked. Yes, it is true that there were times when she needed help to eat…. Maybe her food was mashed for her or she ate a softer diet, but she ate more or less normally.”
“The problem is that the law is very poorly drafted,” Ms. Castellanos said, describing the legislation which legalized euthanasia in Spain in 2021 as “too ambiguous.” According to Ms. Castellanos, Spain’s euthanasia code can apply to almost anyone suffering from a chronic medical condition. She fears more cases like that of Maricarmen’s daughter are likely to occur when a vulnerable patient suffering from a long-term illness is treated by a strongly pro-euthanasia doctor.
Under the euthanasia law, people experiencing “grave, chronic, or impossible suffering” caused by a “chronic and incurable disease” can apply for assistance in dying. Those requests are submitted by the patient’s doctor to a review committee that has the authority to issue a final approval.
The Spanish government’s latest annual report on euthanasia, which came out at the end of 2024, indicates that the practice increased 24 percent in 2023. Half of the 766 requests for euthanasia were approved, and 334 assisted suicides were completed.
In about 25 percent of the cases, applicants died before their request could be approved, and some patients voluntarily withdrew their applications for medical assistance in dying. The report did not detail why some applications for the procedure were rejected and others were accepted.
One study from 2024 has shown that rates of euthanasia in jurisdictions where it is legal vary widely. Among the European countries included in the report, medical assistance in dying is most common in The Netherlands, which went from a rate of 15.7 deaths by euthanasia per thousand deaths when it was legalized in 2002 to a rate of 45.6 per thousand deaths by 2021. In Switzerland, the rate of euthanasias per 1,000 deaths went from 0.9 in 1998, when the practice was legalized, to 17.2 in 2020.
In Spain, the rate of euthanasia per 1,000 deaths reached just .0071 in 2023, according to the country’s health ministry.
The Catalan region of Spain administered the highest number of medical assistance in dying applications—in some cases, triple the number of other comparably populous regions. In Catalonia, 219 people requested euthanasia and 89 of those requests were carried out.
Ms. Castellanos is managing another euthanasia suit in Catalonia. This one involves Noelia, a 24-year-old woman diagnosed with mental health issues who has already attempted suicide twice. In the last attempt she threw herself from the fifth story of a building and ended up partly paralyzed.
She now requires crutches or a wheelchair to get around. After she completed her rehabilitation program, the young woman requested assistance in dying and the procedure was approved. Her father is trying to stop what Ms. Castellanos calls another suicide attempt—this one to be completed with the assistance of the Spanish government and as part of the national medical system. In August, he sued the Catalan government to halt the procedure.
“The woman has a mental illness,” Ms. Castellanos said. “She isn’t in any condition to decide anything, let alone to make a decision to end her life.
“To administer euthanasia for mentally ill people, this is something typical of [Nazi] Germany,” she said. “It seems absolutely outrageous to me that they are trying to end the life of a mentally ill person who has also tried to commit suicide on several occasions…. Her family, who know her best and surely love her the most, are against it.”
The presiding judge ruled on March 11 that the euthanasia of Noelia should proceed despite her family’s objections.
Manuel Martinéz-Selles, M.D., a professor of Medicine at the Universidad Europea de Madrid, is concerned by the normalization of euthanasia within the Spanish medical system.
“I think that there is an obvious attempt to change the opinion of the medical profession on this issue,” he wrote in an email to America. “For example, in the 2021 [medical board] exam, mandatory to be able to practice medicine in Spain, a question was included in which of the four possible answers, three were euthanasia and one was assisted suicide.”
Euthanasia occurs when a doctor administers a lethal dose of medication directly to the patient, and assisted suicide occurs when patients are given a substance to self-adminster their deaths.
Jacinto Bátiz, M.D., is the director of the Institute for Better Care at the Hospital of St. John of God in Santurtzi, a city in northern Spain.
“The temptation of euthanasia as a hasty solution occurs when a patient asks for help to die and is faced with the anguish of a doctor who wants to end his suffering because he considers it intolerable and believes that he has nothing more to offer him,” Dr. Bátiz wrote in an email to America.
He added that facing death or prolonged suffering is especially difficult for patients in Spain because of the lack of palliative care resources. Almost 80,000 people in Spain die in pain each year because they are not offered adequate pain management options, according to the Spanish Society for Palliative Care. Dr. Bátiz attributes those high numbers to insufficient institutional capacity, especially a shortfall of physicians experienced in palliative care.
Spain also struggles to overcome wide gaps between demand and the availability of psychiatric care and services for those suffering from debilitating conditions like multiple sclerosis and atrophic lateral sclerosis. In some cases, those service gaps have driven patients with A.L.S. to consider applying for euthanasia.
In line with recommendations included in “Samaritanus Bonus: On the Care of Persons in the Critical and Terminal Phases of Life,” a Vatican letter issued in 2020, Dr. Bátiz calls for a medical model that does not rely on euthanasia.
“A medical science that needs euthanasia must be transformed as soon as possible into a medicine that provides care even when there is no cure,” he said.
