Euthanasia will be legal in Spain in three months, subject to stringent procedures and criteria

SPAIN has become the sixth country on earth to legalise the right to euthanasia for patients in extreme, constant and incurable pain with no possible relief, subject to a series of strict criteria aimed at preventing abuse, coercion or malpractice.

It was passed in Parliament today (Thursday) with 202 votes in favour, 141 against – the whole of the right-wing PP party and far-right Vox – and two MPs abstaining.

After the notice is published in the State Official Bulletin (BOE), the law will come into effect at three calendar months of the date of its printing.

Other than Spain, only Luxembourg, The Netherlands, Belgium, Canada and New Zealand allow a person to choose to die if their condition 'meets the requisites'.

The process involves several stages and at least two weeks, as well as express consent on the part of the patient, in order to prevent rash decisions and ensure that it is the only available alternative to intolerable pain and incapacity.

Patients must be either Spanish citizens, or legally resident in Spain for at least the past 12 months – a move designed to avoid 'euthanasia tourism' which could lead to fraught international relations or patients relying on doctors not knowing enough about their history to give them clearance, when an ending by choice is not the only possible relief.

The patient must have a clear diagnosis of an 'incurable and serious illness' which is 'incapacitating and chronic', or permanent, which causes 'intolerable suffering' with no possibility of relief from said suffering.

This indicates that even if an illness is incurable, terminal or both, where the pain and extreme discomfort can be controlled medically, the patient will not be granted permission. 

Patients are required to have 'full written information about their medical process and condition' and the 'different alternatives and possibilities', including palliative care options.

Firstly, the patient will have to expressly request the process on two occasions, 15 days apart, after which, within a maximum of 48 hours, his or her doctor will have to decide whether the patient meets the requisites and provide him or her, verbally and in writing, complete information about the 'diagnosis, possible treatments or therapies and expected results therefrom, and palliative care options'.

After this conversation, the patient will be asked again, 24 hours later, whether he or she still wants to go ahead with the request.

Where the answer is in the affirmative, a second doctor, independent of the first medic, will also be required to examine the case and ensure the patient satisfies the legal requirements, with a deadline for this procedure of 10 days.

If the second doctor also gives his or her agreement, the case will be notified to the Evaluation and Control Commission, which will nominate two independent persons to prepare reports that will serve as a guide to it to decide, finally, whether the conditions in place allow the patient's wish to be honoured.

None of this means the patient needs 'permission from a doctor', but those medical professionals called upon to intervene in the process have a duty to evaluate whether the person fulfils the criteria established by the law, including whether he or she does, in fact, suffer from a serious, incurable, permanent and incapacitating illness which means the conditions of the patient's life are intolerable.

If all the criteria are met, in the views of all professional parties to the case after an exhaustive and objective study, permission cannot be denied – although any doctor can express a conscientious objection, in advance and in writing, exempting him or her from performing the final act.

Medics who do express a conscientious objection will be noted on a register, and their decision kept entirely confidential, so the patient will never know; this means none of the names on the 'refusal' log can ever be asked to practice an approved euthanasia.

The patient has to make these reiterated requests him- or herself, personally – next of kin or holders of a power of attorney are not able to do so.

For this reason, the legislation provides for a person diagnosed with a condition that may eventually lead to a situation where a euthanasia request may, theoretically, be honoured, to make a 'living will' whilst he or she is still of sound mind, full comprehension, and capable of signing the documents.

Where the patient is physically incapable of signing – for example, if he or she is paralysed – other methods of giving express permission may be approved, or another adult 'with full legal capacity, comprehension and soundness of mind' can do so in the presence of the patient.

In these circumstances, the signatory must explicitly repeat all the information and seek verbal consent where possible, and must write down exactly why the patient has been unable to sign.

A signatory who is not the patient does not have to be an independent party, but the signing will happen in the presence of the doctor in charge of each stage of the process.

Where permission is denied but the patient still considers he or she meets the requisites stipulated, an appeal can be filed, at the person's express instigation, within a maximum of 15 days.

Given that the complete process can take up to a month, a person who is terminally ill may not have time to complete every stage, so the law allows the doctors involved to transact each step in a much shorter time if they deem it clinically necessary, provided they explain why this is the case.

The patient is allowed to decide whether to die in a hospital, clinic, hospice or similar, private or public, or in his or her own home, but no other places are acceptable – except, possibly, the home of a close family member or friend may be considered to be the patient's 'residence' for the purposes.

Also, the patient can decide whether a doctor administers the euthanasia drug, or whether the medical team simply supply it and the patient injects it him- or herself.

The medical team must continue to provide complete care, support and presence during the process, whichever way it happens, and if the patient decides to administer the drug to him- or herself personally, doctors must be present to witness it.

Once the patient has passed away, the death will be registered as 'natural causes' and detailing the nature of the illness if this was terminal and would have eventually led to his or her demise.

The extreme caution and rigorous criteria is aimed at stopping any of the situations dissenters were afraid of – providing a 'guaranteed' and 'painless' route to suicide for persons with mental health conditions but who are not in insufferable and irremediable physical discomfort, or very elderly or otherwise dependant persons opting for euthanasia 'so as not to be a burden'.

It also means nobody else can get their hands on the euthanasia drug for foul means, as it is only ever administered by a doctor or by the patient personally in the presence of a doctor.

Clearly, anyone who applies for the 'right to die with dignity' must be an adult – minors are not permitted to do so and nobody else is allowed to apply on their behalf.

The above photograph shows the family of terminally-ill Maribel Tellaetxe, who fought for the right to be able to die legally but without success.

Maribel's family raised a petition on Change.org which gained over 185,000 signatures calling for decriminalisation of assisted suicide.