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Date: July 6, 2022 4:24 am

On the first anniversary of the euthanasia law, which came into force on June 25, 2021, at least 172 people in Spain committed suicide using this procedure. This is the data that EL PAÍS collected from all autonomous communities, with the exception of Asturias and La Rioja, which did not provide data. This is the first year of uneven filming in which the involvement of regional authorities has played a decisive role in helping or hindering the progress of this new law, and in which there are still processes that need to be improved. However, despite its problems, the service works well, in general, according to a wide range of health information sources, including institutional sources, the world of medicine, nursing, patients, and bioethics.

The differences in implementation are obvious just by looking at the numbers. Catalonia, one of the communities that experts call one of the most advanced in the use of euthanasia, provided 60 services in the first year, which is three times more than in Madrid (19) with a population of only 13% more, and almost six times more than in Andalusia (11), which has a million more population. These two communities practiced euthanasia less frequently than the Basque Country (25), another one of those reported as a benchmark.

Because even though the law went into effect a year ago, not all communities started euthanasia last summer. To provide the service, it was necessary to form a guarantee committee, an interdisciplinary body that must give final approval to each process, and which in some regions, such as the aforementioned Madrid and Andalusia, was created only a few months after accession. by virtue of the law.

The possibilities of accessing the right to die when the patient wishes are also greater or less depending on administrations. It’s not just about complying with the law, but how they do it: what information they provide to citizens and healthcare professionals, what assurances and training they give to doctors and nurses, or what are the bureaucratic hurdles.

Javier Velasco, president of the Right to Die with Dignity (DMD), acknowledges that there are “some communities that are doing very well and others that are doing very poorly,” but he prefers to focus on progress and not make comparisons until will be – this is official data that the Ministry of Health will have to publish. “We are looking at places where this works well, such as Catalonia and the Basque Country, which are examples from the very beginning. They are united by the fact that they both did their homework on time, promptly created a guarantee committee, made it public and have a website with very detailed information. Both spread the law among the citizens, they did a lot of training for professionals and what else coincided is that in both, although they are not the only ones, they appointed references, whether doctors or nurses in each field of health, which others can turn to colleagues when they have doubts,” explains Velasco.

In some cases, it happens that the patient asks his doctor for euthanasia, and he does not even know what to do. Most often, those who want to exercise this right turn to the family doctor, who usually deals with the sick the most, but they can request it from anyone else. Although Spain does not have data on the most common diseases among people seeking euthanasia, Taira Velasco, President of the Commission on Bioethics of the Madrid College of Nursing, says that unlike other countries where cancer is most common, here the most requests come from those who suffers from neurodegenerative diseases, so there are patients who also go to their neurologist or any doctor they trust. Otherwise, Velasco says, the characteristics of the patients they collected data from are similar to those of other countries with more established euthanasia systems: most men are in their seventies who are euthanized at home.

This nurse is one of those mentioned by the president of DMD. Although in Madrid, where he works, the Ministry of Health has not promoted this figure, some experts have coordinated their efforts to help colleagues. “Care teams often don’t know exactly what to do when a situation arises. First, it is necessary to determine what the patient requires: whether it be information or a formal and documented request for help in dying. From there, you must explore that desire, start a deliberative process, and explore pain in all areas: physical, psychological, social, spiritual….”

Then there are three filters that must give their consent to perform euthanasia: the first is the responsible doctor, to whom the patient applied (if he does not mind). The second, another colleague who did not know the patient. And finally, the Guarantee Board, which is made up of at least medical and legal professionals who must give their approval, but may also include psychologists, pharmacists, nurses, or bioethicists, among other professionals.

Tyra Velasco says that when doctors or nurses come to her for help, she advises both of them on these steps, on the bureaucratic procedures that must be followed, as well as on other issues related to the procedure for administering drugs … not all nurses are used to using them. or related to organ donation. “In such cases, it needs to be done in the hospital, but the National Transplant Organization is very flexible and they adapt well to our cases,” he says.

Thomas Cobo, president of the Collegiate Medical Organization, assures that this year they have not heard of any incidents related to compliance with the law or conscientious objection to military service. “Our duty is to protect the doctors who perform it, which is why we have expanded our code of ethics to not penalize those who provide services within the law, although we do not consider euthanasia a medical act,” he says.

Obstacles on the right

And what are the obstacles in this process? An example is Estrella Lopez, who was euthanized in Seville on April 2. In a letter sent to this newspaper, he denounced the obstacles that the Junta de Andalusia erected against him in order to realize his right to a dignified death. He had to wait five months to start the procedures because the administration did not set up the Guarantee Commission until November, failing to meet the legal deadlines. This was the first of the delays, because the process should not last more than 40 days. Another five months passed due to the lack of protocols from the administration. Your responsible physician did not know to whom to send a request made on November 22, 2021; there was a delay in appointing a consulting physician who denied the request. Following an appeal, the Commission unanimously authorized euthanasia on 22 March. When they approached the Virgen del Rocío Hospital, they were told to do it only on Saturdays and with the exception of certain holidays. Finally, one Monday, they were told that either this would happen next Saturday, or they would have to wait a month, reports Eva Saiz.

Eva Camps, spokeswoman for DMD in Andalusia, says that in this community, “the majority of cases are like that.” “Some died during the process because of the sedatives, others gave up,” he explains. Almost a year after the adoption of the law, Andalusia only regulated the Register of medical professionals who refuse to provide assistance due to death in Andalusia for reasons of conscience. Asked by Council spokesman Elias Bendodo this Wednesday, he replied: “In this community, we have decided to deepen and improve palliative care and strictly uphold the law.”

Marisa de la Rica, President of the Spanish Association of Palliative Care Nurses (Aecpal), explains that euthanasia and palliative care should not be two options. But efforts must be made to improve this care, which for many is overdue. Early detection is important: to minimize problems when the disease occurs. If patients do not start receiving palliatives to the end, there will be no time to treat them, it will treat agony,” he explains.

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