Carme Barahona wears a smile that is only erased when she recalls how her son Ivan Martí died in late 2017. “He sent me a message saying: ‘Thanks for taking care of me, mom. I am going to rest’.”
Marti, 43, had been diagnosed with amyotrophic lateral sclerosis, an incurable neurodegenerative disease that results in a progressive loss of movement and eventually death. Right after receiving her son’s farewell message, Barahona made sure to clock in at her job to prove she had not helped him take his life. Otherwise, she might have been imprisoned.
Since 25 June, however, this risk no longer exists. Spain has legislated that its citizens who suffer from a “chronic and incurable disease, with an unbearable physical or mental suffering” have the right to ask for medical assistance to die.
“The approval of the law legalising euthanasia was a moment of elation, a victory after so many years of struggles,” says Barahona from her flat in Barcelona. The Spanish Parliament passed the law in March with 198 votes in favour, while 138 members of Parliament belonging to the right-wing Popular Party (PP) and the far-right party Vox voted against. Both parties have filed an appeal at the Constitutional Court arguing the law violates several articles of the Constitution. Pablo Casado, PP leader and head of the opposition, said that this wasn’t the best time to pass this law after thousands of Spaniards have lost their lives to Covid-19. He also said that doing it during a state of emergency prevented proper discussion before the final vote.
The legalisation of euthanasia, a word of Greek origin that means “easy” or “good death”, has a number of safeguards to ensure it is done for the good of the patient. Healthcare professionals who know the patients and maintain a meaningful clinical relationship with them have to be involved. After the patient gives informed consent, euthanasia can be realised in two ways: a competent healthcare professional directly administers the substance causing the patient’s death or it is supplied to the patient and self-administered, which is called assisted suicide. If the patient is not fully capable or conscious, euthanasia can still be applied if they have asked for it in a legally recognised document.
The Asociación Derecho a Morir Dignamente (DMD) or the Right to Die with Dignity Association, to which Martí’s mother belongs, followed his case closely. DMD was founded in 1984 and is part of the World Federation of Right to Die Societies, whose president is Sean Davison, founder and director of Dignity South Africa. DMD has been the main actor in the fight for legal euthanasia in Spain. Isabel Alonso Dávila, the vice president of the Catalan branch, welcomed the law, although it does not include all their demands. “Unlike the law in other countries, a Commission controls the process before and not after the exercise of euthanasia,” she says. “It aims at protecting the doctors from lawsuits, but this can extend the process up to 45 days, which is a lot for people in pain.”
The Commission of Guarantee and Evaluation represents a third and final assessment level. The first level relates to the doctor in charge of the patient. The second includes another doctor who specialises in the pathology from which the patient suffers and who also has to give permission. Then, finally, the commission evaluates the case.
“In Belgium, for instance, after the patient requests [euthanasia], it may be applied [after] only two days for really serious cases,” Dávila says.
“Now, after having achieved the primary goal of the association with the new law, we will continue to strive to make the law improve and also include cases that are now not covered.”
Right to die versus right to object
Spain became the first Latin country with a Catholic majority to legalise euthanasia in its whole territory. It is the fifth country in the world to do so. Netherlands was the first in 2001, then Belgium legalised it in 2002, while Luxembourg did the same in 2008. Canada joined in 2016. In New Zealand, the law will come into force in October 2021. In Australia, euthanasia is legal only in Victoria and Western Australia. In the United States, assisted suicide is allowed only in eight states. In Colombia, the Constitutional Court declared euthanasia legal, but Parliament has not yet passed a law to regulate it.
In Switzerland, euthanasia is illegal but a legislative gap allows assisted suicide as long as it is not the result of “selfish motives”. Assisted suicide in Switzerland is also allowed for non-residents, which leads many people from countries where euthanasia is still illegal to move there to end their life, a phenomenon called “suicide tourism”.
The College of Doctors of Catalonia appreciates the way the Spanish evaluation system safeguards and guarantees patients’ rights. “I don’t see a massive request [for euthanasia] coming. We shouldn’t polarise this law on a political level,” says Josep Arimany, member of the Ethics Commission dispelling a popular notion by those against the law.
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He added that “every doctor has the right to conscientious objection” but the will of the patient and their right to euthanasia “must always be respected”. But, as happens with the right to abortion in some conservative regions, patients’ rights might not be respected above the doctor’s right to object. Many fear that widespread conscientious objection from doctors will hinder the application of euthanasia.
The hostility of the PP as well as the Catholic church makes Dávila suspicious. “We will remain attentive to make sure that the law is applied all over the country,” she says at the DMD headquarters in Barcelona’s city centre.
“To begin with, some hospitals with links to the church have already declared that they won’t practise euthanasia. However, the law says that the conscientious objection is an individual right for doctors, not institutions. What is more, many of them receive public funding, so the state has to intervene,” says Dávila.
She points out that, for instance, 95% of the budget of Sant Joan de Déu Hospital in Barcelona is provided by the state. Dávila is also afraid that PP and Vox may appoint people against euthanasia to the Commissions of Guarantee and Evaluation of the regions they rule in order to prevent its exercise. This has already happened in the Murcia region with the appointment of Aurelio Luna Maldonado, professor of legal medicine, and Carmelo Sergio Gómez, president of the Murcian Society of Geriatric and Gerontological Nursing, who are both openly against the law. In particular, last December Maldonado wrote an article against euthanasia titled, Have we lost common sense? for El País, the most widely read newspaper in Spain.
Wide support for new law
Despite this, the law enjoys wide support among the Spanish. According to a survey conducted by Sigma Dos for the newspaper El Mundo, nearly 70% of Spaniards support its legalisation, including 45% of Vox voters. Over a decade, polls conducted by the Sociological Research Centre, a public research entity, have shown that the majority of Spaniards are in favour of euthanasia, especially those under 65 years old. A survey from 2019 conducted by Metroscopia revealed that 59% of religious people were also in favour of it.
To some, these numbers may seem shocking, even more so given that Spain was considered a staunchly conservative society not too long ago. But the percentage of the population attending Sunday masses every week has been dwindling since the transition to democracy in the late 1970s.
“The Catholic church is now paying the price for its support to the military dictatorship,” says Gerard Guerra Rey, a pastor of a small church in Santa Coloma de Gramanet, a working-class neighbourhood close to Barcelona. The Francisco Franco dictatorship, which was established after the Spanish Civil War (1936-1939), lasted 40 years.
“At the time, people went to church in order to have food on the dinner table or to keep their jobs,” he says. “The country had a veneer of fake religiosity that disappeared after the transition. The current Spanish society with its liberal attitudes is the real one.”
Guerra Rey thinks the church should accept a full separation between the state and religion, and thus not oppose those laws passed by Parliament. Nonetheless, he admits that his views are held by a minority within the ecclesiastical institution.
Fortunately for Barahona and all the other people who worked hard to legalise the right to die with dignity, most of the Spanish legislators feel the same as Guerra Rey. But, although she is happy with the progress made by the pro-euthanasia movement, Barahona laments that the law arrived too late for her son. She deeply regrets not having been by his side in his last moments. She hopes no one else will have to face a similar ordeal in Spain.
“My son didn’t want to die. He just didn’t want to live this way.”