Integral ecology

Euthanasia destroys patient-physician trust

Medical professionals, directors of medical corporations, and more than 140 civic organizations have rejected in recent weeks the euthanasia regulation bill being processed in the Senate.

Rafael Miner-February 15, 2021-Reading time: 4 minutes

Photo: RODNAE Productions for Pexels

Professors and directors of departments, institutes and clinics of Christian foundations and universities such as Francisco de Vitoria, CEU San Pablo, Navarra or Comillas, as well as nurses and other professionals, sometimes in a personal capacity, and other times in an institutional way, have made their voices heard these days arguing against the criteria reflected in the bill to regulate euthanasia, which is being promoted by the current parliamentary majority.

The list of those who have come to the fore in recent days is extensive, but it is worth mentioning some of them. The doctors Manuel Martínez Sellésdean of the Madrid College of Physicians, and Álvaro Gándaraformer president of the Spanish Society of Palliative Care (Secpal), and professional of the Palliative Medicine Unit at the Fundación Jiménez Díaz, have intervened in several conferences, as well as Federico de MontalvoPresident of the Spanish Bioethics Committee and Professor at the University of Comillas. 

In addition, Elena Postigo, director of the Bioethics Institute of the Francisco de Vitoria University, and Manuel Bustos, director of the Ángel Ayala Humanities Institute of the CEU San Pablo University; Marina Díaz Marsá, president of the Psychiatry Society of Madrid; Carlos Centeno, director of Palliative Medicine of the Clínica Universidad de Navarra, and José María Torralba, professor at the same university; the deans of the Faculty of Medicine of the U. Francisco de Vitoria, Fernando Caballero, and the deans of the Faculty of Medicine of the U. CEU San Pablo, Tomás Trigo; doctors Jacinto Bátiz and Ricardo Abengózar; José Jara, president of the Bioethics Association of the CEU San Pablo University; Drs. Francisco de Vitoria, Fernando Caballero, and of the U. CEU San Pablo, Tomás Trigo; doctors Jacinto Bátiz and Ricardo Abengózar; José Jara, president of the Bioethics Association of Madrid; Emilio García Sánchez, vice-president of the Spanish Association of Bioethics and Medical Ethics; José Manuel Álvarez Avelló, author of the book Death with dignity. The great dilemmaThe following are some of the speakers: the nurse Encarna Pérez Bret, from the Hospital de Cuidados Paliativos Fundación Vianorte-Laguna, the promoters of vividores,org, Jaume Vives and Pablo Velasco, director of Eldebatedehoy, and many others.

On the other hand, more than one hundred and forty civic associations integrated in the Assembly for Life, Dignity and Liberty, have sent a manifesto to all senators asking them to vote for "in conscience" and do not endorse the euthanasia law. They have also agreed to launch a popular legislative initiative (ILP) to ask the government for a comprehensive palliative care plan.

Against the essence of medicine

"Euthanasia is contrary to the Hippocratic Oath and multiple World Medical Association standards." y "it destroys the essence of medicine, the relationship of trust we have with our patients." Dr. Martínez Sellés has stated in several conferences. 

In their opinion, physicians who practice euthanasia "will be emotionally and psychologically affected in a negative way. In addition, the patient's trust in the healthcare system will be undermined. If a physician kills out of pity, it is a step that is difficult to return."said the Madrid dean at the recent seminar organized by the Francisco de Vitoria University.

Sellés pointed out that the Code of Medical Deontology stressed in 2011 that "the physician shall never intentionally cause the death of any patient, not even at the patient's express request"and mentioned the 2020 report of the Spanish Bioethics Committee of Spain (see, which states, among other things, that "euthanasia and/or suicide assistance are not signs of progress but a backward step of civilization".

Addressing suffering

At the same seminar, Dr. Álvaro Gándara, palliativist and member of the Spanish Bioethics Committee, quoted psychiatrist Viktor Frankl, who said: "Man is not destroyed by suffering; man is destroyed by suffering without any sense." 

Álvaro Gándara focused his analysis on suffering and compassion, and it makes a lot of sense, because all definitions of euthanasia, from its supporters and its detractors, go through suffering. It is the workhorse. We have to try to avoid suffering. On that they all agree, supporters and opponents of euthanasia. The question is how. 

Those who reject euthanasia, who as we are seeing are making themselves heard in increasing numbers and with weighty arguments, point out that the aim is to avoid suffering, to alleviate it, by means of adequate comprehensive palliative care treatment, but that the option cannot in any case be to kill the patient, because this is contrary to the very essence of the medical profession. 

A compassionate intervention

So how to do it? Álvaro Gándara points out that "the care of suffering requires an approach to existential and spiritual needs, and the professional's tasks should be focused here, on facilitating the patient to complete his biography in an integral way, and to close the last chapter of his existence in an adequate manner"..

"Many of us physicians are aware." added the doctorthat we are more expert in symptom care and drug management than in the control of hopelessness, in facilitating reconciliation with one's own history, in helping to find meaning in existence or in facilitating the acceptance of death". 

In his opinion, "Our biology-centered clinical training and disease- and treatment-oriented healthcare model are not only insufficient, but can become an obstacle to meeting real needs at the end of life".

"The skills required to address sufferingDr. Gándara continued, "They are "specific, based on the ability to create a climate of security and trust as well as empathetic and intuitive, non-discursive attention.". Key to this are "the knowledge of the person of the sick person, the ability to identify their fears and values, as well as threats and resources, and the willingness to accompany them in this situation: compassion.".

Steps in the face of suffering

The palliative care expert from the Fundación Jiménez Díaz thus described the "steps for intervention in the face of suffering": "Establish a relationship of trust and a therapeutic bond: identify suffering and its causes; attempt to resolve or defuse threats that can be resolved; explore the patient's resources and abilities to transcend their suffering: and proceed with compassionate intervention, guiding the patient towards the search for meaning, coherence and promoting acceptance of death."

Both Dr. Álvaro Gándara and other professionals, doctors with decades of activity and thousands of patients behind them, have revealed in recent months that when the pain of the very few patients who have asked them to die disappears, the desire to end their lives disappears just as quickly. 

In this sense, they have criticized the assertion of the promoters of the current euthanasia bill, contained in its preamble, on the existence of "a sustained demand of today's society". of euthanasia.

"The importance of care and accompaniment; a necessary training in palliative care; the proper of medicine is to cure and care, not to kill; the danger that looms over the mentally ill; the slippery slope: example of Holland and Belgium; and the need to train young doctors who love life and care for the vulnerable person. Compassion and prudence,were, in the opinion of Elena Postigo, some of the key points of the seminar organized by the U. Francisco de Vitoria.

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