We are immersed in an unprecedented health crisis worldwide due to the pandemic caused by the Covid19 virus. This health crisis will be overcome as humanity has successfully overcome other pandemics. We will suffer an economic and social crisis following the health crisis and we do not yet know its scope and depth, but humanity has overcome economic and social crises of the size of the World Wars of the 20th century. The crisis of values are more silent and invisible, but with longer-lasting and not always recoverable effects, such as those described in health, economic and social crises.
The Congress of Deputies has recently discussed and approved the initiation of the processing of the so-called "Euthanasia Law" to ensure or regulate the right to a "dignified death". The debate in Spanish society has been reopened. It is not just any new topic of debate, it is undoubtedly a crucial issue.
Let us briefly review some scientific, legal, historical, ethical and moral aspects related to euthanasia.
Dignified life, more than "dignified death".
Dignity is intrinsic to every human being and the perception that sick people have of their dignity depends to a large extent on how they are treated. It is preferable to speak of dignified life and not a dignified death. If a person feels that he or she is a burden or that he or she is useless, he or she may feel that his or her life has no meaning. On the contrary, when someone feels loved, appreciated and accompanied, he or she does not feel "unworthy".
Let us recall article 15 of the first section of our Constitution: "Everyone has the right to life and to physical and moral integrity, without under any circumstances being subjected to torture or to inhuman or degrading treatment or punishment.". It therefore seems clear that the current legislation protects us, or at least should protect us.
The reopened debate is not a new debate since the times of Hippocrates (450 B.C.) the mission of physicians has been to defend and care for life from its origin to its end as reflected in the Hippocratic Oath: "I will apply my treatments for the benefit of the sick, according to my ability and good judgment, and I will refrain from doing them harm or injustice. To no one, even if he should ask me, will I give a poison, nor will I suggest to anyone to take it. Likewise, I will never provide any woman with an abortifacient pessary.". It is obvious that the physician is called upon to protect life from the beginning to the end of life.
We physicians are aware that we cannot always cure, we relieve a lot, we always console and nowadays we must also accompany in many cases. It is clear that we know when the end of life is approaching and it is precisely in those moments when the most human facet of the physician must come to the surface. Obviously, we must not fall into the so-called therapeutic "incarceration" and we must attend to the principle of patient autonomy, without forgetting the other ethical principles of doing good and doing no harm. It has taken us 25 centuries of history to reach 2020 and of course Greek philosophy, Roman law and Christian humanism are the pillars of this Europe whose foundations should not be shaken.
The codes of ethics and the principles of medical ethics are very clear. The World Medical Association has reiterated its firm opposition to physician-assisted suicide and euthanasia, since "constitutes an unethical practice of medicine.".
A clear danger observed is that of the "sliding slope" observed in the Netherlands. Euthanasia was first decriminalized for the treatment of incurable diseases, then the use of euthanasia was authorized for chronic diseases with intractable pain, it evolved to patients with mental illnesses and, recently, authorization is being considered for healthy persons over 70 years of age who request it, even if none of the requirements previously contemplated are met.
In addition, euthanasia is sometimes not requested by the patient, with the obvious conflicts of interest that may arise. Theoretically, the law is a guarantor, but in practice variations or deviations may occur.
Despite the Dutch legislation in force since 2001 there are already doctors who supported legalization and now regret it and warn us. Professor Theo Boer, of the University of Utrecht, describes euthanasia as the "homicide of a person"speaks of a Netherlands "in which charity has disappeared" and of a "law that has effects on the whole of society", explaining why their opponents were right "when they said that the Netherlands could find itself on a dangerous inclined plane."The so-called sliding slope described above.
Another interesting case is that of Dr. Berna van Baarsen, a specialist in medical ethics, who has resigned from one of the five regional evaluation committees in the Netherlands set up to oversee the provision of euthanasia. She could not support a major change in the interpretation of her country's euthanasia law to support the administration of lethal injections to an increasing number of dementia patients.
Risk of commoditization
One obvious risk is the commodification of deathbecoming a "consumer product". In the Netherlands, it is already possible to request home treatment. The approximate cost is about 3,000 euros. No comments.
Pope Francis has just sent a message to professionals on the XVIII World Day of the Sick: "Dear health care providers, every diagnostic, preventive, therapeutic, research, treatment or rehabilitation intervention is aimed at the sick personwhere the noun 'person' always comes before the adjective 'sick'. Therefore, let your action constantly keep in mind the dignity and life of the person, without giving in to acts that lead to euthanasia, assisted suicide or ending life, even when the state of the disease is irreversible".
Healing and care
We are in the times of evidence-based medicine. Efficacy, effectiveness and efficiency have been incorporated into the routine of daily practice. Now, more than ever, it is important to affectivity-based medicine, the patient must be at the center of our activity from the moment of pregnancy, birth, through childhood, youth, maturity and finally reaching old age.
Clinical experience sufficiently demonstrates that, for situations of unbearable suffering, the solution is not euthanasia, but adequate, humane and professional care, and this is the aim of the palliative care. The problem is that, according to the Atlas of Palliative Care in EuropeIn Spain we are at the bottom of Europe in terms of human and professional resources as far as palliative medicine is concerned.
A growing social situation is that of the loneliness of chronically ill elderly people who are also residents of depersonalized cities. It might occur to someone that their life is not worth living.
Healing and care must be the two sides of the same scientific and human coin of good physicians who are also good doctors. A movement is underway to re-humanize the doctor-patient relationship that allows us to be optimistic.
In the future we will be judged by the generations to come. Let us recall this text attributed to Martin Niemöller concerning what happened in Nazi Germany in the last century: "First they came for the communists and I said nothing because I was not a communist, then they came for the Jews and I said nothing because I was not a Jew, then they came for the trade unionists and I said nothing because I was not a trade unionist, Then they came for the Catholics and I said nothing because I was a Protestant, then they came for me but, by then, there was no one left to say anything." We could apply it to this euthanasia debate.
Dean and Professor of Ethics and Health Care Communication, Faculty of Medicine, CEU San Pablo University.