"The euthanasia law almost makes the objecting physician look like an offender."Emmanuel LuyirikaRead more : "Africa rejects euthanasia. The focus is on palliative care".Notes for reflection and argument on the euthanasia lawTo create places in which "the culture of care prevails" without professionals feeling pressured to end the lives of patients, nor patients seeing themselves as a "burden and having the assurance that they will be cared for and comprehensively attended to until the natural end".
This is the objective of Euthanasia-free spacesan initiative that a group of professionals from various fields has launched in Spain to preserve, among other things, the right to personal and community conscientious objection to laws such as euthanasia, which, in Spain, has been imposed without due debate and, above all, without nurturing the alternative to death with an expansion and improvement of access to palliative care.
One of its promoters, Luis Zayas, explains that in spite of the pressures suffered, it is encouraging to see that "many institutions are clear about the principles under which they exercise their medical or assistance activity and are not willing to abandon them".
What does the euthanasia-free spaces initiative consist of?
-The initiative Espacios Libres de Eutanasia (Euthanasia Free Spaces) was created to promote the culture of care in the face of the serious threat to coexistence in Spain posed by the legalization of the possibility of killing people who request it.
What was the germ of this initiative?
-It was born out of the concern of a group of people aware of the terrible experience lived in nations that have already legalized euthanasia. In those nations, trust in the doctor-patient relationship has been broken; it has been demonstrated that, in many cases, people have been killed without their consent; there has been evidence of a renunciation of the effort required to care for sick people; many elderly people consider themselves a burden to their families and society and believe that, by asking for death, they will cease to be so; there are cases of sick people who are denied treatment under the excuse that the option of requesting death is more economical.
All this contributes to shaping a disconnected, individualistic society, where those who cannot fend for themselves end up being seen as a problem and are discarded, society forgets about them and looks for a shortcut, a quick "solution" which is death. This is what is called the slippery slope that has been sold and repeated in all the nations that have approved euthanasia and that ends up dehumanizing societies.
What is your main mission?
-Our first mission is to fight against this dehumanization of society by promoting a culture of care that values the person, that accompanies and cares for the person in any situation, that is capable of providing the medical advances available at any time, and that is also capable of giving meaning to suffering. Euthanasia-free spaces is born to keep alive the debate that all life is worthwhile and deserves to be cared for and accompanied. If this debate disappears, the inculturation of death will have prevailed.
Secondly, Euthanasia-free spaces has a clear objective: to repeal the law that allows the killing of people who request it. It is an unjust law and in a legal system worthy of the name there is no place for laws contrary to the dignity, freedom and rights of persons.
Finally, we would like to propose what we call the Euthanasia-free spaces. Places (hospitals, residences, health or care centers, ...) where the culture of care prevails; where health professionals can freely exercise their profession in accordance with the principles of the Hippocratic oath, without fear of being threatened with having to kill patients or stop attending them; where patients and their families can be sure that they will be cared for and comprehensively attended to until the natural end of their lives. Places that show society that every life, in whatever circumstance it may be, deserves to be cared for and accompanied. The Euthanasia-free spaces will be a beacon in a society threatened by the inculturation of death and discarding.
The euthanasia law has been passed "behind the back and as a matter of urgency" without even giving rise to a real debate. Is society aware of what it means for an act such as aid in dying to become a benefit (a right) backed by law?
-It is clear that society has been denied a debate on this issue. And in this sense, the approval of a regulation such as this one being extremely serious, it hurts even more that it has been done at night and with malice aforethought, as a matter of urgency and at a time when the whole of Spain was busy saving lives.
This lack of debate, together with a good-natured campaign in which the government presented the regulation as a response to the demands of extreme cases in which families or individuals requested euthanasia, have caused a large part of society to be unaware of the seriousness of this regulation and its effects in the medium and long term.
Society tends to think that there will be few situations in which people request death and are killed. However, the experience of other countries does not say that. It tells us that euthanasia is gradually creeping into society and making it gangrenous. In the nations that have had euthanasia legalized for the longest time, people requesting to be killed account for between 4-5% of annual deaths. That would be between 16,000 and 20,000 people killed every year. That is a lot of people, a lot of people to whom we have not known or wanted, as a society, to give hope.
We believe that using the terms "health care" or "aid in dying", which appear in the text of the law, contributes to falsify the reality of what the law means to kill sick or elderly people. There is nothing more opposed to health care and aid than to intentionally kill an innocent human being.
Therefore, it is necessary to maintain the debate, Spanish society must be aware of the seriousness and danger of having legalized the possibility of killing those who request it.
In the case, for example, of healthcare entities with principles that are not compatible with this euthanasia law, is the right to collective conscientious objection respected?
-This is a complex issue from the legal point of view. The Spanish Bioethics Committee issued a report in which it considered that conscientious objection by legal institutions is protected by our legal system. However, the law has tried to avoid it expressly in its articles. Therefore, this is an issue that will possibly have to be settled in the courts.
There are other rights recognized in our legal system, such as freedom of enterprise or respect for the ideology of the institution (in the field of education, there are many rulings that recognize the right of an educational center to have its ideology respected by public administrations, which is perfectly applicable to the world of healthcare.) that can be ways, without the need to enter into a complex debate on the conscientious objection of legal persons, that allow institutions that are committed to the care of people and life, not to have to apply a law that goes against the basic principles of medicine.
Do you think that, sometimes, there is fear in the healthcare field of losing, for example, agreements with public administrations if they oppose laws such as those on abortion or euthanasia?
-Undoubtedly, in many cases, healthcare institutions, especially those belonging to the Catholic Church, in their desire to contribute as much as possible to society, have placed their facilities and resources at the service of the public healthcare system in the different autonomous regions with a twofold objective: to support the function of public healthcare and to enable it to reach the greatest possible number of people. This support has materialized in the signing of agreements with the administration.
Right now, these concerts do not contemplate, in most cases, the practice of euthanasia. But the risk exists in the renewal of these agreements. And yes, there is fear in the healthcare institutions that some administrations may use the renewal of the agreements to impose this practice, which is contrary to medical principles. There is no doubt that for some institutions, which through their generosity have placed themselves at the service of public healthcare, the non-renewal of the agreements could pose a risk to their economic viability in the short term, and this is causing a great deal of concern in the sector.
I must also say that many institutions are clear about the principles under which they exercise their medical or assistance activity and are not willing to abandon them, regardless of the pressures they are under.
Hence the importance, from our point of view, of initiatives such as the following Euthanasia-Free Spaces and others, so that society is aware of what is at stake and supports these institutions in the face of the possible attack they may suffer from public administrations. It is necessary to mobilize civil society in favor of these institutions. The public administrations must know that they can count on the support of society to continue caring for and attending to all patients, regardless of their situation.
What work lies ahead for lawyers, physicians and civil society? Is it possible to turn this type of legislation around?
-There is a lot of work ahead. It is necessary to make society aware of the seriousness of this regulation. Of the disastrous impact it will have in the medium term on coexistence and social cohesion. And this is a job for everyone: for lawyers to make them understand the injustice of this law; for healthcare professionals to make them understand how this law damages the doctor-patient relationship and seriously harms the development of palliative care and medical practice; for society to demand that it wants public administrations that are committed to life and not to the discarding or false compassion of offering to kill patients.
If we do not give up the battle in civil society and in the political arena, it is certainly possible to turn this type of legislation around. We have the example of the recent ruling in the United States of the Dobbs vs Jackson which has allowed the reversal of the judgment Roe vs Wade which enshrined the alleged right to abortion. This ruling has brought down one of the pillars of the inculturation of death that seemed untouchable. For that it has taken almost 50 years of work by civil society in all its spheres. Therefore, yes, it is possible, the only thing we need is not to despair or give up the battle. If you want to, you can.
