The delegate of the Holy See to the World Medical Association (WMA) and member of the Pontifical Academy for Life, Pablo Requena, affirmed in the debate organized by the World Medical Association (WMA) and member of the Pontifical Academy for Life, Pablo Requena, in the debate organized by the World Medical Association (WMA). ForumWord that a euthanasia law such as the one being promoted in Spain is going to "disfavor" to the "more vulnerable".
In his opinion, "It is not a question of right or left. What is more, a person on the left would have to realize that the most vulnerable are going to be disadvantaged with a law of this type." said Requena at the colloquium on "What is dying with dignity?", held at the Banco Sabadell headquarters in Madrid, and presented by Alfonso Riobó, director of the magazine Palabra, which organized the event.
"Sometimes these laws are presented as a way to build a freer society... but is it true? Freer perhaps for a few, but less free for many who find themselves in a situation of helplessness, alone, without the necessary conditions to 'live with dignity' the last moments of their lives.", added physician and theologian Pablo Requena.
In his opinion, this law "aims to give the possibility to a few to freely choose the moment of their death". y "it puts a very heavy burden on thousands of people who, if such a law exists, will have to ask themselves every day why they should continue to be a burden to their family and to society"with the resulting "load and strong pressure". According to Requena, these types of laws are presented as regulations that "make the country and the people freer", but he invited to ask "if it really is so".
It does not help to die better
The speaker, who is a professor at the Pontifical University of the Holy Cross in Rome, reflected
in this way at another time: "When we speak of dignity, the Kantian idea immediately comes to mind, according to which dignity is that which has no price, which cannot be bought and sold, and therefore something very characteristic of the human person, something that distinguishes us from animals and things. That is where the discourse should start from"..
"Euthanasia does not offer death with dignity, it simply anticipates the moment of death, but it does not help you die better. What does help you die better is proper medical care, a competent and compassionate care team, family and society."he said. At the same time, he underlined with equal intensity that "It is not necessary to do everything possible to preserve life: sometimes it is thought that euthanasia is necessary to deal with therapeutic obstinacy and the extreme medicalization of death, as if not having a law allowing euthanasia means that we will have to live surrounded by tubes and machines. This is not true. Modern medicine has been considering for more than 40 years now the limit to aggressive therapeutic action"..
Pablo Requena also told some stories about illustrious Belgian, Dutch and British doctors with whom he has dealt in recent years, in order to support the thesis that euthanasia is not good for society. Among others, Theo Boer, who after years of supporting the euthanasia policies of the Dutch government - almost 5 percent of all deaths last year in the Netherlands were due to euthanasia - has now stated that "whoever opposed the law was right.". In the Netherlands "charity has disappeared" y "the law has effects on the whole of society".said Boer with regret. "Looking back on it, I say we were wrong. Euthanasia has slowly become more and more normal and widespread."he adds.
Pro-euthanasia doctors regret it
During the colloquium, Requena acknowledged that it is "very difficult" answer the question "What is to die with dignity?" because "dignity is used to defend as well as to attack." euthanasia. On the other hand, referring to the stories mentioned above, which have helped him to reflect on the issue, he commented that a former president of the Dutch Medical Association, whom he met at the World Medical Association meetings, told him that his father had died in great pain. "This story made me think that each story is unique and unrepeatable and one can never put oneself in this particular patient who perhaps asks to be helped to die. This has helped me to know how to differentiate between the personal situation of the person who may ask for euthanasia at a given moment and the social and political situation of interest in a country."he said.
Pablo Requena drew two conclusions. First, "palliative care has achieved what bioethics has not: to unite in ordinary clinical practice the best technical competence with a profound vision of man and his mystery".". And second: "Physicians for the most part oppose euthanasia because it is not part of medicine.". Requena recalled that this is the position of the WMA, adopted by the 39th Assembly held in Madrid, in October 1987, reaffirmed by the 170th Council Session in Divonne-les-Bains, in France, in May 2005, confirmed by the 200th WMA Council Session held in Oslo, Norway, in April 2015.
In the European panorama of recent months, the parliament of Finland, the paradigm of the welfare society, has rejected the legalization of euthanasia after five years of debate. Portugal has also rejected it, albeit by a small margin. And in France, as Palabra reported, with the debate on euthanasia and assisted suicide in full swing, 175 associations have reached an agreement to subscribe to twelve reasons against its legalization.
"Let them take us more seriously."
The president of the Spanish Society of Palliative Care (Secpal), Rafael Mota, who also intervened as a guest speaker, began by saying that he came to the forum "to talk about life, not death."and assured from his long daily experience that "people don't want to die, but they don't want to suffer, and if you don't give them options...". With Palliative Care we affirm the people that "we are going to help them live until they die.".
Dr. Mota, re-elected president of Secpal last June, and medical director of Integrated Palliative Care Programs at the New Health Foundation in Seville, called on politicians to "take us more seriously"He revealed that at the beginning of one of the bills, the political party Ciudadanos called them to ask for advice. However, they have felt "deceived" because the suggestions they submitted have not been taken into account. "They didn't take us seriously."he reiterated. One of the allegations they raised is that people can ask for more time off from their workplaces to accompany their dying relatives, since they currently only have three days for this purpose. Now, "many have to take a leave of absence due to depression."he said. "Giving life at the end of life."This is how Dr. Mota defined the palliative care offered by the teams of professionals in this specialty, which should not be reserved for the last moments, but rather should be requested "earlier in the day" to make it more effective, he added. Rafael Mota then referred to the "compassionate cities" project, which aims to provide training to all social sectors: in the family, in schools, associations, etc. The aim is to raise awareness and train street people in the end-of-life processes and how they can help people in their environment. It arose in the United Kingdom and is being developed all over the world, including Spain. In his opinion, "we have to create a network to guarantee the patient that he will receive our support, not only to die in peace, but to help him live with dignity until he dies."he said.
That it permeates society
In a statement to Palabra, Rafael Mota recalled that his association wishes to "We have to transmit a message that permeates society, to transmit the many profound experiences of life, of intensity of life, that all of us who work in Palliative Care live in first person on a daily basis. We have to do it from Secpal, but also from numerous instances, because together and united we will have more strength.".
"If we are able to reach the people on the street, transmitting the values we have been learning on a daily basis, accompanying thousands and thousands of patients at the end of their lives and their families, society itself will demand the highest scientific and human quality of care from our governments. Only then will we achieve our goals of accreditation and recognition of our work.", he points out.
Contacts after Christmas
The president of Secpal said that they will meet with the Socialist Party after Christmas to discuss the last details of the law, which is pending revision. "Among other things, we ask that there be a political will to develop palliative care in all the autonomous communities, whether at home or in hospitals, so that in Spain, to die well, does not depend on a particular city, but is something that everyone can receive quality care in their end-of-life process, which is still very deficient".Mota told Religión Confidencial.
"Spain has great professionals in palliative care but they are overburdened."said Rafael Mota. The internist assumes that "society needs this right, and end-of-life care needs to be elevated to a speciality.". "We do not reach all diseases, nor all audiences, for example, children. We have to create a network to guarantee the patient that they will receive our support, not only to die in peace, but to help them live with dignity until they die."he stressed.
Therapeutic obstinacy
One of the issues that is most strongly argued in an attempt to legalize euthanasia is that without this law it would not be possible to limit the so-called "therapeutic incarceration". In part of his speech, as noted, and in several conversations during his quick stay in Madrid, the doctor and priest Pablo Requena referred to it, since it is recent publication of a book of his with the provocative title. "Doctor, don't go all out!". This refers to the common request to doctors to do everything possible to save the life of a person, usually a family member.
The physician and professor explains the reason for the book. "I intend to show, based on recent clinical literature, that limitation of therapeutic effort is common in medical practice. From a bioethical point of view, it is a manifestation of good practice, since it is not always appropriate to use the entire therapeutic arsenal available. Limitation is a concretization of the classic principle of medical ethics 'primum non nocere', of which the principle of non-maleficence is its modern version.". The delegate of the Holy See to the WMA explained his views to Palabra, and referred to a detailed explanation in an interview granted to medicos y pacientes.com, the website of the Organización Médica Colegial. Here is a summary of his argumentation on this matter. "I think that medicine has changed a lot in the last 100 years... and that is one of the reasons for the birth of bioethics in the 1960s. Today, there are many contexts in which the possibility of limitation is planned, from cardiopulmonary resuscitation to ECMO (artificial support of the respiratory and cardiopulmonary systems), chemotherapy, etc., to the use of bioethics.".
So, what role does the growing scientific and technological progress play in situations that, in some cases, reach the so-called therapeutic incarceration? Requena answers:
"The entry of technology in medicine has certainly brought great benefit to the patient in many pathologies. At the same time, it has generated ethical questions that did not exist before, and which have not always found the healthcare operator in a position to face them. Personally, I do not like the term 'therapeutic incarceration', since the physician is very rarely 'incarnated' with the patient..., although I recognize that it has become part of the usual way of talking about these issues. But it is true that, at times, we find what some call 'therapeutic obstinacy': the attempt to continue fighting to the end, even in situations where it would be more appropriate to put aside therapies in view of a cure, and concentrate on the palliation of the patient.".
The limits
The question now is: what would be the limits? How can we know? Paul says
Requena: "This is precisely the question the book tries to answer. It seems to me that, in the determination of these limits, which is sometimes really complicated, some concepts of classical medical ethics, such as the principle of proportionality, as well as the categories of bioethical reflection, among which autonomy and quality of life stand out, can be of help. I have the impression that an effort is needed to manage all these concepts, and to avoid the temptation to resort to overly simplistic 'ethical recipes'.".
When in doubt or asked who should make decisions in critical situations, the Holy See's delegate to the AMM is clear: "In a very synthetic way we can summarize by saying that it is up to the physician to establish the limits of good clinical practice for the pathology of the patient they are treating. It is the physician who establishes whether a hypothetical treatment is futile or not. At a second stage, when he has already established which possible treatments are considered reasonable, he must talk to the patient to see which therapeutic course he prefers"..
Pablo Requena concludes: "It is increasingly common to find in the medical and bioethical literature the expression 'share decision making'. I consider it a good synthesis between two extremes that do not help good practice: medical paternalism that considers the patient as if he were a minor, and decisional autonomy that reduces the physician to a technician who must carry out his own wishes."The last question concerns the assumption that the patient no longer has the capacity to decide. Who should do it then? Your answer: "In the case of patients who are unable to decide, the legal representative, who in many cases is a family member, should be consulted. This person will be able to decide what he/she considers best for the patient within the limits that the referring physician proposes as appropriate.".
GLOSSARY OF TERMS
Euthanasia
"Conduct (action or omission) intentionally aimed at ending the life of a person who has a serious and irreversible illness, for compassionate reasons and in a medical context." (Spanish Society of Palliative Care). "The deliberate act of ending a patient's life, even if it is of the patient's own free will or at the request of family members, is unethical. This does not prevent the physician from respecting the patient's wish to let the natural process of death take its course in the terminal phase of his illness." (World Medical Association).
Palliative Care
Palliative care, or Hospice-type care, as it was called in many countries, is the
Palliative care is a special type of care designed to provide comfort and support to patients and their families in the final stages of a terminal illness. Palliative care aims to ensure that patients have the days that they need to live in the last stages of their lives.
They will remain conscious and free of pain, with their symptoms under control, so that their last days can be spent with dignity, at home or in a place as close as possible, surrounded by the people who love them.
More about Palliative Care
Palliative care neither accelerates nor stops the dying process. It does not prolong life, nor does it hasten death. It is only intended to be present and to provide specialized medical and psychological care and emotional and spiritual support during the terminal phase in an environment that includes home, family and friends.
Terminal illness
In the situation of terminal illness, some important characteristics concur. The fundamental elements are: presence of an advanced, progressive, incurable disease; lack of reasonable possibilities of response to specific treatment; presence of numerous intense, multiple, multifactorial and changing problems or symptoms; great emotional impact on the patient, family and therapeutic team, closely related to the presence, explicit or not, of death; limited life prognosis. It is essential not to label a potentially curable patient as terminally ill (Spanish Society of Palliative Care).
Assisted or assisted suicide
"Physician-assisted suicide, like euthanasia, is unethical and should be condemned by the medical profession. When the physician intentionally and deliberately assists the person to end his or her life, then the physician is acting unethically." (World Medical Association). In assisted suicide, it is the patient himself who activates the mechanism that ends life, even if he needs another or others to carry out his purpose. In euthanasia, it is another person, most of the time a physician, who provides the drugs to end the patient's life.
to administer them himself.
