There is a way of dealing with conscientious objection in the law, which is to invite "considering the objecting physician as a suspicious category of a person who is not advanced, not progressive or who does not follow the ideology in vogue". And this mode of regulation is the one chosen by the legislator in the new law on euthanasia, said the professor of Roman Law and Ecclesiastical Law of the State, María José ValeroThe Core Curriculum Department of Villanova University organized a round table discussion on the topic.
Applied to the new Spanish law, the solution, explained María José Valero, has been to incorporate clauses in the law itself. In this way, "the objector's reproach to the ideology of the law tends to weigh down the clauses, to the point that it almost seems that the conscientious objector is the offender".
In the opinion of the professor, the text practically turns objectors into "persecuted heroes", so they must be "registered". In her opinion, registers "are always dangerous, not because of the register itself, but because of the use that is made of them", so she warned of the "not remote possibility that these registers become employment criteria".
María José Valero's presentation followed two medical interventions on the new law, which provided a clinical and ethical perspective. The setting was the round table on 'And after the Spanish euthanasia law, what next?', organized by the Villanueva University and moderated by Professor Santiago Leyra, who offered various perspectives on the euthanasia law that comes into force on June 25, and whose real debate is beginning now, as the May issue of Omnes magazine points out on its cover.
"Against suffering, love".
The well-known oncologist and professor at the Universidad Autónoma de Madrid, Manuel González Barón, pointed out that "what most concerns us physicians is not physical pain, which can be combated with painkillers, major opioids, etc., but suffering, and its younger sister, hopelessness".
"We must try to help the patient to find his or her own resources, investigate his or her personality to help him or her cope with suffering," he explained. In his opinion, pain can be combated medically nowadays, and it is suffering that must be approached in a different way, summarized in a maxim: "Against physical pain, opioids. Against suffering, love.
Talking to the sick
For the oncology patient, "the loss of hope is a source of enormous suffering". "The patient puts his hope in what the doctor says, and we doctors want to tell the patient that he can be cured. The downside comes when time passes and there is no relief of symptoms."
González Barón considers, after decades of professional experience, that "when a patient is in pain and it does not go away, he should change doctors, because that means that those who treat him do not know how to do so. Not all oncologists know how to handle suffering well".
In his opinion, we must speak of palliative sedation in very precise terms: "It has an ethical framework and is not a right of the patient or the family: it is an indication as precise and important as open-heart surgery. It must have certain conditions: there must be a refractory symptom, informed consent and a conversation with the patient; the drugs must have a short life in the blood and there must be antidotes, because palliative sedation must always have the possibility of reversion, and the process must be monitored".
The oncologist, who has been head of Oncology at La Paz Hospital, also insisted on the importance of "talking, of psychotherapy. There are many doctors who do not talk to patients about their problems. That is where resources can come from to face the suffering, to help". If the disease is serious, and even irreversible, the patient must be able to "say goodbye to his or her loved ones, forgive and forgive, give thanks, take stock, reach the end with serenity, with peace, and if the patient is a believer, with God.
Finally, González Barón harshly criticized the law regulating euthanasia since its preparation and processing in numerous aspects, such as "the institutions that have been skipped out of the law", its incompatibility with art. 15 of the Spanish Constitution and Declarations of human rights, and with the Code of Ethics of the medical profession, or the absence of a law on Palliative Care, as other experts have pointed out in omnesmag.com.
"Change doctor...."
In a similar vein, the family physician and palliative care physician Ángel José Sastrewith extensive professional experience accompanying the terminally ill, stressed that "the Euthanasia Law gives the patient the feeling of being a burden", and wondered: Are we moving towards a progressive or regressive society? Societies advance when they take care of their weak", he said.
Sastre insisted, for example, on the problem of the irreversibility of a decision to kill a patient. The doctor evoked several cases from his personal experience with patients who, after being on the verge of giving up, later thanked him for not heeding their request. "When someone asks you to end their life, it makes you want to tell them to change doctors," said the specialist in Family and Community Medicine, agreeing with Dr. González Barón.
Dr. Sastre had stated at the beginning of his intervention that "we cannot repeal the law, but we can treat people well enough so that they do not ask for euthanasia", and he persuaded physicians to "be prepared to suffer with the patient". Like González Barón, Ángel José Sastre reiterated that the rupture of the doctor-patient relationship of trust is very serious with this law.
