For those of us who advocate medicine in the service of life and the dignity of the health profession, the rejection of euthanasia (active and passive) is as essential as that of therapeutic bitterness. Starting from the belief that killing or helping to kill oneself is not ethically the same as letting die if there is no therapy and the situation is irreversible, we insist that the basic principle must be maximum respect for human life. Interestingly, although I am in favor of abortion and euthanasia, this allows me to analyze with some concerns In order to avoid further distortions and manipulations of the most commonly used terms around the subject of euthanasia, we consider that it is necessary to clarify the conceptual meaning of the following terms and expressions: – Euthanasia: the act or omission of the doctor or another person, with the intention of causing the death of the incurable or highly dependent patient, out of compassion and to eliminate all pain. – Voluntary euthanasia: One that is performed with the patient`s consent. – Involuntary euthanasia (also called cacothanasy or coercion): that practiced against the will of the patient who expresses his desire not to die. – Non-voluntary euthanasia: that which is performed without the consent of the patient, who cannot express a wish, as is the case for children and patients who have not directly expressed their consent. – Active euthanasia: which causes the death of the patient by a positive action. – Passive euthanasia: intentionally allowing the patient to die because the care or treatment indicated and provided is omitted. The term passive euthanasia is sometimes used inappropriately to refer to correct medical practice, based on the omission of treatments that are disproportionate or unnecessary to the result to be achieved. In this case, it would not be passive euthanasia, but before the correct limitation of therapeutic effort or the restriction of futile therapies, which is in accordance with bioethics and medical ethics and respects the patient`s right to autonomy in order to decide and refrain from treatment. – Therapeutic bitterness (also called dysthanasia or stubbornness or therapeutic cruelty): the practice, contrary to medical ethics, of applying unnecessary or, if useful, disproportionately embarrassing treatments in relation to the expected result of them.
– Orthothanasis: allow natural death in case of incurable and incurable diseases, treat them with the maximum of palliative treatments to avoid suffering, and resort to reasonable measures. Faced with euthanasia, which seeks its moral and juridical legitimacy from the autonomist claim and the desacralization of human life and against the so-called therapeutic bitterness, also ethically unacceptable, orthothanasia (from the Greek orthos, right, just, which respects the law according to reason) is elevated as an acceptable legal and moral position. Orthothanasia consists in not anticipating death by a deliberate medical act; accompany the terminally ill and contemplate his life, although dependent and suffering, always dignified; relieve pain as much as possible with all available means and promote their well-being; offer psychological and spiritual support to realize your right to accept your death process; Never leave the patient, but know how to let him die if we can`t cure him. Incurable disease: one who suffers from a disease from which it cannot be expected to recover, fatal in a predictable way in the short term, which can last from a few weeks to several months at most. – Palliative care: attention to the physical, mental, social and spiritual aspects of people in final situations, whose main objective is the well-being and promotion of the dignity and autonomy of the sick and their families. This care typically involves multidisciplinary teams, which may include health professionals (doctors, nurses, social workers, occupational therapists, practical nurses, psychologists), ethics experts, spiritual advisors, lawyers, and volunteers. – End of sedation: the deliberate administration of drugs to obtain the relief of physical and / or psychological suffering inaccessible with other measures through the sufficiently deep and predictable irreversible decrease in consciousness in a patient whose death is expected very close, with the explicit, implicit or delegated consent of the latter. From an ethical point of view, it is irrelevant that as an unintended side effect of the administration of sedation, the death of the person is favored, as long as this is not directly intended for the end of the action. – Suicide: the act of committing suicide voluntarily.
Assisted suicide: the act of helping to commit suicide in the event that the person is unable to do so on their own. – Living will: the express manifestation of the living will in the event that the person is not authorized to decide on his medical treatment. In this sense, it is necessary to highlight two elements of the legal reality that are very relevant with regard to euthanasia in its current treatment. First, the penalty provided for entails less protection of the welfare of human life, which is contrary to the constitutional provision of Article 15 EC of 1978. Even if the purpose of the sanction is not only to assess the protected asset, there is no doubt that the result is unfair if the protection is negligible. On the other hand, it cannot be ignored that in comparative law, in the few legal systems where murder by euthanasia has been decriminalized, the path began with the application of the principle of possibility by the Public Prosecutor`s Office and led to de facto decriminalization, which then led to legalization in the cases of Belgium and the Netherlands. with the argument that legalisation is necessary to ensure legal certainty. The law does not submit to ideal requirements in the name of one moral perspective or another, but must take care of the real situation of intersubjective relations in a particular society.
In this sense, with continuous effort, it is very doubtful that in today`s Spanish society cases of therapeutic tenacity increase, due to a vitalist position to prolong life at all costs. On the contrary, the current circumstances show a certain risk of therapeutic cessation for economic reasons compared to life which is considered unworthy. Therefore, it is even riskier to increase the power of the doctor and the health system to end a dependent human life, increase pressure on patients, or create protocols of action that objectively promote euthanasia. Since the sixties, with the founding of the Association for Dignified Death in the United States, the issue of euthanasia has changed in terms of consideration. From the classic defense of humanitarian death, of people who have suffered supposedly undignified living conditions, it has gone to the elevation of a so-called right to kill anyone who claims it while he is in subjective and objective conditions of humiliation. This defends a supposed control over one`s own life through murder by euthanasia in the name of autonomy, especially of people who are in less autonomous conditions. Spanish constitutional jurisprudence has repeatedly insisted that the right to life and the right not to be subjected to inhuman or degrading treatment do not include the right to be killed at one`s own request. Both in the Senate Committee`s debate on euthanasia and in cases where legalization bills have been defeated, the majority argument was that in euthanasia there is transitivity, one person kills another, which justifies state intervention in protecting human life at its most vulnerable time. It should also be borne in mind that in comparative jurisprudence, especially in American jurisprudence, one of the elements considered to overcome the autonomy of those who refuse particular medical treatment is precisely the intention to commit suicide, which is never protected by law, even if it is not sanctioned. The promotion of euthanasia, so intense in some regions, is generally based on taking into account very specific border situations.
It is necessary to distinguish what the analysis of specific cases can be from an inalienable principle: no one has the right to cause the death of another seriously ill human being, either by act or omission. A society that accepts the cessation of the lives of certain people because of the insecurity of their health and the actions of third parties inflicts on itself the crime of considering the lives of certain sick or seriously diminished people as unworthy.