Almost 150 doctors in Malaga province are against death with dignity

It is more than two years since the passing of the euthanasia law (Muerte Digna) in Spain on 25 June 2021, although it was not until autumn 2021 that requests began to be processed in Andalucía. As SUR exclusively reported a few days ago, Malaga province registered 18 euthanasia cases between 2021 and 2022 which accounted for 35 per cent of all the cases presented in the region, making it by far the province with the greatest number of applicants to use the legislation. This was revealed in a report drawn up by the Commission for Guarantee and Evaluation in Andalusia (CgyEA) on the law of dignified death; a document to which SUR has had access and which covers the period from November 2021 to December 2022.

One of the aspects most commented on by both the associations for a dignified death and the medical associations and the Monitoring Commission is the issue of conscientious objection.

According to official data, in the province there are 144 doctors registered as conscientious objectors out of a total of 803 in the whole of the Andalucía rehion . Of these, 107 belong to the primary care sector.

Although not all doctors are directly affected, these 144 are out of a total of 5,602 doctors working for the public health system in the province. Despite the percentage being small, the main associations related to death with dignity, and also the Monitoring Commission, claim that on many occasions the legal procedures are not being followed.

Article 16 of the law regulating euthanasia establishes that health professionals directly involved in the provision of aid in dying may exercise their right to conscientious objection, although this must be expressed "in advance and in writing". The only cases of conscientious objection that may be declared are the direct administration of a substance to the patient by a competent healthcare professional; and the prescription or supply to the patient by a healthcare professional of a substance, in such a way that the patient may self-administer it, in order to cause his or her own death.

According to the law, this right is recognised for those who suffer from a serious, chronic and incapacitating illness or a serious and incurable disease. To request it, the patient must be of legal age and have full capacity to act.

The request must be made twice in writing, with a separation of at least fifteen calendar days between the two requests. The procedure begins with an initial written request from the patient to their doctor, who must sign it and verify that it meets the requirements. Within two days, a deliberative process must take place in which doctor and patient must discuss the therapeutic alternatives available, as well as the possibility of access to palliative care.

It is precisely at this point where the controversy arises, because although objection is a legitimate and recognised right, the professional must make the request so that another colleague can continue with the process. "The problem is not the objection itself," said Fernando Marín, president of Derecho a Morir Dignamente (DMD). "It is a right that must be guaranteed. However, conscientious objectors and objectors of convenience often fail to fulfil their obligation," he said. "Although they do not have to participate in the process, they do have a duty to receive and sign the euthanasia requests they receive and forward them to their superiors.”

The CgyEA report noted: "Throughout this year, we have been able to see how some files have reached us incomplete, with insufficient clinical information content in relation to the process of aid in dying, which in our opinion reflects a lack of knowledge of the process from an administrative point of view and possibly a lack of time and knowledge about the process".

DMD spokesperson Eva Camps said that, extrapolating the data in comparison with other countries with similar legislation (in which between one and four per cent of deaths are due to euthanasia), they estimated that in Andalucía 12 people a week would die under the law which is a figure far removed from the current reality.

"There is a very significant fact that sets us apart: here almost all deaths are of patients with neurodegenerative diseases, while in other countries most of them are terminal illnesses, such as cancer. People come late and the deadlines take forever. The law establishes 35 days, and in Andalucía we have an average of 80 days," said Camps, who believes that this is the reason for the low figures.

"I personally have tried to help fifteen people with the process, and ten died before it was completed. There is bad management of the objectors," Camps added.