Cultural, social and ideological differences mean that opinions about euthanasia are not neutral but rather positionings influenced by ingrained and deeply discrepant beliefs and feelings.
We understand the controversy and the need for a social debate that is as inevitable as it is necessary, among all the implicated parties. Such debate should take place freely, respecting plurality, with precise use of language, and with seriousness in the arguments and responses.
We have not been asked as citizens about this issue, but social concerns and need exist. Citizen groups such as the federated association Derecho a Morir Dignamente, and private entities such as the Instituto Borja de Bioética, or the Observatorio de Bioética y Derecho, and public institutions such as the Catalan Bioethics Consulting Committee, have actively endorsed the ethical and legal admissibility of euthanasia.1
“The Goals of Medicine”, published by the Hastings Center, underscore that the traditional objective of Medicine to restore health and avoid death has fallen short, and that the purposes of Medicine should extend beyond the healing of disease and the prolonging of life. Special emphasis is placed on aspects such as palliation of pain and suffering, placing healing and caring on a par, and alerting against the temptation to prolong life unduly.2
In Intensive Care Units, the adaptation of life support therapies is a very common practice and a quality criterion, and there appears to be sufficient ethical and legal consensus on this issue.3 This scenario should be distinguished from euthanasia, where sufficient and majority consensus still appears to be lacking in Spanish society. Discrepancies are also found among the professionals, and fortunately the legislation regulating euthanasia (LORE) in this country allows for room, recognizing the possibility of consciousness objection in this regard.4 There are likewise differences between different autonomous communities in Spain, and discrepancies among the deontological codes, that can generate doubts among the professionals.
As to whether euthanasia should be regarded as a medical act, the debate should focus on whether or not such practice may form part of the official attributes of healthcare professionals, in a quest to relieve suffering by producing death. In some countries in our setting, such as The Netherlands, Belgium or Luxembourg, society, citizens and professionals have accepted that this is indeed so.
The role of intensive care professionals in relation to assistance in dying should be compassionate but at the same time also rational and technical, since in a medical scenario as highly technified and rationalized as intensive care, professionals must be rational but also empathic, compassionate and close to people, in order to assist their hidden needs… But this is also another debate.
