Finally, the proposal proposed by the Podemos group for an organic law, the examination of which was rejected by the Chamber of Deputies at the end of March – 86 deputies in favour, 132 against and 122 abstentions – is the only one that directly concerns euthanasia and provides for a modification of the wording of the Penal Code. Article 143.4: “The conduct of a person who cooperates in necessary and direct acts on another person or causes his death, if he has expressly, unequivocally and repeatedly requested it in accordance with the provisions of the specific legislation, is not punishable. The applicant must suffer from a serious illness that necessarily results in his death or that suffers from physical or mental suffering that he considers intolerable. The specific characteristics of this proposal are set out in Table 4. Nizama-Valladolid M. Medical Humanism. Rev Soc Peru Med [Internet]. 2002; 15(1). Available in: sisbib.unmsm.edu.pe/bvrevistas/spmi/v15n1/humanis_medico.htm MEDICAL CIVIL LIABILITY Omission of preparation and incomplete anamnesis as attribution factors objectives APPLIED RESEARCH PROJECT Without wishing to enter into the casuistic analysis typical of an ethics committee, we propose to briefly highlight some aspects of an ethical nature that must be taken into account when explaining this final process. to ensure at all times respect for the inherent dignity of the patient, thus ensuring the highest quality and maximum well-being in the last phase of his life. The pursuit of a peaceful death, taking into account the patient`s value and belief system, is a first-rate ethical imperative. However, this professional duty opens up a series of interpretations and practices based on the contexts, actors involved, beliefs and value system of the professional, patient and family. The phrase “accompany to die with dignity” represents a desideratum that houses practices and decisions of a very different kind, and sometimes legitimizes actions that are at opposite levels.8-11 In this article, we intend to address the ethical, medico-legal and legal aspects in this regard in a comprehensive and coordinated manner, so that the health professional has the necessary update to act in accordance with the lex artis in the current legal framework and to promote the reflection of the professional profession on this issue in anticipation of possible future regulatory changes. In addition to a legal obligation (Law 41/2002), truthful, comprehensible and appropriate information to the patient on his diagnosis and prognosis is an ethical and deontological duty12.
Managing information in the end-of-life process presents extraordinary challenges due to the emotional impact that certain messages can bring. Law 41/2002 regulating the autonomy of patients and the rights and obligations with regard to clinical information and documentation19, which drew up the above-mentioned Oviedo20 Convention in Spain, adequately reflects these aspects. Every person or patient has the right to receive truthful information about their process and disease, to refuse treatment, to limit therapeutic effort and to choose between available options. The principle of patient autonomy in the process of death can be articulated by informed decision-making appropriate at that time or by carrying out a DVA. Various regional regulations22 have made it possible to develop and implement them, but there is a need to further advance and improve advance care planning, as well as knowledge of the register of living wills and its documents and its accessibility, both by citizens themselves and by the professionals who visit it14. The current debate on end-of-life support can be demagogic and superficial if it does not take into account all the actors involved in the process. The proposal for the decriminalisation of Article 143, i.e. the decriminalisation of euthanasia and assisted suicide, should take into account the associated risks arising from a possible impairment of decision-making power in end-of-life situations, and the relevant protocols should be agreed and developed in advance in an appropriate manner.
There is no room for generalization and the debate is not considered viable without prior ethical and medico-legal reflection involving the professionals and patients directly involved. In Spain, there are currently 3 different proposals for an organic law, presented by different political groups, relating to the end-of-life process. The Citizens` Group presented the “legislative proposal on the rights and guarantees of the dignity of the person before the last process of his life”, while the Socialist Group presented the “legislative proposal regulating human rights before the last process of life”. Both bills are essentially consistent with what is regulated regionally, taking into account palliative sedation and the pain phase, rather than including universal nuances such as the requirement for professionals to consult the register of living wills before a patient who is actually unable to work, or the right to individual placement and family and spiritual support. More importantly, they contain the deletion of point 3 of the wording of Article 11 of the Patients` Autonomy Act (Table 3), thus omitting the mention of lex artis and, in the case of citizens, adding the right of professionals to conscientious objection against the legal obligation to respect the will. the patient`s values, beliefs and preferences in clinical decision-making (Article 15). Both peculiarities are controversial and are rejected by the end-of-life medical care group of the Collegiate Medical Organization and the Spanish Society of Palliative Care (SECPAL)32.