Ignacio Pascual of the organizations Professionals for Ethics told ZENIT that these "citizens' advice for a dignified death" information offices aim to counsel the sick, elderly and their relatives on end-of-life issues.
However, he said, the centers, in Rivas-Vaciamadrid and Getafe, outside Madrid, are managed by the Asociación Derecho a Morir Dignamente (Right to Die with Dignity Association), which favors euthanasia.
Pascual noted that people who enter these offices for advice are handed a document known as a "living will" or "advance directions," a model that seems to follow the spirit of the law that governing these types of documents. In other words, it proposes to help the person express his will in the case of serious circumstances of health that would prevent him from making his wishes known later on.
However, the Professionals for Ethics organization noted that this text, which people are encouraged to sign, is ideologically slanted in favor of euthanasia. It expressly states that: "If at the time the legislation regulates the right to die with dignity through active euthanasia, it is my will to avoid all types of suffering and to die quickly and painlessly."
According to Doctor Maria Alonso, a family practitioner from Madrid, the best practices guide for medical professionals does not include putting an end to the person suffering through euthanasia, but rather to offer care for the person in pain that is humanized in a special way for those moments.
Thus, she noted, "it is a contradiction" to speak about best practices with regard to euthanasia.
Hence, Professionals for Ethics warned that the advance directions document, which is being distributed in these centers, is consciously prepared to influence a person's consent in favor of euthanasia. In this regard, it does not respect the patient's free will, one of the values most defended by Spain's juridical legislation.
Moreover, the document assumes that the signatory will not wish to live with brain damage, dementia, tumors, chronic or degenerative illnesses, in a vegetative state, after a cerebral-vascular accident or in any other serious or irreversible suffering.
Thus, the living will model proposed by the pro-euthanasia association is uncertain in juridical terms, the ethics organization noted, as it leaves grey areas in some suppositions that the patient should be able to point out in a clear, explicit way.
The document also invites the citizen to affirm: "I do not want for myself a dependent life in which I will need the help of other persons to carry out the 'basic activities of daily life,' such as bathing, dressing, using the toilet, walking and eating."
Need for support
Alonso stated: "Faced with this type of expressions from persons who say they do not want to live, psychiatry proposes an approach through individualized treatment, usually with a very good response.
"On almost all occasions these persons feel very grateful for the medical treatment received, and forget their desire to die.
"These sentiments and desires to die in response to the inability to manage on one's own normally give way when the patient places his trust in health professionals, and receives the help and support of relatives and of the society."
The document concludes with the request for "the medication that palliates my suffering, especially, even in the case that my life might be shortened, terminal sedation, that I be allowed to die in peace."
According to Alonso, this expression introduces confusion between palliative sedation and terminal sedation.
In palliative sedation, she explained, medication is used to alleviate the suffering of a patient who is not necessarily terminal; in terminal sedation, it is a question of a patient who is going to die in a few hours or days. The doctor noted that if the document only speaks of terminal sedation it probably means that the objective is to put an end to the patient's life in a matter of hours.
In any case, Professionals for Ethics noted that even if a person has signed this document that opts for death in almost all circumstances, the doctor, the health team and all those who attend the patient must respect the previous instructions within the limits established in the law.
Moreover, it stated, the medical professionals will be able to exercise conscientious objection in compliance with the said previous instructions.