Euthanasia, dementia and advance directives: arguing for a new model in Spain
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Abstract
The law regulating euthanasia in Spain establishes that individuals without decision-making capacity are eligible for assisted dying if they have previously signed an advance directive and meet the criteria of an “euthanasic context”. This article aims to expose a vulnerability in the handling of assisted dying requests in Spain, particularly concerning individuals with dementia. To address this, we will examine the requirements for requesting euthanasia both with and without advance directives and compare Spain’s legal framework for advance directives with that of other countries. Subsequently, we will present two types of arguments: one negative (as the directives help prevent certain harmful circumstances) and one positive (as they promote desirable situations), which underscore the vital importance of implementing changes in the use of advance directives to request euthanasia in cases of dementia.
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Ministerio de Ciencia, Tecnología e Innovación
Grant numbers PID2020-118729RB-I00
References
Aalten, Pauline, van Valen, Evelien, de Vugt, Marjolein, E., Lousberg, Richel, Jolles, Jelle y Verhey, Frans, R. (2006). Awareness and behavioral problems in dementia patients: a prospective study. International psychogeriatrics, 18(1), 317. https://doi.org/10.1017/S1041610205002772
Asscher, Eva, Constance, Alida y van de Vathorst, Suzanne (2020). First prosecution of a Dutch doctor since the Euthanasia Act of 2002: what does the verdict mean? Journal of Medical Ethics, 46(2), 71-75. https://doi.org/10.1136/medethics-2019-105877
Assemblée Nationale du Québec (2023). Bill 11, An Act to amend the Act respecting end-of-life care and other legislative provisions. Recuperado de: https://www.publicationsduquebec.gouv.qc.ca/fileadmin/Fichiers_client/lois_et_reglements/LoisAnnuelles/en/2023/2023C15A.PDF
Barbero, Javier, Díaz, Laura, Coca, Cristina, del Rincón, Carola y López-Fando, Teresa. (2008). Las instrucciones previas en funcionamiento: una herramienta legal con valor psicoterapéutico. Psicooncología, 5, 117-128.
Boletín Oficial del Estado (2002). Ley 41/2002 de 2002. Básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica. 14 de noviembre de 2002. BOE núm. 274. Recuperado de: https://www.boe.es/buscar/act.php?id=BOE-A-2002-22188
Boletín Oficial del Estado (2021). Ley Orgánica 3/2021 de 2021. Regulación de la eutanasia. 24 de marzo de 2021. BOE núm. 72. Recuperado de: https://www.boe.es/diario_boe/txt.php?id=BOE-A-2021-4628
Boletín Oficial del Estado (2023). Sentencia 19/2023 de 2023. 22 de marzo de 2023. BOE núm. 98. Recuperado de: https://www.boe.es/diario_boe/txt.php?id=BOE-A-2023-10044
Bosch, G. J. van den, Roos, R. A. N., Otten, R., Bockting, Claudi y Smulders, Y. M. (2021). Are patients accurate forecasters of their emotional response to medical conditions? A scoping review on affective forecasting. BMJ Open, 11(12). https://doi.org/10.1136/bmjopen-2021-053370
Bryce, Cindy L., Loewenstein, George, Arnold, Robert M., Schooler, Jonathan, Wax, Randy S. y Angus, Derek C. (2004). Quality of Death: Assessing the Importance Placed on End-of-Life Treat-ment in the Intensive-Care Unit. Medical Care, 42(5), 423-431. https://doi.org/10.1097/01.mlr.0000124245.62354.57
Cabeza de Vaca, María, Josefa (2018). Contenido de las declaraciones de las voluntades vitales anticipadas en el hospital universitario Puerta del Mar de Cádiz y conocimientos y actitudes de los profesionales sanitarios de los servicios implicados en el final de la vida. Tesis Doctoral. Cádiz: Universidad de Cádiz. Recuperado de: https://rodin.uca.es/handle/10498/20236
Cerejeira, Joaquim, Lagarto, Luísa y Mukaetova-Ladinska, Elizabeta B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 73. https://doi.org/10.3389/fneur.2012.00073
Clark, David (2001). Religion, Medicine, and Community in the Early Origins of St. Christopher’s Hospice. Journal of Palliative Medicine, 4(3), 353-360. https://doi.org/10.1089/109662101753123977
Clifford, Kristen, Moreno, Monica y Kloske, Courtney M. (2024). Navigating late-stage dementia: A perspective from the Alzheimer’s Association. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 16(1), 1-5. https://doi.org/10.1002/dad2.12530
Conlin, Michael, O’Donoghue, Ted y Vogelsang, Timothy J. (2007). Projection Bias in Catalog Orders. The American Economic Review, 97(4), 1217–1249. http://www.jstor.org/stable/30034090
Corte Constitucional (2021). Sentencia C-233/21 de 2021. Recuperado de: https://www.corteconstitucional.gov.co/Relatoria/2021/C-233-21.htm [Consultado el 12 de febrero de 2024].
Couceiro, Azucena. (2007). Las directivas anticipadas en España: contenido, límites y aplicaciones clínicas. Revista de Calidad Asistencial, 22(4), 213-222. Recuperado de: https://www.elsevier.es/es-revista-revista-calidad-asistencial-256-articulo-las-directivas-anticipadas-espana-contenido-13109343
DeGrazia, David (1999). Advance directives, dementia, and ‘the someone else problem’. Bioethics, 13(5), 373-391. https://doi.org/10.1111/1467-8519.00166
Diário da República (2023). Lei n.º 22/2023 de 2023. 25 de mayo de 2023. Recuperado de: https://diariodarepublica.pt/dr/detalhe/lei/22-2023-213498831
Dying With Dignity Canada (2023). Advance requests. Recuperado de: https://www.dyingwithdignity.ca/advocacy/parliamentary-review/advance-requests/ [Consultado el 12 de febrero de 2024].
End of Life Law in Australia (2023). Voluntary Assisted Dying. Recuperado de: https://end-of-life.qut.edu.au/assisteddying
Espericueta, Luis (2023). Primer informe oficial de la eutanasia en España: comparación con las experiencias canadiense y neozelandesa. Medicina Clínica, 161(10), 445-447. https://doi.org/10.1016/j.medcli.2023.06.014
Espericueta, Luis (2024). Analysis of the legal situation regarding euthanasia in Ecuador, Colombia, and Peru: Towards a Latin American model of medical assistance in dying? Developing World Bioethics. https://doi.org/10.1111/dewb.12457
Espericueta, Luis (2025). Advance Requests for Medical Assistance in Dying in the International Context: Some Legal Issues for the Canadian Case. Healthcare Policy, 20(2). doi: 10.12927/hcpol.2024.27478
Espericueta, Luis (preprint). La prohibición de la eutanasia por trastornos mentales en España: análisis sobre la vulneración del principio de igualdad y no discriminación.
Fazel, Seena, Hope, Tony y Jacoby, Robin (1999). Dementia, intelligence, and the competence to complete advance directives. The Lancet, 354(9172), 48. https://doi.org/10.1016/s0140-6736(99)01911-x
Fedlex (1937). Code Pénal Suisse. Recuperado de: https://www.fedlex.admin.ch/eli/cc/54/757_781_799/fr
Ferrier, Catherine (2022). MAiD by advance directive. Brief submitted to the Special Joint Committee on Medical Assistance in Dying. Recuperado de: https://www.ourcommons.ca/Content/Committee/441/AMAD/Brief/BR11782756/br-external/FerrierCatherine-e.pdf
Hegde, Soumya y Ellajosyula, Ratnavalli (2016). Capacity issues and decision-making in dementia. Annals of Indian Academy of Neurology, 19(Suppl 1), S34-S39. https://doi.org/10.4103/0972-2327.192890
Heyland, Daren K., Heyland, Rebecca, Dodek, Peter, You, John J., Sinuff, Tasnim, Hiebert, Tim, Jiang, Xuran, Day, Adrew G. y ACCEPT Study Team and the Canadian Researchers at the End of Life Network (CARENET) (2017). Discordance between patients’ stated values and treatment preferences for end-of-life care: results of a multicentre survey. BMJ supportive & palliative care, 7(3), 292-299. https://doi.org/10.1136/bmjspcare-2015-001056
Kim, Scott, Y., Caine, Eric, D., Currier, Glenn W., Leibovici, Adrian y Ryan, J. Michael (2001). Assessing the competence of persons with Alzheimer’s disease in providing informed consent for participation in research. The American journal of Psychiatry, 158(5), 712-717. https://doi.org/10.1176/appi.ajp.158.5.712
KNMG (2021). End-of-life decisions. KNMG position. Recuperado de: https://knmg-standpunt.maglr.com/knmg-standpunt-levenseinde/standpunt-levenseinde
Law Bank (2002). Termination of life on request and assisted suicide law. Recuperado de: https://wetten.overheid.nl/BWBR0012410/2021-10-01
Libération (2022). Jean-Luc Godard a eu recours au suicide assisté. Recuperado de: https://www.liberation.fr/culture/jean-luc-godard-est-mort 20220913_LLEGXZFQSFDC3FBJCP7AWXSYWI/ [Consultado el 19 de abril de 2024].
Loewenstein, George (2005). Projection bias in medical decision making. Medical Decision Making: an International Journal of the Society for Medical Decision Making, 25(1), 96-105. https://doi.org/10.1177/0272989X04273799
Loewenstein, George, O’Donoghue, Ted y Rabin, Matthew (2003). Projection Bias in Predicting Future Utility. The Quarterly Journal of Economics, 118(4), 1209-1248. http://www.jstor.org/stable/25053938
McKeith, Ian y Cummings, Jeffrey (2005). Behavioural changes and psychological symptoms in dementia disorders. The Lancet. Neurology, 4(11), 735-742. https://doi.org/10.1016/S1474-4422(05)70219-2
Mellett, James, Mack, Cheryl y Leier, Brendan (2021). Advanced Requests for MAID: Are They Compatible with Canadian Medical Practice? Canadian Journal of Bioethics / Revue canadienne de bioéthique, 4(2), 78-81. https://doi.org/10.7202/1084453ar
Minister of Justice (1985). Criminal Code. Recuperado de: https://laws-lois.justice.gc.ca/PDF/C-46.pdf
Ministère de la Justice (2002). Loi du 28 mai 2002 relative à l'euthanasie. Recuperado de: https://www.ejustice.just.fgov.be/cgi_loi/change_lg.pl?language=fr&la=F&table_name=loi&cn=2002052837
Ministerio de Salud (2018a). ABECÉ. Documento de Voluntad Anticipada (DVA). Resolución 2665 de 2018. Recuperado de: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/abece-voluntad-anticipada.pdf
Ministerio de Salud (2018b). Resolución 2665 de 2018 (por medio de la cual se reglamenta parcialmente la Ley 1733 de 2014 en cuanto al derecho a suscribir el Documento de Voluntad Anticipada). Recuperado de https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No.%202665%20de%202018.pdf
Ministre de la Santé et de la Sécurité sociale (2009). Loi du 16 mars 2009 sur l'euthanasie et l'assistance au suicide. Recuperado de: https://legilux.public.lu/eli/etat/leg/loi/2009/03/16/n2/jo
National Hospice and Palliative Care Organization (NHPCO) (2021). Statement on Medical Aid in Dying. Recuperado de: https://www.nhpco.org/wp-content/uploads/Medical_Aid_Dying_Position_Statement_July-2021.pdf
Nebot, Cristina, Ortega, Blas, Mira, José Joaquín y Ortiz, Lidia (2010). Morir con dignidad: Estudio sobre voluntades anticipadas. Gaceta Sanitaria, 24(6), 437-445. https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-91112010000600002
New Zealand Parliamentary Counsel Office (2019). End of Life Choice Act 2019. Recuperado de: https://www.legislation.govt.nz/act/public/2019/0067/latest/whole.html?search=ts_act%40bill%40regulation%40deemedreg_end+of+life+choice+act_resel_25_a&p=1#DLM7285956
Okonkwo, Ozioma C., Griffith, Harold Randall, Belue, Katherine, Lanza, Stephanie T., Zamrini, Edward Y., Harrell, Lindy E., Brockington, John C., Clark, David, Raman, Rema y Marson, Daniel C. (2007). Medical decision-making capacity in patients with mild cognitive impairment. Neurology, 69(15), 1528–1535. https://doi.org/10.1212/01.wnl.0000277639.90611.d9
Parliament of Canada (2021). An Act to amend the Criminal Code (medical assistance in dying). Bill C-7. Recuperado de: https://www.parl.ca/DocumentViewer/en/43-2/bill/C-7/royal-assent
Peicius, Eimantas, Blazeviciene, Aurelija y Kaminskas, Raimonsas (2017). Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals. BMC Medical Ethics, 18, 40. https://doi.org/10.1186/s12910-017-0197-6
Rodríguez Lainz, José Luis (2022). La Ley española de eutanasia a la luz de la Sentencia del Tribunal Europeo de Derechos Humanos del caso MORTIER v. Bélgica. Diario La Ley. Recuperado de https://diariolaley.laleynext.es/dll/2022/12/01/la-ley-espanola-de-eutanasia-a-la-luz-de-la-sentencia-del-tribunal-europeo-de-derechos-humanos-del-caso-mortier-v-belgica
Rodríguez Lainz, José Luis, Fuertes Rocañín, José Carlos, Fuertes Iglesias, Carlos y Rodríguez Jiménez, Beatriz (2021). Eutanasia y testamento vital. Navarra: Thomson Reuters Aranzadi.
Rodríguez-Arias, David (2005). Una muerte razonable: testamento vital y eutanasia. Bilbao: Desclée de Brouwer.
Sabatino, Charles P. (2010). The evolution of health care advance planning law and policy. The Milbank Quarterly, 88(2), 211-239. https://doi.org/10.1111/j.1468-0009.2010.00596.x
Scheeres-Feitsma, Trijntje M., van Laarhoven, Angela J. J. M. Keijzer, de Vries, Ralph, Schaafsma, Petruschka y van der Steen, Jenny T. (2023). Family involvement in euthanasia or Physician Assisted Suicide and dementia: A systematic review. Alzheimer’s & Dementia: the Journal of the Alzheimer’s Association, 19(8), 3688–3700. https://doi.org/10.1002/alz.13094
Schuurmans, Jaap (2023). Euthanasia requests from patients with dementia. Tesis doctoral. Países Bajos: Radboud University Medical Center. Recuperado de: https://repository.ubn.ru.nl/bitstream/handle/2066/295099/295099?sequence=1
Schuurmans, Jaap, Crol, Chantalle, Olde Rikkert, Marcel y Engels, Yvonne (2021). Dutch GPs' experience of burden by euthanasia requests from people with dementia: a quantitative survey. BJGP Open, 5(1). https://doi.org/10.3399/bjgpopen20X101123
Seoane, José Antonio (2006). Derecho y planificación anticipada de la atención: panorama jurídico de las instrucciones previas en España. Revista Derecho y Salud, 14(2), 285-295.
ten Have, Henk y Welie, Jos V. (2014). Palliative Sedation Versus Euthanasia: An Ethical Assessment. Journal of Pain and Symptom Management, 47(1), 123–136. https://doi.org/10.1016/j.jpainsymman.2013.03.008
Torrente, Rafa (2022). Salud a todo Twtich, por Joan Carles March. [Archivo de vídeo]. Recuperado de: https://www.youtube.com/watch?v=kpdQRPO3AIg [Consultado el 19 de abril de 2024].
Van Rickstal, Romy, De Vleminck, Aline, Aldridge, Melissa D., Morrison, Sean, Koopmans, Raymond, van der Steen, Jenny, Engelborghs, Sebastiaan y Van den Block, Lieve (2019). Limited engagement in, yet clear preferences for advance care planning in young-onset dementia: An exploratory interview-study with family caregivers. Palliative Medicine, 33(9), 1166-1175. https://doi.org/10.1177/0269216319864777
Van Rickstal, Romy, De Vleminck, Aline, Chambaere, Kenneth y Van den Block, Lieve (2023). People with young-onset dementia and their family caregivers discussing euthanasia: A qualitative analysis of their considerations. Patient Education and Counseling, 115, 107882. https://doi.org/10.1016/j.pec.2023.107882
Velasco-Sanz, Tamara Raquel y Rayón-Valpuesta, Esperanza (2016). Instrucciones previas en cuidados intensivos: competencias de los profesionales sanitarios. Medicina Intensiva, 40(3), 154-162. https://doi.org/10.1016/j.medin.2015.04.011
Vogel, Asmus, Waldorff, Frans Boch y Waldemar, Gunhild (2010). Impaired awareness of deficits and neuropsychiatric symptoms in early Alzheimer’s disease: the Danish Alzheimer Intervention Study (DAISY). The Journal of neuropsychiatry and clinical neurosciences, 22(1), 93-99. https://doi.org/10.1176/jnp.2010.22.1.93
Zabala, Jaime y Díaz, José. (2010). Reflexión sobre el desarrollo y utilidad de las instrucciones previas. Medicina de Familia. SEMERGEN, 36(5), 266-272.