Spain embroiled in end-of-life care row over fate of gravely ill woman

The family of a Spanish woman with an advanced degenerative disease was on Wednesday in conflict with a hospital that refuses to resuscitate her if she goes into cardiorespiratory arrest, arguing it would cause her unnecessary suffering.

Spain embroiled in end-of-life care row over fate of gravely ill woman
Photo: AFP

The family of a Spanish woman with an advanced degenerative disease was on Wednesday in conflict with a hospital that refuses to resuscitate her if she goes into cardiorespiratory arrest, arguing it would cause her unnecessary suffering.

The case, which has reached the courts, has sparked debate over end-of-life care in Spain and it mirrors recent similar high-profile cases elsewhere such as that of Vincent Lambert in France that has drawn in Pope Francis. 

French doctors last week began turning off life support for the quadriplegic road accident victim following a protracted battle with his family.

The Spanish case involves a 54-year-old woman, Maria Teresa, who for over two decades has suffered the effects of ataxia, a degenerative disease of the nervous system which causes difficulty walking, lack of coordination and slurred speech.

Her doctors have decided that if she goes into cardiorespiratory arrest, “advanced techniques of resuscitation” which are “aggressive and invasive” should not be used” since they would “not benefit” this patient, the Hospital Universitario Principe de Asturias which has treated her said in a statement.

Doctors consider that resuscitation would “generate suffering for the patient without providing a benefit” and the hospital has referred the case to a court in Alcala de Henares near Madrid where it is located, the statement added.

The hospital said the woman's clinical situation was “complex” and she had received “the best medical assistance possible”.

Her family has asked the court to ensure measures are taken to “guarantee Maria Teresa's life”, arguing that refusing to resuscitate her was the equivalent to “euthanasia”, top-selling daily newspaper El Pais reported Wednesday.

Contacted by AFP, the court in Alcala de Henares declined to confirm the newspaper report.

The woman “does not speak, but she listens and laughs….  Why won't they resuscitate her? She's not an animal,” Maria Teresa's brother Maximo told El Pais.

The Spanish Association of Cristian Lawyers, which is representing the woman's family, argues on its website that “keeping Teresa alive would represent hefty economic cost for the hospital”.

It will give a news conference on Thursday about the case.

The hospital said the woman's treatment has always been determined by “healthcare criteria, not economic ones”.

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How Spain could stamp out smoking

A fifth of Spain's population smokes on a daily basis. With such high numbers, here's how the country's pulmonologists propose to get smokers to quit.

Spain plans to get people to quit smoking
How Spain plans to get people to stop smoking. Photo: Khalil MAZRAAWI / AFP

For many outsiders, Spain is a nation of smokers. 

The stats from Spain’s Ministry of Health show that 23.3 percent of men smoke every day in Spain, compared with 16.4 percent of women.

For both males and females, the highest number of smokers are aged between 25 and 34, meaning that it’s the younger population who are smoking slightly more than the older generations. 

Spain’s pulmonologists are now pushing for the country’s tobacco laws to be tightened, claiming that reform is needed after the last legislation was approved a decade ago.

READ ALSO: Spain warns against smoking and vaping in public to avoid Covid infections

Why is smoking such a problem in Spain and what is being done about it?

The latest stats from the Spanish Ministry of Health show that lung cancer, often caused by smoking, is the third most frequently diagnosed cancer in Spain, with 29,549 cases diagnosed so far in 2021.

Given these high figures Spain’s Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has proposed five measures to help get people to stop smoking.

SEPAR points out that every time anti-smoking legislation is reformed and things for smokers made more difficult, the prevalence of smoking decreases.  

Smoking on terraces was banned in some regions during the pandemic. Photo: CRISTINA QUICLER / AFP
  • Price of tobacco to rise in 2022

The first point on their list is to raise the price of tobacco, which must cover all forms, from cigarettes to cigars, through to rolling tobacco, and electronic cigarettes.  

This first measure may soon become a reality as the Spanish government has already predicted that the price of tobacco will rise in 2022, after several years of stagnation.  

It is expected that tobacco will be responsible for almost a third of all special taxes received in 2022, equating to €21.8 billion.

According to the World Health Organization (WHO), “cheap tobacco” in Spain guarantees “a percentage of smokers above 30 percent”.

In Spain, the price of a pack of tobacco is around €5, which is much cheaper than in other countries. In Australia for example, a pack of tobacco costs around €22, and in the United Kingdom and France, each pack of tobacco costs around €12.4 and €10.5, respectively.

According to Dr. Carlos A. Jiménez Ruiz, pulmonologist and president of the society, the current anti-smoking law has “some deficiencies” that need to be addressed in order to develop legislation that is more effective and efficient, especially with regard to the prevention of tobacco consumption in young people, but also in helping smokers to stop smoking and in protecting the health of non-smokers. 

READ ALSO – Maps: Which beaches in Spain have banned smoking?

Besides increasing the cost of tobacco SEPAR proposes four other measures to get Spain to quit smoking. These include:

  • Banning the consumption of tobacco in public spaces, even outdoors
    During the pandemic, several regions approved a regulation to prohibit smoking on terraces. SEPAR proposes that smoking be prohibited not only in spaces such as terraces but also in sports stadiums, beaches, parks and bullrings, and that fines should be imposed for those who do not comply.

  • Establish generic packaging
    SEPAR also wants Spain to introduce generic packaging, which means no logos and images of the tobacco companies. This measure has also proven to lower the sales of tobacco in countries where it has been implemented, such as Australia and New Zealand. According to the latest statistics from the Australian National Drug Strategy Household Survey around 11.6 percent of adults in Australia smoke daily. 

  • The regulation of other smoking devices
    Despite the fact that all products that burn tobacco such as cigarettes are already regulated, SEPAR believes that it is also necessary to regulate the sale, consumption and advertising of electronic cigarettes. This is because e-cigarettes have become particularly popular among young people. 

  • Promote help for those seeking to quit smoking
    The last proposal is the creation and development of special units in public health departments to help people to stop smoking and to put more funds towards these programmes. 

How does Spain compare with other European countries when it comes to smoking?

According to the Organisation for Economic Cooperation and Development (OECD), while Spain does have a high number of smokers there are still several European countries that have more. The European countries with the highest number of smokers are Greece, Bulgaria and Hungary.

The latest European survey from 2020 shows that 42 percent of Greeks claim to be smokers, which is only slightly above Spain. 

On the other side, the European countries with the lowest number of smokers are mainly Nordic countries, such as Sweden, Finland, Iceland and Norway.