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HEALTH

One year since Spain’s euthanasia law was passed, what has changed?

A year since Spain's euthanasia law was passed, there have been over 150 assisted deaths in the country but still many objectors from within the medical sphere. Here's what the data reveals about Spain's approach to this highly divisive practice.

One year since Spain's euthanasia law was passed, what has changed?
Supporters of Spain's euthanasia law hold signs saying: "To choose to die without suffering" and "I decide when and how to die" during a March 2021 demonstration in Madrid. Photo: JAVIER SORIANO/ AFP

Spain’s historic euthanasia law was passed a year ago on June 25th, 2021.

Since that day at least 171 people have ended their lives through the assisted dying procedure, although the statistics to date are both regional and provisional. That number could, in reality, be higher.

The figure is based on figures from Spanish newspaper El Mundo, although it must be said that it doesn’t include the regions of Asturias and La Rioja, where the data is not yet available.

Before the landmark legislation, assisting somebody who wanted to die was punishable by up to ten years in prison, and the law, which made Spain the fourth country in Europe to allow people to end their own life, following the Netherlands, Belgium and Luxembourg, was as controversial as it was groundbreaking.

Pedro Sánchez’s PSOE-led coalition government had to rely on the congressional support of minor left-wing parties to pass the bill, and although it was celebrated by right-to-die campaigners in Spanish society -described as creating a “a more humane and fair society,” by Health Minister Carolina Darias – it outraged many conservative and religious groups.

 
The law

Although widely known as Spain’s euthanasia law, in reality the legislation prescribes two forms of dying: euthanasia and assisted suicide.

Euthanasia is the procedure of prematurely ending a life to relieve suffering or pain – via lethal injection administered by a doctor, for example.

Assisted suicide, however, is undertaken by the person themselves with help.

Both euthanasia and assisted suicide can be carried out on consenting patients suffering from chronic and debilitating conditions, incurable illness, or conditions that cause immense suffering.

You must be an adult Spanish national or have legal residency in Spain, and be “fully aware and conscious” when you make the request, which must submitted twice in writing, two weeks apart.

But that doesn’t mean that applying, or having your application accepted, is easy.

The Local had delved into the realities of Spain’s historic euthanasia legislation one year on.

Regional variations

Although there are still no officially collected and aggregated statistics on a national level, and even some slight variation on the figures within Spanish media outlets, using provisional regional data it is possible to gage how the law has been implemented in its first year.

Nationally speaking, it seems at least 336 Spaniards requested euthanasia procedures in the first year of legal euthanasia, of which 171 were performed, 18 applications rejected, and 43 still pending decisions. 

But data from the first year of euthanasia procedures paints an interesting regional picture. Euthanasia and assisted dying have so far been, it seems, concentrated in certain regions of Spain.

Catalonia, for example, has performed 60 in the first year alone, while Andalusia, with one million more inhabitants than Catalonia, just 11.

In Andalusia, just 19 applications were made, of which 11 were accepted, six rejected and two still pending. In Catalonia that figure was 137.

After Catalonia, Basque Country had the second most euthanasia procedures, with 25 of 75 applications accepted. Third was Madrid, with 19, and fourth the Valencian Community, where 13 procedures have already been completed out of 23 applications made. 

On the Balearic Islands, eight were carried out of the 17 applications, whereas in the Canary Islands seven applications were made with four still awaiting a decision.

In Castilla-La Mancha eight applied, with four approved. But in Galicia, it seems the Galician government have a lower threshold for accepting euthanasia applications: of the 19 applications it received this year, just four were accepted. 

Similarly, in Castile y Leon, just two of the seven applications were accepted, and it is believed that the process became so drawn out that some patients even died before receiving a verdict.

In Murcia, on the other hand, four of the five total applications have already been carried out. In Cantabria, 12 procedures were requested, five completed, two rejected, and one still pending decision, 

Across the rest of Spain’s autonomous communities, none have completed more than five procedures.

How quickly is euthanasia approved in Spain?

Judging from the raw numbers, it seems that Catalonia and the Basque Country are the most willing to grant euthanasia procedures, but are also the fastest bureaucratically speaking: it takes patients, on average, 41 days from application to procedure in the two northern regions.

In Andalusia and Madrid, however, the process is much slower. In Andalusia, for example, the regional government took five months to even implement the law, and it is believed that they have kept applications waiting as long as three months due to a convoluted bureaucratic process that passes the application between different doctors with no streamlined system, which leads to a lag in processing.

Other regions, however, have already set up systems to deal with the applications.

In Catalonia, Navarre, the Basque Country and the Canary Islands, applications are dealt with by specially created teams made up of at least one doctor and a nurse who have studied and specialise in the implementation of the law. 

Medical objections

While the issue of euthanasia has long been politically and religiously controversial, the law has also divided doctors. In just the six regions alone where data is available, it is believed 4,500 doctors have objected to the procedures, either refusing to carry it out or withdrawing from the process altogether. 

Madrid has had the most objections from doctors, with almost 3,000 in the first year alone, while in Andalusia over 500 have objected.

Interestingly, even in a region with very few applications such as Castille y León, where only seven patients requested the procedure, over 400 doctors have ruled themselves out of the euthanasia process. That is more than Catalonia (167) where the most applications and procedures were recorded.

However many believe, the figures, admittedly provisional and very patchy at a national level, for now, could be hiding greater numbers of doctors who are uncomfortable with Spain’s new euthanasia law. 

The president of the Ethics Commission of the Andalusian Council of Medical Associations, Dr. Ángel Hernández Gil, said that “there are a very large number of doctors who are conscientious objectors” but are not recorded in the official statistics “because they are only registering as conscientious objectors when the request arrives. In the event that the application does not arrive, people will not register,” he explained in the Spanish press this week.

Speaking as a representative of the medical profession in Spain’s most populous region, Hernández Gil suggested so many doctors are against euthanasia because they believe “is not within the purpose of medicine.”

“Our position has nothing to do with any kind of political ideology, religious principle or moral principles,” he added.

“We understand that euthanasia is not a medical act.”

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ECONOMY

Increasing food prices put Spaniards at risk of poor nutrition

The skyrocketing prices of basic foods are putting Spaniards at risk of poor nutrition and increasing the use of food banks.

Increasing food prices put Spaniards at risk of poor nutrition

The effects of Spain’s rampant inflation and upwards price pressures on food are having an impact not only on Spaniards bank accounts, but their health too.

In Spain, supermarket prices have skyrocketed in recent months. The price of a melon, for example, recently topped €13, an increase so extreme that it highlights the nutritional quality of poorer Spaniards’ lives during times of economic hardship, and how they can be priced out of healthy, nutritious goods.

According to Spain’s national statistics body, the INE, in June of this year the prices of 46 household products were more expensive and above the overall Consumer Price Index (the rate used to calculate inflation, known as CPI) of 10.2 percent.

But in times of economic crisis, rising shopping basket prices can also effect the quality of nutrition people are able to access, and this is especially true in lower income families.

READ ALSO: Spain’s July inflation rate reaches new 38-year high

Figures from the Food and Agriculture Organization of the United Nations (FAO) suggest that food prices have reached their highest level since 1990.

The Organization of Consumers and Users (OCU) warned in July of a 15.2 percent price increase in the price of food shopping in a year. OCU figures also point to a 52.6 percent increase in olive oil prices and a rise of 12.4 percent for fruit and vegetables.

Spaniards across the country are being priced out of balanced, healthy diets and surviving on a deficit of fruits, vegetables, fish and olive oil – staples of the much famed Mediterranean diet – and types of the food products that have increased in price.

The rising price of staple foods can end up causing consumers to look to “low quality, cheap and appetite-relied” products, Professor of Nutrition at the Complutense University of Madrid, Jesús Román, told the Spanish press last week.

READ MORE: Rising inflation in Spain: Six cost-cutting ways to fight it

Rising prices, he says, forces poorer income families to “opt for cheaper foods that are usually of lower quality, restricting those that are healthier.”

Unable to afford to eat healthily, many Spaniards are now forced to opt for cheaper and unhealthier alternatives. The consequences are clear, particularly on children who can’t access a nutritional diet during their developmental years.

In a Report on Childhood Obesity in Spain put together by supermarket chain Eroski, they concluded that childhood obesity is “a form of excessive malnutrition that, in many cases, also continues in adulthood.”

Research by the International University of Valencia (VIU) indicates that in the decade between 2011 and 2021 the percentage of overweight children in Spain increased to almost 40 percent. Among adolescents, that figure is 30 percent.

The Spanish government recently introduced the National Strategic Plan for the Reduction of Childhood Obesity with the aim of reducing obesity rates by 25 percent over the next decade.

Spain is one of the EU’s member states with the highest correlation between the risk of child poverty and obesity, and with rising food prices making a healthier, balanced diet more expensive and difficult to access, the combination of post-pandemic economic recovery and record inflationary pressures on food prices could push more into poverty.

Data published last May by the Spanish Federation of Food Banks (Fesbal) shows that in 2022, 20 percent more Spaniards will visit and rely on food banks than in 2021.

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