How euthanasia works in Spain

In March 2021 the Spanish government passed ground-breaking (if not controversial) legislation on euthanasia in Spain.

The law went beyond traditional euthanasia and, in doing so, it became the fourth European nation to decriminalise assisted suicide following the Netherlands, Belgium and Luxembourg.

The bill, which can be found here, came into law later that year in June, and allows medical staff to intentionally end life in order to relieve the 'intolerable suffering' of patients.

It has been controversial since its initial vote in the Spanish Congress. 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 at the time as creating a "a more humane and fair society" by Health Minister Carolina Darias - it outraged many conservative and religious groups.

A full breakdown with a useful question and answer guide to the rules can be found here on the Spanish Department of Health website.

READ ALSO: TODAY: Spain's euthanasia law comes into effect

Upheld in court

Despite the widespread opposition in political and even in some medical circles, in September 2023 Spain's Euthanasia law was upheld in the Spanish constitutional court with a large majority - nine votes in favour with two votes against - a firm rejection of an appeal lodged by far-right party Vox against the law.

So what does the law say and how does euthanasia in Spain actually work?

READ ALSO: One year since Spain's euthanasia law was passed, what has changed?

What are the legal requirements?

The process of deciding, applying, arranging and undertaking it is as follows.

Firstly, in order to request a euthanasia procedure in Spain, the following requirements must be met. The applicant must:

• Be of legal age.
• Be capable and conscious at the time of the request.
• Have Spanish nationality, legal residence in the country, or a certificate accrediting a period of residence in Spain of more than one year.
• Suffer from a serious and incurable illness or a serious, chronic and disabling condition.
• Have voluntarily made two separate applications that are not the result of any external pressure, with at least fifteen calendar days between the two applications.
• Give informed consent prior to receiving the final procedure.

What are the steps?

Step one is to find a doctor willing to support the application and carry out the procedure. That may be more difficult than you imagine in Spain. Since the legislation was first passed, thousands of doctors across Spain have refused to do any euthanasia interventions and have ruled themselves out of the process entirely on the grounds of being 'medical objectors'.

In fact, as of 2022, in six regions where data is available, it is believed upwards of 4,500 doctors have objected to the procedures, either refusing to carry it out or withdrawing from the process altogether. In Madrid almost 3,000 doctors objected in the first year alone.

Once you've found a doctor, you make your first written request.

Step two is to make a second request 15 days later. Once a minimum of 15 days have passed since the first application, the applicant must submit the 2nd application to your doctor. This period is mandatory and intended as a period of reflection.

If the second request is made, within a couple of days the doctor will resume the deliberative process and inform the relevant medical bodies and family of the patient's intention. The applicant then signs an informed consent form.

Step three is a clinical examination by a consultant doctor -- a second opinion of sorts. The doctor in charge of your application must by law consult with a second doctor, who, after studying your history and examining you, confirms that the application meets the requirements of the law and issues a report within 10 days of the second application being made.

Step four is sending off the application to the La Comisión de Garantía y Evaluación (CGE). The chair of the CGE appoints a doctor and lawyer to examine the history and may interview the healthcare team and applicant. The CGE issues a report within 7 days of the application.

As part of the CGE checks, you may be interviewed by phone, video call or even through a home visit. Within 2 days of any interview the CGE decides and sends the result to the doctor in charge of your application. If it is denied, you can appeal the decision (this must be done within 15 days) and the CGE then has 20 days to respond. If no response is made, the application is considered denied.

If the decision of the CGE is favourable, however, you can then decide when, how and where to die.

Spain's Euthanasia Law does not stipulate a time limit on this, though the Ministry of Health's Manual of Good Practice recommends that, after about 15 days, a postponement of between 1 and 2 months should be requested, but ultimately it is up to the patient, family, and health care team responsible.

What about the procedure itself?

According to the Ministry of Health website, the euthanasia procedure "may be carried out in public and private or subsidised healthcare centres, or in the patient's home, without access and quality of care being impaired by the place where it is carried out or by the exercise of healthcare objection."

Patients have the right to be accompanied by their relatives and friends and treated with the utmost respect and discretion.