Spain’s law regulating euthanasia comes into force

Organic Law 3/2021 of 24 March regulating euthanasia came into force on 25 June 2021, three months after its publication in the BOE on 25 March. Congress had given it final approval on 18 March. The law regulates what it calls “assistance in dying”, which is included in the common portfolio of services of the National Health System and is publicly funded. This note summarises what the text provides, without entering into the underlying debate.

Who can request it

The law distinguishes two modalities: a health professional directly administers the substance to the patient, or prescribes or supplies a substance that the patient takes themselves. To request it, the person must have a serious and incurable illness or a serious, chronic and disabling condition, certified by the doctor in charge, involving constant and intolerable physical or psychological suffering.

In addition, article 5 requires Spanish nationality, legal residence or a registration certificate showing more than twelve months in Spain; being of legal age and capable and conscious at the time of the request; having received in writing information about the medical condition, including alternatives and palliative care; making two voluntary requests, in writing and free of outside pressure, at least fifteen calendar days apart; and giving informed consent before receiving the service, which is added to the medical record.

The procedure

After the first request, the doctor in charge opens a deliberative process with the patient on the diagnosis, the alternatives and palliative care, and explains it in writing. After 24 hours, the doctor asks the patient whether they wish to continue and, if so, obtains signed informed consent. A consulting doctor examines the patient and issues a report within ten calendar days of the second request. The regional Guarantee and Evaluation Commission then steps in: its chair appoints two members, a doctor and a lawyer, who verify within seven calendar days that the requirements are met; if they disagree, the full commission decides.

If the doctor in charge refuses the request, this must be done in writing with reasons, and the patient may appeal to the commission within fifteen calendar days. The service may be provided in public, private or contracted health centres, or at home, and access to and quality of care may not be reduced by conscientious objection or by the place where care is given.

Advance directives and conscientious objection

If the patient is not in full possession of their faculties and cannot give free, voluntary and conscious consent, the law allows the service to be provided in line with an advance directive, living will, advance wishes or other legally recognised equivalent document, if it was signed earlier and the other requirements are met. In that case, the request may be submitted by another adult with full capacity, accompanied by the document. The advance directive is therefore the route the law provides for these situations.

Health professionals directly involved may object on grounds of conscience. The objection must be declared in advance and in writing, and each health authority must set up a confidential register of objectors. Every autonomous community, as well as Ceuta and Melilla, must have a Guarantee and Evaluation Commission of at least seven members, including doctors, nurses and lawyers; according to the press, not all had been set up by the day the law came into force. In Catalonia, the Govern approved on 22 June a decree-law creating the Catalan Guarantee and Evaluation Commission and the register of health professionals who object on grounds of conscience.

Vox and the PP have filed appeals of unconstitutionality against the law with the Constitutional Court. The law is in force while they are decided: filing an appeal does not by itself suspend its application.

It is a sensitive law, with its own procedure and safeguards, best understood through what its text says.