In Spain, there are currently 3 different proposals for an organic law, presented by different political groups, relating to the end-of-life process. The Citizens` Group presented the “legislative proposal on the rights and guarantees of the dignity of the person before the last process of his life”, while the Socialist Group presented the “legislative proposal regulating human rights before the last process of life”. Both bills are essentially consistent with what is regulated regionally, taking into account palliative sedation and the pain phase, rather than including universal nuances such as the requirement for professionals to consult the register of living wills before a patient who is actually unable to work, or the right to individual placement and family and spiritual support. More importantly, they contain the deletion of point 3 of the wording of Article 11 of the Patients` Autonomy Act (Table 3), thus omitting the mention of lex artis and, in the case of citizens, adding the right of professionals to conscientious objection against the legal obligation to respect the will. the patient`s values, beliefs and preferences in clinical decision-making (Article 15). Both peculiarities are controversial and are rejected by the end-of-life medical care group of the Collegiate Medical Organization and the Spanish Society of Palliative Care (SECPAL)32. To ignore the lex artis, which is the true guarantee of good medical practice, would be to change its foundations on the basis of scientific evidence, ethical foundations and legal standards. According to the latest data presented by secpal, only half of patients in Spain who need it receive special palliative care. This means that about 60,000 people die each year, with intense avoidable suffering, because they are not properly cared for. An advanced country must have resources to alleviate human suffering, other than to end the life of the person who suffers from it. The debate on euthanasia should be based on extensive experience of comprehensive and adequate end-of-life care that could have an impact on social opinion as to the need for a possible change in the law.

Without going into the casuistic analysis typical of an ethics committee, we propose to briefly describe some aspects of an ethical nature that must be taken into account when explaining this final process, in order to ensure at all times respect for the inherent dignity of the patient and, in turn, to ensure the highest quality and maximum well-being in the last phase of your life. Proposal for an organic law on euthanasia of the Podemos group (rejected by the Congress in March 2017) We intend to address in this article the ethical, medico-legal and legal aspects in this regard in a comprehensive and coordinated way, so that the health professional has the necessary update to act in accordance with the lex artis. within the current legal framework and promote the reflection of the professional community on this issue in anticipation of possible future regulatory changes. This article analyzes the vast subject of euthanasia, but from a very specific point of view, that of its social implications. Here, it is argued that euthanasia is not exclusively an individual decision, but above all has a significant social impact. There are many countries around us that have specific laws on the end-of-life process, and some of them have even passed laws on euthanasia and medically assisted suicide. The laws of Belgium, the Netherlands, Luxembourg, Switzerland, Canada and some US states (e.g. Oregon, Washington and California) differ in the latter sense, and the current debate on end-of-life support can be demagogic and superficial if it does not take into account all the actors involved in the process. The proposal for the decriminalisation of Article 143, i.e. the decriminalisation of euthanasia and assisted suicide, should take into account the associated risks arising from a possible impairment of decision-making power in end-of-life situations, and the relevant protocols should be approved and developed appropriately in advance.

There is no room for generalization and the debate is not considered viable without prior ethical and medico-legal reflection involving the professionals and patients directly involved. Law 41/2002 regulating the autonomy of patients and the rights and obligations with regard to clinical information and documentation19, which drew up the above-mentioned Oviedo20 Convention in Spain, adequately reflects these aspects. Every person or patient has the right to receive truthful information about their process and disease, to refuse treatment, to limit therapeutic effort and to choose between available options. The principle of patient autonomy in the process of death can be articulated by informed decision-making appropriate at that time or by carrying out a DVA. Various regional regulations22 have made it possible to develop and implement them, but there is a need to further advance and improve advance care planning, as well as knowledge of the register of living wills and its documents and its accessibility, both by citizens themselves and by the professionals who visit it14. In recent months, the political debate about a dignified death in Spain has been significantly fuelled. While this is not the first time this debate has reached the Congress of Deputies, various political parties have recently tabled motions to address end-of-life conditions, including the decriminalization of euthanasia in such a motion.1-3 Some of these laws explicitly refer to the difference between regulated end-of-life procedures and the concept commonly identified as euthanasia. For example, article 143 of the current Penal Code32 criminalizes assisted suicide. It is not considered a punished case, the limitation of therapeutic efforts before the futility of treatment and the irreversibility of a disease that allows death by withdrawal or non-initiation of the maintenance of life. Offences in this context are listed in Table 2 in accordance with the current wording of the Penal Code, with particular emphasis on the planned reduction of the sentence in the cases referred to in article 143.4. The subject of the debate is by no means simple. The concept of euthanasia can be misleading and respond to subjective interpretations that currently polarize society.

However, there is an urgent need to establish end-of-life care as a priority and protocol to ensure the universalization of palliative care for all populations. Comprehensive care for patients in this situation should be strengthened in order to maximize well-being, which can have a direct impact on decision-making in this regard. Concepts such as the limitation of therapeutic effort, therapeutic futility or proportionality of care must be addressed jointly and sensitively between health professionals, patients and relatives, while preserving the patient`s autonomy. Public authorities and health institutions need to improve pedagogy through decision-making tools, which are little used, by encouraging their inclusion as a clinical safety instrument in the lex artis, which also increases the legal certainty of professionals.