Advance Care Planning and end-of-life care: A Spanish perspective

We need to clarify the meaning of the terms we employ to describe end-of-life interventions. Surely this should not be necessary in countries such as USA (although the debate around the “Obama death panels” is worrying), Canada, Australia and, probably, in Europe (in the UK or Holland). However it is a real and important problem in many countries around the world, for example in Mediterranean countries such as Portugal, Italy, France, Greece and, of course, Spain.

The more problematic term is “euthanasia”, a highly toxic word, because its meaning seems to be different for each person in each country. The toxicity increases with the use of the adjectives “passive”, “active”, and so on, thereby blocking any possibility of philosophical, clinical, ethical or legal consensus.

In Europe it should not be very difficult to reach basic agreements about the ethical acceptability of:

 a) palliative care as the core strategy for end-of-life care;

 b) voluntary and informed refusal, by competent patients,
 of interventions even if this would lead to their death;

 c) palliative sedation, even if this could hasten death;

 d) the withdrawal or withholding of those interventions that can be categorised clearly as
   “treatments”, such as mechanical ventilation or dialysis, when they are considered futile;

 e) the withdrawal of any kind of life support in the event of brain death,
   should the patient be a candidate for organ donation or not;

 f) the implementation of advance directives or decisions adopted by qualified surrogates
   on behalf of the incompetent patient.

These agreements should then be transferred into legislation of each country and of the European Union. The more that we are able to reach consensus about these topics, the more that the implementation of Advance Care Planning programs in European healthcare settings would be increased, because people, health professionals and politicians would not confuse this with “euthanasia”. In Europe it is now more difficult to reach consensus about interventions like: a) Euthanasia or assisted suicide; b) Withdrawal of food and fluids.