Organic Law 3/2021, of March 24, will take effect on June 25, 2021. This act regulates the rights of all people who meet the established conditions to request and receive the assistance needed to die in any public or private hospital (including home care), as an additional service of the National Health System.
According to the act, assisted dying must be provided with the utmost care and professionalism by the healthcare professionals. This includes all professionals on the healthcare staff, which means physical therapists as well. Our involvement is even greater considering that one of the patient groups that can request it will be those who suffer from conditions we are providing rehabilitative care for.
If conscious, the patient must indicate the method by which they wish to receive the assisted dying service. There are two ways:
1. Direct administration to the patient of a substance by the competent medical professional. With this option, all healthcare professionals will provide care to the patient until the moment of their death.
2. The patient is prescribed or supplied by the medical professional with a substance that can be self-administered to cause their own death. With this option, after prescribing the substance that the patient will self-administer, the healthcare professionals must provide the due task of observation and support until the moment of death.
As you can see, the act involves all healthcare professionals in this process at all times, so it is important that physical therapists understand this service.
The requirements for requesting this service include being of legal age and having full use of their mental faculties, that they request it directly or through instructions given prior to losing their cognitive capacity, and that they are in any of the following circumstances:
-“Severe, chronic and incapacitating condition”: limitations that have a direct impact on physical autonomy and daily activities that prevent them from caring for themselves. And on the capabilities of expression and relationship, which have a associated physical or psychological pain that is constant and uncontrollable for those who suffer from it, as long as there is certainty or a great probability that such limitations will persist over time, with no possible cure or notable improvement. This can sometimes mean absolute dependence on technological support.
-“Serious and incurable disease”: which, due to their nature, cause constant and unbearable physical or psychological suffering with no possible relief that the person considers tolerable, with a limited life expectancy, in a context of progressive frailty.
Two requests must be made, 15 days apart, and an informed consent must be signed.
As you can see, it is highly probable that our patients will be the ones requesting this service, and we need to be ready to meet their demands and collaborate in the process.
Finally, I would like to inform you that you have the right to indicate your conscientious objection to providing this service. You must indicate this in advance to be included in a Register of Objectors, which has no negative effect on the professionals included in it. Prior conscientious objection is the only way to avoid taking part directly in this assistance in dying, if it is something that affects you morally.
Cristina Núñez is professor of Health Law