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Intensive Care Medicine

, 34:2300 | Cite as

End-of-life care in Spain: legal framework

  • Lluís Cabré
  • María Casado
  • Jordi Mancebo
Legal and Ethical Issues on Clinical Research

Introduction

Prominent cases affecting care at the end of life in critically ill patients have been reported in several European countries [1, 2]. These cases have fueled a necessary debate regarding the need of having a legal framework to appropriately deal with these issues [3, 4].

In Spain, there is no specific legislation regulating the withdrawal or withholding of treatment in end-of-life care or in critical patients on life support. However, the avoidance of inappropriate prolongation of life and the withdrawal or withholding of life support when the patient desires it or when it is considered futile is considered good clinical practice [5]. This decision takes place in the confidential context of the physician–patient relationship.

A few months ago, a patient who was permanently a ventilator dependent because of a progressive muscle dystrophia, asked for ventilator withdrawal. This patient, who had always complete consciousness to take decisions, was admitted in a hospital owned...

Keywords

Brain Death Penal Code Spanish Society Persistent Vegetative State Assisted Suicide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Maggiore SM, Antonelli M (2005) Euthanasia, therapeutic obstinacy or something else? An Italian case. Intensive Care Med 31:997–998PubMedCrossRefGoogle Scholar
  2. 2.
    Lemaire F (2006) Do we need (good) laws for end of life in ICUs? Intensive Care Med 32:787PubMedCrossRefGoogle Scholar
  3. 3.
    Lemaire FJP (2004) A law for end of life care in France? Intensive Care Med 30:2120PubMedCrossRefGoogle Scholar
  4. 4.
    Giannini A (2005) ICU physicians, end-of-life care, and the law. Intensive Care Med 31:1725PubMedCrossRefGoogle Scholar
  5. 5.
    Cabré LI, Abizanda R, Baigorri F, Blanch L, Campos JM, Irribarren S, Mancebo J, Martín MC, Martínez K, Monzón JL, Nolla M, Rodriguez A, Sánchez JM, Saralegui I, Solsona JF, y Grupo de Bioética de la SEMICYUC (2006) Código ético de la SEMICYUC. Med Intensiva 30:68–73CrossRefGoogle Scholar
  6. 6.
  7. 7.
    Cabré L, Solsona JF, y Grupo de trabajo de Bioética de la SEMICYUC (2002) Limitación del esfuerzo terapéutico en medicina intensiva. Med Intensiva 26:304–311Google Scholar
  8. 8.
    Cabré L, Mancebo J, Solsona JF, Saura P, Gich I, Blanch L, Carrasco G, Martín MC, The bioethics working group of the SEMICYUC (2005) Multicenter study of the multiple organ dysfunction syndrome in intensive care units: the usefulness of sequential organ failure assessment scores in decision making. Intensive Care Med 31:927–933PubMedCrossRefGoogle Scholar
  9. 9.
    Bioética y medicina intensiva. Dilemas éticos en el paciente crítico. Coordinadores: J.A. Gómez Rubí, R. Abizanda Campos. Edika Med. Barcelona 1998Google Scholar
  10. 10.
    Decisiones terapéuticas al final de la vida. Coordinador: LI. Cabré Pericas. Edika Med. Barcelona 2003Google Scholar
  11. 11.
    Organ extraction and transplantation are regulated by Law 30/1979, of October 27, and its development by Royal Decree 2070/1999, of December 30Google Scholar
  12. 12.
    Ley orgánica 10/1995 de 23 de Noviembre del Código PenalGoogle Scholar
  13. 13.
    Michalsen A, Reinhart K (2006) “Euthanasia”: a confusing term, abused under the Nazi regime and misused in present end-of-life debate. Intensive Care Med 32:1304–1310PubMedCrossRefGoogle Scholar
  14. 14.
    Del Nogal F (2006) Opiates at the end of life in an emergency department in Spain; euthanasia or good clinical practice? Intensive Care Med 32:1086–1087CrossRefGoogle Scholar
  15. 15.
    Audiencia Provincial de Madrid. Auto No. 47/2008. Madrid 21 de Enero 2008Google Scholar
  16. 16.
    Silverman HJ (2005) Withdrawal of feeding-tubes from incompetent patients: the Terri Schiavo case raises new issues regarding who decides in end-of-life decision making. Intensive Care Med 31:480–481PubMedCrossRefGoogle Scholar
  17. 17.
    Law 21/2000 of December 29, regarding the patient’s rights to information about the health and autonomy and clinical documentation. DOGC no. 3303 of 11 January 2001Google Scholar
  18. 18.
    Cal MA, Latour J, Reyes M, Palencia E (2003) Recomendaciones de la 6ª conferencia de consenso de la SEMICYUC. Estado vegetativo persistente post anoxia en el adulto. Med Intensiva 27:544–555Google Scholar
  19. 19.
    European charter of patients’ rights. Rome, November 2002Google Scholar
  20. 20.
    Spanish society for palliative care. http://www.secpal.com. Accessed on 12 March 2007
  21. 21.
    Spanish Society of Neonatology (2002) Decisiones de limitación del esfuerzo terapéutico en recién nacidos críticos: estudio multicéntrico. Anales Españoles de Pediatria 57:547–553Google Scholar
  22. 22.
    Instrumento de ratificación del Convenio para la protección de los derechos humanos y la dignidad del ser humano con respecto a las aplicaciones de la biología y la medicina (Convenio relativo a los derechos humanos y la biomedicina), hecho en Oviedo el 4 de abril de 1997. B·O.E. (no. 251) de 20 de Octubre de 1999Google Scholar
  23. 23.
    Esteban A, Gordo F, Solsona JF, Alia I, Caballero J, Bouza C, Alcala-Zamora J, Cook DJ, Sanchez JM, Abizanda R, Miro G, Fernandez Del Cabo MJ, de Miguel E, Santos JA, Balerdi BL (2001) Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study. Intensive Care Med 27:1744–1749PubMedCrossRefGoogle Scholar
  24. 24.
    Vincent JL (2006) End-of-life practice in Belgium and the new euthanasia law. Intensive Care Med 32:1908–1911PubMedCrossRefGoogle Scholar
  25. 25.
    Quality indicators in critically ill patients. http://www.calidad.semicyuc.org/ http://www.esicm.org/PAGE_guidelinesandrecommendations?5sg4. Accessed on 4 September 2007
  26. 26.
    Catalan consultative committee on bioethics: http://www.gencat.net/salut/depsan/units/sanitat/html/ca/consells/spbioe00.htm. Accessed on 12 March 2007
  27. 27.
    Observatory on Bioethics and Law. http://www.bioeticayderecho.ub.es. Accessed on 12 March 2007 and http://www.ub.edu/fildt/bioetica.htm. Accessed on 12 March 2007
  28. 28.
    Institut Borja de Bioética. http://www.ibbioetica.org/. Accessed on 12 March 2007
  29. 29.

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Servei Medicina IntensivaHospital de Barcelona. SCIASBarcelonaSpain
  2. 2.Observatori de Bioètica i Dret. UBCátedra UNESCOBarcelonaSpain
  3. 3.Servei Medicina IntensivaHospital de Sant PauBarcelonaSpain

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