Three Years of Euthanasia in Spain: A Study by Luis Espericueta

Speed-read

• Euthanasia is one of the most sensitive topics; it affects the very essence of human life: suffering, death, and dignity.
• An academic who is actively devoted to this topic is Luis Espericueta.
• In June of this year, Espericueta published the study “Three Years of Euthanasia in Spain: Data, Controversies, and Challenges,” which is the focus of this interview.
• Spain has successfully implemented a solid and rights-protective euthanasia law, notable for its regulatory structure and the design of the application process.
• By the end of 2023, according to official reports from the Ministry of Health, Spain had recorded 1,515 requests for assistance in dying, of which 697 were carried out—approximately 46% of the total.
• Most requests involved euthanasia with intravenous administration, while medically assisted suicide accounted for only about 3.8%. During the first two years, the most common setting for the procedure was the patient’s home. Applicants were predominantly between 70 and 79 years old, and the conditions initially justifying the requests were mainly neurological, although since 2023, oncological diseases have slightly surpassed them.
• The system is being continuously refined, and the Spanish model is becoming a reference point in international legislation.

Euthanasia is one of the most sensitive topics; it affects the very essence of human life: suffering, death, and dignity. Debates on the subject often provoke strong reactions, as the right to life and each person’s right to decide for themselves how to end their life are in conflict. For example, physicians are trained to save lives, so actively participating in end-of-life care raises dilemmas. Some see euthanasia as a conflict with the Hippocratic Oath; others believe that assisting in dying with dignity is an expression of compassion. In addition, there is the question of religion.

It is worth noting that this decision primarily affects family members and loved ones, causing feelings of sadness and guilt. They must accept the decision, cope with it, and ultimately understand that a person who was part of their life is dying in this way. Countries that allow euthanasia introduce strict laws and multiple safeguards to ensure that every decision is voluntary, well considered, and justified.

The world’s first euthanasia law was approved in the Netherlands in 2001 and came into force on April 1, 2002. The patient must request euthanasia voluntarily and intentionally if they suffer from an illness or unbearable pain. All cases must be reported to the competent authorities for oversight and abuse prevention. After the Netherlands, other countries passed similar laws: Belgium (2002), Luxembourg (2009), Canada (2015), and Colombia (2015), and each country has developed its own criteria and controls.

Spain is the seventh country to legalize euthanasia, with its own law, the LORE (Organic Law Regulating Euthanasia). The Spanish model is considered one of the strictest in Europe. The first laws in the world established a standard of safety, ethics, and oversight, recognizing the patient’s right to a dignified death, but with strict conditions to prevent abuse. An academic who is actively devoted to this topic is Luis Espericueta.

The work of Luis Espericueta in bioethics and human rights

Luis Espericueta is a PhD candidate in bioethics and a researcher-in-training lecturer at the University of Granada. He is part of the ESPACYOS research group (Public Health Ethics for Action, Care, and Social Observation) and LIBERESP (Ibero-American Laboratory of Public Health), and he holds a law degree from UASLP, Mexico, and a master’s degree in Moral and Political Philosophy from the University of Salamanca. Espericueta also has experience as a human rights defender in his hometown, San Luis Potosí.

San Luis Potosí is the city where Francisco Javier Estrada Murguía, the first Mexican physicist, lived much of his life and where he conducted scientific research and contributed to technological progress in Latin America.

Among Espericueta’s publications are international studies on advance requests for medical assistance in dying, analyses of euthanasia in dementia contexts in Spain, and controversial cases such as that of the “Tarragona gunman.” He has addressed issues of transhumanist ethics, violence, and discrimination in Indigenous communities, as well as debates on morality and law in Latin America. Espericueta actively participates in research projects that contribute to generating knowledge on applied bioethics, social justice, and the legal and ethical challenges at the end of life. He has also been consulted by the UK Parliament during the drafting of its assisted dying bill.

Three years of euthanasia in Spain

In June of this year, Espericueta published the study “Three Years of Euthanasia in Spain: Data, Controversies, and Challenges.” Therefore, the topic of this interview is precisely this study. It should be noted that the three most recent official reports on euthanasia in Spain cover the period from June 25, 2021, to December 31, 2023. The reports for 2024 and 2025 have not yet been published, meaning there is no recent official data.

This is a very sensitive issue that requires not only access to and medical knowledge, but also an understanding of what the person is going through. What do you think has worked particularly well in Spain?

Luis Espericueta: Spain has successfully implemented a solid and rights-protective euthanasia law, which stands out for its regulatory structure and the design of the application process. In fact, I consider it one of the euthanasia laws with the strongest safeguards worldwide. In this sense, it is important to note that in Spain, euthanasia is recognized as both a right and a healthcare service. Personally, I believe these three years have served to integrate this new medical practice into health services. A notable example is the creation of “reference teams,” whose role is to advise, accompany, and support professionals in each territorial area in handling requests for assistance in dying.

Summary of the study

On March 18, 2021, Spain approved the Organic Law Regulating Euthanasia (LORE), which regulates the right of people with serious, chronic, or incurable illnesses to request the end of their lives with medical assistance. The law came into force on June 25, 2021, making Spain the seventh country in the world to legalize euthanasia and medically assisted suicide. Although the law uses the term “euthanasia,” in practice it also covers medically assisted suicide. The distinction is important: in euthanasia, the physician actively administers the lethal substance, whereas in medically assisted suicide, the patient takes the prepared medication themselves under medical supervision. Spanish law uses the term “medical assistance in dying” as a broad concept that includes both practices.

By the end of 2023, according to official reports from the Ministry of Health, Spain had recorded 1,515 requests for assistance in dying, of which 697 were carried out, approximately 46% of the total. The remaining requests were resolved through withdrawal, postponement, denial, or the applicant’s death before completion of the procedure. It is worth noting that euthanasia continues to represent a small percentage of total deaths in the country: 0.01% in 2021, 0.06% in 2022, and 0.07% in 2023—figures far below initial projections (around 5%) and comparable to countries such as the Netherlands and Canada.

Most requests involved euthanasia with intravenous administration, while medically assisted suicide accounted for only about 3.8%. During the first two years, the most common setting for the procedure was the patient’s home. Applicants were predominantly between 70 and 79 years old, and the conditions initially justifying requests were mainly neurological, although since 2023, oncological diseases have slightly surpassed them.

Challenges include third-party judicial intervention, delays in access to assistance, declarations of conscientious objection by some physicians, and adapting the system for patients with dementia and advance directives. Even so, the system is continually being refined, and the Spanish model is becoming a reference point in international legislation.

Legalization of euthanasia in Spain

“This new legal provision, which came into force on June 25, 2021, made Spain the seventh jurisdiction in the world to decriminalize and regulate both euthanasia and medically assisted suicide.” What do you think Spain has had the opportunity to learn from other countries, and how important is public opinion in this case? What aspects still need improvement?

Luis Espericueta: Spain was the fourth country in Europe to legalize euthanasia. Although the Benelux countries have extensive experience in its application, Spain has developed a model with its own characteristics. For example, for a person to access euthanasia in Spain, in addition to evaluations by two physicians, their request must be reviewed by a specialized interdisciplinary commission (the “Guarantee and Evaluation Commission”). In the Benelux countries, this prior control does not exist, which makes the Spanish measure an additional mechanism of oversight and legal compliance. This interdisciplinary control model has also been followed by Portugal’s assistance-in-dying law (not yet in force) and has been considered by British parliamentarians in drafting their own bill.

On the other hand, I believe that the legalization process and social acceptance of euthanasia in Spain have been influenced by high-profile Spanish cases, such as that of Ramón Sampedro, whose story inspired the movie Mar adentro, which won the Academy Award for Best Foreign Language Movie in 2005. Likewise, organizations such as Derecho a Morir Dignamente (DMD) have contributed to raising awareness, promoting public debate, and advocating for the legal recognition of the right to a dignified death.

In practice, there are challenges. Which do you consider the most crucial to resolve in the future? “Another major challenge in Spain is ensuring adequate access to assistance in dying.” This is a very important issue. What do you think would be the solution?

Luis Espericueta: There is currently no legal doubt about the legitimacy of assistance in dying in Spain. Therefore, the most important challenge is to maintain and improve what has been achieved. In this regard, although there have been major controversies around some high-profile cases, I believe one of the most significant challenges is making the management of euthanasia requests more efficient.

This challenge is reflected in several aspects; for example, in 2023, one in four people who requested euthanasia died before the process could be completed. Some specialists suggest that one possible cause is that terminal patients are informed about the option of assistance in dying at a very advanced stage of their illness. In any case, one unavoidable challenge is reducing the time between the request and the application of euthanasia. In 2023, the average was 67 days, whereas under optimal conditions, the procedure could be completed in just over 35 days.

Finally, and no less importantly, it is necessary to identify possible barriers to access to euthanasia. It cannot be ruled out that the actual number of people wishing to request it is higher than officially recorded, due to cases in which the responsible physician may be a conscientious objector—without having declared it—and the applicant is unable to find another available professional.

Measures that could help guarantee access to euthanasia include continued training and specialization of healthcare personnel in assistance in dying, ensuring that these professionals have adequate working conditions, and improving data collection and analysis systems. The latter is essential for identifying possible territorial inequalities or delays in processing and could be strengthened by learning from international experience. In this regard, proposals such as the creation of a Global Observatory for Medical Assistance in Dying have been mentioned.

“On June 16, 2021, almost three months after the final approval of the LORE, 50 members of parliament from the VOX parliamentary group filed a constitutional appeal… The Court concluded that the assistance-in-dying law is fully legitimate and constitutional and dismissed the appeal.” Here we could also mention the Hippocratic Oath, but the fact is that people who request this are going through indescribable suffering, and for them this step is extremely difficult, as it is for their families. How important are politicians’ words when we talk about euthanasia? We live in an era in which many diseases destroy patients’ quality of life and dignity. Should the medical profession have the final say?

Luis Espericueta: Politicians have the responsibility to give effect to the demands of the citizens who elected them. In this sense, it is relevant to note that the euthanasia law approved by the Spanish Parliament has the status of an “organic law,” which guarantees a higher level of stability and legal protection, since this type of law requires stricter legislative procedures and provides a solid framework for its application.

It should be emphasized that, unlike in other countries where the decriminalization of euthanasia arose from judicial rulings, in Spain, its recognition was achieved through an absolute parliamentary majority. This strengthens the legitimacy of the law, later consolidated by the Constitutional Court by linking euthanasia to the fundamental right to physical and moral integrity.

In this context, politicians must not only respect the euthanasia law but also ensure that its regulatory development and associated protocols adequately address the needs of those who request it and the healthcare professionals responsible for its implementation. In this latter aspect, researchers play a key role by analyzing its implementation and proposing evidence-based improvements.

Data analysis, challenges, and support

“According to the three annual reports on assistance in dying published to date by the Ministry of Health, covering the period from June 25, 2021, to December 31, 2023, a total of 1,515 requests for this healthcare service have been recorded in Spain.” Did this figure surprise you?

Luis Espericueta: This figure is relatively low compared to other countries. For example, in Canada, which has nearly 9 million fewer inhabitants than Spain, there were 19,660 requests in 2023 alone. Likewise, in New Zealand—a country with approximately nine times fewer inhabitants than Spain—1,066 requests were recorded in its latest annual report. This notable disparity had already been identified two years ago.

“Over the three years analyzed, most applicants belonged to the 70–79 age group.” Could these data be used in any way to provide additional support to older people? Do they receive sufficient emotional support?

Luis Espericueta: These data are indeed similar to those of other countries. According to the latest official reports, in Canada, the average age of people who received euthanasia fell within the same decade of life, while in New Zealand, 79% of applicants were aged 65 or older. These figures are very likely associated with the types of diseases and how they manifest in older patients.

On the other hand, in Spain, the euthanasia law establishes in Article 5.1.b) that every applicant must be informed about access to comprehensive palliative care and to benefits or services in accordance with dependency care regulations. In this context, it is relevant to highlight that the commissions responsible for evaluating requests are interdisciplinary, including social workers and mental health professionals, which helps ensure a comprehensive approach attentive to the needs of older patients.

Euthanasia and the culture of donation in Spain

“Indeed, in 2023, 271 requests were attributed to oncological diseases, compared to 266 corresponding to neurological conditions.” This was also the period after the pandemic. To what extent do you think the pandemic may have influenced these decisions?

Luis Espericueta: There is no evidence that the pandemic influenced subsequent requests for assistance in dying. In this regard, it should be recalled that the Spanish euthanasia law came into force on June 25, 2021, one year after the end of the last lockdown in Spain. Moreover, during that first year, only 173 requests were recorded, compared to 576 in 2022 and 766 in 2023. The difference observed in the first year could be explained by the fact that euthanasia was legalized halfway through 2021, and the system was just beginning to be implemented. It is therefore likely that the subsequent increase in requests reflects the progressive consolidation of the procedures and administrative structures necessary for its application.

“9% of the people who received assistance in dying expressed the desire to donate their organs after death.” No one can remain indifferent to this topic, but I must ask: How prepared must a society and a country be for a law of this kind?

Luis Espericueta: Spain is a world leader in organ donation and transplantation, with a deeply rooted culture of donation. Several decades of experience in this field have enabled the National Transplant Organization (ONT), together with healthcare personnel, to develop appropriate protocols to manage the particularities of organ donation after euthanasia, seeking to ensure safety and respect for patients. Moreover, it should be noted that this new type of donation is not exclusive to Spain but also occurs in countries such as Canada, Belgium, and the Netherlands.

Strengthening the Spanish euthanasia model through continuous effort

Regarding your study, which part raised new questions for you, and what is the most important thing you would like people to know about euthanasia in Spain?

Luis Espericueta: Thanks to the contact I have had with healthcare professionals involved in processing euthanasia requests, applicants and families of those who have requested assistance in dying, policymakers, and associations that promote a dignified death, I can affirm that there is a constant, serious, and cross-cutting effort to consolidate the progress achieved and strengthen the Spanish model, which has already become a reference for other international legislations.

Luis Espericueta’s work contributes significantly to the knowledge needed to better understand end-of-life decisions. Thanks to studies like his, we can learn more about the legal, social, and medical challenges that arise when implementing assisted dying practices. Although euthanasia is a topic that generates intense debates and deep emotions, it is important to approach it with humanity.

This is an opportunity to protect human dignity and provide appropriate support to those facing serious or incurable illnesses, who are, in fact, the most important.

Image courtesy of Luis Espericueta

Additional information

The statements made by Luis Espericueta are personal in nature and do not necessarily reflect the positions of the working groups with which he collaborates.

This work has been funded by the Ministry of Science and Innovation and the State Research Agency of the Government of Spain (10.13039/501100011033) within the framework of the R&D&I Project “INEDyTO II” (PID2020-118729RB-I00) and the “pre-doctoral contract grants” (PRE2021-098759), as well as by the “Ariadna Project: Evaluation of the Factors Conditioning the Grieving Processes Before and After Death by Euthanasia” (PPJIB-2024-55, University of Granada). Funding for the open access charge: University of Granada/CBUA.