The role of the ethics expert in Spanish legislation on euthanasia and mental health

Abstract

This article examines the assessment of mental capacity in the context of euthanasia,particularly when requested by patients with mental illnesses. It proposes a holisticalternative approach to the traditional functional model, arguing that the latter isinsufficient to capture the complexity of these patients’ decisions. Using approachesbased on narrative, hermeneutic, and dialogical ethics, it offers an evaluation thatconsiders the patient’s life story, values, and context. Shared decision-making andempathy are identified as fundamental components to ensure informed and consensualdecisions, promoting an environment of respect and mutual understanding. Thearticle reviews Spanish legislation on euthanasia, highlighting the need to includemedical ethics experts in the Guarantee and Evaluation Commissions. These expertsprovide a comprehensive ethical perspective essential for addressing the ethicalcomplexities in euthanasia requests and ensuring fair decisions that reflect the patient’strue will. It recommends reviewing and expanding current protocols, as wellas including continuous ethics training to improve medical practice in this context.The conclusions suggest that an assessment of mental capacity based on ethicalprinciples and an integrated narrative can significantly improve medical practiceand decision-making in euthanasia, especially for these patients. Furthermore, theinclusion of ethics experts in the commissions can provide a more humane andjust perspective, ensuring that decisions respect the patient’s dignity and autonomy.