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Resumen: La entrada en vigor de la Ley Orgánica de Regulación de la Eutanasia en junio de 2021 obliga a los clínicos a un replanteamiento de su quehacer profesional ante una nueva prestación que expande los límites de lo que hasta ahora se iba considerando correcto. Una nueva prestación que recae en todo el sistema sanitario, pero especialmente sobre los profesionales de atención primaria. Más allá de los aspectos procedimentales y de tipo moral, es necesario replantearse la valoración del paciente que expresa su deseo de morir. En esta revisión partimos de la relativamente reciente definición de deseo de anticipar la muerte (DAM), sus causas, la epidemiologia y el diagnóstico diferencial; se profundiza en los diferentes marcos mentales que se encuentran en el proceso de morir y en el concepto de «buena muerte», y finalmente se analizan los caminos que pueden llevarnos a la prestación de ayuda a morir en el marco de la legislación actual. El DAM es específico de las peticiones en caso de «enfermedad grave y avanzada», no en los otros supuestos contemplados por la Ley. Ante una petición de activar la prestación de ayuda a morir en el contexto de DAM, es decir, en proximidad de muerte, sería necesario procurar aumentar la sensación de control por parte del paciente, empezar a trabajar el duelo y, ante un proceso administrativo que va a ser necesariamente largo, contemplar la adecuación del esfuerzo terapéutico y la sedación como opciones posibles. Entendemos que es fundamental no crear falsas expectativas a pacientes/familiares y no sobrecargar a los profesionales con tareas administrativas que probablemente serán fútiles. Un equilibrio difícil ante la petición de acceso a un derecho al que el paciente siempre debe poder acceder. Abstract: The entry into force of the Organic Law on the Regulation of Euthanasia in June 2021 obliges clinicians to reconsider their professional work, in the face of a new service that expands the limits of what was considered correct until then. This new service affects the entire healthcare system, but especially primary care professionals. Beyond the procedural and moral aspects, it is necessary to rethink the assessment of the patient who expresses a wish to die. In this review, we start with the relatively recent definition of the wish to hasten death (WTHD), its causes, epidemiology and differential diagnosis. Then, we examine the different mental frameworks found in the process of dying and the concept of a «good death». Finally, we analyse the paths that can lead to the provision of aid in dying within the framework of current legislation. The WTHD is specific to requests in case of «serious and advanced illness», not in other cases contemplated by the Law. When faced with a request to activate the Aid in Dying Prestation in the context of WTHD (that is, in the proximity of death), it becomes necessary to increase the patient's sense of control and begin to work on grief. Besides, in the face of an administrative process that will necessarily be long, adapting the therapeutic efforts and sedation should be considered as possible options. We understand that it is essential not to create false expectations for patients/families and not to overload healthcare professionals with administrative tasks that will be futile. It is difficult to balance these in the face of a request for a right to which the patient should always have access.

Introduction and purpose: Palliative care is designed to ensure proper comfort in living and dying, primarily by alleviating suffering in patients for whom medical interventions have proved ineffective. In situations where suffering is unbearable, palliative care offers "last resort" treatment, namely palliative sedation. This involves the intentional administration of sedative drugs to the patient to reduce the level of consciousness, even inducing sleep, in order to control suffering caused by conditions that are resistant to other treatments. The aim of this article is to present various perspectives on palliative sedation. Description of the state knowledge: Topics discussed include: cessation of hydration and nutrition, loss of patient control over decision-making in treatment progression after the induction of pharmacological coma, the principle of double effect, complications arising from the use of indiscriminate polypharmacy, and views on life shortening through palliative sedation or its comparison to euthanasia. The distinction between palliative sedation and euthanasia is explored, with arguments on both sides contributing to ongoing debates. The paper concludes by advocating for comprehensive guidelines and interdisciplinary assessments to ensure ethical and patient-centered decision-making in the application of palliative sedation in terminally ill patients. Summary: A discussion is necessary on the creation of acceptable and appropriate procedures that would not arouse the controversies currently associated with the use of palliative sedation.

The problem of the euthanasia is one of the most important topic of social debate. This is not only a moral problem, but also a medical, legal and social issue. Opinion of the medical community (including nurses) in the topic of euthanasia is a point of reference for social discourse. The aim of the research was to analyze the opinions of the nursing staff on euthanasia and to examine the relationship between supporting the euthanasia and selected sociodemo-graphic variables. The study involved 146 nurses. The research was carried out using the diagnostic survey method, non-probability sampling. The survey was anonymous and voluntary. An original questionnaire was used. Statistical ana-lysis was performed in the 4.1.3. R Core Team program, using Mann-Whitney, Kruskal-Wallis tests, post-hoc analyzes with the Dunn test. The threshold of α = 0.05 was considered as the significance level. Most of the surveyed nurses support the legalization of the euthanasia (46.58%) and a significant part of them would agree to their own euthanasia (38.35%), to the euthanasia of an adult family member (34.24%) or a child from the family (24.66%). The attitude towards the euthanasia depends on demographic variables such as an age, a marital status, a religion and a work experience in the nursing profession. An opposition to euthanasia in Poland among nursing staff is decreasing, a support for the legalization of the euthanasia, and a declarations of consent to practice the euthanasia are becoming more frequent, especially among younger nurses.

AbstractIn this paper we focus on an important specific issue which has not received serious attention in the scholarly literature on euthanasia, namely, that of the coercive imposition (by way of sanction-backed regulations) of the practice of voluntary active euthanasia (in particular) on faith-based, aged-care organizations. In Section 1 we outline the relevant conceptual background drawing on existing literature. In Section 2, we consider two conflicting ethical standpoints on voluntary active euthanasia. In Section 3 we outline the nature and extent of the push to impose the practice of voluntary active euthanasia on Catholic-run aged-care organizations. In Section 4 we argue that the argument for coercively imposing the practice of voluntary active euthanasia on faith-based, aged-care organizations, is not well-made, especially in the context of liberal democracies committed to pluralism.