“Making the advance directive document is important to be able to choose the end of your life. Only you can decide, and in the event that you cannot verbalize it at the moment (due to a physical disability), you must have left it in writing. No one can make this decision for you,” Gloria Ribas, a volunteer with the Right to Die with Dignity (DMD) Catalunya association, tells La Vanguardia. “Since the euthanasia law has been in force, many relatives express “my father wanted”, “my mother had said”… But if they now have dementia, and have not put it in writing, no one can decide for themselves. they".
There is increasing awareness about the importance of the right to die with dignity, and the figures confirm it. The DVA or Living Will (TV) is the document through which a person, of legal age, with sufficient capacity and freely, records the instructions regarding the treatments, medical care and cures that he or she wishes to receive or reject. when you find yourself in circumstances that do not allow you to express your will.
Well, these Advance Wills Documents (DVA) are the notarial procedures that have grown the most in 2023, with an increase of 41% compared to the previous year, according to data from the III Notarial Observatory of Catalonia. Although the numbers are increasing, in the state as a whole only 9 out of every 1,000 inhabitants have registered their wishes, 0.9% of the Spanish population.
Now, thanks to a change in regulations approved in February, presenting this document is easier in Catalonia, since it can be validated by a health professional in primary, hospital or social health care. Until now it could only be formalized (in this community) through a notary or three witnesses, who attested that the person is competent and signs the document without coercion. This third way (easier and more affordable) is added, thanks to the modification of the rule, promoted by the Right to Die with Dignity Catalunya association. “The payment of a notary fee or the difficulty of providing three witnesses to formalize the document had been shown to be insurmountable obstacles for some people,” they explain to La Vanguardia.
The two main ways used to present the advance directive document—before a notary or with witnesses—are in force in almost all communities. The procedure can be done before a notary in all of them, except in Andalusia and Madrid. In front of witnesses it can be done in all territories, except in Andalusia, which has a particular regulation on the subject, as explained by DMD. There the document must be formalized with official personnel or authorized by the Ministry of Health.
On the other hand, the third way or assumption (without needing to go through a notary or three testimonies), which has now been facilitated in Catalonia, involves different procedures depending on the communities. “In most cases it is done before official personnel, in charge of registering documents, or from the Ministry of Health. Euskadi, Navarra and Catalonia are particular cases: in Euskadi it can be done before medical and nursing personnel, assigned to Health who are civil servants, a case similar to what has now been implemented in Catalonia; In Navarra, those who process the document in public health are social workers; in Catalonia they must be doctors or nurses. In Madrid it can also be done in health and social health centers, but in administrative units and patient care services."
Miquel Alias is a lawyer, a member of the Health Law Section of the Illustrious Bar Association of Barcelona, and an administrator at an outpatient clinic of the Catalan Institute of Health. “Putting the responsibility or burden of deciding on the end of your life on a family member without putting it in writing can be a complicated situation,” he explains. “That is why the DVA can be key at the end of your life, saving many problems and preventing the person responsible for the patient from having to enter into contradictions with themselves, if they have to decide about the death of their father or mother, for example” .
Josep Lluís Tejeda is 63 years old, he has always dedicated himself to teaching and is now retired. “When you retire and get older, these things go through your mind. Death does not scare me, but the end of life is part of existence, and after a talk on the subject at the Right to Die with Dignity association, in which there was a lot of talk about dignity and the right, I became member, I am a volunteer, and this prompted me to make the document. Until that moment I had heard very little about this option of advance directives.”
In your document you have expressed the option of euthanasia. “I specifically noted that, in the circumstances discussed, and if I cannot communicate, the euthanasia process will begin. These conditions are two: that my situation is irreversible and there is no possible recovery, and especially that this fact causes me unbearable physical or mental suffering. I checked the box that in the event that this happens, with knowledge of the facts – because I am fine now –, euthanasia will be applied,” he reflects.
“We are getting older, and dementia is more prevalent. In the association's model document there is a section in which you indicate when you consider that your life is not worth living. We have all had experiences with Alzheimer's, for example, with people who have stopped being themselves and can no longer interact. All this is what made me think the most,” adds Josep Lluís.
Lurdes Bascompte is 64 years old, retired and was also dedicated to teaching. “Dignified death and bad death were topics of conversation at home, but my parents were believers and never wanted to make the document. At one point I put my life in order, I made a living will and later completed it. My latest version of the last will is from 2020, then euthanasia was not legal, although the assumption that it was approved at the time of my death is already contemplated. Maybe I'll redo the document soon," she says.
"The trigger for me to decide to do it were difficult end-of-life situations that lead you to think that you don't want your life to be prolonged unnecessarily. I experienced my grandfather's dementia at home and my mother also suffered from it. This is what It touches me more and that is why I want that, if I experience that, what I have written is taken into account,” adds Lurdes.
To present the document of last wills you need to be of legal age in all communities except Aragón and the Valencian Community, where emancipated minors are allowed; and in Navarra to these and also from the age of 16. Another general requirement is to be fully capable of expressing freely and in advance the instructions to be taken into account when circumstances do not allow you to personally communicate your will.
The documentation to be provided depends on each territory, and in each of them, also on the route chosen if there are several options (notary, witnesses or health personnel, for example). You can consult all of this in the territorial guides that the Right to Die with Dignity association offers on its website (or in the list we offer above).
In Catalonia, for example, when it is done before three witnesses, a requirement is that at least two must not have a kinship relationship up to the second degree or be linked by property relationship.
The content of the Advance Directives Document is free, it is not standardized, because it depends on each person. There is no official document. Even so, there are recommendations that can be practical. It is recommended that you include the hierarchy of values, beliefs and personal expectations of the author of the document. Also the specific health situations in which these fundamental criteria must be taken into account, the specific instructions and limits in relation to medical action in the face of planned decisions based on evolutionary possibilities. In any case, there are models that can be used as a guide, provided by the Health Department of the Generalitat and by the Right to Die with Dignity association.
Alias gives some tips for preparing the document. “This document must have objectivity. This means that it must be applicable. An example: one should not talk about diseases such as “having cancer”, or “suffering from Alzheimer's”, but instead describe objective situations such as irreversible disease, chronic vegetative state, advanced state of dementia, vegetative state...”, points out the specialist. Secondly, according to Alias, it must be taken into account that, if it is the wish of the person who formalizes the document, it is linked to the Euthanasia law. “By signing the document it is considered that the first step in requesting euthanasia is taken.” Alias advises processing it with trusted health professionals, since it represents financial savings and this is a staff that is trained to advise and manage it."
There is no obligation to officially register the DVA, this registration is voluntary, although it is also recommended so that doctors can access it at any time, and it is available in the person's medical history, accessible throughout the state. “You can keep it at home and explain to your family that your wishes are these, and the moment you are in this situation, it will be used. But it is advisable to officially register it because when a health problem occurs you may be away from your place of residence,” says the lawyer. Once the document is made, it does not expire, but it can be reviewed and renewed whenever the person considers it appropriate.
