The Right to a Good Death in Times of Pandemic

The health crisis caused by the COVID-19 has strained the structures of our National Health System in all phases of medical care, including the one of death. The recognition of the health professionals’ performance within the framework of this pandemic is unanimous, and community initiatives and collective responsibility account for the capacity of citizens to respond to an emergency with solidarity and creativity. Still, there are some considerations regarding the management of the last phase of life, which we should also face based on those same values. The traumatic fact that the virus is shortening thousands of lives, sometimes unexpectedly, does not excuse the need to tackle the situation with the responsibility that can be expected from a mature society. The end of a worthy life is a worthy death, and we must try to preserve this principle, even in these complicated circumstances.

Although the citizens have accepted the temporary suspension of some rights during the State of Alarm, of which the freedom of movement would be the maximum exponent, we understand that a responsible State must minimize, as much as possible, the regression in this matter. For this reason, we consider it appropriate to recall that the ability to decide on one’s life and the family presence are part of the rights of patients and should be guaranteed as far as possible. It is necessary that citizens have their rights in mind so that they value their different options, they request the application of those they consider appropriate, that professionals help them to make them possible; and that the institutions guarantee the rights of the patient previously mentioned.

Making the decision to resign to certain treatment seems easier when there is a clear diagnosis of suffering a terminal process with a deterioration in health so severe that it prevents us from being independent. In the case of the Covid-19, since it is not necessarily irreversible, the decisions at the end of life are much more complex. However, it should be noted that an informed consent is the foundation of the healthcare relationship and that, therefore, also in this difficult situation it is necessary to make an effort to respect the right to information, to choose between the different clinical options, to the relief of pain, and to a dignified death in the company of our loved ones. Before making any decision, it is very important, and a legal imperative, to ask each person about their values and their will, which should be respected as much as possible.

Strict isolation measures for coronavirus patients are causing them end-of-life distress situations that could be mitigated, as it is indeed being done in some cases, at least by ensuring telematic communication. Beyond that, and being aware of the difficulty, we must also try to guarantee the accompaniment of at least one family member or trusted person, with the appropriate protection measures, in those cases where the disease becomes irreversible. In this sense, we welcome the proposals by professional associations, such as  SEMFYC or SECPAL, as well as the implementation of protocols from the institutions, and urge the Autonomous Communities that have not yet done so to take measures to guarantee a dignified death.

Decisions at the end of life should not be improvised; they must adhere to some values and to a concept of dignity that each person must reflect on, share with their close family and with professionals, basically those in primary care. To cope with death and plan decisions at the end of life, the best tool is the living will, also known as a directive or advance directive document. For this reason, we request the Ministry of Health and the Autonomous Communities to reinforce primary care in the dissemination and signing of the living will.

From DMD we also urge the competent authorities—Ministry of Health and regional Health Councils—to guarantee palliative care, both at home and in hospitals and residences, to facilitate a dignified death without suffering, both for people who wish to remain at home, as well as those who are in hospitals, accompanied by their loved ones. Lastly, we understand that funeral rites should be considered essential activities, in order to allow a more humane farewell and in keeping with our culture.