Spanish regulation of euthanasia and physician-assisted suicide.

In March 2021, the Spanish Congress approved the law regulating euthanasia, that regulates both euthanasia and physician-assisted suicide (PAS). In this article, we analyse the Spanish law regulating euthanasia and PAS, comparing it with the rest of the European laws on euthanasia and PAS (Netherlands, Belgium and Luxembourg). Identified strengths of the Spanish law, with respect to other norms, are that it is a law with many safeguards, which broadly recognises professionals' right to conscientious objection and the specification that it makes on the prior comprehensive care of the patient, including the approach to care dependency. Regarding its shortcomings, the law does not differentiate well between euthanasia and PAS; it barely assigns a role to the healthcare team as a whole (similar to other regulations); it does not clarify the functions of the different professionals involved; it does not detail the specific composition and duration of theevaluation commission; it has not been accompanied by a prior or simultaneous regulation of palliative care; and, lastly, the period of time to implement the law is too short.

Psychological well-being of palliative care professionals: Who cares?

BACKGROUND: Traditionally, the psychological well-being of healthcare workers has been taken for granted - it has even been considered a part of the requirements that were demanded of them. When these professionals have experienced suffering and psychological depletion, they have been held accountable for this suffering, adopting an individualistic and reductionist viewpoint focused only on the professional. This approach has become obsolete due to its proven ineffectiveness, especially from an ethics of responsibility and organization viewpoint. CONTEXT: The psychological well-being of the healthcare worker (and its opposites: suffering, exhaustion, and disenchantment) is advantageous to the professional's commitment to the institution, to their work performance, and to their personal life. OBJECTIVE: The objective of this paper is to reflect on the psychological suffering of the palliative care professional. METHOD: We will reflect on the three levels of responsibility that influence such suffering (micro-meso-macro-ethical; worker-environment-institution). RESULTS: We will propose a global strategy for the care of psychological well-being supported by scientific evidence and key references. SIGNIFICANCE OF RESULTS: We conclude with some contributions on what we have learned and still have to learn on this topic.

Cinco cuestiones esenciales para acompañar en el sufrimiento / Five essential questions to accompany in the suffering

El sufrimiento aparece de manera natural y espontánea cuando no tenemos recursos para hacer frente a una situación que se convierte en una amenaza. Acompañar el sufrimiento no es tarea fácil y requiere destrezas, habilidades y conocimientos, así como desarrollo personal. Identificar y abordar el sufrimiento es una de las principales funciones de la práctica clínica. Poder identificar cómo esta experiencia afecta a los profesionales sanitarios, así como generar estrategias para hacerle frente podría protegernos y facilitar el ejercicio de la ayuda. Este artículo tiene como objetivo principal realizar una revisión teórica, acompañada de claves prácticas, para presentar cinco cuestiones previas que configuran un conocimiento esencial para el acompañamiento. Se pretende estimular la reflexión y el aprendizaje de habilidades que nos permitan desarrollar nuestras acciones desde la consciencia y en coherencia con nuestros valores y objetivos

Suffering appears naturally and spontaneously when we do not have resources to deal with a threat. Accompanying suffering is not an easy task and requires skills, abilities and knowledge, as well as personal development. Identifying and addressing suffering is one of the main functions in clinical practice. To be able to identify how this experience affects healthcare professionals, and to generate strategies to face it, could protect us and facilitate the exercise of helping others. The main objective of this article is to realize a theoretical review, accompanied by practical keys, in order to present five previous questions that constitute an essential knowledge for accompaniment. It is intended to stimulate reflection and learning skills that allow us to develop our actions from consciousness and in coherence with our values and objectives

Meaning of work and personal protective factors among palliative care professionals.

OBJECTIVE: Healthcare professionals who work in palliative care units face stressful life events on a daily basis, most notably death. For this reason, these professionals must be equipped with the necessary protective resources to help them cope with professional and personal burnout. Despite the well-recognized importance of the construct "meaning of work," the role of this construct and its relationship with other variables is not well-understood. Our objective is to develop and evaluate a model that examines the mediating role of the meaning of work in a multidisciplinary group of palliative care professionals. Using this model, we sought to assess the relationships between meaning of work, perceived stress, personal protective factors (optimism, self-esteem, life satisfaction, personal growth, subjective vitality), and sociodemographic variables. METHOD: Professionals (n = 189) from a wide range of disciplines (physicians, psychologists, nurses, social workers, nursing assistants, physical therapists, and chaplains) working in palliative care units at hospitals in Madrid and the Balearic Islands were recruited. Sociodemographic variables were collected and recorded. The following questionnaires were administered: Meaning of Work Questionnaire, Perceived Stress Questionnaire, Life Orientation Test-Revised, Satisfaction with Life Scale, Subjective Vitality Scale, Rosenberg Self-Esteem Scale, and the Personal Growth Scale. RESULT: The explanatory value of the model was high, explaining 49.5% of the variance of life satisfaction, 43% of subjective vitality, and 36% of personal growth. The main findings of this study were as follow: (1) meaning of work and perceived stress were negatively correlated; (2) optimism and self-esteem mediated the effect of stress on the meaning attached to work among palliative care professionals; (3) the meaning of work mediated the effect of stress on subjective vitality, personal growth, and life satisfaction; and (4) vitality and personal growth directly influenced life satisfaction. SIGNIFICANCE OF RESULTS: The proposed model showed a high explanatory value for the meaning professionals give to their work and also for perceived stress, personal protective factors, and sociodemographic variables. Our findings could have highly relevant practical implications for designing programs to promote the psychological well-being of healthcare professionals.

[Terminology in clinical bioethics]. / Terminología en bioética clínica.

In this article some of the most relevant terms in clinical bioethics are defined. The terms were chosen based on three criteria: impact on the most important problems in clinical bioethics, difficulty in understanding, and need to clarify their meaning. For a better understanding, the terms were grouped into 5 areas: general concepts (conflict of values, deliberation, conflict of interest, conscientious objection); justice (justice, distributive justice, models of justice, triage); clinical matters (information, competency, capability, informed consent, mature minor, coercion, secrecy, privacy, confidentiality, professional secrecy); end of life (prior instructions, limitation of therapeutic efforts, professional obstinacy, futility, palliative care, palliative sedation, principle of double effect, euthanasia, assisted suicide, persistent vegetative state, minimally conscious state, locked-in syndrome, brain death), and beginning of life (assisted reproduction, genetic counseling, preimplantation genetic diagnosis).

En el artículo se definen algunos de los términos más relevantes en bioética clínica. Los términos se han escogido con base en tres criterios: repercusión en los problemas más importantes en bioética clínica, dificultad en su comprensión y necesidad de aclarar su significado. Para su mejor comprensión, los términos se han agrupado en 5 áreas temáticas: conceptos generales (conflicto de valores, deliberación, conflicto de intereses, objeción de conciencia); justicia (justicia, justicia distributiva, modelos de justicia, triage); relación clínica (información, competencia, capacidad, consentimiento informado, menor maduro, coacción, intimidad, privacidad, confidencialidad, secreto profesional); final de la vida (instrucciones previas, limitación de los esfuerzos terapéuticos, obstinación profesional, futilidad, cuidados paliativos, sedación paliativa, principio del doble efecto, eutanasia, suicidio asistido, estado vegetativo persistente, estado de mínima conciencia, síndrome de enclaustramiento, muerte encefálica), e inicio de la vida (reproducción asistida, consejo genético, diagnóstico genético preimplantacional).