To compare the Spanish law on euthanasia and assisted suicide with those that exist in other countries.
Systematic review of the bibliography.
Medline/PubMed, EMBASE and the Cochrane Library were searched for studies that contained in their title or abstract the descriptors «euthanasia» or «assisted suicide» and also «legislation» or «law», between 2002 and the end of 2020.
The search found 1647 studies and after screening 663 were assessed, of which 30 were included in the review. Studies that only contained opinions or did not provide data on euthanasia/assisted suicide in the countries that have them regulated were rejected.
We registered the criteria that regulate the acceptance or rejection of a request for euthanasia or assisted suicide in Spain and in the other countries where they are decriminalized.
The euthanasia regulations in the world can be grouped into three groups: laws that allow euthanasia and assisted suicide (Netherlands, Belgium, some states of Australia, New Zealand, Spain), those in which the law only allows assisted suicide (USA) and those in which only assisted suicide is admitted and based on court decisions, without specific legislation (Switzerland, Germany).
Although there are differences, the laws that the Spanish euthanasia law most closely resembles are those of the Netherlands and Belgium, so it is foreseeable that the casuistry of euthanasia and its figures in Spain will resemble that of those countries in the future.

To review the available evidence on nurses\' attitudes to and knowledge about euthanasia.
A literature review was carried out in the databases: PubMed (including Medline), CINAHL, Scopus, PsycINFO, Web of Science and CUIDEN, with inclusive terms of nurses\' attitudes and knowledge regarding euthanasia both nationally and internationally. The selection criteria were articles in Spanish, English, Catalan or French published from January 2012 to September 2019 and studies that analysed the nurses\' attitudes and knowledge regarding euthanasia and articles that were full available for analysis.
Initially a total of 566 articles were found, and finally 8 met the inclusion criteria of the research question in the review. The total number of nurses participating in the studies was 3,571. Most of the nurses, both at international and national level, have a positive attitude towards the legalization of euthanasia; however, all studies report a lack in nurses\' knowledge on the specific theme of euthanasia.
The results show that nurses describe their attitude as positive towards the practice of euthanasia. In terms of knowledge, nurses reported the need to have more specific training on this subject is conclusive. In addition, this review provides a global and current vision that can serve as a necessary starting point for further work and progress in nurse training and for future research.

OBJECTIVE: To identify the neurological diseases for which euthanasia and assisted suicide are most frequently requested in the countries where these medical procedures are legal and the specific characteristics of euthanasia in some of these diseases, and to show the evolution of euthanasia figures.
METHODS: We conducted a systematic literature review.
RESULTS: Dementia, motor neuron disease, multiple sclerosis, and Parkinson\'s disease are the neurological diseases that most frequently motivate requests for euthanasia or assisted suicide. Claims related to dementia constitute the largest group, are growing, and raise additional ethical and legal issues due to these patients\' diminished decision-making capacity. In some countries, the ratios of euthanasia requests to all cases of multiple sclerosis, motor neuron disease, or Huntington disease are higher than for any other disease.
CONCLUSIONS: After cancer, neurological diseases are the most frequent reason for requesting euthanasia or assisted suicide.

The Spanish Euthanasia Law introduces a new right that is added to the portfolio of services provided by the Spanish health system and whose application is guaranteed within a period of 40 days. From the perspective of clinical experience, it is argued that without the effective right to quality palliative care and given the current shortcomings in dependant care, this law may send a threatening message to particularly fragile and dependant individuals that will lead to them feeling like a burden to their families and society. It is reasoned that basing the right to die on the dignity of the individual may have unexpected social repercussions. The text of the law presents the flaws of having been written hastily and without the support of advisory entities. There are issues that require clarification with regard to the application of euthanasia within the context of general practice. The conclusion is that this new law will pose more problems of the type it aims to resolve.

The approval of the euthanasia law represents a challenge for medicine and culminates a process of civic maturation of society in the face of death. There are challenges that the application of the law will have to meet. Seeking an objective and irreversible medical solution to subjective suffering - where there may be conditioning social determinants - implies a serious risk of inequity that requires policies that establish a pre-decisional guaranteeing framework. Euthanasia should be an exception thanks to the existence of strong clinical, informational and relational safeguards that can only be guaranteed in the context of a solvent primary care that accompanies people throughout their lives. In this primarist and community context, euthanasia can be the last resort of a professional committed to not abandoning a patient with severe and irreversible suffering who requests it.

OBJECTIVE: To review the available evidence on nurses\' attitudes to and knowledge about euthanasia.
METHODS: A literature review was carried out in the databases: PubMed (including Medline), CINAHL, Scopus, PsycINFO, Web of Science and CUIDEN, with inclusive terms of nurses\' attitudes and knowledge regarding euthanasia both nationally and internationally. The selection criteria were articles in Spanish, English, Catalan or French published from January 2012 to September 2019 and studies that analysed the nurses\' attitudes and knowledge regarding euthanasia and articles that were full available for analysis.
RESULTS: Initially a total of 566 articles were found, and finally 8 met the inclusion criteria of the research question in the review. The total number of nurses participating in the studies was 3,571. Most of the nurses, both at international and national level, have a positive attitude towards the legalization of euthanasia; however, all studies report a lack in nurses\' knowledge on the specific theme of euthanasia.
CONCLUSIONS: The results show that nurses describe their attitude as positive towards the practice of euthanasia. In terms of knowledge, nurses reported the need to have more specific training on this subject is conclusive. In addition, this review provides a global and current vision that can serve as a necessary starting point for further work and progress in nurse training and for future research.

The use of studies based on online surveys has expanded significantly. Despite having particularly small response rates, they allow a large sample size to be easily obtained. However, this strategy may entail a selection bias that significantly compromises the results. The results of two surveys on the regulation of euthanasia and assisted suicide are compared. One is an online survey with a self-selected sample and the other a survey with random sampling, conducted in 2018 among the members of the Medical Association of Bizkaia. The response rates were 10.4% (online survey) and 87.8% (random survey). No differences were found in sociodemographic characteristics, although there were differences in the opinion variables, so that the percentage of people who opposed euthanasia regulation was overestimated. The results of this study show that this sampling strategy generates biases in the results, some of which are difficult both to detect and to repair.

OBJECTIVE: The Law (4/2017) on rights and guarantees of persons in the process of dying in Community of Madrid regulates the exercise of the rights of the person during this process. The main objective of this study was to determine the knowledge and preferences about palliative sedation (PS), euthanasia, physician-assisted suicide (PAS), and adequacy of the therapeutic effort (ATE).
METHODS: A questionnaire was designed to collect knowledge about definition and legality of detailed resources, and disposition for themselves or for a relative. The questionnaire was completed by a total of 192 palliative care Conference attendees (October 2017).
RESULTS: Of those that completed the questionnaire, 160 (83.3%) were women, and the mean age was of 39 years (SD=15.8). More than two-thirds (131; 68.2%) did not know that the law existed. The definition with the highest rate of knowledge was on PS (89.1%; 171) and the lowest was ATE (50.5%; 97). On legality, the most successful was euthanasia (94.8%; 182) and the lowest was ATE (63.5%; 122). PS was considered the most appropriate resource (93.2%; 179), and the greater willingness of use in both relatives (91.7%; 176) as well as by themselves (90.6%; 174). PAS was the least suitable (34.4%; 66), and that less might resort in case of end-of-life of a relative (29.7%; 57), and themselves (33.3%; 64).
CONCLUSIONS: There is a greater awareness of the condition of legality or illegality of each resource than of the definition of the terms. The use of the PAS and euthanasia is disapproved. It is important to clarify the meaning of ATE, and clarify its confusion with other measures such as PS and PAS.

OBJECTIVE: To determine the opinion held by professionals in an intensive care unit on the limitation of therapeutic effort process at the end-of-life (LTE). To collect this information, and then use it to improve the basic aspects that the LTE have on the quality of care by intensive care unit staff.
METHODS: A prospective descriptive study was carried out in the Intensive Care Unit of a third level public university hospital. A questionnaire was prepared that included questions on their demographic profile and others to provide an ethical valuation profile, as well as to find out the knowledge and information that the professional had on the LTE. Descriptive study of the sample and comparative statistics were performed using the chi-squared statistical test.
RESULTS: A total of 65 valid questionnaires were obtained from a convenience sample of 70 professionals. Almost all of them (98%) were in favour of the limitation of therapeutic effort. The LTE was considered as some kind of euthanasia (active or passive) in up to 28% of the replies, valuations by professional categories is shown in. More than three-quarters (77%) had the belief that not to start treatment was not the same as withdrawing an already established treatment. Just over half (52%) of the respondents believe the value that should have more weight when considering LET would be the prognosis of the current illness of the patient, and 46% the future quality of life of the patient. The economic cost of treatment to be applied was not considered in any case.
CONCLUSIONS: The LTE is approved by the majority of professionals in our Intensive Care Unit. Although a non-negligible percentage understood it as a form of euthanasia.

OBJECTIVE: The decriminalisation of euthanasia and assisted medical suicide has generated a continuous debate. The terminological confusion is one of the main difficulties in obtaining medical practice consensus. The objective of this study was to determine whether the terms of Euthanasia and physician assisted suicide are used with the same meaning by doctors in Extremadura (Spain).
METHODS: A qualitative study was conducted using two focus groups in which doctors from different specialties who attended a large number of terminal patients participated. No other focus group was required due to saturation. The sessions were tape recorded and transcribed by two experts in qualitative methodology. Atlas.ti software was used for the analysis. We were advised by the \"Health Care at the end of life\" Group of the Organizacion Médica Colegial of Spain.
RESULTS: Terminological confusion was verified in: 1) The mixture of etymological, functional and social concepts, 2) the term Passive Euthanasia, 3) the association between euthanasia and physician assisted suicide, 4) the confusion with the equivalent \"wish to hasten death\", and 5) the difficulty of differentiating sedation with Euthanasia. There was consensus on some aspects: a) Full voluntariness, b) the condition of terminal illness, and c) the condition of unbearable symptoms.
CONCLUSIONS: Conceptual variability persists in relation to the concept of Euthanasia, and is particularly noticeable in the persistence of the concept of passive euthanasia. It would be desirable to achieve a common language to assign a precise meaning to these words to help doctors in their professional practice.