The euthanasia law returns to the political, health, and social forefront. The immediate reason is not only legal or technical: it is also human. The case of Noelia Castillo, who became a national and international trend after a very long and extremely exposed process, has reopened the debate on the right to euthanasia and the procedures, resources, and territorial inequalities.
In that context, El País has reported that the Ministry of Health already has ready a new Manual of Good Practices in Euthanasia with a very specific objective: to make the procedure more agile in urgent situations, strengthen the role of Nursing and better order its application throughout the country. The document was to be voted on this Friday in the Interterritorial Council of the National Health System, although it has finally been postponed until April 9 due to the impact of the medical strike on the meeting.
The important thing here is that it is not, at least formally, an improvised last-minute reaction. According to the information advanced by El País, Health maintains that the manual is the result of years of work within the Public Health directorate, although its arrival inevitably coincides with the media and political earthquake caused by the death of Noelia Castillo.
The big news: less waiting in urgent cases
The main modification that the new text introduces affects the very heart of the procedure. In the current law, the applicant must request euthanasia twice and between both requests there must be a period of at least 15 days.
The new manual states that that interval can be shortened in urgent cases in which the patient's life or their capacities run an imminent risk, provided that the doctor justifies it in a report.
That change does not eliminate guarantees nor does it turn the process into something automatic. The scheme remains, according to the advanced information itself, very guaranteeing: the approval of the responsible doctor, the intervention of a second medical professional unrelated to the case and the supervision of the guarantees committee continue to be central pieces of the system.
There lies one of the most delicate points of the debate. Because a part of the problem has not been the existence of controls, but rather the way in which those controls, added to territorial disparity and the judicialization of some cases, have ended up delaying procedures to the extreme for the defenders of this right. El País underlines that approximately one third of those who request euthanasia die before accessing it, a fact that by itself explains why Health wants to touch the times without touching the architecture of guarantees.
More prominence for Nursing and less territorial disorder
The other great leg of the practical reform goes through the role of Nursing. The new manual makes her a much more visible reference figure within the process, with functions of informational support, accompaniment to the applicant person, preparation of the environment and material, provision of care and guidance to family members and caregivers, even in resources linked to grief.
It is not a minor detail. In a service so sensitive, so emotionally difficult and so dependent on clinical coordination, the accompaniment weighs almost as much as the processing. And there Health seems to assume that it is not enough for the procedure to be recognized in the law; a more solid and more homogeneous structure is also needed to make it truly accessible.
That is why the manual also incorporates a new organization based on administrative support units, already present in some autonomous communities, with the idea of offering information to citizens, operational support to professionals and coordination with health services. The stated objective is to combat territorial inequity, one of the system's big holes since the law came into force.
The difference between communities is, according to the information advanced, enormous: there are territories that proportionally perform many more euthanasias than others without there being a sufficient demographic explanation. El País speaks of a distance of up to 20 times between the Basque Country and Extremadura. That disparity is precisely the kind of data that turns a state law into a deeply unequal experience according to the postal code.
The case of Noelia Castillo
The new manual is not officially born by Noelia Castillo, but it would be naive to pretend that her case has not completely altered the political and social climate around euthanasia.
Noelia died after a very long legal battle, with enormous public exposure and after her father and the organization Christian Lawyers repeatedly tried to stop the process. Her story reactivated the clash between the individual right to decide and the capacity of third parties to block or at least delay that right in the courts.
In fact, the Supreme Court will bring to the plenary session on May 19 a key debate to establish doctrine on whether the relatives of patients who request euthanasia are legitimate to judicially oppose that decision. That movement by the high court makes clear that the issue is no longer just health-related: it is also jurisprudential and of enormous scope for future cases.
In parallel, the Parliament of Catalonia is processing an initiative to reduce the deadlines for judicial appeals and try to avoid delays like those suffered by Noelia, who had to wait 20 months since her euthanasia was approved. That is to say, the case has not only generated conversation: it is beginning to move concrete pieces at various levels of the system.
Health moves euthanasia and also palliative care
The meeting of the Interterritorial Council not only had the new euthanasia manual on the table. It also included the Palliative Care Strategy 2026-2030, another relevant document because it tries to shield that care as a right throughout the territory, regardless of the place of residence or the illness.
That intersection is not casual. In Spain, the public debate about euthanasia and palliative care is usually presented as if they were two opposing blocks, when the healthcare system itself is reviewing them at the same time.