Todas las Voces

 

Index

1. Introduction

2. Results

2.1. Opinion of the medical community

2.1.1.  Opinion of Spanish physicians

2.1.2.  Opinion of doctors in Europe and the Western world

2.2. Opinion of the general public

2.2.1. Spanish population

2.2.2.  European population

3. Discussion

4. Conclusion

5. References

6. Bibliography and notes

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1.         Introduction

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Euthanasia and assisted suicide are the subjects of considerable controversy in the Western world, not only in their medical, social and ethical aspects, but also in relation to their legalization^{1, 2} on which various political, professional and social groups have differing opinions³.

With respect to their possible legalization, it is important to determine whether there is a favourable opinion in society, particularly in the medical community. In order to do so, surveys have been conducted, both among healthcare professionals and the general public.

In this study, we will focus mainly on the analysis of these surveys, and above all on establishing whether or not it can be concluded that in the medical community and in mainstream society, there is a social demand for the legalization of euthanasia and assisted suicide.

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2.  Results

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2.1. Opinion of the medical community

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When analysing the feedback of the medical community on whether or not euthanasia and assisted suicide should be legalized, we shall refer separately to Spanish physicians and those of countries with a similar socio-economic situation.

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2.1.1.   Opinion of Spanish physicians

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To try to determine the views of Spanish clinicians, we shall analyse the latest surveys carried out in Spain on this issue.

In April 2002, the Spanish Centre for Sociological Research (CIS) performed a comprehensive survey on euthanasia and assisted suicide⁴, conducting 1057 interviews in the 17 autonomous regions of Spain. The question asked was: Do you think the law should be changed to allow patients to request and receive physician-assisted suicide and/or active euthanasia? Of those surveyed, 41.5% of clinicians answered yes, but only for terminally ill patients of sound mind, while 18.4% also said yes for patients with serious chronic illness; 31.4% answered “Don’t know” or “No response”.

In terms of the most recent surveys carried out in Spain, we shall first examine those performed by four Spanish medical associations: the Vizcaya medical association (Colegio de Médicos de Bizkaia) in 2018 and those of Tarragona (Colegio Oficial de Médicos de Tarragona), Las Palmas de Gran Canaria (Colegio Médico de Las Palmas) and Madrid (Ilustre Colegio de Médicos de Madrid) in 2019.

Vizcaya Medical Association⁵

The survey was conducted between 23 October and 11 November, 2018, and included 382 physicians out of    a total of 7754 association members. The question asked was: Do you think euthanasia should be regulated by law in Spain? The same was asked for assisted suicide. A total of 330 physicians (86.39%) answered yes (this section included both those who were completely sure and those who were not completely sure; the same approach was followed in the other three surveys conducted by the other medical associations), while 34 (9.94%) answered no. In relation to assisted suicide, 272 physicians (71.21%) answered yes and 69 (19.90%) no.

However, when asked whether doctors should be entitled by law to refuse to perform euthanasia or assisted suicide, if these practices are contrary to their personal or religious beliefs, 321 physicians (84.03%) said ‘yes’ and 45 (11.78%) ‘no’. Regarding conscientious objection, 118 (28.27%) replied that they would claim conscientious objection and 76 (60.48%) that they would not.

Madrid Medical Association⁶

This survey was conducted in July 2019. The sample included 1044 physicians out of 46,146 association members. The question was also: Do you think euthanasia should be regulated by law in Spain? A total of 903 physicians (86.9%) answered yes and 73 (6.9%) no. This contrasts with the number of physicians who would claim conscientious objection, as 393 physicians (37.6%) would invoke it and 505 (48.3%) would not.

Tarragona Medical Association⁷

This survey was conducted in June 2019. The sample included 715 physicians out of 3,325 association members. The question asked was: Do you want euthanasia and medically assisted suicide to be regulated by law? Just over two thirds of physicians (69.26%) answered yes to the regulation of euthanasia, but if these figures were added to those who were not completely sure, the percentage increased to 86%; 5.94% answered no, and 3.93% were unsure.

The survey also asked whether clinicians should have the right to refuse to participate in euthanasia practices, i.e. conscientious objection; 91% answered yes and 9% no. As to whether they would be willing to apply euthanasia, 68% answered no, while 31% said yes. Regarding the regulation of assisted suicide, 84% replied that it should be regulated.

 Las Palmas de Gran Canaria Medical Association ⁸

This survey was conducted between September and October 2019. The sample included 365 physicians out of 5,778 association members. The question was: Do you think euthanasia should be regulated by law in Spain? Of those who responded, 81.9% answered yes and 13.4% said no. For assisted suicide, these percentages were 68.5% and 25.7%, respectively.

With respect to whether doctors should have the right to refuse to participate in euthanasia or assisted suicide, 78.36% answered yes and 16.99% no. On whether they would invoke conscientious objection, 28.58% answered yes and 58.3% no.

Apart from these particular data from the individual medical associations, in a survey conducted in 2014 that asked Spanish doctors as a whole whether assisted suicide should be allowed, 36% replied yes, compared to 48% in 2010⁹.

Furthermore, the Spanish Medical Association maintains a clear position against euthanasia, declaring that “we doctors are in favour of life and the dignity of the person. The doctor shall never bring about death of the patient, even if the patient so requests”¹⁰.

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2.1.2.   Opinion of doctors in Europe and the Western world

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On 28 February 2020, the British Medical Association (BMA) published a report describing the path it has taken since 1950, and the opinion of physicians on euthanasia and assisted suicide in the United Kingdom (UK) ¹¹. At that time, its members were clearly opposed to any type of euthanasia, and their opinion on this and assisted suicide remained unchanged in subsequent years.

Moreover, in 2009, 73.4% of palliative care physicians in the UK were completely opposed to the legalization of euthanasia, while 63.2% were against assisted suicide¹².

In addition to these surveys, in 2011, McCormack et al. carried out, for the first time, a systematic review of the opinion of UK doctors on euthanasia and assisted suicide¹³. The percentage of those who supported the legalization of euthanasia ranged from 2.6% to 47%, with a mean of 27.50%, while the percentage of those who opposed it ranged from 33% to 80%, with a mean of 59.54%. These percentages for assisted suicide were 2.6% to 54%, with a mean of 31.89%, and 36% and 73%, with a mean of 54.90%, respectively. Additionally, the percentage of doctors who would participate in an act of euthanasia ranged from 12% to 46%, with these percentages for assisted suicide being 12% to 43%.

More recently, in 2014, Medscape conducted a survey in seven European countries that included 21,531 physicians on whether assisted suicide should be legalized. Forty-seven percent of British doctors answered yes, up from 33% in 2010¹⁴.

In 2016, the opinion of BMA members was again gauged regarding the need to amend the current laws on euthanasia and assisted suicide in the UK. The result of the vote showed that 63% of its members did not wish to change the legal status of euthanasia and assisted suicide in the UK¹⁵.

Nevertheless, the social debate has remained active in the UK over the past few years, and so the BMA has again asked its members for their views on this issue¹⁶.  The survey was conducted from 6-27 February 2020, and asked whether the BMA should support, oppose or maintain a neutral position on the current legal status of euthanasia and assisted suicide in the UK. The results will be made public at the BMA’s Annual Representative Meeting in June this year. Pending these findings, the BMA published its position on euthanasia and assisted suicide in 2016¹⁷, stating that the BMA: a) believes that the ongoing improvement in palliative care allows patients to die with dignity; b) insists that physician- assisted suicide should not be made legal in the UK; c) insists that voluntary euthanasia should not be made legal in the UK; d) insists that non-voluntary euthanasia should not be made legal in the UK; and e) insists that if euthanasia were legalized in the UK, there should be a clear demarcation between those doctors who would be involved in it and those who would not.

Apart from the actions promoted by the BMA, the Royal College of Physicians (RCP) also conducted a sur- vey between 1 February and 1 March, 2019, among   its 6,865 members. It found that 43% of them are opposed to amending the law currently in force. This percentage is similar to that obtained in another survey carried out in 2014, which was 44%. In contrast, the percentage of physicians who supported the change was 25% in 2014 and 32% in 2019. In addition, 25% of clinicians thought that the RCP should remain neutral on this issue, unless 60% of their members were in favour of or opposed to a change¹⁸.

The Royal College of Physicians Radiologists has also published the results of another survey, which included 1,572 clinical radiologists or radiology residents, con- ducted in February 2019. Of the 540 respondents, 47% per cent were against a change in the law, while 37% per cent were in favour; the remaining 16% were un- decided¹⁹.

The Scottish parliament also promoted a draft bill aimed at legalizing assisted suicide in Scotland²⁰.

 With regard to the views of Italian doctors, an article published in Italy in 1999 revealed that the debate on euthanasia and assisted suicide had been limited up to then, but the same article published data from a survey of 520 physicians, to which 336 responded. It concluded that 13.3% believed that euthanasia should be made le- gal, 12.1% somewhat agreed, 11.2% neither agreed nor disagreed, and 52.1% strongly opposed it; for assisted suicide, these percentages were 15.1%, 16.3%, 15.4% and 43.8%, respectively²¹.

In 2014, a new survey was conducted in Italy asking whether assisted suicide should be allowed. Forty-two percent of physicians responded yes, up from 34% in 2010²².

In December 2019, another Italian survey was published, this time of 444 physicians, to which 207 (46.6%) responded. It found that 75 physicians (36.2%) were in favour of legalizing euthanasia while 130 (62.8%) were opposed. In relation to assisted suicide, 74 doctors (35.9%) were in favour and 130 (63.4%) against. When asked if they would be willing to participate in an act of euthanasia, 58 (28.9%) answered yes and 147 (71.7%) no. When asked about assisted suicide, 63 (30.4%) answered yes and 142 (68.6%) no (21%).

In Germany, the issue of euthanasia is considered from a particularly sensitive perspective due to the country’s experiences during the Nazi era. In 2005, a survey was published that included data from a survey of 481 clinicians, 233 of whom responded (48%). This showed that 33% would not perform euthanasia and only 5% would; in contrast, 42% would have no objection to doing so in the case of assisted suicide²³.

Subsequently, in 2014, another survey was published asking whether assisted suicide should be allowed, with 47% answering yes, compared to 33% in 2010²⁴.

Nonetheless, in addition to these opinions of individual physicians, the German Medical Association’s code of conduct explicitly prohibits German clinicians from participating in euthanasia or assisted suicide²⁵.

The position held by the three Scandinavian countries on euthanasia and assisted suicide differs substantially among them. A survey conducted in Norway in 1997, which included 1,476 clinicians, 66.4% of whom responded, asked: “Should the doctor be allowed to bring the patient’s life to an end painlessly?” It did not distinguish between euthanasia and assisted suicide. Six- ty-five percent of clinicians said no, 17% yes and 18% did not know what they would do. When asked the same question, but for non-terminal patients, 84% responded no and 4% yes²⁶.

In Denmark, a 1996 survey of 491 physicians, to which 34% responded, asked whether euthanasia and assisted suicide should be ethically acceptable. Thirty-four per- cent answered no for euthanasia and 37% for assisted suicide; in comparison, 29% responded yes for euthanasia and 32% for assisted suicide. However, if both practices became legal in Denmark, 31% of clinicians would have no objection to participating in euthanasia and 33% in assisted suicide²⁷.

More recently, in 2015, another 12-question survey was conducted asking whether euthanasia and assisted suicide should be legalized. It included 261 Danish geriatricians, 120 (46%) of whom returned the questionnaire. Twenty-seven of them (22.5%) answered yes for euthanasia and 67% (55.8%) no. When asked whether euthanasia should be offered as an alternative to palliative care, 16 clinicians (13.3%) responded yes and 88 (73.4%) no. When the same was asked about assisted suicide, 18 clinicians (15%) said yes and 96 (76.6%) no²⁸.

Furthermore, apart from these individual opinions, both the Danish Council of Ethics and the Danish Medical Association were favourable to euthanasia and assis- ted suicide²⁹.

In Sweden, between 1995 and 1996, a questionnaire was sent to 287 doctors asking whether “active help   in dying” might sometimes be justified; 39% said yes and 47% no. Additionally, 25% would be in favour of legalizing these practices and 51% would not, although only 26% would be willing to participate in them if they were legal³⁰ .

In the Netherlands, a 2005 survey that included 391 physicians asked whether euthanasia should be accepted; 64% answered yes, but if the patients were in- competent, the percentage was 36%, and if they had dementia, 6%³¹.

In another survey conducted in 2012, asking whether they would participate in euthanasia, 1456 clinicians (86%) answered yes³².

In 2014, a questionnaire was sent to 1,955 Dutch general practitioners, asking them about their choice concerning euthanasia and assisted suicide. In total 793 physicians (41%) responded. Thirty-six percent preferred euthanasia to assisted suicide; 34% preferred assisted suicide; and 25% showed no preference³³.

Moreover, the Royal Dutch Medical Association stated in 1989 that “legal euthanasia should remain a crime, but that if a physician, after having considered all the aspects of the case, shortens the life of a patient who is incurably ill and in the process of dying, the court will have to judge whether there was a conflict of duties which could justify the act of the physician”³⁴. A year later, in 1990, the same Association and the Ministry of Justice stated that the physician participating in an act of euthanasia would be guaranteed immunity from pro- secution, taking into account the requirements of good medical practice³⁵.

In Belgium, in a 2011 questionnaire asking doctors if they were prepared to perform euthanasia, 81% an- swered yes³⁶. In Northern Ireland, a survey conducted in the year 2000 asked whether euthanasia should not be legal. The questionnaire was returned by 401 of 1053 eligible physicians (38%): 300 answered yes (75%), 54 no (14%), and 44 (11%) maintained a neutral attitude. In relation to assisted suicide, 286 (72%) answered yes, 54 (14%), no and 55 (14%) were neutral. When asked if they would be willing to participate in active euthanasia, 48 (12%) answered yes, 321 (81%) no and 29 (7%) were neutral. When the same question was asked about assisted suicide, 42 (10%) responded yes, 311 (78%) no, and 46 (12%) were neutral³⁷. In France, in 2014, when doctors were asked whether assisted suicide should be allowed, 40% responded yes, compared to 38% in 2010³⁸.

When the views of doctors in Europe were assessed as a whole, in a survey that included 4000 physicians from Germany, the UK, Italy, France, and Spain, asking whether assisted suicide should be allowed, 42.4% answered yes and 37.2% no³⁹.

In the United States (US), there has been ample discussion on euthanasia since the late nineteenth century⁴⁰. More recently, in a survey published in 2000 that evaluated the opinion of 3,299 oncologists, 22.5% were favourable to assisted suicide and 6.5% to euthanasia⁴¹. Prior to these national surveys, two US states had also expressed their views. In Oregon, in a 1996 survey, 51% of clinicians supported the legalization of assisted suicide, which had just been made legal, and 49% were against⁴². In Michigan that same year, 56% of doctors were in favour of the legalization of euthanasia⁴³.

Apart from these particular views of doctors, in 2001, the American College of Physicians-American Society of Internal Medicine declared that it did not support the legalization of assisted suicide, owing to the ethical concerns it raises. Thus, physicians should not provide this practice to their patients⁴⁴.

In Canada, in a survey published in 2015, 88% of physicians in the Canadian Society of Palliative Care opposed the legalization of euthanasia and 80% opposed assisted suicide⁴⁵.

If the opinions of European and American doctors are compared, 42.4% of Europeans think that assisted suicide should be allowed versus 54% of Americans; in turn, 37.2% and 31%, respectively, think it should not⁴⁶.

Finally, in Australia, 85% of palliative care specialists oppose the legalization of euthanasia and 75% oppose assisted suicide⁴⁷.

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2.2.      Opinion of the general public

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In relation to the general public, we shall also analyse the Spanish population separately from that of other countries, especially those in Europe.

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2.2.1.   Spanish population

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The most commonly used survey on what the Spanish population thinks about the legalization of euthanasia is the one conducted in 2009 by the CIS48. It includes 63 questions, of which we shall consider those we deem most pertinent to this analysis.

Question 24 was as follows: When a person has a terminal illness that causes great suffering and will cause death in a short time, do you think the law should allow doctors to end a person’s life and suffering, if that person freely requests it? In other words, it asks whether or not the respondent wants euthanasia to be legalized in Spain. In total, 1,570 people (63.3%) answered “Yes, I’m completely sure”; 426 (17.2%) said “Yes, but I’m not completely sure”; 229 (9.2%) “No, I’m completely sure”; and 131 (5.3%) “No, but I’m not completely sure”. The rest answered “Don´t know” or “No response”.

Question 25 was as follows: And if this person freely requests it from their doctors, do you think the law should allow these doctors to provide them with the means necessary for them to end their life? In other  words, they are clearly asking about assisted suicide. In total, 1,233 people (49.7%) answered “Yes, I’m com- pletely sure”; 451 (18.2%) “Yes, but I’m not completely sure”; 225 (9.1%) said “No, but I’m not completely sure”; and 401 (16.2%) answered “No, I’m completely sure”. The rest of the respondents answered “Don´t know” or “No response”.

The survey includes two more questions (numbers 35 and 36), which refer to the legalization of euthanasia when the patient is not terminally ill. In total, 1,226 people (49.4%) answered “Yes, I’m completely sure”; 496 (20.0%) “Yes, but I’m not completely sure”; 354 (14.3%) answered “No, I’m completely sure”; and 167 (6.7%) “No, but I’m not completely sure”. The rest an- swered “Don't know” or “No response”.

When this same question referred to assisted suici- de, 1,006 people (40.5%) answered “Yes, I’m completely sure”; 482 (19.4%) “Yes, but I’m not completely sure”; 522 (21.0%) answered “No, I’m completely sure” and 250 (10.1%) “No, but I’m not completely sure”. The rest answered “Don´t know” or “No response”.

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2.2.2.   European population

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There are fewer polls seeking the opinion of the European population on the legalization of euthanasia and assisted suicide. Nevertheless, there are three ^49,50,51 by Joachim Cohen’s group from Vrije Universiteit in Brussels, which due to their length and quality (especially the third⁵²), provide adequate information on what the population thinks in relation to the issues discussed herein.

The second study had  already  determined  that  the degree of acceptance of euthanasia varied widely among European countries⁵³. Nevertheless, it also noted that there were very few recent data on the issue ^54,55 and that furthermore, the fact that each of these studies used different methods makes it difficult to compare the findings. This encouraged them to start their study in 47 European countries.

The three papers by the Cohen group ^{56, 57, 58} use data from the European Values Study (EVS). For the last paper, these data were collected in 2008.

According to the authors, in the last of the three articles⁵⁹, they had the opportunity to compare, for the first time, the opinion of the general public of European countries with and without legal coverage of euthanasia.

The question used in the survey was: Please tell me whether you think euthanasia can always be justified, never be justified, or something in between? Responses had to be rated on a scale of 1 to 10. Levels 1 and 2 would include the responses of those who said that it would never be justified; levels 3 and 4, those who said that it would only be justified on some occasions; levels   5 and 6, those for whom its justification would always be more or less doubtful; levels 7 and 8, those who said it might be justified on some occasions; and levels 9 and 10, that it would always be justified.

The results indicate that no European country is in- cluded in acceptance levels 7, 8, 9 or 10, with Denmark being the country with  a  higher  degree  of  acceptance (6.79), followed by Belgium (6.75), France (6.75), the Netherlands (6.67), Sweden (6.54), Luxembourg (6.09), Spain (6.08), Finland (5.91), Iceland (5.78), Great Britain (5.64), Norway (5.62), Slovenia (5.51), Czech Repu- blic (5.33), and Switzerland (5.05). This is followed by a group of 14 countries where the level of acceptance ranges from 4.94 to 4.0; another 10 between 3.86 and 3.06; and finally 9, with a degree of acceptance of less than 3.

The Economist and Ipsos MORI, in an online poll of 2000-2200 adults from 15 countries, conducted between 15 and 19 June 2015, asked whether or not it should be legal for a doctor to assist a patient aged 18 or over in en- ding their life, if that is the patient’s wish, provided that the patient is terminally ill, of sound mind, and expresses a clear desire to end their life. In other words, they were clearly asking about euthanasia. The percentage of affirmative responses ranged from 47% in Russia and 48% in Poland to 84% in France and 86% in Belgium.

When asked whether it should not be legal, responses ranged from 32% in Russia and 29% in Poland to 4% in Belgium and 5% in France. When the same was asked about assisted suicide, 65% of French and 64% of Belgians, and 34% of Russians and Italians said yes. When asked whether it should not be legal, 16% of Belgians and 18% of French answered yes, while that percentage was 48% for Russians and Italians. When the same was asked for children under the age of 18, the support rates were much lower, ranging from 24% to 45%, being higher only for Belgians, at 70%. In contrast, the percentages of those who were against it ranged from 11% for Belgians to 55% for Russians⁶⁰.

In the British Social Attitudes (BSA) survey conducted in Britain in 2010 on the issue of euthanasia, 74%  of those polled supported assisted suicide if the disease was terminal, but this percentage fell to 45% if it was not. In another survey in 2013, also conducted by the BSA, 70% and 51% supported the legalization of euthanasia and assisted suicide, respectively. Finally, in another survey similarly carried out by the BSA in 2014, 73% supported euthanasia and 42% assisted suicide⁶¹.

In the United States, support for euthanasia and as- sisted suicide by the general public had risen from 37% in 1947 to 53% in 1970⁶². In another 2002 study, this support was 48% for assisted suicide and 49% for euthanasia^63. In another survey conducted the same year, the percentage of people supporting assisted suicide ranged from 34% to 65%, the average being 50.16%⁶⁴.

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3.  Discussion

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The aim of this study was to assess whether there is indeed a real demand among the medical community and the general public to legalize euthanasia and assisted suicide, mainly in countries which, like Spain, are currently discussing the legalization of both practices⁶⁵. In relation to Spanish doctors, in the surveys carried out by four medical associations^66,67,68,69 responses in favour of the legalization of euthanasia were high (86.39%, 86.49%, 86.0% and 81.9%); however, in the largest survey conducted by the CIS⁷⁰, this percentage was 41.5%. We believe this can be explained by the fact that in the surveys of the four medical associations, the question asked was whether euthanasia should be “regulated” and not whether it should be “legalized”, as was the case in the CIS survey. Of course, most Spanish doctors, including myself, would be in favour of euthanasia being “regulated”, so as to legally ensure its professional practice, but this is far from wanting it to be “legalized”. This semantic manipulation of the surveys of the four medical associations undoubtedly has serious social implications, especially when it can be used by political parties who are promoting the legalization of euthanasia in Spain⁷¹.

The findings for clinicians in Europe vary widely, not only among different countries, but in each country over time, showing an increasing tendency towards acceptance of the legalization of euthanasia and assisted suicide.

When evaluating these facts, we shall refer primarily to the most recent surveys to bring us closer to the current situation. Thus, in a 2015 survey conducted in Denmark, 22.5% of physicians considered that euthanasia should be legalized, while 55.8% did not⁷². Similar data were found in Italy, as according to a 2019 survey, 62.8% of Italian doctors were opposed to the legalization of euthanasia, compared to 36.2% in favour⁷³. More focused on their opinion were clinicians in the UK. In 2019, they also expressed a less favourable opinion to legalize euthanasia: 43% of physicians oppose changing the current UK laws, which regard euthanasia practices as illegal, while 32% would have no problem in its amendment⁷⁴. Similar findings were observed in France, where a 2014 survey found that 40% of French doctors believed that assisted suicide should be allowed⁷⁵.

General practitioners in Northern Ireland were less favourable to euthanasia, as 75% of them believe that euthanasia should not be legal and 14% that it should⁷⁶. Dutch doctors take an opposite view: in a 2005 survey, 64% of them were in favour of euthanasia practices⁷⁷.

In a subsequent survey conducted in 2012, asking whether they would be willing to participate in euthanasia, 86% of Dutch physicians answered yes⁷⁸. In Belgium too, the percentages were similar, as 81% of physicians would have no difficulty participating in euthanasia⁷⁹.

As we can see, the views of European clinicians vary widely from one country to another, yet in a European survey of 4,000 physicians which asked whether assisted suicide should be allowed. 42.4% answered yes and 37.2% no⁸⁰. In other words, the percentage of European doctors who are in favour (42.4%) or against (37.2%) the legalization of assisted suicide is very similar⁸¹, which would seem to support a lack of widespread demand among clinicians for euthanasia to be legalized.

In the United States, the aforementioned survey⁸² indicated that 54% of medical professionals are in favour of allowing assisted suicide, while 31% are not, i.e. they appear to be moderately in favour of this practice; however, in Canada, a 2015 survey of palliative care physicians found that 88% opposed the legalization of euthanasia and 80% opposed assisted suicide⁸³. Thus, as in Europe, neither the United States nor Canada seems to have a wide demand among practitioners for euthanasia and assisted suicide to be legalized.

In terms of the Spanish population, according to the survey carried out by the CIS in 2009⁸⁴, 80.2% were in favour of euthanasia, with this percentage including those who are completely sure and those who harboured some doubts about it, while 17.93% were against it (also including both groups); for assisted suicide these percentages were 67.9% and 25.3%, respectively. In Spain, the legalization of euthanasia is under discussion⁸⁵.

As far as the European population is concerned, there is little recent data on this subject ^{86, 87}. In our opinion, the most interesting results are those provided by Cohen and his group^{88, 89, 90}. In their last paper⁹¹, in which this topic was first studied in Europe, analyzing opinions in 47 European countries, the results show that in no European country does its citizens believe that euthanasia is justified, the most favourable being the Danes with an acceptance rate of 6.79%, meaning that their acceptance is doubtful. Denmark is followed by Belgium (6.75), France (6.75), the Netherlands (6.67), Sweden (6.54), Luxembourg (6.09), Spain (6.08), Finland (5.91), Iceland (5.78), Great Britain (5.64), Norway (5.62), Slovenia (5.51), the Czech Republic (5.33) and Switzerland (5.05). There is then a group of 14 countries where the level of acceptance ranges from 4.94 to 4.0; another 10 between 3.86 and 3.06 and finally 9, with an acceptance rate of less than 3.

In these data, it should be noted that in no European country is the opinion of its people in favour of the legalization of euthanasia, since none of them is at an acceptance level of 7 or more. It also highlights that a large part of the European population is between moderate and low acceptance, and that finally, there is a group of countries that think that the acceptance of euthanasia is never justified.

Nevertheless, it should also be noted that, comparing these results with those obtained by the same authors in their previous studies, the greatest increase in the acceptance of euthanasia is in Spain, Portugal, Great Britain, Germany and Italy, with a decrease in this acceptance in Russia, Ukraine, Greece, Slovakia and Belarus⁹².

The authors conclude that “public acceptance of euthanasia tends to be relatively low to moderate in a large part of Europe”, although such acceptance naturally varies according to the requirements of each country to practice euthanasia. They also emphasize that the acceptance of euthanasia is greater in Western than Eastern European countries.

We also think it interesting to note that in this European macro-survey, Spain is among the countries that show hesitant acceptance of euthanasia, when the CIS survey⁹³, showed it to be overwhelmingly accepted (80.2%). In our view, this difference could be due to the different phrasing used in both surveys. In the CIS survey, the question referred to whether respondents think doctors should be able to end a patient’s life and suffering, which in a way does not indicate a direct reference to euthanasia. In contrast, in the European survey, respondents were asked whether they thought that euthanasia can always be justified. Explicitly including the word euthanasia seems to be important when assessing the opinion expressed⁹⁴.

In another survey conducted two years later in 15 European countries, which included 2000-2200 adults in each country, the percentage of affirmative responses ranged from 47% in Russia and 48% in Poland to 84% in France and 86% in Belgium; when asked whether it should not be legal, the answers varied between 32% in Russia and 29% in Poland to 5% in France and 4% in Belgium. When asked whether assisted suicide should be legal, 65% of French, 64% of Belgians, and 34% of Russians and Italians said yes, and when asked whether it should not be legal, 16% of Belgians and 18% of French replied yes, while 48% of Russians and Italians said no.

In evaluating these data, attention is drawn to the differences found between the Cohen group survey⁹⁵ and the poll conducted by The Economist and Ipsos MORI⁹⁶. These differences could be due to the fact that the terms euthanasia and assisted suicide are not explicitly mentioned in the latter, as they ask whether “it should be legal for a doctor to assist a patient in ending their life,” a question that seems to refer to euthanasia, but does not explicitly include it. The same is true of assisted suicide.

In the United States, almost 50% of the population⁹⁷ support the legalization of euthanasia and assisted suicide, that is, a percentage quite similar to that of the European population. Thus, I think it can be safely said that this is approximately the percentage of acceptance of both practices in the developed world.

But to conclude, we need to ask why there are such significant differences in the surveys conducted to assess whether the general public or medical community want euthanasia or suicide to be legalized? It seems to us that, in general terms, it could be argued that many of the differences found may lie in the different questions used in the surveys⁹⁸, because this can un- doubtedly introduce biases, which we should think are not ideologically intentional by those who develop the aforementioned polls.

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4. Conclusion

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The main aim of this article is to try to determine whether there really is a social demand in Western countries that justifies seeking the legalization of euthanasia and suicide, especially in countries in which, like Spain, the issue is currently being discussed. We believe it can be argued that, in these countries, there is no clear social demand for the legalization of both practices.

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5.  References

.

Bachman, J. G., Alcser, K.H., Doukas, D.J., Lichtenstein, R.L., Corning, A. D., Brody, H. «Attitudes of Michigan Physicians and the Public Toward Legalizing Physician-Assisted Suicide and Voluntary Euthanasia». New Eng- land Journal of Medicine. 1996; 334(5): 303-9.

British Medical Association. [Publicación en línea] «The BMA’s position on physician-assisted-dying». 2020. https://www.bma.org.uk/advice-and-support/ethics/ end-of-life/the-bmas-position-on-physician-assist- ed-dying [Consulta: 22/05/2020]

Canadian Society of Palliative Care Physicians Position Statement. [Publicación en línea] «Position on euthanasia and assisted suicide». 2015 .http://www. cspcp.ca/wp-content/uploads/2014/10/CSPCP-Posi-tion-on-Euthanasia-and-Assisted-Suicide-Feb-6-2015. pdf

Centro de Investigaciones Sociológicas. [Publi- cación en línea] «Actitudes y Opiniones de los médicos ante la eutanasia». Estudio nº 2451. 2002. http:// www.cis.es/cis/export/sites/default/-Archivos/Mar- ginales/2440_2459/2451/Es2451mar.pdf [Consulta: 20/05/2020]

Centro de Investigaciones Sociológicas. [Publicación en línea] «Atención a pacientes con enfermedades  en fase terminal». Estudio nº 2803. 2009. http://www. cis.es/cis/export/sites/default/Archivos/Margina- les/2800_2819/2803/es2803.pdf [Consulta: 27/05/2020]

Cohen, J., Marcoux, I., Bilsen, J., Deboosere, P., van der Wal, G., Deliens, L. «Trends in acceptance of eutha- nasia among the general public in 12 European countries (1981–1999)». European Journal of Public Health. 2006a; 16: 663–669.

Cohen, J., Marcoux, I., Bilsen, J., Deboosere, P., van der Wal, G., Deliens, L. «European Public Acceptance of Euthanasia: Socio-Demographic and Cultural Factors Associated With the Acceptance of Euthanasia in 33 European Countries». Social Science and Medicine. 2006b; 63(3): 743-56.

 Cohen, J., Van Landeghem, P., Carpentier, N., Deliens, L. «Public acceptance of euthanasia in Europe: a survey study in 47 countries». International Journal of Public Health. 2014; 59(1): 143-56.

Colegio de Médicos de Bizkaia. [Publicación en línea] Informe «Eutanasia y suicidio médicamente asistido» 2018. https://www.cmb.eus/informe-encuesta-eutanasia-y-suicidio-medicamente-asistido-del-cmb [Consulta: 20/05/2020]

Colegio de Médicos de Las Palmas. [Publicación en línea]«Resultados Encuesta eutanasia». 2019. https://medi-coslaspalmas.es/images/COLEGIO/fundamentos/resul-tados-encuesta-eutanasia.pdf [Consulta: 21/05/2020]

Col.legi Oficial de Metges de Tarragona. [Publicación en línea] «Resultats de l’enquesta realitzada sobre la percepció de l’eutanàsia entre el col·lectiu de metges». 2019. https://www.comt.org/actualitat-i-publicacions/noticies-del-comt/5998-resultats-de-l-enquesta-real-itzada-sobre-la-percepcio-de-l-eutanasia-en%20tre-el-col-lectiu-de-metges[Consulta: 21/05/2020]

De Lima, L., Woodruff, R., Pettus, K., Downing, J., Buitrago, R., Munyoro, E., et al. «International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide».  Journal of Palliative Care. 2017; 20: 8-14.

De Wachter, M. A. «Active Euthanasia in The Netherlands». JAMA. 1989; 262(23): 3316-9.

Emanuel, E. J. «Historical, ethical, and empirical perspectives». Arch Intern Med. 1994; 154: 1890-901.

Emanuel, E. J., Fairclough, D., Clarridge, B. C., Blum, D., Bruera, E, Penley, W. C., et al. «Attitudes and Practices of U.S. Oncologists Regarding Euthanasia and Physician-Assisted Suicide». Annals of Internal Medicine. 2000; 133(7): 527-32.

Emanuel, E. J. «Euthanasia and Physician-Assisted Suicide. A Review of the Empirical Data From the United States». Archives of Internal Medicine. 2002; 162(2): 142-152.

Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., Cohen, J. «Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Cana- da, and Europe». JAMA. 2016; 316(1): 79-90.

Folker, A. P, Holtug, N., Jensen, A. B., Kappel, K., Nielsen, J. K., Norup, M. «Experiences and attitudes towards end of life decisions amongst Danish physicians». Bioethics. 1996; 10: p. 233-49.

Førde, R., Aasland, O. G., Falkum, E. «The Ethics of Euthanasia--Attitudes and Practice Among Norwegian Physicians». Social Science and Medicine. 1997; 45(6): 887-92.

Foro de la Familia. [Publicación en línea] «Escocia rechaza la ley de suicidio asistido». 2015. https://www. forofamilia.org/noticias/escocia-rechaza-la-ley-de-suicidio-asistido/ [Consulta: 25/05/2020]

Grassi, L., Magnani, K., Ercolani, M. «Attitudes Toward Euthanasia and Physician-Assisted Suicide Among Italian Primary Care Physicians». Journal of Pain and Symptom Management. 1999; 17(3): 188-96.

Iacobucci G. «RCP adopts neutral stance on assisted dying after poll of members». British Medical Journal. 2019; 364: l1340.

Ilustre Colegio Oficial de Médicos de Madrid. [Publicación en línea] «Jornada de debate sobre la eutanasia». 2019. https://www.icomem.es/formacion/3/ Formacion-Medica-Continuada/123/Jornada-de-debate-sobre-la-Eutanasia[Consulta:19/05/2020]

Ilvemark, J., Dahle, B., Matzen, L. E. «Questionnaire- based survey suggests that the majority of Danish geriatricians are against euthanasia». Danish Medical Journal. 2016; 63(2): A5187.

Ipsos Mori. [Publicación en línea] «Public attitudes to Assisted Dying». 25/06/2015. https://www.ipsos.com/ ipsos-mori/en-uk/public-attitudes-assisted-dying [Consulta: 27/05/2020]

Kmietowicz, Z. «BMA annual meeting: Doctors vote to maintain opposition to assisted dying». British Medical Journal. 2016; 353: i3486.

Kouwenhoven, P.S.C., Raijmakers, N.J.H., van Delden, J.J.M., Rietjens, J.A.C., Schermer, M.H.N., van Thiel, G.J.M.W., et al. «Opinions of Health Care Professionals and the Public After Eight Years of Euthanasia Legislation in the Netherlands: A Mixed Methods Approach». Palliative Medicine. 2013; 27(3): 273-80.

Kouwenhoven, P.S.C, van Thiel, G.J.M.W., Raijmakers, N.J.H., Rietjens, J.A.C., van der Heide, A., van Delden,

J.J.M. «Euthanasia or Physician-Assisted Suicide? A Survey From the Netherlands». European Journal of General Practice. 2014; 20(1): 25-31.

Lee, M. A., Tolle, S. W. «Oregon’s Assisted Suicide Vote: The Silver Lining». Annals of Internal Medicine. 1996; 124(2): 267-9.

Maitra, R. T., Harfst, A., Bjerre, L. B., Kochen, M. M., Becker, A. «Do German General Practitioners Support Euthanasia? Results of a Nation-Wide Questionnaire Survey». The European Journal of General Practice. 2005; 11(3-4): 94-100.

Materstvedt, L. J., Kaasa, S. «Euthanasia and Physician- Assisted Suicide in Scandinavia--with a Conceptual Suggestion Regarding International Research in Relation to the Phenomena». Palliative Medicine. 2002; 16(1): 17-32.

McCarthy, J. [Publicación en línea] «Seven in 10 Americans Back Euthanasia». Gallup. 18/06/2014.https://news.gallup.com/poll/171704/seven-americans-back-euthanasia.aspx [Consulta: 28/05/2020]

McCormack, R., Clifford, M., Conroy, M.  «Attitudes of UK doctors towards euthanasia and physician-assist- ed suicide: A systematic literature review». Palliative Medicine. 2011; 26: 23-33.

McGlade, KJ, Slaney L, Bunting BP, Gallagher AG. «Voluntary Euthanasia in Northern Ireland: General Practitioners’ Beliefs, Experiences, and Actions». British Journal of General Practice. 2000; 50(459): 794-7.

Medscape. [Publicación en línea] «Medscape Ethics Re- port 2014, Part 1: Life, Death, and Pain». https://www. medscape.com/features/slideshow/public/ethics2014- part1 [Consulta: 21/05/2020]

Mercadante, S., Masedu, F., Degan, G., Marinangeli, F., Aielli, F. «Physicians’ Attitudes Toward Euthanasia and Assisted Suicide in Italy». Journal of Pain and Symptom management. 2018; 56: e1–e3.

Nilstun, T., Melltorp. G., Löfmark, R., Sjökvist, P. «Disa- greement among physicians about active euthanasia. 245 answers from a Swedish questionnaire reflect uncertainty». Lakartidningen. 1996; 93(14): 1350-1351.

Observatorio de Bioética. Universidad Católica de Valencia. [Publicación en línea] «La eutanasia que nos llega. Reflexión médica, jurídica y moral». 10/02/2020 https://www.observatoriobioetica.org/2020/02/la-eutanasia-que-nos-llega-reflexion-medica-juridica-y- moral/32598 [Consulta: 28/05/2020]

PROCON. ORG. [Publicación en línea] «Euthanasia & Physician-Assisted Suicide (PAS) around the world». Legal Status in 28 Countries from Australia to Uruguay. 2020. https://euthanasia.procon.org/euthanasia-physician-assisted-suicide-pas-around-the-world/ [Consulta: 19/05/2020]

Ramírez, J. P. [Publicación en línea] «La OMC plantea una ley de atención al final de la vida en pleno debate sobre la eutanasia». iSanidad. 14 de febrero 2020. http://isanidad.com/155364/la-omc-plantea-una-ley-de-atencion-al-final-de-la-vida-en-pleno-debate-so- bre-la-eutanasia/ [Consulta: 19/05/2020]

Rietjens, J. A. C., van der Heide, A., Onwuteaka-Philipsen, B.D., van der Maas, P. J., van der Wal, G. «A Compa- rison of Attitudes Towards End-Of-Life Decisions: Sur- vey Among the Dutch General Public and Physicians». Social Science & Medicine. 2005; 61(8): 1723-32

Rimmer, A. «Assisted dying: BMA surveys its members for first time». British Medical Journal. 2020; 368: m459.

Schröder, C., Schmutzer, G., Klaiberg, A., Brähler, A. «At- titudes Towards Professional Euthanasia in the Range Between Grement in the Society and Personal Preferences--Results of a Representative Examination of the German General Population».  Psychotherapie, Psychosomatik, medizinische Psychologie. 2003; 53(8): 334-43.

Seale, C. «Legalisation of Euthanasia or Physician-Assis- ted Suicide: Survey of Doctors’ Attitudes». Palliative Medicine. 2009; 23(3): 205-12.

Sheahan, L. «Exploring the Interface Between ‘Physician- Assisted Death’ and Palliative Care: Cross-Sectional Data from Australasian Palliative Care Specialists». Internal Medicine Journal. 2016; 46(4): 443-51.

Smets, T., Cohen, J., Bilsen, J., Van Wesemael, Y., Rurup,

M. L., Deliens, L. «Attitudes and Experiences of Bel- gian Physicians Regarding Euthanasia Practice and the Euthanasia Law». Journal of Pain and Symptom Management. 2011; 41(3): 580-93.

Snyder, L., Sulmasy, D. P., «Ethics and Human Rights Committee. American College of Physicians-American Society of Internal Medicine. Physician-assisted Suicide». Annals of Internal Medicine. 2001; 135(3):   p. 209-16.

The conversation. [Publicación en línea] «The murky issue of whether the public supports assisted dying». 5/10/2017 [Consulta: 28/05/2020]

van der Wal, G., Dillmann, R. J. «Euthanasia in The Netherlands». British Medical Journal. 1994; 308(6940): 1346–1349.

 .

6. Bibliography and notes

.

1 Emanuel, E. J. «Historical, ethical, and empirical perspectives». Arch Intern Med. 1994; 154: 1890-901.

2 PROCON. ORG. [Publicación en línea] «Euthanasia & Physician-Assisted Suicide (PAS) around the world». Legal Status in 28 Countries from Australia to Uruguay. 2020. https://euthanasia.procon.org/euthanasia-physician-assisted-suicide-pas-around-the-world/ [Consulta: 19/05/2020]

3 De Lima, L., Woodruff, R., Pettus, K., Downing, J., Buitrago, R., Munyoro, E., et al. «International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide». Journal of Palliative Care. 2017; 20: 8-14.

 4 Centro de Investigaciones Sociológicas. [Publicación en línea]«Actitudes y Opiniones de los médicos ante la eutanasia». Estudio nº 2451. 2002. http://www.cis.es/cis/export/sites/default/-Archivos/ Marginales/2440_2459/2451/Es2451mar.pdf [Consulta: 20/05/2020]

5 Colegio de Médicos de Bizkaia. [Publicación en línea] Informe «Eutanasia y suicidio médicamente asistido» 2018. https://www.cmb.eus/informe-encuesta-eutanasia-y-suicidio-medica-mente-asistido-del-cmb [Consulta: 20/05/2020]

6 Ilustre Colegio Oficial de Médicos de Madrid. [Publicación    en línea] «Jornada de debate sobre la eutanasia». 2019. https:// www.icomem.es/formacion/3/Formacion-Medica-Continuada/123/ Jornada-de-debate-sobre-la-Eutanasia [Consulta: 19/05/2020]

7 Col.legi Oficial de Metges de Tarragona. [Publicación en línea] «Resultats de l’enquesta realitzada sobre la percepció de l’eutanàsia entre el col·lectiu de metges». 2019. https://www. comt.org/actualitat-i-publicacions/noticies-del-comt/5998-resul-tats-de-l-enquesta-realitzada-sobre-la-percepcio-de-l-eutana- sia-en%20tre-el-col-lectiu-de-metges [Consulta: 21/05/2020]

8 Colegio de Médicos de Las Palmas. [Publicación en línea] «Resultados Encuesta eutanasia». 2019.https://medicoslaspalmas.es/images/COLEGIO/fundamentos/resultados-encuesta-eutanasia.pdf [Consulta: 21/05/2020]

9 Medscape. [Publicación en línea] «Medscape Ethics Report 2014, Part 1: Life, Death, and Pain». https://www.medscape.com/ features/slideshow/public/ethics 2014-part 1 [Consulta: 21/05/2020]

10 Ramírez, J. P. [Publicación en línea] «La OMC plantea una  ley de atención al final de la vida en pleno debate sobre la eutanasia». I Sanidad. 14 de febrero 2020. http://isanidad.com/155364/ la-omc-plantea-una-ley-de-atencion-al-final-de-la-vida-en-pleno-debate-sobre-la-eutanasia/ [Consulta: 19/05/2020]

11 British Medical Association. [Publicación en línea]  «The  BMA’s position on physician-assisted dying». 2020.

https://www.bma.org.uk/advice-and-support/ethics/end-of-life/the-bmas-posi-tion-on-physician-assisted-dying [Consulta: 22/05/2020]

12 Seale, C. «Legalisation of Euthanasia or Physician-Assisted Suicide: Survey of Doctors’ Attitudes». Palliative Medicine. 2009; 23(3): 205-12.

13 McCormack, R., Clifford, M., Conroy, M. «Attitudes of UK doctors towards euthanasia and physician-assisted suicide: A systematic literature review». Palliative Medicine. 2011; 26: 23-33.

14 Medscape, op. cit. 9

15 Kmietowicz, Z. «BMA annual meeting: Doctors vote to maintain opposition to assisted dying». British Medical Journal. 2016; 353: i3486.

16 Rimmer, A. «Assisted dying: BMA surveys its members for first time». British Medical Journal. 2020; 368: m459.

17 British Medical Association, op. cit. 11.

18 Iacobucci G. «RCP adopts neutral stance on assisted dying after poll of members». British Medical Journal. 2019; 364: l1340.

19 Iacobucci., op. cit. 18.

20 Foro de la Familia. [Publicación en línea] «Escocia rechaza la ley de suicidio asistido». 2015. https://www.forofamilia.org/noticias/escocia-rechaza-la-ley-de-suicidio-asistido/[Consulta: 25/05/2020]

21 Grassi, L., Magnani, K., Ercolani, M. «Attitudes Toward Euthanasia and Physician-Assisted Suicide Among Italian Primary Care Physicians». Journal of Pain and Symptom Management. 1999; 17(3): 188-96.

22 Ibid., 9.

23 Maitra, R. T., Harfst, A., Bjerre, L. B., Kochen, M. M., Becker, A. «Do German General Practitioners Support Euthanasia? Results of a Nation-Wide Questionnaire Survey». The European Journal of General Practice. 2005; 11(3-4): 94-100.

24 Ibid., 9.

25 Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., Cohen, J. «Attitudes and Practices of Euthanasia and Physician- Assisted Suicide in the United States, Canada, and Europe». JAMA. 2016; 316(1): 79-90.

26 Førde, R., Aasland, O. G., Falkum, E. «The Ethics of Eutha- nasia--Attitudes and Practice Among Norwegian Physicians». Social Science and Medicine. 1997; 45(6): 887-92.

27 Folker, A. P, Holtug, N., Jensen, A. B., Kappel, K., Nielsen, J. K., Norup, M. «Experiences and attitudes towards end of life decisions amongst Danish physicians». Bioethics. 1996; 10: p. 233-49.

28 Ilvemark, J., Dahle, B., Matzen, L. E. «Questionnaire-based survey suggests that the majority of Danish geriatricians are against euthanasia». Danish Medical Journal. 2016; 63(2): A5187.

29 Ilvemark y cols., op.cit. 28.

30 Nilstun, T., Melltorp. G., Löfmark, R., Sjökvist, P. «Disagreement among physicians about active euthanasia. 245 answers from a Swedish questionnaire reflect uncertainty». Lakartidningen.  1996;  93(14): 1350-1351.

31 Rietjens, J. A. C., van der Heide, A., Onwuteaka-Philipsen, B.D., van der Maas, P. J., van der Wal, G. «A Comparison of Attitudes Towards End-Of-Life Decisions: Survey Among the Dutch General Public and Physicians». Social Science & Medicine. 2005; 61(8): 1723-32.

32 Kouwenhoven, P.S.C., Raijmakers, N.J.H., van Delden, J.J.M., Rietjens, J.A.C., Schermer, M.H.N., van Thiel, G.J.M.W., et al. «Opinions of Health Care Professionals and the Public After Eight Years of Euthanasia Legislation in the Netherlands: A Mixed Methods Approach». Palliative Medicine. 2013; 27(3): 273-80.

33 Kouwenhoven, P.S.C, van Thiel, G.J.M.W., Raijmakers, N.J.H., Rietjens, J.A.C., van der Heide, A., van Delden, J.J.M. «Euthanasia or Physician-Assisted Suicide? A Survey From the Netherlands». European Journal of General Practice. 2014; 20(1): 25-31.

34 De Wachter, M. A. «Active Euthanasia in The Netherlands». JAMA. 1989; 262(23): 3316-9.

35 Van der Wal, G., Dillmann, R. J. «Euthanasia in The Netherlands». British Medical Journal. 1994; 308(6940): 1346–1349.

36 Smets, T., Cohen, J., Bilsen, J., Van Wesemael, Y., Rurup, M. L., Deliens, L. «Attitudes and Experiences of Belgian Physicians Regarding Euthanasia Practice and the Euthanasia Law». Journal of Pain and Symptom Management. 2011; 41(3): 580-93.

37 McGlade, KJ, Slaney L, Bunting BP, Gallagher AG. «Voluntary Euthanasia in Northern Ireland: General Practitioners’ Beliefs, Experiences, and Actions». British Journal of General Practice. 2000; 50(459): 794-7.

38 Ibid., 9.

39 Ibid., 9.

40 Emanuel op.cit. 1.

41 Emanuel, E. J., Fairclough, D., Clarridge, B. C., Blum, D., Bru- era, E,, Penley, W. C., et al. «Attitudes and Practices of U.S. Oncolo- gists Regarding Euthanasia and  Physician-Assisted  Suicide».  Annals of Internal Medicine. 2000; 133(7): 527-32.

42        Lee, M. A., Tolle, S. W. «Oregon’s Assisted Suicide Vote: The Silver Lining». Annals of Internal Medicine. 1996; 124(2): 267-9.

43        Bachman, J. G., Alcser, K.H., Doukas, D.J., Lichtenstein, R.L., Corning, A. D., Brody, H. «Attitudes of Michigan Physicians and the Public Toward Legalizing Physician-Assisted Suicide and Voluntary Euthanasia». New England Journal of Medicine. 1996; 334(5): 303-9.

44        Snyder, L., Sulmasy, D. P., «Ethics and Human Rights Com- mittee. American College of Physicians-American Society of Internal Medicine. Physician-assisted Suicide». Annals of Internal Medicine. 2001; 135(3): p. 209-16.

45        Canadian Society of Palliative Care Physicians Position State- ment. [Publicación en línea] «Position on euthanasia and assisted suicide». 2015. http://www.cspcp.ca/wp-content/uploads/2014/10/

49 Cohen, J., Marcoux, I., Bilsen, J., Deboosere, P., van der Wal, G., Deliens, L. «Trends in acceptance of euthanasia among the general public in 12 European countries (1981–1999)». European Journal of Public Health. 2006; 16: 663–669.

50 Cohen, J., Marcoux, I., Bilsen, J., Deboosere, P., van der Wal, G., Deliens, L. «European Public Acceptance of Euthanasia: Socio-Demographic and Cultural Factors Associated With the Acceptance of Euthanasia in 33 European Countries». Social Science and Medi- cine. 2006; 63(3): 743-56.

51 Cohen, J., Van Landeghem, P., Carpentier, N., Deliens, L. «Public acceptance of euthanasia in Europe: a survey study in 47 countries». International Journal of Public Health. 2014; 59(1): 143-56.

52 Cohen y cols., op. cit. 51.

53 Cohen y cols., op. cit. 50.

54 Schröder, C., Schmutzer, G., Klaiberg, A., Brähler, A. «Attitudes Towards Professional Euthanasia in the Range Between Grement in the Society and Personal Preferences--Results of a Representative Examination of the German General Population». Psychotherapie, Psychosomatik, medizinische Psychologie. 2003; 53(8): 334-43.

55 Rietjens y cols., op. cit. 31.

56 Cohen y cols., op. cit. 49.

57 Ibid., 50

58 Ibid., 51

59 Ibid., 51

60 Ipsos Mori. [Publicación en línea] «Public attitudes to Assisted Dying». 25/06/2015. https://www.ipsos.com/ipsos-mori/en-uk/public-attitudes-assisted-dying [Consulta: 27/05/2020]

61 The conversation. [Publicación en línea] «The murky issue of whether the public supports assisted dying». 5/10/2017 [Consulta: 28/05/2020]

62 McCarthy, J. [Publicación en línea] «Seven in 10 Americans Back Euthanasia». Gallup. 18/06/2014.https://news.gallup.com/poll/171704/seven-americans-back-euthanasia.aspx [Consulta: 28/05/2020]

63 Emanuel, E. J. «Euthanasia and Physician-Assisted Suicide. A Review of the Empirical Data From the United States». Archives of Internal Medicine. 2002; 162(2): 142-152.

64 Emmanuel., op. cit. 63

65 Observatorio de Bioética. Universidad Católica de Valencia. [Publicación en línea] «La eutanasia que nos llega. Reflexión médica, jurídica y moral». 10/02/2020. https://www.observatoriobioetica.org/2020/02/la-eutanasia-que-nos-llega-reflexion-medica-juridica-y-moral/32598 [Consulta: 28/05/2020]

66 Colegio de Médicos de Bizkaia., op.cit. 5

67 Ilustre Colegio de Médicos de Madrid., op.cit. 6

68 Col.legi Oficial de Metges Tarragona., op. cit. 7

69 Colegio de Médicos de Las Palmas., op. cit. 8

70 Centro de Investigaciones Sociológicas., op. cit 4.

71 Ibid., 4.

72 Ibid., 28.

73 Mercadante, S., Masedu, F., Degan, G., Marinangeli, F., Aielli, F. «Physicians’ Attitudes Toward Euthanasia and Assisted Suicide in Italy». Journal of Pain and Symptom management. 2018; 56:  e1–e3.

74 Ibid., 18.

75 Ibid., 9.

76 McGlade y cols., op.cit. 37. 77 Ibid., 31.

78 Kouwenhoven y cols., op.cit. 32.

79 Smets y cols., op.cit. 36.

80 Ibid., 9.

81 Ibid., 9.

82 Ibid., 9.

83  van der Wal y cols., op.cit 35.

84 Centro de Investigaciones Sociológicas, op.cit. 48.

85 Observatorio de Bioética., op.cit. 65

86 Schröder y cols., op.cit. 54 87 Ibid., 31.

87 Ibid., 31.

88 Ibid., 49.

89 Ibid., 50.

90 Ibid., 51.

91 Ibid., 51.

92  Ibid., 51.

93  Ibid., 48.

94 Materstvedt, L. J., Kaasa, S. «Euthanasia and Physician-Assisted Suicide in Scandinavia--with a Conceptual Suggestion Regarding International Research in Relation to the Phenomena». Palliative Medicine. 2002; 16(1): 17-32.

95 Ibid 51.

96 Ipsos Mori., op.cit. 60. 97 Ibid., 63.

98 Emanuel y cols., op.cit. 25.