Ética y muerte digna

This book is an study about the bill of Death with Dignity Act, written by the Andalusian Commission on Healthcare Ethics and Research. The aim of the Act would be to “establish the criteria and conditions to be adopted by the health system to guarantee adequate healthcare during life’s final process based on the prevention of suffering and respect for each person’s dignity and free choice”.

La eutanasia en Bélgica.

The experience of the Netherlands in relation with the legalization and practice of euthanasia is better known in Spain than the Belgian experience in this matter. But the historical process of social debate in Belgium has many specific details which should be known by Spanish healthcare professionals, bioethicists, politicians and lawyers. This paper begins with a comparative analysis of both countries: Spain and Belgium and follows with a description of the milestones of the historical process of debating and, finally, passing the Belgian Law on Euthanasia in 2002. The next chapter consists of a description of the main contents of this important Law. The paper continues then with an approach to the epidemiology of the practice of euthanasia in Belgium and finishes with a description of the different positions of the actors of the process. Two positions are described more in depth: the opinion of the specialists in palliative care, and the opinion of the Catholic Church. The paper ends underlining the reason for the incorporation of the Belgian experience on euthanasia to the debate about the possibility of legalizing euthanasia in Spain.

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996-2007 (MEDEA project).

Abstract Background: Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods: We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results: Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions: Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process. Keywords: Preventable avoidable mortality, Causes of death, Inequalities in health, Small area analysis