# The role of the ethics expert in Spanish legislation on euthanasia and mental health

## TL;DR

This paper explores how ethics experts can improve euthanasia decisions for patients with mental illness by using a more holistic and empathetic approach.

## Contribution

The paper introduces a holistic, narrative-based ethical framework for assessing mental capacity in euthanasia cases involving mental illness.

## Key findings

- Traditional functional models are insufficient for evaluating mental capacity in euthanasia requests from patients with mental illness.
- Shared decision-making and empathy are essential for informed and consensual euthanasia decisions.
- Including ethics experts in evaluation commissions can lead to fairer and more humane decisions.

## Abstract

This article examines the assessment of mental capacity in the context of euthanasia, particularly when requested by patients with mental illnesses. It proposes a holistic alternative approach to the traditional functional model, arguing that the latter is insufficient to capture the complexity of these patients’ decisions. Using approaches based on narrative, hermeneutic, and dialogical ethics, it offers an evaluation that considers the patient’s life story, values, and context. Shared decision-making and empathy are identified as fundamental components to ensure informed and consensual decisions, promoting an environment of respect and mutual understanding. The article reviews Spanish legislation on euthanasia, highlighting the need to include medical ethics experts in the Guarantee and Evaluation Commissions. These experts provide a comprehensive ethical perspective essential for addressing the ethical complexities in euthanasia requests and ensuring fair decisions that reflect the patient’s true will. It recommends reviewing and expanding current protocols, as well as including continuous ethics training to improve medical practice in this context. The conclusions suggest that an assessment of mental capacity based on ethical principles and an integrated narrative can significantly improve medical practice and decision-making in euthanasia, especially for these patients. Furthermore, the inclusion of ethics experts in the commissions can provide a more humane and just perspective, ensuring that decisions respect the patient’s dignity and autonomy.