Background: In 2021, Spain became the first Southern European country to grant and provide the right to euthanasia and medically assisted suicide. According to the law, the State has the obligation to ensure its access through the health services, which means that healthcare professionals’ participation is crucial. Nevertheless, its implementation has been uneven. Our research focuses on understanding possible ethical conflicts that shape different positions towards the practice of Medical Assistance in Dying, on identifying which core ideas may be underlying them, and on suggesting possible reasons for this disparity. The knowledge acquired contributes to understanding its complexity, shedding light into ambivalent profiles and creating strategies to increase their participation. Methods: We conducted an exploratory qualitative research study by means of semi-structured interviews (1 h) with 25 physicians and nurses from primary care (12), hospital care (7), and palliative care (6), 17 women and 8 men, recruited from Madrid, Catalonia, and Andalusia between March and May 2023. Interviews were recorded, transcribed, and coded in Atlas.ti software by means of thematic and interpretative methods to develop a conceptual model. Results: We identified four approaches to MAiD: Full Support (FS), Conditioned Support (CS), Conditioned Rejection (CR), and Full Rejection (FR). Full Support and Full Rejection fitted the traditional for and against positions on MAiD. Nevertheless, there was a gray area in between represented by conditioned profiles, whose participation cannot be predicted beforehand. The profiles were differentiated considering their different interpretations of four core ideas: end-of-life care, religion, professional duty/deontology, and patient autonomy. These ideas can intersect, which means that participants' positions are multicausal and complex. Divergences between profiles can be explained by different sources of moral authority used in their moral reasoning and their individualistic or relational approach to autonomy. Conclusions: There is ultimately no agreement but rather a coexistence of plural moral perspectives regarding MAiD among healthcare professionals. Comprehending which cases are especially difficult to evaluate or which aspects of the law are not easy to interpret will help in developing new strategies, clarifying the legal framework, or guiding moral reasoning and education with the aim of reducing unpredictable non-participations in MAID.

Many groups (healthcare professionals, lawyers, philosophers, non-governmental organisations, bioethics committees, journalists, religious groups, etc.) participate in the bioethical debate about medical assistance in dying (MAiD). Bioethics literature on the topic involve different approaches (analytic, empirical, policy oriented, activist) and various normative perspectives (discourses based on deontological premises as the sanctity of life and human dignity, or on utilitarianism, libertarianism, etc.), some of which are at times irreconcilable. Regarding empirical studies, some voices (e.g., healthcare professionals) have been widely considered but the voice of people who request MAiD has been neglected. Understanding the personal and medical circumstances that lead to MAiD, which can only be achieved by listening to the phenomenological discourse of those involved, is key. This study aims to provide knowledge from the testimonies and experiences of patients who have initiated a MAiD request. We believe this research protocol can increase our understanding of a social and academic controversy that lacks important information to be complete. By doing so, this type of research could inform and improve end-of-life public policies, and particularly the health care of individuals who request a MAiD. We propose a qualitative phenomenological study using semi-structured interviews of people in the process of requesting MAiD, as outlined in the Ley Orgánica 3/2021, de regulación de la eutanasia (LORE), the Spanish Law on the Regulation of Euthanasia. The study is conducted nationally using a convenience sampling. The number of interviews is determined sequentially and cumulatively, depending on the richness of the narratives and the saturation of the information that has been collected. For the purposes of analysis, the interviews are transcribed verbatim and pseudonymised afterwards. Data analysis is conducted at the same time as data collection. The proposed study has received a favourable report from the Coordinating Committee on Biomedical Research Ethics of Andalusia (CCEIBA).

Los derechos sexuales y reproductivos de las mujeres y la primera infancia se encuentran amenazados debido a la crisis ocasionada por la COVID-19. Tanto las mujeres gestantes y puérperas como sus criaturas están siendo víctimas de las consecuencias del paradigma del patriarcado ginecobstétrico en tiempos de pandemia. En este artículo analizamos las consecuencias negativas que ha tenido la gestión del coronavirus en los procesos de parto y aborto. Asimismo, defendemos que la crisis desencadenada por la COVID-19 puede ser una oportunidad para visibilizar situaciones de injusticia sexual y reproductiva y para provocar cambios que garanticen los derechos y las libertades de gestantes y criaturas.

From the beginning of the practice of surrogate pregnancy, ethical approaches to it have included several dimensions. Central issues such as surrogates’ genuine autonomy, the risk of exploitation of people in vulnerable situations, or the legitimacy of the commercialization of the body have kept this debate alive for more than three decades. Among all the conflicts, those related to healthcare professionals involved in the surrogacy process have been less frequently addressed. Which patient(s) should they protect? Whose interests should they preserve, the surrogate mother's or the intended parents’? Are there differences in healthcare provision betweenregularpregnant women and those who are going to relinquish their babies? Is adequate compliance with the ethical standards of the caregiver–patient relationship possible? In this article, I will address these questions to identify interests and practices at stake in the healthcare context, where an important part of the surrogacy process occurs.

In 2021, Spain passed Organic Law 3/2021, which regulates euthanasia and represents an extension of rights to make decisions in the context of health care.