Euthanasia in Spain: Whose life is it anyway?

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1:02And I'm Linda Presley.

1:07And this was Noelia Castillo-Ramos in an interview with I Ahora Son Soles on the Spanish network Antena 3. I'm 25 years old, she says, and I have just four days left.

1:26Because on the 26th of March, I'm having euthanasia. When this fragile young woman was injected with a lethal drug on that March evening in a health clinic in Catalonia, the death she chose became headline news in Spain and around the world. In this week's assignment, we're exploring what's happened since Noelia's euthanasia, how the legal ground is shifting in Spain so that an adult's request for assisted dying can be challenged by their loved ones, and how Noelia's death is being used to raise questions about organ donation in euthanasia cases in Spain. So who was Noelia Castillo Ramos? A troubled teenager with a history of problematic mental health, Noelia was in and out of state care after her parents separated.

2:14Then, when she was 21, she was attacked in a gang rape. Noelia attempted to take her own life. She jumped from a fifth-floor balcony. It left her paraplegic, debilitated and in pain. 18 months later, she formally asked for euthanasia. In July 2024, the commission overseeing Spain's right-to-die law in Catalonia approved Noelia's request. It verified she met the legal criteria, that she suffered from a serious incurable disease or a serious chronic and disabling condition causing intolerable physical or psychological suffering, and that she was capable of making the decision. In Spain, an applicant for euthanasia doesn't have to be terminally ill.

2:59But Noelia's father didn't agree with his daughter's decision. He used the courts to halt the process and keep her alive until his final appeal failed. Noelia's father was represented by the Fundación Española de Abogados Cristianos, the conservative Christian lawyers' foundation that's campaigned against abortion, LGBT-themed books in schools, and is now leading the charge against Spain's euthanasia law. Polonia Castellanos is its president.

3:30What we said, together with Noelia's family, her father, is that she didn't have capacity to choose euthanasia because she had borderline personality disorder. In the courts, the only thing they said was she could decide for herself. We were fighting to say she wasn't capable of that. But Noelia herself as well, she testified before the court that this is what she wanted to do, that this was her wish.

4:00Yes, she wanted to end her life, just as she had when she jumped from the fifth floor. It's similar to someone with anorexia saying they want to be thinner. These are people whose judgment is impaired by a mental disorder or illness, which is what happened to Noelia. And until the law is repealed, it's essential a person is obliged to receive treatment before undergoing euthanasia. We don't know what Noelia's treatment regime was. We don't have her medical records. We do know that every court challenged by her father resulted in Noelia's right to autonomy being upheld. That is, she could decide for herself as a competent adult after she was medically assessed to fulfil the criteria for euthanasia in Spain.

4:55Running alongside the drama of Noelia's euthanasia, but rarely in the headlines, is the story of a man in his mid-50s, again in Catalonia, whose death has been postponed repeatedly. Francesc Auche is still alive.

5:12I have a lot of pain, more mental than physical, but people don't see this pain. They think it doesn't exist. Francesc was speaking to Spanish media Informativos Telecinco and Antena 3 Noticias last year. He's had two heart attacks and four strokes and struggles with his speech. I don't want to continue suffering what I've suffered. I was me, and now I'm not that person anymore. I want to go. and they won't let me, he said. Francesc's request to die was approved by Catalonia's Euthanasia Review Commission back in July 2024, the same month Noelia got the go-ahead. Francesc's death was scheduled time, place and location.

5:57Back then, he lived with his dad, Jordi, a man in his mid-90s. Jordi was horrified by his son's decision to die and contacted a lawyer, Valentín Gómez.

6:13At the time Señor Jordi came to me, I thought he was of completely sound mind. I simply found myself speaking with a father who was very worried and deeply sad about his son's situation. And what he explained was that Francesc, who had suffered strokes and other health problems, was recovering quite well. It's true Frances was feeling very low, but his father believed that if he took the medication and continued with psychological support, he could improve. Francesc's father went to court to stop his son's euthanasia, arguing, much as Noelia's father had, that Francesc couldn't make an autonomous decision about ending his own life because of his mental health.

6:57Francesc's plan to die was halted by the judiciary. Then the case took a different legal turn. The central question became, did Francesc's father, Jordi, have a right to challenge his adult son's death wish? In other words, did the father have what's called legal standing? And recently, the Supreme Court ruled that those with a particularly close connection to the person wanting to die may contest a euthanasia decision. Valentin Gomez believes his client's relationship with his son, Francesc, would qualify.

7:32The relationship between the two has been extremely close. Father and son lived together until a short time ago. Francesc was the person who took care of his father. I do know Jordi is now living with other relatives, but I'm not aware the relationship has broken down. So what about Jordi's son? This is the building that houses the Catalan courts here in Barcelona. We wanted to meet Francesc Auge, but Francesc didn't want to meet us, so we're here to meet his lawyer. In one of the small, bare meeting rooms, we sit down with Montserrat Bell. Hair pulled back from her face in a high ponytail. She tells us that in spite of what we've been told by Francesc's father's lawyer, the relationship between Jordi and Francesc isn't close.

8:24Francesc doesn't even live with his father so I think this raises many doubts about the relationship And when this decision came out of the Supreme Court what was Francesc's reaction to it? He was extremely discouraged he's been suffering for two years I argued the courts shouldn't be debating whether Francesc's father has legal standing they should address the substance of the case whether Francesc can have euthanasia or not. One court has already ruled in his favour and medical reports confirm he has mental capacity. Now Francesc says he has a plan B, to take his own life. He says they're forcing him to die by suicide.

9:09Following the Supreme Court ruling, the decision to give Francesc the green light for euthanasia will have to be examined again before a judge.

9:21At the Catalan Department of Health, we have an appointment to meet Clara Pareja. She's a CEO in Catalonia's Department of Health and has responsibility for implementing Spain's euthanasia law in the region. Is she expecting more challenges from family members? We really don't know, but it's true that it's a door that has opened in this sense, for good or for bad. But I mean, what has happened in the Supreme Court is that it disrupts this philosophy, which Spain has in the euthanasia law, that is its individual autonomy, is that one person has the right to decide for themselves. It disrupts that.

10:02Yes, it does. It does, really does. But we will see what happens in the future. For us, it will not change our way of proceeding because we will give the same support to professionals, to patients and to the whole process. Maybe patients who think that their parents or their loved ones are not loved ones. It's a way of saying more, those master canals, the more the people who are closer, closer. the closest in their family or others may intervene, maybe these patients decide to take along this process in a more intimate or a more secret way. I don't know. And not to tell their loved ones or their family.

10:47Maybe, but this is an interpretation. We don't know. This is a documentary from the BBC World Service.

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12:28You're listening to Assignment from Spain.

12:37A short train ride north of Madrid is the municipality of Alcobendas. It's home to Puri and Salvador, still grieving the loss of their daughter, Ana. They show us the last picture they have of her.

12:54it's in the room in the hospital Anna's in bed we're both with her so you're both in scrubs with masks on Anna is lying in a hospital bed she's smiling a few tubes coming in and out of her we can just see one arm

13:14Anna was born with spina bifida It's when a baby's spine and spinal cord don't develop fully during pregnancy and can cause serious physical impairment. Anna chose to die when she was just 28 because of her physical deterioration and the acute pain she experienced. The Supreme Court ruling on potential family involvement in euthanasia cases has baffled her parents. The Supreme Court has decided that the Supreme Court has decided that. I respect it, but I don't understand it. The Supreme Court has ruled that way. I respect it, but I don't understand it. I can make decisions about things that belong to me, but a child is not a possession, not my property.

13:57And I can understand not wanting your child to die, but we decided to accompany Ana in her decision, because she was an adult, because she was independent. Tell us what she was like, what kind of character did she have, what kind of girl and young woman was she? Ana, sobre todo, por lo que destacaba... What really stood out about Ana was her joy. And she maintained that despite all the difficulties, rehabilitation, the hospital stays and admissions, she was always fighting, striving to improve and to feel a bit better. Y de adolescente, ella hacía teatro... From the time she was a teenager, she was involved in theatre.

14:38She was very funny and had a very British sense of humour. Anna planned to keep studying and began training to care for children with special needs. She had a completely normal outlook on life and her future. Things changed for Anna in her late teens. She was in and out of hospital for two years. Anna had hydrocephalus when excess fluid builds up in the brain and the surgical attempts to control this led to infection, including meningitis and neurological pain, something difficult to treat. I think she didn't know how to cope with that pain, both physical and emotional, of being confined to a hospital bed for so long, unable to move.

15:25COVID and lockdown quickly followed. Anna couldn't attend rehabilitation and her health went down. Her nerve pain got worse.

15:37She couldn't tolerate the pain and made two suicide attempts. The second was just a few months before Spain's euthanasia law was approved. We asked Ana to wait until the law passed, because it's not the same to die alone as it is to die peacefully with others and under sedation. She listened to us and she waited. And there was more unwelcome news about Ana's health in November 2022. At a hospital appointment, Puri told the consultants Ana had episodes at night when she stopped breathing. I'd run into her room and shake her awake. She was often heavily sedated. Once awake, her breathing would improve.

16:21But what the doctors told Ana was that she would probably die from asphyxiation. She said she didn't want to die suffocating. That was when she decided to request euthanasia. So she applied for euthanasia. The application went through. How did you as a family, how did you prepare for what was coming? How can you prepare for the death of a child? The only thing that helped me bear it was that I was convinced Anna herself was certain about what she was doing and that we had time to say goodbye. It's like an hourglass with the sun slowly running through. and you know when the sun runs out, that's when she dies.

17:10After Christmas, a family holiday, and time spent saying goodbye to her many friends and relatives, Anna died by lethal injection in an operating theatre in hospital on the 27th of January, 2023. We stayed with her a few minutes, but we couldn't stay long. Puri, Salvador and their loved ones gathered in a room in the hospital.

17:40We heard the helicopter and said, there it goes, maybe it's carrying Ana's kidney or some other organ to save someone's life.

17:53A committed blood donor, Ana chose to donate her organs after her euthanasia. In the operating theatre where she died, it was almost the last thing she talked about, apologising to the team of assembled surgeons that she was going to give them a lot of work that day. More than 20 people benefited from transplants from Anna's organs. A few months after Anna's death, we were passed a letter from the person who'd received her heart. This is all done anonymously. They wrote that they understood the hurt we were feeling. They thanked us and said that they always take care of their new heart. With all the pain we felt, hearing that Ana's heart was beating in another person so someone could continue to live, that was incredibly meaningful.

18:42It helped us a great deal.

18:49Spain's widely seen as having a health service that supports one of the world's most successful organ donation programmes. But since Noelia Castillo's death, that system's been used to attack Spain's euthanasia law. And this is why. The problem about the organs is that Noelia signed a form about that because she was a vulnerable person. The doctor filled it out and made Noelia sign the document saying she would donate her organs. This is Yolanda Ramos, Noelia's mother, speaking to one of Spain's TikTok warriors who goes by the moniker of El Duque, about what happened before the courts first stopped Noelia's euthanasia in 2024.

19:36Noelia wanted to donate her organs. She believed it was a good thing in the world. But as her mother, I could see they were rushing things. We wanted to speak to Yolanda. We were told she's too upset after the death of her daughter. Also that she's negotiating to make a documentary, so shouldn't speak to other media like the BBC. Yolanda's represented now by Abogados Cristianos, the Christian Lawyers Foundation. When the group at first succeeded in using the courts to halt Noelia's death two years ago, Polonia Castellanos says Yolanda went to the hospital where her daughter was living to inform everyone Noelia's euthanasia was on hold.

20:22Noelia's mother told us the hospital staff told her what a shame that was, because all of Noelia's organs had already been allocated. That's a shocking allegation, isn't it, Esperanza? It is, and it just isn't possible. It doesn't happen like that. Organ donation, retrieval and transplant are extremely complex. Noelia would have undergone a series of medical tests if she was committed to being a donor. There's no evidence he underwent those procedures. Noelia later decided not to donate her organs. When she died, nothing was removed from her body. But the Christian lawyers have made further claims related to Noelia and organ donation.

21:03They say the doctor initially responsible for supporting Noelia in her application for euthanasia, known as the reference doctor, was also a coordinator for organ transplants. We don't know if that's the case. No one would tell us whilst there's an ongoing investigation at the hospital where Noelia died. Polonia Castellanos also questions the financing of organ retrieval and transplant in Spain. In addition to whatever salary a doctor may get, they also receive extra money through the organ donation program. And there's cash paid for the hospital that receives the organs, as well as the specialists, technicians and support staff.