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Reviews Film

Film reopens euthanasia debate in Spain

BMJ 2004; 329 doi: (Published 07 October 2004) Cite this as: BMJ 2004;329:864
  1. Gonzalo Casino, medical journalist (gcasino{at}
  1. El País, Spain

    A film based on a true story of assisted suicide has unexpectedly rekindled the ethical, medical, and political debate about legalising euthanasia in Spain. Mar Adentro (The Sea Inside) focuses on the death six years ago of Ramón Sampedro, a sailor who became quadriplegic after injuries sustained when he was 25 years old.

    The huge media impact that the film had when it opened in Spain last month has made it possible for the main groups supporting and opposing euthanasia to express their positions publicly. The Catholic church has stood by its view that euthanasia is “immoral and antisocial”; the country's Socialist government has been forced to make a statement; and finally the issue has reached the Spanish parliament.

    Mar Adentro, directed by Alejandro Amenábar, has been highly acclaimed and won the special jury award at the Venice Film Festival. But even the film's artistic merits are surpassed by the poignancy of Ramón Sampedro's story. Sampedro, who spent half his life on a bed, unable to move, became a charismatic figure thanks to his insight and his unsuccessful fight with the Spanish legal system for the right to a decent death.

    “I consider life a right, not an obligation, as it is in my case. I have been forced to endure this terrible situation for 29 years, four months and a few days. After all this time, when I evaluate what I have been through, I do not get happiness as an end result.” These were Sampedro's words in a video taped minutes before he drank the cyanide that killed him.

    Every year in Spain more than 200 people with terminal illnesses ask for help to die. Spanish law deems assisted suicide and euthanasia as crimes, even though it allows suicide (survivors remaining unpunished). In Sampedro's case, more than 2000 people confessed to having helped him obtain the cyanide. Finally, the court decided to close its investigation without pressing any charges.

    Embedded Image

    Immobile: Javier Bardem as Ramón Sampedro

    The Spanish prime minister, José Luis Rodríguez Zapatero, who attended the premiere of Mar Adentro with some of his cabinet ministers, has said that he “probably would not” have helped Sampedro to die. Although the right to euthanasia is on the Socialists' agenda, Zapatero has said that there is no time earmarked to meet this commitment and that following Belgium and the Netherlands (the only two countries in Europe that have legalised euthanasia) is not a priority.

    The Association for the Right to Die with Dignity—Spanish acronym DMD—which features in the film, saw the presence of government members at the premiere as promising. DMD's president, the writer Salvador Pániker, has said he thinks “society is a lot more mature than the politicians” and has highlighted the fact that “surveys show that 70% of the population is in favour of euthanasia.”

    Hay Alternativas (There Are Alternatives), a group that opposes euthanasia and abortion, has labelled the film “an ode to death” and has declared that the information given in the film is biased.

    Director Alejandro Amenábar has said that his film is not a demand for euthanasia, and its only aim is to confront the audience with the abyss of death. “It's more a reflection than a demand. I am sure that euthanasia will be regulated in the future and I do not want this film to lose its validity.”

    Sampedro's story is a wise blend of emotion, drama, and humour. “I am just a head stuck to a body,” he says in the film. “For me, those crucial couple of yards to get to you and be able to touch you are an impossible trip, an illusion, a dream… And that is why I want to die.”

    Actor Javier Bardem, who won the best actor award at the Venice festival for his portrayal of Sampedro and who only moves his head and neck in the film, has said: “The immobility that I had to endure while we were filming helped me understand Ramón's torture and his helplessness.”

    The Federación de Asociaciones de Defensa de la Sanidad Pública—a group of doctors and health professionals—has demanded an urgent regulation of euthanasia and assisted suicide. The more conservative Organización Médica Colegial (OMC)) and the Standing Committee of European Doctors are against euthanasia.

    The debate reached the Spanish parliament on 22 September, when health minister Elena Salgado said that the government would not legalise euthanasia during this term of office. However, she announced that palliative care would be improved and that steps would be taken to create a record of living wills and to avoid “therapeutic cruelty.”

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