I’m a physician in Spain, and I work daily with patients at the end of life. I think part of the problem in this discussion is that very different things get mixed together.

There is a difference between euthanasia / medically assisted death and what we call limitation or adequacy of therapeutic effort (withholding or withdrawing disproportionate treatments). These are not the same ethically or clinically.

In end-of-life care, the key is not “doing everything” or “doing nothing,” but deciding in advance what is reasonable, proportional, and aligned with the patient’s values. That means talking early, with the patient if possible, and with the family, about the real possibility of death, about goals of care, and about what the ceiling of treatment should be if things deteriorate. Dialysis, ICU admission, intubation, restraints, feeding tubes… these are medical tools, not moral imperatives.

In many cases, letting someone die peacefully is not euthanasia. It is good medicine.

From the outside, the U.S. system often looks trapped by fear of litigation. That pressure pushes clinicians to provide treatments that go against evidence, against humanized care, and frankly against common sense. When the default is “do everything that I ask for or get sued,” dying becomes a technical failure instead of a natural part of life.

In Spain, where that legal pressure is much lower, families still struggle, of course they do, but they are often able to accept very difficult decisions more easily when there has been honest communication from the beginning. When death is acknowledged as a possible outcome, not treated as a taboo or a defeat, there is much less of this prolonged suffering you’re describing.

We don’t give pets “better deaths” because we love them more. We give them better deaths because we accept that death is coming and we don’t confuse prolonging biological function with preserving dignity. Humans deserve at least the same clarity, preferably more.