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When Ana decided to die by euthanasia, her parents knew they were facing the greatest pain they would ever have to endure.
"It's like an hourglass in which the sand is falling little by little," remembers Salvador, Ana's father. "And you know that, when it stops falling, she is going to die."
Ana was born with spina bifida, a malformation that occurs when the fetus's spine and spinal cord do not close completely during pregnancy and can cause disability.
In Ana's case, after several interventions and infections, she reached her twenties with intense neuropathic pain and serious mobility problems.
The doctors told her that she would surely die of asphyxiation.
"And that's when she said she didn't want to die like that and asked for euthanasia," says Puri, her mother.
Ana's parents did not try to prevent her from requesting euthanasia. He died in 2023 at age 28.
How could his parents cope? The answer is clear: with love.
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"I may or may not agree with your decision, but I'm going to be with you because I love you," Salvador says.
"She was very clear that she was going to hurt us a lot," says Puri. "But that's what love is, it's being where the person asks you to be and if they ask you to be with them to die, you do it."
It was a short life marked by pain, but Puri and Salvador also remember Ana's joy and her desire to live.
Something that has become more difficult this year, which has had a bittersweet taste for them.
image copyrightHope Escribano
A case that shocked Spain
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In March of this year, Noelia Castillo, 25, died via euthanasia in Catalonia. His case made headlines around the world.
Noelia had been a troubled teenager. He has been in and out of the child protection system since his parents separated.
At the age of 21, she suffered a gang rape. The young woman tried to take her own life by jumping from a fifth-floor balcony. The attempt left her paraplegic and in pain.
After she requested euthanasia and was authorized to receive it in 2024, her father went to court to try to prevent what he considered a state-sponsored suicide. Lost.
"What we were saying is that Noelia was not capable of choosing because she suffered from borderline personality disorder; her judgment was affected," says Poland Castellanos, president of Christian Lawyers, a group of conservatives that represents Noelia's parents.
The association has also campaigned against abortion or against the presence of LGBT-themed books in schools.
But the courts, which had previously assessed that Noelia met the medical criteria that Spain requires for someone to access euthanasia, determined that Noelia was a competent adult and capable of deciding for herself, and that her father had no right to intervene in her death.
Image source, Atresmedia
Two months after Noelia's death, the Supreme Court issued a ruling that changes the landscape of euthanasia.
The court decided that those who have "an especially close relationship" with the person who wishes to die can challenge the decision.
Poland Castellanos considers that it is a good first legal step. But his organisation, Christian Lawyers, will continue to campaign for the euthanasia law to be repealed entirely.
The Supreme Court's decision has perplexed Puri and Salvador, Ana's parents.
"I don't understand it," says Puri. "I can understand that someone doesn't want their child to die, but a child is not property."
How Ana came to request euthanasia
Ana fought during her illness to improve and stay positive. He participated in a theater group and had a good circle of friends. She even started a course caring for children with special needs.
But his illness became complicated. Ana had hydrocephalus, an excessive accumulation of fluid in the brain, the result of her spina bifida.
As a result of his stays in the hospital, he contracted an infection and meningitis that caused neurological pain that was difficult to treat.
With the coronavirus pandemic and confinement, Ana could not go to rehabilitation and got worse.
"He couldn't stand the pain and made two suicide attempts," says Puri.
There were only a few months left until Spain approved the euthanasia law, something that happened in Congress in March 2021 (the law came into force in June of that same year).
Puri and Salvador asked their daughter to wait. "Dying alone and in a violent and aggressive way against oneself is not the same as dying accompanied and in peace," says Puri.
In October 2022, Ana obtained approval to undergo euthanasia. He wanted to spend Christmas with his parents and say goodbye to his family and friends.
He died in the operating room on January 27, 2023 when doctors administered the lethal injection.
"For us, the most special thing was being able to hug her and say goodbye to her until she fell asleep," Puri emphasizes.
"It was a way of saying 'we love you up to here, even here'."
But they couldn't stay long: Ana wanted to donate all her organs and that meant they had to act quickly.
A few seconds before dying, Ana thanked the entire medical team that was there to fulfill her wish.
"And he apologized because he was going to give them a lot of work," Puri recalls.
A couple of minutes after Ana died, Puri and Salvador had to leave the operating room.
More than 20 people benefited from the donation of Ana's organs.
But now, groups that are against euthanasia say that people like Ana should not be able to donate any tissue from their body.
The transplant system
Spain is known for having one of the best organ donation systems in the world.
But since the death of Noelia Castillo, Christian Lawyers has questioned the ethics of the system, after Noelia's mother, Yolanda Ramos, said in a TikTok video that the team in charge of her daughter's euthanasia process pressured her to authorize the donation of her organs.
In 2022, when the courts temporarily stopped Noelia's euthanasia, her mother told the hospital the news.
"From the hospital they tell her that it is a shame because all her organs had already been awarded," says Poland Castellanos, the president of Christian Lawyers who represents Noelia's mother.
The BBC has not been able to verify this information, for which no evidence has been provided.
Both the Department of Health of Catalonia, on which the hospital where Noelia died depends, and the National Transplant Organization, ensure that the process is transparent and that no patient is ever pressured to be a donor.
What the BBC has been able to verify, from sources close to the case, is that Noelia did not undergo any of these tests nor, finally, donated any of her organs.
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But Christian Lawyers takes its complaints further and questions the financing of the transplant system.
"Apart from the salary, there is an extra remuneration for an organ donation program," says Poland Castellanos. "We say that this extra cannot depend on euthanasia."
The association considers that there is an economic interest in those who die by euthanasia donating their organs. And that is not true, says the general director of the National Transplant Organization of Spain, Beatriz Domínguez-Gil González.
"A huge number of highly specialized professionals have to be mobilized for many hours," explains Domínguez-Gil González. "We're paying them for their work; it's not an incentive."
Medical teams charge extra for their work in organ transplantation.
In Andalusia, for example, 4,000 euros (about US$4,500) are paid to be distributed among hospital specialists who have identified, maintained and managed a donation.
If a kidney is removed, the doctors involved charge a sum of around 2,000 euros (about US$2,275), to be distributed among all of them; and nurses, 600 (about US$685).
But these extra payments are made because the health professionals involved in transplants do not receive any compensation for being available 24 hours a day.
"It would be unsustainable for the system," explains Domínguez.
"Suggesting that health professionals encourage euthanasia to obtain a transplant and charge for it is very irresponsible, because it calls into question not only the transplant program, but also the morality and legal behavior of health professionals," he emphasizes.
Of the 565 people who agreed to euthanasia in 2025, 73 were organ donors. A very small number of the total of 2,547 donors who died the same year.
Christian Lawyers and other related groups want organ donation to be prohibited in cases of euthanasia.
Domínguez has a frontal response on this matter. "In Spain, euthanasia is legal. And people who want to donate their organs can do so," he emphasizes.
"Our obligation is to facilitate this because it is important to respect the wishes and autonomy of the people who die and their families."
For parents like Puri and Salvador, prohibiting organ donation in cases of euthanasia would not make sense.
After Ana's death, both were reunited with their loved ones at the hospital. They heard a helicopter. "Maybe Ana's kidney goes there to save other lives," Puri told them.
Two months later, the hospital's transplant coordinator sent them a letter that had been given to him. It was from the person who had received Ana's heart.
The Spanish transplant system is anonymous and the person did not know their donor, nor did Puri and Salvador know who the person was who had their daughter's heart.
"He told us that he understood the pain that the family members could have, but that he appreciated their generosity and that he would always take care of that heart," says Puri.
"For us it was an injection of morale," remembers Salvador.
"With all the pain we had, knowing that Ana's heart is working in another person and has helped her have life helped us a lot."
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