Two attempts to approve euthanasia at a national level have failed, but there are three regional laws concerning personal rights at the end of life with another being processed in the Balearic Islands. Two of the existing laws (Andalucía and Aragon) are said to allow the covert implementation of euthanasia, and all of the regional laws are said to confuse palliative care with extraordinary measures such as withdrawal of nutrition and hydration or terminal sedation, and to fail to prevent abuses. Attempts to force change in the courts (all so far unsuccessful) include the famous case of Ramón Sanpedro, which inspired the film "Mar Adentro" ("The Sea Inside").
The national Personal Autonomy and Dependent Care Law integrated care for non-independent persons into public social protection. It is a law ruling for all regions in Spain. The dependence can be owed to incapacity, limitations of activity or participation, social environment, and social or cultural circumstances. Spanish palliative care is running at half capacity with only 3 in 10 terminal patients having access to palliative care, and there are imbalances between the regions. Numbers of doctors, nurses, social workers and psychologists working in palliative care are considerably lower than EU recommended levels.