Fighting against assisted dying in Spain: catholic-inspired civic mobilization during the COVID-19 pandemic

Abstract

The article analyzes the network structure and dynamics of the Spanish field of catholic-inspired secular organizations (CISO-N), and their mobilization against the Euthanasia Bill amidst the COVID-19 pandemic. In addition to a relational perspective, it adopts a historical-comparative approach to political opportunities that affect the praxis of these organizations. Drawing on 7-year fieldwork, including in-depth interviews with CISO-N activists and participant observation of their demonstrations, it traces CISO-N's discourse of ‘moral panic’ and ties to religious and political organizations, particularly the far-right party VOX. We advance a novel perspective, bridging literature on assisted dying and social movement studies, particularly focusing on far-right Christian populist mobilizations. The article offers one of the first sociological analyses of euthanasia as the new moral, political, and cultural neoconservative anti-rights front, which has been mainly studied from bioethics, socio-medical studies, and medical jurisprudence perspectives.

Introduction

On March 18, 2021, in the context of the socio-health crisis triggered by the COVID-19 pandemic, Spain became the fifth country in Europe and the 11th in the world to regulate assisted dying. With 202 votes in favor, 141 against and two abstentions, the Spanish Congress passed, after almost four decades of political blockade, a law sponsored by the Spanish Socialist Workers' Party (Partido Socialista Obrero Español, PSOE).¹ The Euthanasia Law introduced a new individual right, but also a new benefit to the portfolio of the National Health System, measures that had enjoyed widespread support in Spanish society for over 30 years, notwithstanding the fierce opposition of both the Catholic Church, and the civic and political organizations that will be addressed in this article.

Our study examines the mobilization of the multi-organizational field (Klandermans, 1992) of catholic-inspired secular organizations of neoconservative ideology (henceforth CISO-N) against the Euthanasia Bill. This field encompasses civic organizations that are statutorily non-denominational—hence denying formal ties with the Catholic Church—but that are nonetheless committed to fighting against moral policies (Euchner, 2019) that contradict the catholic mandate of defending life “from conception to natural death.” These organizations are part of what we call ‘organized laity,' developing a novel style of activism “outside the parishes,” and beyond the channels of conservative political parties. They fall within the umbrella of catholic neoconservatism, a political ideology that believes in the “civic power” of religion (Díaz-Salazar, 2007) to order society, and considers Catholicism as the only legitimate and desirable template for “national morality,” especially in matters related to rights to autonomy and bodily integrity.

Our article studies CISO-N mobilization against assisted dying, from the first protest events against the Euthanasia Bill in 2018, to the time of its passage in 2021. We study this mobilization from both a relational and historical-comparative perspective. In doing so, we focus, first, on the network structure and dynamics (Diani, 2003) of the multi-organizational CISO-N field, and its ties to a broader field composed of religious as well as political organizations, particularly the far right-wing party VOX. VOX. Like CISO-Ns, these organizations seek to erode, curtail or curb the expansion of rights related to bodily autonomy and self-determination, forming what we call an ‘expanded anti-rights field.’ Additionally, we study these fields as ‘relational arenas’ (Somers, 1994) formed by contested yet relatively stable ties between organizations, public narratives, and the tactics that make up their protest repertoire. The historical-comparative approach, in turn, considers the structures of political opportunities (Meyer and Minkoff, 2004) that affect the praxis of these organizations. As we will demonstrate, in addition to the socio-sanitary crisis triggered by COVID-19, these structures have been strongly influenced by the arrival of the progressive PSOE-Unidas Podemos (PSOE-UP) coalition to the Spanish Presidency, and the entry of VOX into political institutions.

Taking into account this dual perspective, our article sets out to answer the following questions: How did the socio-health crisis triggered by COVID-19 and the irruption of the far-right VOX party, both of which occurred in the context of a progressive coalition administration, influence anti-assisted dying mobilization? How was the CISO-N field reconfigured and what types of ties were established with the organizations of its expanded field in order to fight the Euthanasia Bill? And, finally, what was the impact of these changes at the level of political opportunities and network structure and dynamics, both on the mobilizational repertoire (Tilly, 2012) and on the anti-euthanasia identity work (Melucci, 1996) carried out by these organizations?

As we will show, the pandemic opened an unexpected window of opportunity not only to revive anti-euthanasia mobilization, weakened since 2018, but also to deepen CISO-N's discourse of ‘moral panic,’ both on the context of approval of the law, and on the practice of assisted dying itself. Evidencing the existing ties between anti-rights civic, religious and political organizations, the anti-euthanasia discourse inspired by the Church and “translated” and transferred to the public arena by CISO-Ns, particularly by the civic organization Vividores, leapt to the institutional political sphere and the mass media in the context of the Bill's parliamentary debate. In April 2020, in the midst of home confinement, VOX accused the PSOE-UP progressive administration of having “euthanized” (Olivas Osuna and Rama, 2021, 4) thousands of elderly people who had died in nursing homes. According to VOX, this followed a deliberate “gerontocidal” policy that sought to save economic and human resources—an argument put forward by the Spanish Episcopal Conference (CEE). Adopting the diagnostic framing (Benford and Snow, 2000) developed by CISO-Ns, the party went on to affirm the legalization of assisted dying turned the government into a “killing machine,” and doctors into its “accomplices and executioners” (LaSexta, 2020). Both actors were thus identified as the “them” against which CISO-N contentious collective action should be directed. This diagnosis opened a new phase in the anti-rights protest cycle (Tarrow, 1998), characterized by the strategic triangulation of protest tactics (Doherty and Hayes, 2018) between civic, religious, and political organizations,² and by the formation of what we call an ‘anti-euthanasia identity front.’

Our study aims to make a threefold contribution to the literature on euthanasia and social movements and, more specifically, to the study of far-right Christian populist movements (Graff and Korolczuk, 2022). First, by analyzing mobilization against assisted dying, our article offers one of the first sociological analyses of the new moral, political, and cultural neoconservative anti-rights front. In Spain, as in other parts of the world, the study of assisted dying has so far been approached mainly from three perspectives: bioethics, socio-medical studies, and medical jurisprudence. The few sociological investigations on the subject analyze social representations on the end-of-life process (Marí-Klose and de Miguel, 2000), or the growing levels of social acceptance of euthanasia (Serrano del Rosal and Heredia Cerro, 2018). Second, the CISO-N field has been mainly studied from the framework of the deprivatization of religion (Cornejo-Valle and Pichardo, 2020), and research using the perspective of social movements has focused, solely, on the mobilization against sexual and reproductive rights and freedoms (Aguilar Fernández, 2012). In summary, to date there is no research addressing the issue of euthanasia by focusing on the complex networks of civic, political, and religious organizations that oppose its legalization; our article aims to fill in this gap. Third, our study presents a systematic analysis of the ties between the CISO-N and the expanded anti-rights fields, an area of study that remains largely unexplored. As we will demonstrate, the results of this relational analysis indicate the need to qualify the conclusions of two sets of studies: those portraying CISO-Ns as either Church delegates or proxies, and those depicting them as being “at the service” of conservative political parties. The former (Dobbelaere and Pérez-Agote, 2015) emphasize the role of catholic bishops, and overestimate the impact of CEE and Vatican documents and declarations on anti-rights protests. As a consequence, CISO-Ns are reduced to the role of mere “translators” and “transmission belts” of the ecclesiastical message. The latter (Möser et al., 2021), in turn, present ties between CISO-Ns and political organizations as “parasitic.” While this may have been true in the past—with parties using CISO-Ns as “vote collectors” and “scriptwriters” for their opportunistic opposition to progressive moral policies—current ties with VOX seem to be, so far, more of a “symbiotic” type.

In addition to being among the extremely few countries having legalized assisted dying, Spain is a paradigmatic case for the study of CISO-N and anti-euthanasia mobilization for what we call its ‘double exceptionalism.’ Spain is at the European forefront in the legislation of moral policies recognizing and regulating rights related to self-determination over one's own body and intimacy (Griera et al., 2021), including assisted dying. Likewise, comparative studies indicate that the Spanish CISO-N field is one of the oldest, most belligerent, and mobilized in Europe (Kuhar and Paternotte, 2017) and that, in recent decades, it has become a clear referent for the Latin American neoconservative fabric (García Martín et al., 2023). Thus, our study provides the first empirical data that, we trust, will shed light on the incipient anti-euthanasia mobilizations sprouting in other European countries (e.g., Ireland, Italy, and Portugal), and may also foreshadow the strategies of anti-rights organizations in countries such as Argentina and Uruguay, where debates around the regulation of euthanasia are beginning to emerge.

The article is organized as follows. After describing our qualitative methodological design, we provide a brief overview of widespread misconceptions around the concept of euthanasia, and offer a detailed account of its regulation, supporters, and opponents around the world. This is followed by the presentation and discussion of results. The third section focuses on the CISO-N field in Spain, its cycle of protest, and multi-organizational networks. The fourth section analyzes the CISO-N anti-assisted dying mobilization, starting in 2018 with the introduction of the Euthanasia Bill, and ending with the passing of the Law in 2021 amidst the COVID pandemic. Finally, in the fifth section we trace the cognitive and emotional identity work (Goodwin et al., 2001) performed by CISO-Ns, focusing on their diagnostic, prognostic, and motivational frameworks (Benford and Snow, 2000).

Data and methods

Data analyzed in this article come from a multi-methods qualitative study supported by a 7-year fieldwork divided into two phases (see Table A1 in the appendix). During the first phase (2016–20) we conducted (1) in-depth interviews with a purposive sample of CISO-N activists (n = 20; see Table A2); (2) participant observation of their demonstrations (n = 4); and (3) secondary data analysis (e.g., official documents). The interviews were conducted in the cities of Bilbao, Pamplona, and Madrid, where the CISO-N recruitment and training networks are more extensive and effective. The sampling took into account two criteria: the relevance of the organization, and the interviewee's level of responsibility within that organization.

The set of CISO-Ns studied (Forum, Platform, CG-HO, and Vividores) is detailed in Table A1. These organizations played a fundamental role in the anti-euthanasia mobilization, together with the main organizations of the expanded anti-rights field: (1) the CEE, the administrative institution under the authority of the Roman Pontiff integrated by all bishops leading Spanish catholic dioceses, and the highest authority of the Catholic Church in Spain; and (2) the radical right-wing party VOX, currently the main CISO-N political ally (particularly of its most radicalized organizations), after the dissolution of the tie with the conservative Popular Party (PP).

During the second phase (2020–23), largely coinciding with the pandemic, we conducted the netnographic fieldwork (Kozinets, 2009). It involved the collection of public data from the web, official webpages, and official Youtube and Twitter accounts. Netnography allowed us to study a mobilizational field strongly based on cyberactivism, and to “overcome” the restrictions imposed by home confinement and the subsequent limitation of mobility. Data collected during both phases have been analyzed following the principles of network and qualitative content analysis.

Euthanasia worldwide: from concept to the Spanish regulation

Enormous confusion has surrounded the meaning of the term euthanasia, much of it fueled by the very organizations analyzed in this article. The term derives from the Greek words eu and thanatos, meaning, respectively, “good” and “death.” Throughout history, the concept has acquired different meanings, but all of them converge in identifying it with a peaceful and painless death. In the mid-twentieth century, secular bioethics also incorporated patients' consent and co-responsibility in their own process of dying as central and indispensable elements (Picón-Jaimes et al., 2022). In this article, we utilize the most recent umbrella term of ‘assisted dying,’ defined as “the act of terminating the life of a person upon that person's explicit and autonomous request” (Kayacan, 2022, 8).

The regulation of euthanasia is meant to provide a legal response to the demand of right-to-die organizations (Mroz et al., 2021) fighting for ‘exit rights’ (Serrano del Rosal and Heredia Cerro, 2018) in the face of disease-associated pain and suffering, functional and cognitive decline, and related experiences of loss of dignity, autonomy, and quality of life. Despite widespread social support for the practice in developed countries over the past few decades (Inglehart and Welzel, 2005), the regulation of euthanasia has been a thorny issue as it poses enormous challenges in the legal, philosophical, moral, and religious realms (Pless et al., 2020). Coherently, investigations highlight euthanasia as one of the most controversial moral policies worldwide (Euchner, 2019), generating sharp levels of social polarization (Preidel and Knill, 2015). As of today, only 11 countries out of 195 have managed to regulate it (see Table 1).

Table 1. Regulation of assisted dying around the world, by type, 2023

Note: Prepared by the authors.

^a Year in which assisted dying laws were first passed; since then, most of them have been reformed.

^b Regulated in at least one sub-national jurisdiction; the date refers to the year of regulation in the first jurisdiction Both the German and Italian Federal Constitutional Courts have ruled in favor of “cooperation with suicide” in certain circumstances; they have also encouraged their respective Parliaments to legislate the right to assisted dying.

Notable differences exist between these countries' assisted dying laws. All of them agree, however, that it must occur in the context of lasting, unbearable, and irreversible suffering caused by an illness or accident that cannot be alleviated; and that patients and physicians must reach consensus regarding the absence of a reasonable prognosis of improvement. There are currently two ways of carrying out assisted dying. First, the so-called ‘active euthanasia,’ in which a healthcare professional intentionally ends the life of a patient by means of active drug administration at the patient's explicit request. Second, ‘physician-assisted suicide’ (PAS), suicide by a patient facilitated by means (such as a drug prescription) or by information (such as an indication of a lethal dosage) provided by a physician aware of the patient's intent. While PAS is legislated in 11 countries, active euthanasia, considered more ethically compromising and therefore facing stronger opposition, is legislated in only eight of these countries, Spain being one of them (see Table 1).

These countries share significant increases in life expectancy, technically advanced healthcare systems, and a shift toward granting patients greater autonomy and co-responsibility in the management of their health and dying process. More importantly to our argument, they all have a strong catholic tradition, even though they are currently undergoing intense processes of conscience secularization (Strohm, 2011) associated with the legislation of progressive moral policies. Consequently, these countries have the Catholic Church as the main institution leading the opposition to assisted dying, considered at the very heart of what Pope John Paul II called the ‘culture of death’ (1995, n. 100). This opposition is shared by a series of palliative care organizations, patient associations, and, mainly, religious groups of Christian orientation (Inbadas et al., 2017). In Spain, they are joined by civic organizations in the CISO-N field, and conservative and extreme right political parties. Despite their vital role in international anti-euthanasia mobilization, no systematic study exists to date on this set of anti-rights organizations.

All the aforementioned characteristics are fulfilled in the case of Spain, where assisted dying was regulated in 2021 after 40 years of political deadlock. Since 1994, more than 15 euthanasia bills had been rejected (Calvo and Martínez, 2022) by the Spanish Congress, a trend that largely contradicted the decades-long majority acceptance of the practice among Spaniards.³ This political impasse was overcome as a result of two main processes. On the one hand, the recurrent mediatization of clandestine euthanasias such as Ramón Sampedro's⁴ (1998) and María José Carrasco's (2019). These cases increased social awareness around the issue, and ignited a collective debate on the self-determination of the sick, and the decriminalization of assisted dying—legally defined as “homicide” until the passing of the 2021 Law, and thus punishable by imprisonment through Article 143 of the Spanish Penal Code. On the other, the consolidation of a bloc of right-to-die collectives that since the 1980s have been fighting to manage complex end-of-life situations.

These processes managed to force the hand of political parties, particularly those in the center to left-wing spectrum, leading them to initiate assisted dying congressional debates in several sub-national jurisdictions. Finally, in 2018, and reflecting a clear departure from its longstanding opposition to assisted dying, upon arrival to the Spanish Presidency in coalition with the far-left Unidas Podemos (UP), the socialist PSOE sponsored a state-level Euthanasia Bill. As we will show below, this milestone ignited a new phase in the CISO-N field's cycle of protest. As with their previous mobilization against so-called ‘gender ideology’ (Kuhar and Patternote, 2017), CISO-Ns aimed at polarizing debate in the public sphere—including legislative bodies, the media, and civil society as a whole—to prevent deliberation, compromise, and consensus around the Bill. Three years later, however, in the context of the socio-health crisis triggered by COVID-19, Spain would finally legalize assisted dying. The Euthanasia Law, as it came to be known, was backed by PSOE, UP, and a wide array of regional parties, mainly of moderate and progressive ideology; among its steadfast opponents were the conservative PP, and the extreme right-wing party VOX.

The catholic-inspired CISO-N field in Spain: cycle of protest and multi-organizational networks

The mobilization against the Euthanasia Bill in Spain is inscribed in the self-styled “pro-life” (Rubio Núñez, 2005) multi-organizational field, which we have redefined as CISO-N. As mentioned, the field includes civic organizations (Baldassarri and Diani, 2007) that deny ties with the Catholic Church, but that are absolutely aligned with the defense of life “from conception to natural death,” denying the right to self-determination in matters of sexual and reproductive rights and freedoms (Cornejo-Valle and Pichardo, 2020) and, more importantly for our study, the management of the end-of-life process. As shown in Figure 1 below, over the last four decades CISO-Ns have mobilized against divorce, women's sexual and reproductive rights, LGTB + rights, assisted reproduction, biomedical research, and, more recently, euthanasia. CISO-Ns have a twofold mission: waging a ‘culture war’ (Bar-On, 2021) based on the strategic secularization (Vaggione, 2020) of the Church's discourses of moral (Cohen, 2011) and sexual panic (Herdt, 2009) against the aforementioned moral policies; and mobilizing in support of traditional values linked to the catholic worldview, and against those legislative initiatives, political parties, and social movements that transcend or actively position themselves against this framework. Thus, these multi-issue organizations (Aguilar Fernández, 2012) act on behalf of public and collective interests, and play a fundamental role in the construction of civil society (Diani, 2015) insofar as they contribute to political discussion, deliberation, and mediation.

Figure 1. Protest cycle of the CISO-N field, in relation to political opportunity structures, 1992–2021

Source: Prepared by the authors based on the analysis of in-depth interviews with CISO-N leaders and activists, secondary data, and netnographic data. Note: When not otherwise indicated, dates associated with the laws correspond to the year in which they were passed. Dates associated with CISO-Ns correspond to their founding or re-founding years. Sectoral CISO-N organizations (see endnote 7) have been excluded due to their peripheral role in the mobilization against assisted dying.

These organizations are part of what we call ‘organized laity,’ developing a novel style of activism “outside the parishes” and beyond the channels of conservative political parties. As such, CISO-Ns are a result of two overlapping processes. On the one hand, the Catholic Church's global strategic shift after the Second Vatican Council (1962–65), aiming to resist and contain the undeniable advances of secularization. This shift was based on the end of the Church's interference in institutional politics, and on the empowerment of the laity as the new ‘political contender’ (Aguilar, 2012) and representative of ecclesiastical interests in the public sphere. On the other, the beginning of the second wave (1960–2000) of the Spanish secularization process (Pérez-Agote, 2010) after 40 years of national catholic military dictatorship, and overwhelming influence of the Church on both private life and the public sphere (Callahan, 2012). During the late Franco years and the Democratic Transition (1975–78) Spain underwent one of the most accelerated processes of modernization and cultural and religious change in the West, experiencing in a single generation “what in most of Europe [took over] a century” (Davie, 1999, 78). The combination of these processes accounts for what we have called Spain's ‘double exceptionalism:' its world-leading status in the legislation of progressive moral policies, including euthanasia, and the robustness and referential character of its CISO-N field.

As shown in Figure 1, since its emergence in the late 1970s, the protest cycle of the CISO-N field can be divided into three phases. The mobilization against the Euthanasia Bill (2018–21) takes place in the context of the third phase, characterized by the arrival of the PSOE-UP progressive coalition to the Spanish Presidency, and by the entry of the far-right party VOX into national politics. During this phase, the CISO-N field is characterized by a ‘two-clique structure’ (see Figure 2), encompassing two cliques⁵ divided by predominant ideological leanings, and what we call a ‘tactical-discursive cleavage.’ The “moderate clique,” formed by organizations of conservative catholic ideology, and characterized by conventional repertoires and a relatively “conciliatory” discourse, is led by two hubs: the Spanish Family Forum (Foro Español de la Familia, Forum hereafter) and the Yes to Life Platform (Plataforma Sí a la Vida, Platform hereafter). The Forum is a network of associations founded in 1999 by people close to Opus Dei and with strong informal ties with the CEE; it is mainly dedicated to welfare and training in family issues. The Platform, composed by a rhizome of self-proclaimed “pro-life” associations with a strong focus on assistance to pregnant women, and informally linked to the CEE, has as its sole activity the organization of an annual demonstration on the International Day of Life⁶ in favor of the “innocent unborn child” and, since 2019, against euthanasia. The “radical clique,” in turn, is led by Citizen Go-Make Yourself Heard (Citizen Go-Hazte Oír, CG-HO henceforth), currently the most internationalized organization in the field, and the one with the most radicalized protest tactics and discourse, strongly influenced by the American “pro-life” groups (Doan, 2009), and ideologically closer to the Spanish political far right. This bipartite field structure dates back to 2009, when the former CISO-N ‘single block’ (2004–09), under the hegemonic leadership of the Forum, splintered over strategic disagreements amidst the anti-abortion mobilization.

Figure 2. Structure of the CISO-N and expanded anti-right fields, years 2020–2021

Source: Prepared by the authors based on the analysis of in-depth interviews with CISO-N leaders and activists. Sectoral CISO-N organizations (see endnote 7) have been excluded due to their peripheral role in the mobilization against assisted dying. A preliminary version of this figure can be found in García Martín and Perugorría (2023).

As shown in Figure 2, these CISO-N organizational nodes have ties of different kinds amongst themselves, and with a wider network of organizations integrating the expanded anti-rights field.⁷ In 2018 and 2021, period in which mobilization against the Euthanasia Bill took place, the most important ties were those linking the CISO-N field with the CEE. Since their organizational decoupling from the Church in the mid-1970s, the relationship between the CISO-N organizations and the CEE has been ideologically strong, but organizationally informal, particularly with the moderate Forum and Platform. This informal link translates, for example, into the free use of Church premises, the overt advertising of anti-rights protests, and the strong presence of CISO-N activists in catholic media—institutional or other. Additionally, certain CISO-Ns are also tied to political organizations. After the erosion of the tie between the moderate Forum and the conservative PP during Phase 2, political alliances have shifted to the far-right party VOX. Ties with VOX are held by the most radicalized organizations: CG-HO and Vividores, the CISO-N that, as we will describe in the following section, spearheaded the mobilization against assisted dying. Following the lines of the above-mentioned cleavage, these ties correlate with similarities in discourse and repertoire (Tilly, 2012), and also denote the two-clique clustering of organizations around catholic conservative or far-right ideological leanings.

Mobilizing against the Euthanasia Bill: tactical triangulation of anti-rights civic, political, and religious organizations

Over the last few decades, opposition to assisted dying amongst Spanish CISO-Ns and the expanded anti-rights field has been clear-cut, but has taken a back seat to anti-gender mobilizations (Cabezas, 2022). This trend changed in 2018, when the PSOE introduced the Euthanasia Bill in Congress, and CISO-Ns began a process of mobilization largely informed by the moderate/radical tactical-discursive cleavage that, since 2009, has segmented the field. On September 10, 2019, the Right to Live Platform (Plataforma Derecho a Vivir)—anti-abortion arm of the radical CG-HO—organized the first specifically anti-euthanasia protest event in Spain. Participants displayed a banner with the hashtag #StopEuthanasia in front of Congress, and hooded activists carried out a performance representing the groups allegedly “threatened” by the Bill: the “elderly,” [patients with] “AIDS,” “in coma” and with “terminal cancer,” and “disabled people” (see Image 1). In parallel, as we have mentioned, the Platform incorporates the fight against euthanasia into its annual demonstration. Likewise, all CISO-Ns, including the Forum, published institutional communiqués condemning the Bill, interpreted as an advance of the ‘culture of death’ (FEF, 2019), a framework inherited from the international and Spanish mobilizations against abortion. So did the CEE, which declared euthanasia as a “shortcut that allows us to save human and economic resources” (CEE, 2020: 4). Despite this widespread consensus in the CISO-N and anti-rights field, mobilization against the Bill was short-lived. The issue did not acquire greater public resonance and, in March 2020, Spanish society and the world were hit by the COVID-19 pandemic.

Image 1. Anti-euthanasia concentration of the Right to Live Platform (anti-abortion branch of CG-HO) in front of the Spanish Congress, Madrid, 2019

Source: CG-HO Flickr account.

Note: Hooded activists carry printouts naming the alleged victims of the Euthanasia Law; “the elderly, the disabled, people with AIDS, in coma, or with terminal cancer.”

The socio-health crisis triggered by the pandemic opened an unexpected window of opportunity not only to revive CISO-N mobilization, but also to deepen the moral panic discourse against assisted dying, in line with the discursive strategy of the field's most radicalized organizations. News reports on the havoc that the virus was wreaking among the elderly population, especially amongst those living in nursing homes, supported the diagnosis crafted by CISO-Ns, and facilitated its leap into the mass media and the institutional political sphere in the context of the Bill's congressional debate. In April 2020, in the midst of home confinement, VOX representatives in Congress accused the PSOE-UP administration of having carried out a “geriatricidal” and “criminal” (EFE, 2020) management of nursing homes, applying euthanasia “by deed (…) to more than 8,000 elderly people who have died totally abandoned and evicted” (20Minutos, 2020). The use of this type of ‘bomb rumors’ (Harsin, 2006) to produce disorientation and confusion about what is fact and fiction is a typical communicative strategy of anti-rights organizations.

Our data show that the opposition to the Bill was based on the triangulation of antagonistic protest tactics (Santos and Geva, 2022) between CISO-N civic organizations and the political and religious organizations in the expanded anti-rights field. First, the CEE (2020) made few but resounding declarations on the dignity of human life until natural death, the role of care, and the importance of intergenerational dialogue and accompaniment at the end of life. Second, given the restrictions on mobility and the consequent inability to mobilize in the public space, CISO-Ns concentrated their mobilization on cyberactivism through conservative digital media and social media networks. The Forum and Platform did so with moderate messages close to the pronouncements of the CEE; CG-HO and its Right to Live Platform, on the other hand, with a more radicalized discourse. Finally, VOX focused on propagating the latter message through the mass media and parliamentary debate; it also used the lawfare tactic, threatening to prosecute the management of nursing homes and, a year later, appealing the Euthanasia Law before the Constitutional Court.

In this context, October 2020 saw the emergence of Vividores, the first CISO-N specifically aimed at opposing “unjust legislative initiatives” (Vida Nueva, 2020) related to the management of the end-of-life process. As shown in Figure 2, insofar as it was created by the Catholic Association of Propagandists (Asociación Católica de Propagandistas), Vividores was born as an organization close to the Forum, and thus targeted a moderate, conservative, and catholic sector close to the CEE. However, as the congressional debate on the Euthanasia Bill progressed, Vividores transcended the existing radical/moderate tactical-discursive cleavage between the main CISO-N cliques, and forged stronger ties with CG-HO. Our netnographic observations of different CISO-N mobilizations during the pandemic show that activists of both organizations, together with VOX representatives and militants, collaborated in numerous protest events (PE). As a matter of fact, all three organizations participated in PE5, organized on the day of the Bill's final vote (see Table 2).

Table 2. Vividores protest events and tactics, years 2020–2021

Source: Prepared by the authors based on netnographic data for the years 2020–2022.

Table 2 describes the main characteristics of the five PEs organized by Vividores between 2020 and 2021. As we have mentioned, PE1 was based solely on the tactic of cyberactivism. However, mobilization quickly migrated to the public space, adding performances (PE2–3), street poster campaigns (PE4), display of banners, and rallies in front of Congress (PE5). In this way, Vividores became the only CISO-N to take up the baton of the anti-euthanasia mobilizations that had been initiated in 2019 by CG-HO's Right to Live anti-abortion platform. The cross-cutting strategy for all these PEs consists of the cross-fertilization between offline and online protests, following a clear sequence. First, the organization of a disruptive action in the public space, visually “spectacular” and dramatic in tone, aimed at generating high-impact audiovisual content. Provocative hashtags and “tweet templates” appear in these events, reflecting typical anti-rights moral panic discourse, and inciting the emergence of digital conversations between activists and citizens. Second, the dissemination of this audiovisual material, accompanied by the aforementioned hashtags and tweets, mainly through Twitter. In this phase, the aim is to multiply conversations and amplify the message. This cross-fertilization strategy mirrors anti-gender campaigns designed by CG-HO since the mid-2010s—accompanied by the hashtags #StopTransLaw (#StopLeyTrans) and #StopFeminazis—and also its anti-euthanasia protest event depicted in Image 1. Another constant in Vividores' mobilizations in the public space is the use of activist uniforms, consisting of black jackets with white skulls on the back, and a Salvador Dalí mask (PE5). Uniforms are complex entities, loaded with social connotations and with a strong symbolic function. Like ideologies, or speeches, protest tactics and activist uniforms express the political identity and moral vision of protesters (Jasper, 1997). Thus, while the jackets “carry” a message of death and destruction associated with assisted dying, the masks—worn by the protagonists of the highly popular Spanish TV series Money Heist (2017)—try to convey a “resistant” narrative against the injustices of the PSOE-UP administration.

Table 2 shows that Vividores' PEs coincide with key dates in the Euthanasia Bill's congressional debate; hence, we can conclude that their main objective was to prevent or delay the passing of the Law. A second objective, less urgent but equally important to the field, was to dismantle the pro-rights discourse associating euthanasia and “progress,” and to raise public awareness on the perverse consequences of its legalization. The table also shows the diachronic evolution of Vividores' message. From the beginning, this message was framed within the ‘culture of life’ versus ‘culture of death’ dichotomy, inherited from anti-abortion mobilizations, both in Spain and abroad. However, coherently with the shift in the organization's alliances from the Forum to CG-HO, the increasing levels of drama and alarm displayed in its PEs are evident. The digital campaign (PE1), of moderate tone and positive message, focused on “listening” and “helping to live,” gave way, in a matter of months, to PEs of belligerent tone and dystopian message synthesized in the hashtag #GovernmentOfDeath (#GobiernodelaMuerte) (PE4–5). In addition, there is an evident politicization of event targets, from sick people and their relatives (PE1–3) and the general public (PE2–3), to the Government and political parties supporting the Bill (PE4–5).

Anti-euthanasia identity work: framing processes and strategic mobilization of emotions vis-à-vis the Euthanasia Bill

In this section, we focus on the identity work carried out by Vividores amidst its anti-euthanasia mobilization. We understand collective identity (Melucci, 1996) as an interactive and shared definition, forged by a number of individuals or organizations in relation to the orientations of their action, and to the field of opportunities and constraints in which such action takes place. This processual approach to collective identities views them as something constructed and negotiated in a dialectical interaction with political opportunity structures (Meyer and Minkoff, 2004), and through the repeated activation and deactivation of ties binding groups or individuals.

Social movements arise to alleviate or alter situations that activists identify as problematic. Their action depends, therefore, on a diagnostic definition based on the identification of the sources of the problem, and on the drawing of identity boundaries (Snow and Benford, 1992) between an “us” and a “them” against which mobilization is directed. Following a friend/enemy logic, this discourse mobilizes emotions to divide actors in camps, stigmatize the antagonists, and expel them from the democratic debate. Table 3 allows us to reconstruct the identity work developed by Vividores, and then transferred to the institutional political sphere and the mass media by VOX. The “them” comprises, mainly, the PSOE-UP administration, and, to a lesser extent, the “healthcare system;” this is synthesized in the hashtag #GovernmentOfDeath, developed in the context of PE4–5. This hashtag characterizes the government as the “regulator” of—and therefore responsible for—the death of “the most in need and defenseless” (Lozano, 2020a), to whom it denies assistance and rights. On the other hand, the “medical establishment” is described as the state's “accomplice and executioner,” “eliminating the terminally ill and the weakest” (LaSexta, 2020).

Table 3. Anti-euthanasia framing crafted by Vividores and transferred to the institutional political sphere by VOX, years 2020–2021

Source: Prepared by the authors based on the analysis of netnographic data for the years 2020–2021.

In its first digital campaign (PE1)—moderate in tone and focused on interviews with people in vulnerable life situations, family members, and healthcare professionals—Vividores demarcated the “us:” a community of “persons” who have decided to enjoy life, and to wage the culture war in life's defense.⁸ Speaking of “persons,” in lieu of activists or militants, allows individuals with different characteristics and trajectories to feel part of the same collective. This term synchronizes (Mische, 2008) potentially alienating axes of participation, and is consistent with the CISO-N field's strategic discursive secularization. The strategy is aligned with widespread populist stances (Santos and Geva, 2022) in the anti-rights field, portraying its organizations as representatives of the “normal” members of society, a “wide majority” that has been silenced by a “progressive minority.”

This diagnostic frame exemplifies what Gamson (1995) calls “injustice frames,' that is, an interpretative schema that characterizes the actions of an authoritarian system as unjust and thus legitimizes its disobedience. In the case of euthanasia, this frame has two components. First, the characterization of the process behind the passing of the Euthanasia Law. Vividores situated this process in the context of the socio-sanitary emergency caused by the COVID-19 pandemic. Its diagnosis focuses on the “scant public debate” and “social demand,” the “lack of prior consultation with experts,” and the unusual “acceleration of legislative procedures” (Alías, 2020). Hence, the slogan “approval through the back door,” that is, in a stealthy and fraudulent way, and the hashtag #KidnappedDebate (#DebateSecuestrado) that the organization used in its PE2. Despite its inaccuracy, this diagnosis coincides with the CEE's (CEE, 2020) and the moderate CISO-Ns' public declarations regarding the passing of the Law.

The second component of the diagnostic definition of euthanasia has to do with its characterization as a practice for managing the end-of-life process. VOX and Vividores reframe pro-euthanasia slogans, arguing that “good language, such as ‘death with dignity’ or ‘good death,’ hides bad things” (Alías, 2020). They also maintain, as stated in one of the texts distributed in PE3, that by equating euthanasia with “progress” the Government was deceiving Spaniards, and that, far from guaranteeing the “self-determination of the sick,” the legalization of euthanasia was actually making them feel like a “burden to their families” (Bastante, 2020). For Vividores and VOX, the pro-euthanasia camp is fixated on “illness and suffering” and their associated “indignity.” In the face of this, anti-rights organizations call for a focus on “persons” (not “patients”) and families, and argue that the true basis of dignity can only be found in “life's meaning.” This is one of the main tropes of the pro-life narrative (Munson, 2010) and is also used by the moderate CISO-Ns.

These moderate CISO-Ns also share three other arguments of the diagnostic definition of euthanasia developed by Vividores. According to the moral argument, euthanasia constitutes a violation of the intrinsic value of life and a “moralization of the act of killing” (VOX, 2020a), akin to abortion. Meanwhile, the legal argument focuses on the violation of the “right to life and care by the healthcare system.” Vividores, and also VOX, associate assisted dying with the “prostitution” (LaSexta, 2020) of the Hippocratic oath, and the consequent erosion of the doctor–patient bond. Finally, the economic argument alludes to euthanasia as a way of saving economic and human resources, a reasoning already used by the CEE. In the words of a PE5 participant: “whether you like it or not, when you are old and in a hospital, you are left behind, you cost money and you are taken out of the way” (Lozano, 2020b).

Finally, VOX denounces that the Euthanasia Bill brings about a transformation in the function of the State, from a “welfare state” dedicated to the “protection of life,” to a “regulator of the right to kill.” It also affirms that the Law establishes a “totalitarian system” that confers the State with the “supreme power over the life and death of its subjects” (VOX, 2020b), based on a definition of “quality of life” that the State itself establishes and modifies. This is consistent with the VOX's (2020a) association between euthanasia, eugenics, and Nazism, used only by the most radicalized organizations in the field. With regard to this last point, the anti-rights discourse once again misrepresents reality: through the Euthanasia Law, the Spanish State recognizes the right to request death, but leaves the decision entirely up to the patient.

Secondly, prognostic framing is the articulation of a solution to the problem that has been diagnosed, and the design of strategies to achieve that goal (Benford and Snow, 2000). Thus, in the face of the #LethalDose (#DosisLetal) allegedly proposed by the PSOE-UP administration and the medical establishment, Vividores proposes “defending life,” “caring first,” and “alleviating suffering” (Lozano, 2020b)—three measures synthesized in what VOX will later call “culture of care” (VOX, 2020b). To this end, Vividores designs two strategies, distilled in the hashtags #VitalDose (#DosisVital) and #MorePaliatives (#MasPaliativos). The first, central message of its PE3, is based on the care and love of those who are close to the patients (CEE, 2020, n. 4). The second, transversal to all PEs, demands a national Palliative Care Law based on “integral accompaniment” (Hispanidad, 2020) and endowed with economic and human resources. As Vividores states in its PE2: “50% of the sick who need palliative care do not receive it and, instead, the Spanish Government offers them death” (Aciprensa, 2020). This statement is not only imprecise, but also creates a false dichotomy between palliative care and assisted dying, two practices that respond to different situations and that, far from being mutually exclusive, are potentially complementary, provided the patient so requests.⁹ Despite this inaccuracy, this moderate prognosis is shared by all CISO-Ns and the broader anti-rights field.

Finally, motivational framing refers to the articulation of a ‘call to arms’ (Benford and Snow, 2000), generally characterized by a highly emotional component. Passion and emotions, as well as ideology and interests associated with cognitive agreements and negotiations, push people to mobilize and act collectively (Goodwin et al., 2001). Thus, Vividores encourages “persons” to empathize and act to stop assisted dying regulation (PE3). In its original digital campaign (PE1), Vividores presented itself as “a project to talk about life and death, joys and sorrows. To reflect on the meaning of pain and suffering” (Vida Nueva, 2020). The focus on suffering, omnipresent in the organization's discourse, and the constant allusion to the population affected by the Law as “the weakest” and “defenseless,” aimed to strategically mobilize compassion as a motivator for participation (Dunn, 2004). The following tweet, released during PE3, perfectly illustrates this discursive strategy: “Faced with death as a solution, it is necessary to invest in the care and closeness that we all need in the final stage of this life. This is true compassion,” as catholic doctrine maintains. The activation of compassion is also combined with the appeal to core family bonds: “If you don't want to give a lethal dose to your grandfather, don't ask a doctor either. Your grandfather needs a #VitalDose, he needs his grandson” (PE3). This tactic aims to maximize empathy and identification with the organization's message and goal, and is in line with the CEE's declarations on the importance of intergenerational dialogue and care.

Conclusions

This article has analyzed the mobilization against the process that culminated with the passing of the Spanish Euthanasia Law in 2021. We have studied this mobilization from a relational and historical-comparative perspective, highlighting the changing structure and network dynamics of the CISO-N field, and its ties to the religious and political organizations that make up what we have called the ‘expanded anti-rights field.' We have also focused on the context of the passing of the Law amidst the progressive PSOE-UP administration, a window of political opportunity strongly impacted by the irruption of VOX in political institutions, and by the socio-health crisis triggered by COVID-19.

We have shown that, in order to oppose the regulation of assisted dying, civic, religious, and political anti-rights organizations developed a strategic triangulation of complementary protest tactics. While the CEE set the general lines and tone of the catholic anti-euthanasia position through the publication of institutional declarations, VOX led the opposition to the Bill in Congress and the mass media, and Vividores, the first specifically anti-euthanasia CISO-N, engaged in a short but intense campaign based on cyberactivism and mobilization in the public space. Data indicate that, when designing its mobilization strategy and generating a narrative around assisted dying, the informal though increasingly strong ties between Vividores, CG-HO, and VOX prevailed over those with the moderate CISO-Ns that had given birth to the anti-assisted dying organization. This shift in alliances, overcoming the ‘two-clique structure’ and the moderate/radical ‘tactical-discursive cleavage' that had characterized the field since 2009, is evidenced in the growing radicalization of Vividores' discourse, in the use of increasingly antagonistic tactics, and in the co-participation in protest events such as the rally in front of Congress on the day of the Law's final vote. The more moderate CISO-Ns, close to the CEE and of conservative catholic ideology, abstained from participating in these belligerent protest events. These findings highlight the so-far overshadowed CISO-N organizational complexity, and provide much-needed granularity to challenge prevailing monolithic portrayals of the field.

Although the Law ended up being approved, causing the subsequent deactivation of Vividores, the anti-euthanasia mobilization left a deep discursive imprint on the CISO-N and expanded anti-rights fields. Vividores translated the CEE message and developed an identity narrative based on the friend/foe logic, mobilizing emotions to both divide political actors into camps and stigmatize their opponents. VOX made this identity work its own, replicating Vividores' diagnostic, prognostic, and motivational framing, point by point, in its congressional interventions. The more moderate CISO-Ns also adopted most of the diagnostic framing (except for VOX's association of euthanasia, eugenics, and Nazism), and the totality of prognostic and motivational frames developed by Vividores. For this reason, in addition to triangulating their protest tactics, we assert that CISO-Ns and the religious and political organizations of the expanded anti-rights field formed, in their struggle against the Euthanasia Bill, a true ‘identity front.’ This buttresses our questioning of studies portraying CISO-Ns as mere Church proxies and “transmission belts,” or as “vote collectors” and “scriptwriters” at the service of conservative and far-right political parties. Although it has not always been the case, in the current phase of the CISO-N protest cycle, the ties between these anti-rights organizations are more “symbiotic” than “parasitic.” This is a significant contribution to current understandings of the interaction between the Catholic Church, institutional politics, and what we have called the ‘organized laity.'

Given Spain's ‘double exceptionalism,’ that is, its world-leading status in the legislation of progressive moral policies, including euthanasia, and the robustness and referential character of its CISO-N field, these findings might shed light on the incipient anti-assisted dying mobilizations currently sprouting around the world, from Ireland to Argentina.