Inmaculada Echevarría was a woman with Progressive Muscular Dystrophy who was totally dependent on mechanical ventilation. In October 2006, she publicly asked to be disconnected of the ventilator. The clinical and biographical data of the case are presented in the first part of the work. The paper goes on to explain the decisions of the two committees that evaluated her request, that is the Regional Ethics Committee and the Consultative Council of Andalusia. Finally, the outcome of the case is presented. The second part analyzes the background of the debate on end-of-life decision making in Spain in cases such as those of Ramon Sampedro, Jorge Leon or Madeleine Z. It then presents four different settings of end-of-life decision making that have been clarified over these last years: euthanasia and assisted suicide, limitation of life-prolonging treatment, treatment refusal and palliative sedation. The article concludes that the latter three can be considered as sufficiently clarified after the case of Inmaculada Echevarría. However, the first one, that is euthanasia and assisted suicide, must be confronted by the Spanish society in forthcoming years.