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Regulation of advance directives in Italy: a bad law in the making

Giuseppe Renato Gristina| Erica Martin| Vito Marco Ranieri
Legal and Ethical Issues
Volume 38, Issue 11 / November , 2012

Pages 1897 - 1900

Abstract

Purpose

The Advance Directives (ADs) have been adopted in many countries to defend patients’ autonomy. In Italy, the role of ADs has recently been the subject of heated debate involving political parties and the Roman Catholic Church. In February 2009, the conservative government coalition presented a bill of law on this issue. It has been passed by the Low Chamber and is now being discussed in the Senate. The purpose of the article is to highlight any possible bill’s contradiction with Italian Constitution, Italian Code of Medical Ethics (ICME), and Oviedo Convention contents, relevant for intensivists.

Methods

Analysis of bill’s content in the light of Italian Constitution, ICME, Oviedo Convention articles and in comparison with French legislation regarding end of life (Leonetti law).

Results

In the Authors’ point of view the bill’s articles ­limit the moral and judicial importance of four main issues as informed consent, permanent incapacity, artificial nutrition/hydration, and withdraw/withhold treatments.

Conclusions

In the Authors’ opinion the ADs must represent informed preferences made freely by patients within the relationship with their physicians, as part of an advance care planning. When this relationship develops in accordance with the ICME rules, it contains all of the ethical/professional dimensions to legitimate right choices in each case. The law should draw inspiration from ICME principles, assigning them a juridical power, acknowledging their validity in legitimating end-of-life decisions, and defining a framework of juridical legitimacy for these decisions without infringing on patients’ right to autonomy with prescriptions on the care.

Keywords

References

  1. Prendergast TJ, Claessens MT, Luce JM (1998) A national survey of end-of-life care for critically ill patients. Am J Respir Crit Care Med 158:1163–1167
    • View reference on PubMed
  2. Cohen S, Sprung CL, Sjokvist P, Lippert A, Ricou B, Baras M et al (2005) Communications of EOL decisions in European ICU’s. Intensive Care Med 31:1215–1221
  3. Drazen JM, Desai NR, Green P (2009) Fighting on. N Engl J Med 360:444–445
    • View reference on PubMed
    • View reference on publisher's website
  4. Gillick MR (2004) Advance care planning. N Engl J Med 350:7–8
    • View reference on PubMed
    • View reference on publisher's website
  5. Cartwright CM, Parker MH (2004) Advance care planning and end-of-life decision making. Aust Fam Physician 33:815–819
    • View reference on PubMed
  6. Moratti S (2010) The Englaro case: withdrawal of treatment from a patient in a permanent vegetative state in Italy. Camb Q Healthc Ethics 19:372–380
    • View reference on PubMed
    • View reference on publisher's website
  7. Andorno A, Biller-Andorno N, Brauer S (2009) Advance health care directives: towards a coordinated European policy? Eur J Health Law 16:207–227
    • View reference on PubMed
    • View reference on publisher's website
  8. Senato della Repubblica (Senate of the Italian Republic) Atto Senato n. 10 XVI Legislatura (2011) Disposizioni in materia di alleanza terapeutica, di consenso informato e di dichiarazioni anticipate di trattamento (Provisions regarding the therapeutic alliance, informed consent, and advanced treatment directives). http://www.senato.it/japp/bgt/showdoc/frame.jsp?tipodoc=Ddlpres&leg=16&id=607562. Accessed 23 May 2012
  9. Council of Europe convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine: convention on human rights and biomedicine. http://conventions.coe.int/Treaty/en/Treaties/Html/164.htm. Accessed 23 May2012
  10. Position of the American Dietetic Association (ADA) (2008) Ethical and legal issues in nutrition, hydration, and feeding. J Am Diet Assoc 108:873–882
    • View reference on publisher's website
  11. Società Italiana di Nutrizione Parenterale ed Enterale (Italian Society for Parenteral and Enteral Nutrition) (2002) Linee guida per la Nutrizione Artificiale Ospedaliera (Guidelines for hospital based artificial nutrition) Rivista Italiana di Nutrizione Parenterale ed Enterale 20 S5:S1–S171
  12. Solarino B, Bruno F, Frati G, Dell’Erba A, Frati P (2011) A national survey of Italian physicians’ attitudes towards end-of-life decisions following the death of Eluana Englaro. Intensive Care Med 37:542–549
  13. Federazione Nazionale degli Ordini dei Medici Chirurghi e degli Odontoiatri (FNOMEeO) (National College of Physicians and Dentists) (2009). Documento del Consiglio Nazionale della FNOMCeO sulle D.A.T. (Document on ADs drafted by the College’s National Board of Directors). http://www.omceoudine.it/news/195. Accessed 23 May 2012
  14. White H. Eluana Englaro’s father investigated for homicide (02 March 2009). http://www.lifesitenews.com/news/archive/ldn/1990/30/9030201 Accessed 23 May 2012
  15. Pope Benedict XVI Angelus—pro life day (4 Feb. 2007). http://www.vatican.va/holy_father/benedict_xvi/angelus/2007/documents/hf_ben-xvi_ang_20070204_en.html. Accessed 23 May 2012
  16. Evans S, Bausewein C, Menaca A, Andrew EV, Higginson IJ, Pol R, Gysels M, On behalf of project PRISMA (2012) A critical review of advance directives in Germany: attitudes, use and healthcare professionals’ compliance. Patient Educ Couns 87:277–288
    • View reference on PubMed
    • View reference on publisher's website
  17. Baumann A, Audibert G, Claudot F, Puybasset L (2009) Ethics review: end of life legislation—the French model. Crit Care Crit Care 13:204
  18. Fagerlin A, Schneider CE (2004) Enough. The failure of the living will. Hastings Cent Rep 34:30–41
    • View reference on PubMed
    • View reference on publisher's website
  19. Degenholtz HB, Rhee YJ, Arnold RM (2004) The relationship between having a living will and dying in place. Ann Intern Med 141:113–117
    • View reference on PubMed
  20. Briggs L (2004) Shifting the focus of advance care planning: using an indepth interview to build and strengthen relationships. J Palliat Med 7:341–349
    • View reference on PubMed
    • View reference on publisher's website
  21. Quenot JP, Rigaud JP, Prin S, Barbar S, Pavon A, Hamet M, Jacquiot N, Blettery B, Hervé C, Charles PE, Moutel G (2012) Impact of an intensive communication strategy on end-of-life practices in the intensive care unit. Crit Care Med 38:145–152
  22. Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300:1665–1673
    • View reference on PubMed
    • View reference on publisher's website
  23. Quenot JP, Rigaud JP, Prin S, Barbar S, Pavon A, Hamet M, Jacquiot N, Blettery B, Hervé C, Charles PE, Moutel G (2012) Suffering among carers working in critical care can be reduced by an intensive communication strategy on end-of-life practices. Crit Care Med 38:55–61
  24. Paterlini M (2009) Italy urged to give end-of-life bill more time for debate. Lancet 373:1413
    • View reference on PubMed
    • View reference on publisher's website

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