Department of Anaesthesia & Intensive Care, A Manzoni General Hospital, Via dell'Eremo 9/11, Lecco, Italy.
J Med Ethics. 2010 Jun;36(6):333-5. doi: 10.1136/jme.2009.034835. Epub 2010 May 3.
In 1992, Eluana Englaro was involved in a car accident in Italy that eventually left her in a permanent vegetative state requiring artificial nutrition and hydration. This paper, after briefly reviewing Eluana's case, gives a chronicle of Eluana last months until her death on 9 February 2009, and discusses the right-to-die controversy in Italy. For many years, Mr Englaro, Eluana's father, would litigate to enforce what he considered to be his daughter's wish to discontinue life-prolonging treatment. In July 2008, the Court of Appeal of Milan has given its authorization for artificial life support to be withdrawn. This ruling sparked a crusade, led by the government and the Vatican, against the court and Eluana's father, which included insinuations that the latter was murdering his daughter. Public opinion has overwhelmingly been sympathetic to the father's difficult decision, in stark contrast to the reactionary stance taken by the government. With the notable advances of medicine, doctors are increasingly faced with ethical issues. The vegetative state is just one of the many clinical conditions that obligate health professionals to reflect on ethical matters. The withdrawal of life-supporting care, and of artificial nutrition and hydration in particular in permanent vegetative state patients remains a measure which violates a tradition and a consolidated practice. It was thus inevitable that it would create great controversy. We should work towards making a decision process that ensures that continuation or suspension of artificial nutrition and hydration follows an explicit procedure, promoting the sharing and respect of the diverse moral responsibility of family members, nursing and medical staff.
1992 年，意大利的埃卢阿娜·恩格勒罗（Eluana Englaro）遭遇车祸，最终陷入永久性植物人状态，需要接受人工营养和水合作用。本文简要回顾了埃卢阿娜的病例，记述了她在去世前的最后几个月，直到 2009 年 2 月 9 日去世，并讨论了意大利的安乐死争议。多年来，埃卢阿娜的父亲恩格勒罗先生一直在打官司，以执行他认为女儿想要停止延长生命的治疗的意愿。2008 年 7 月，米兰上诉法院批准停止人工生命支持。这一裁决引发了一场由政府和梵蒂冈领导的、针对法院和埃卢阿娜父亲的运动，其中包括暗示后者正在谋杀自己的女儿。公众舆论压倒性地同情父亲的艰难决定，与政府的反动立场形成鲜明对比。随着医学的显著进步，医生越来越多地面临伦理问题。植物人状态只是迫使卫生专业人员思考伦理问题的众多临床情况之一。停止生命支持治疗，特别是在永久性植物人患者中停止人工营养和水合作用，仍然是一种违反传统和既定惯例的措施。因此，它必然会引起很大的争议。我们应该努力制定一个决策过程，确保继续或停止人工营养和水合作用遵循明确的程序，促进家庭成员、护理人员和医务人员之间分享和尊重不同的道德责任。
