Turillazzi Emanuela, Fineschi Vittorio
Department of Legal Medicine, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy.
Med Sci Law. 2011 Apr;51(2):76-80. doi: 10.1258/msl.2010.010201.
The authors present a review of the Italian bioethical and juridical debate about advance directives. The relevant points of difference between desistence from therapy and euthanasia and of the definition of the concept of therapy are also examined. The Italian Senate has passed a bill in which the value of advance health-care directives is affirmed. However, it is also affirmed that in conditions of emergency or when the subject's life is at immediate risk, the advance health-care directives should not be applied and artificial nutrition and hydration cannot be included in advance directives. In fact, these practices are thought to be of vital support and physiologically aimed at alleviating suffering until the end of life. Therefore, they cannot be the object of advance health-care directives. It is the authors' view that it is not at all desirable to trust legislative choices about a subject which continually varies in relation to scientific and clinical knowledge, options and alternatives. The physician is rather asked for a behaviour inspired by the value of the dignity and autonomy of the persons involved, by the respect of wishes previously expressed or, in any case, objectively proved.
作者对意大利关于预立医疗指示的生物伦理和法律辩论进行了综述。还探讨了停止治疗与安乐死之间的相关区别要点以及治疗概念的定义。意大利参议院已通过一项法案，其中肯定了预立医疗指示的价值。然而，也明确指出，在紧急情况下或当患者生命面临直接危险时，不应适用预立医疗指示，且人工营养和水合作用不能包含在预立医疗指示中。事实上，这些做法被认为是至关重要的支持措施，其生理目的是减轻痛苦直至生命结束。因此，它们不能成为预立医疗指示的对象。作者认为，对于一个因科学和临床知识、选择及替代方案而不断变化的主题，完全依赖立法选择是不可取的。相反，要求医生的行为应受到所涉人员尊严和自主权价值的启发，尊重先前表达的意愿，或者无论如何，尊重客观证明的意愿。
