Trauma Center and Intensive Care, S. Camillo, Forlanini Hospital, Rome, Italy.
Intensive Care Med. 2012 Nov;38(11):1897-900. doi: 10.1007/s00134-012-2656-3. Epub 2012 Aug 2.
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.
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).
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.
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.
预嘱（Advance Directives，ADs）已在许多国家被采纳，以维护患者的自主权。在意大利，ADs 的作用最近成为涉及政党和罗马天主教会的激烈辩论的主题。2009 年 2 月，保守派政府联盟提出了一项关于该问题的法律法案。该法案已在众议院获得通过，目前正在参议院讨论。本文的目的是强调任何可能的法案与意大利宪法、意大利医学伦理法典（ICME）和奥维多公约内容之间的矛盾，这些内容与重症监护医生相关。
根据意大利宪法、ICME、奥维多公约的条款以及法国关于生命末期的立法（Leonetti 法），分析法案的内容。
在作者看来，该法案的条款——限制了知情同意、永久无能力、人工营养/水合、以及撤回/停止治疗这四个主要问题的道德和司法重要性。
在作者看来，ADs 必须代表患者在与医生关系中自由做出的知情偏好，作为预先护理计划的一部分。当这种关系符合 ICME 规则发展时，它包含了在每种情况下做出合法选择的所有伦理/专业维度。法律应从 ICME 原则中汲取灵感，赋予其法律权力，承认其在合法化生命末期决策中的有效性，并在不侵犯患者自主权的情况下，为这些决策定义一个法律合法性框架，同时规定护理方面的规定。
