Bersani Giuseppe, Rinaldi Raffaella, Iannitelli Angela
Dipartimento di Scienze e Biotecnologie Medico-chirurgiche, Sapienza Università di Roma.
Dipartimento di Scienze Anatomiche, Istologiche, Medico-legali e dell'Apparato Locomotore, Sapienza Università di Roma.
Riv Psichiatr. 2018 Jul-Aug;53(4):173-176. doi: 10.1708/2954.29693.
The debate on different forms of request of death has taken on a broad dimension in public opinion over last years, often referring on profoundly differentiated and often opposing positions of principle. Beyond cultural, political or ideal positions, a further critical issue, often underestimated or quite not considered, concerns a person’s ability to express a valid consent to the request of death, according to the same criteria of validity of the informed consent to any medical act. This assumes particular importance in the case of assisted suicide. Assisted suicide represents a phenomenon in sharp growth in Western world. It is legal in many nations, and in Switzerland it is also allowed for foreign citizens, thus increasing the phenomenon of the so-called “tourism of suicide”. In addition to neoplastic and neurological diseases, depression has also been accepted as a disease that makes assisted suicide possible. This imposes profound clinical and ethical considerations, since depression is unanimously recognized as a treatable disease and since in its most serious forms, such as those in which suicidal ideation dominates, it can compromise the patient’s ability to express a valid consent to any medical act, including the assisted suicide. Furthermore, it is often overlooked that any serious and disabling somatic disease, source of intense and chronic suffering, carries the very high risk of the onset of unrecognized depressive conditions, able in turn to negatively influence the ability to express valid consent. Faced with this situation, which has involved a large number of Italian citizens in recent years, the personal and official voice of psychiatry is absolutely lacking, contrasting its silence with the opinions of those who do not want to take into account its potentially fundamental considerations.
在过去几年里，关于不同形式的死亡请求的辩论在公众舆论中呈现出广泛的层面，常常涉及到截然不同且往往相互对立的原则立场。除了文化、政治或理想层面的立场之外，一个常常被低估或完全未被考虑的更为关键的问题是，根据对任何医疗行为的知情同意的有效性标准，一个人是否有能力对死亡请求表达有效的同意。这在协助自杀的情况下尤为重要。协助自杀在西方世界是一个急剧增长的现象。在许多国家它是合法的，在瑞士甚至允许外国公民这样做，从而加剧了所谓的“自杀旅游”现象。除了肿瘤和神经疾病外，抑郁症也被视为一种使得协助自杀成为可能的疾病。这引发了深刻的临床和伦理思考，因为抑郁症被一致认为是一种可治疗的疾病，而且在其最严重的形式中，比如自杀观念占主导的那些形式，它会损害患者对任何医疗行为，包括协助自杀，表达有效同意的能力。此外，人们常常忽视的是，任何严重且致残的躯体疾病，作为强烈和慢性痛苦的根源，都极有可能引发未被识别的抑郁状况，而这种状况反过来又会对表达有效同意的能力产生负面影响。面对近年来涉及大量意大利公民的这种情况，精神病学缺乏个人和官方的声音，其沉默与那些不愿考虑其潜在根本考量的人的观点形成了鲜明对比。
