意大利新法 219/2017 的回顾与分析：“知情同意和预先指示治疗的规定”。
A review and analysis of new Italian law 219/2017: 'provisions for informed consent and advance directives treatment'.
机构信息
Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy.
出版信息
BMC Med Ethics. 2019 Mar 4;20(1):17. doi: 10.1186/s12910-019-0353-2.
BACKGROUND
In December 2017, Law 219/2017, 'Provisions for informed consent and advance directives', was approved in Italy. The law is the culmination of a year-long process and the subject of heated debate throughout Italian society. Contentious issues (advance directives, the possibility to refuse medical treatment, the withdrawal of medical treatment, nutrition and hydration) are addressed in the law.
MAIN TEXT
What emerges clearly are concepts such as quality of life, autonomy, and the right to accept or refuse any medical treatment - concepts that should be part of an optimal relationship between the patient and healthcare professionals. The law maximizes the value of the patient's time to decide. Every patient is allowed to make choices for the present (consenting to or refusing current treatment) as well as for the future, conceived as a continuation of the present, and to decide what comes next, based on what he/she already knows. The law identifies three distinct but converging paths towards the affirmation of a care relationship based on reciprocal trust and respect: the possibility to consent to or refuse treatment, the shared care planning, and advance directives.
CONCLUSIONS
The fundamental point to emerge from the new Italian law is that consensus is an essential connotation of the treatment relationship. Consensus is not limited to the acceptance/rejection of medical treatment but is ongoing. It is projected into the future through shared care planning and advance directives which act as tools for self-determination and the manifestation of the beliefs and preferences of persons unable to express their will. These principles are in line with the idea of appropriate care as evaluated from two different perspectives, one of scientific adequacy and the other commensurate with the individual's resources, fragility, values, and beliefs. Surely, however, the new law is not the end of the matter on issues such as conscientious objection, which is deeply rooted within the Italian cultural and political debate. In this regard, healthcare institutions and policymakers will be called upon to develop and implement organizational policies aimed at the management of foreseeable conscientious objection in this field.
背景
2017 年 12 月，意大利通过了第 219/2017 号法案，即“知情同意和预先指示规定”。该法律是为期一年的法律制定过程的结晶，也是意大利全社会激烈辩论的主题。该法律涉及到有争议的问题（预先指示、拒绝治疗的可能性、停止治疗、营养和水合作用）。
主要内容
明确出现的概念包括生活质量、自主权和接受或拒绝任何医疗的权利等概念，这些概念应该成为患者与医疗保健专业人员之间最佳关系的一部分。该法律最大限度地增加了患者决定的时间价值。每个患者都可以为现在（同意或拒绝当前治疗）以及未来做出选择，将未来设想为现在的延续，并根据自己已经知道的情况决定下一步。该法律确定了三条截然不同但趋同的道路，以确立基于相互信任和尊重的护理关系：同意或拒绝治疗的可能性、共同护理规划和预先指示。
结论
意大利新法律的一个基本要点是，共识是治疗关系的一个基本内涵。共识不仅限于接受/拒绝医疗，而是持续存在的。它通过共同护理规划和预先指示来预测未来，这些规划和指示是自我决定和表达无法表达意愿的人的信仰和偏好的工具。这些原则与从两个不同角度评估适当护理的理念是一致的，一个是科学充分性，另一个是与个人资源、脆弱性、价值观和信仰相称。然而，新法律肯定不是在诸如出于良心拒绝对等问题上的结束，这在意大利文化和政治辩论中根深蒂固。在这方面，医疗机构和政策制定者将被要求制定和实施旨在管理该领域可预见的出于良心拒绝对策的组织政策。
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