Romanò Massimo
Comitato Ordinatore Master di 2 livello in Cure Palliative, Università degli Studi, Milano Past-Director S.C. Cardiologia, Ospedale di Vigevano-ASST della Provincia di Pavia.
G Ital Cardiol (Rome). 2024 Jun;25(6):383-389. doi: 10.1714/4269.42461.
The Italian law 217/2019 on "Informed consent and advance directives" is an important step forward in the redefinition of patient-doctor relationships. The law points out the principles of the decisional autonomy and freedom of the patient to choose the treatment options. However, it is underestimated and largely unapplied by the Italian cardiologists. The main elements of patient-doctor communication are present in the law. The most important is the time devoted to the patient-doctor relationship, necessary to ease the disease awareness. This time is clearly emphasized in the law, but the healthcare institutions did not arrange for the appropriate organizational procedures. Through the advance directives (ADs) the patients may express their own wishes about healthcare treatments, as well as their consent or refusal regarding the diagnostic or therapeutical doctors' suggestions, allowing their respect in case they become incompetent. This right is supported by the patients' designation of a healthcare proxy, who can interact for them with the healthcare team. However, after 6 years since the law enactment, only 0.4% of the Italian citizens signed ADs, due to insufficient information and organization by the healthcare authorities. In the Law, the advance care planning is closely related to ADs. In this process, the adults can understand and share their personal values, life goals and preferences, in order to define the potential future medical care and to discuss all the issues with family and physicians. These processes can be integrated in a broader shared decision-making, a strong tool of the patient-doctor alliance.
意大利关于“知情同意和预立医疗指示”的第217/2019号法律是重新定义医患关系方面向前迈出的重要一步。该法律指出了患者决策自主权和选择治疗方案的自由原则。然而,意大利心脏病专家对其重视不足且大多未予应用。医患沟通的主要要素在该法律中均有体现。其中最重要的是用于医患关系的时间,这对于增强疾病认知是必要的。该法律明确强调了这段时间,但医疗机构并未安排适当的组织程序。通过预立医疗指示,患者可以表达自己对医疗治疗的意愿,以及对诊断或治疗医生建议的同意或拒绝,以便在他们丧失行为能力时得到尊重。这项权利得到患者指定医疗代理人的支持,该代理人可以代表他们与医疗团队进行沟通。然而,自该法律颁布6年后,由于医疗当局的信息和组织工作不足,只有0.4%的意大利公民签署了预立医疗指示。在该法律中,预立医疗照护规划与预立医疗指示密切相关。在这个过程中,成年人可以理解并分享他们的个人价值观、生活目标和偏好,以便确定未来可能的医疗护理并与家人和医生讨论所有问题。这些过程可以融入更广泛的共同决策中,这是医患联盟的有力工具。