End-of-life care and assisted suicide: An update on the Italian situation from the perspective of the European Court of Human Rights - 13/04/22

Doi : 10.1016/j.jemep.2022.100752

G. Montanari Vergallo ^a , M. Gulino ^b,^⁎
^a Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Viale Regina Elena, 336, 00161 Rome, Italy
^b Department of Clinical Sciences and Translational Medicine, TorVergata University of Rome, Via Montpellier, 1, 00133 Rome, Italy

^⁎Corresponding author.

Summary

Background

Italy enacted targeted legislation governing informed consent and advanced healthcare directives in 2017. No provisions of this law legalize euthanasia and/or assisted suicide. This study examines from the ethical and legal perspectives the Italian courts’ trend concerning the right to a dignified death, also through physician-assisted suicide, taking into consideration the main rulings on that subject issued by the European Court of Human Rights.

Methodology

A literature search was conducted on social and biomedical science databases (PubMed and Scopus), over the 2000–2020 time frame, on end-of-life, euthanasia, death with dignity, assisted suicide, advance healthcare directives and palliative care. Searches on Italian and international legal cases have been conducted using the main online databases (Foro Italiano, Pluris Data, De Jure and LexisNexis), along with the official websites of the Italian Constitutional Court and ECHR.

Results

ECHR's trend has significantly evolved the right of EU member state's citizens to decide when and how to end their own lives. Consistently, the Italian Constitutional Court has declared aid in suicide lawful as long as certain circumstances occur. However, opponents and certain deontological precepts still remain claiming that the legalization of assisted suicide entails more risks than benefits.

Conclusion

Italian and European cases have highlighted a sense of powerlessness and compassion in the public opinion and institutions. The impact of the Italian Constitutional Court's decision must be tested in clinical practice. New policies for the implementation of palliative care are necessary to uphold the right to effective and personalized treatment for those who decide to end their lives with dignity, in addition to the right to refuse healthcare treatments.

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Keywords : Assisted suicide, Euthanasia, Life-saving treatments, Palliative care, Quality of life, Refusal of care, Right to die