Why assisted suicide is already common in Italian hospitals
Why assisted suicide is already common in Italian hospitals
End of life: three little words with great implications. They didn’t stop professor Giuseppe Maria Saba, an anaesthetist from Cagliari, in Sardinia, Italy, from admitting in a recent interview that he has helped his patients to die “whenever it was possible”. The 87-year old doctor claims to have ‘pulled the plug’ a hundred times on his patients, explaining: “It’s a well-established practice in all Italian hospitals but nobody talks about it.” Just a few days earlier a neurologist at the Catholic hospital Gemelli in Rome told journalists that patients suffering from motor neurone disease in his hospital “can choose to die”.
West asked Dr Mario Riccio (who, in 2006, complied with the request of Piergiorgio Welby and switched off his ventilator) what he thinks his Sardinian colleague’s views.
“With all due respect to my colleague, I don’t think there is anything new in his statement. I’ve noticed that recently there’s been some kind of race to speak out and not a day goes by without a doctor saying that they have ‘pulled the plug’. So if you’re asking me if there is a practice in Italy that tends to respect the choices of patients who want to discontinue therapies that can keep them artificially alive, then I would say that yes, the practice does exist and it is consolidated. And yes, patients can freely refuse treatments, with the due consequences.”
Even so, euthanasia is illegal in Italy and following the statements of some medics, many voices have disagreed.
“In my opinion, one crucial factor has been left out of this whole question. What counts isn’t the answer one wants to give to a problem but the question one should ask in the first place. Using linguistic tricks and euphemism, several colleagues are trying to avoid the only real question that the problem poses: does the patient have a right to refuse or interrupt medical treatment – albeit life-saving? The only correct answer, from both a legal and an ethical standpoint, is yes – and that is valid today just as it was eight years ago with Piergiorgio Welby.
“My distinguished colleagues should recognise, therefore, the simple and only reality of things and should limit themselves to explaining their own personal opposition to the constitutional right for patients to decide for themselves.”
So in the doctor-patient relationship, is the former always right?
“No, quite the contrary. I’ll give you an example that maybe not everyone knows about. The Policlinico Umberto I in Rome, a hospital that has a doctor for every four patients, has adopted a policy whereby patients suffering from degenerative diseases are asked to sign a form giving consent to the possibility of having tubes fitted. Nothing unusual in that, except that if the patient refuses to sign, they are discharged. This not only doesn’t take into account the rights of the patients but it also obliged them to adhere to practices they don’t wish to take part of. That’s not to mention the debasement of basic health care, which should be guaranteed to all, unless it’s proved otherwise, even in the last hours of life.”
Put aside the different medical opinions, why are end-of-life issues in Italy debated and so often disputed by institutions?
“To address this issue, first of all we need some clarity with numbers. Eight years ago, I was able to disclose a study by the Mario Negri institute, which gives the number of patients who received intensive therapy and the percentage of deaths. At that time there were 30,000 deaths per 150,000 hospitalisations in intensive care units. The number of people who died due to withdrawal of treatment (with the help of the doctor) was 18,000. What I want to underline is that the problem with respect to the end of life should not arise in cases such as Welby’s, where there is full ability to understand and choose (in this case death). The main difficulties arise in cases in which the doctor defines the patient as ‘not competent’, which according to the Negri study, is in 90% of cases.
What happens in these cases?
“There are two types of situation. In the first, treatment would have little or no effect because, in a strictly clinical sense, the patient is in such a serious condition that they will soon die. In the second, much more complex, type of case, although the clinical condition of the person is compromised, there could be some treatment to stabilise them. The Englaro case, for example, falls into the latter category.”
And this is where the factors – identified by the media and public opinion as ‘aggressive treatment’ and ‘euthanasia’ – come into play?
“Exactly. And in both cases, they are inaccurate terms. The media and politicians should take most of the responsibility for spreading misinformation, in my opinion.”
Can you enlarge?
“Euthanasia doesn’t exist in Italy and even in the European countries where patients are helped to die (the Netherlands and Belgium, ed) it’s incorrect to talk about a “sweet death” because what is actually being practiced is assisted suicide. But staying with Italy, euthanasia technically means the administration by a third party – to a person who has made an explicit and contextual request – of one or more substances that can quickly, directly and permanently stop cardiac and/or respiratory activity. Obviously, the patient is first sedated. In any case, we are talking about situations that require two sets of proven conditions. Firstly, the existence of a terminal illness where the patient is expected to live less than 18 months. And secondly, palliative care has not had any effect on the patient. In any case, it’s important to remember that in countries where euthanasia is legal, the practice is reserved only for patients who are deemed ‘competent’ at the time of the request.
In your opinion, where did policy and information go wrong?
“The end of life in our country has always been understood as a battlefield where people’s own interests can be thrashed out. The use – in the media or otherwise – of the term euthanasia has created great confusion. The problem is essentially linguistic – because the reality in Italy is that this process actually entails the interruption of care. To demonstrate this it’s good to know that when a patient is taken off a ventilator, the injection given by the doctor isn’t lethal, but is just used to sedate the patient and spare them the physical suffering that results from discontinued treatment. To be clear, the event that causes death is coming off the ventilator, not the sedation administered by a doctor.”
How do you think we should relate to ethical issues of such great importance?
“Above all, we should restore order amid the chaos that has been – often purposely – created in recent years. To do this, we should avoid mixing political interests in issues that have more to do with conscious freedom of individuals. Giving patients the choice of discontinuing treatment is within a right guaranteed and protected by our Constitution. It is an eventuality that in no way jeopardises the rights or wishes of those who prefer to choose otherwise.”
article by Michela Maisti
Pin It
