End‐of‐life decision‐making and advance care directives in Italy. A report and moral appraisal of recent legal provisions

Botti, Caterina; Vaccari, Alessio

doi:10.1111/bioe.12615

Cited by 4 publications

(2 citation statements)

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“…A large heterogeneity is observed worldwide with respect to making decisions to forgo life-sustaining treatments in ICUs (Lobo et al 2017;Sprung et al 2019). Declining to provide a treatment that is medically inappropriate or futile is ethically sound (Botti and Vaccari 2019;Wilkinson and Savulescu 2011). Despite the expectation that patients would die sooner if invasive interventions were forgone, no such association was found (Ramazzotti et al 2019).…”

Section: Concepts Models and Designs Of The Care Provisionmentioning

confidence: 99%

What do we know about experiencing end-of-life in burn intensive care units? A scoping review

et al. 2022

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Objectives The aim of this article is to review and synthesize the evidence on end-of-life in burn intensive care units. Methods Systematic scoping review: Preferred Reporting Items for Systemic Reviews extension for Scoping Reviews was used as a reporting guideline. Searches were performed in 3 databases, with no time restriction and up to September 2021. Results A total of 16,287 documents were identified; 18 were selected for analysis and synthesis. Three key themes emerged: (i) characteristics of the end-of-life in burn intensive care units, including end-of-life decisions, decision-making processes, causes, and trajectories of death; (ii) symptom control at the end-of-life in burn intensive care units focusing on patients’ comfort; and (iii) concepts, models, and designs of the care provided to burned patients at the end-of-life, mainly care approaches, provision of care, and palliative care. Significance of results End-of-life care is a major step in the care provided to critically ill burned patients. Dying and death in burn intensive care units are often preceded by end-of-life decisions, namely forgoing treatment and do-not-attempt to resuscitate. Different dying trajectories were described, suggesting the possibility to develop further studies to identify triggers for palliative care referral. Symptom control was not described in detail. Palliative care was rarely involved in end-of-life care for these patients. This review highlights the need for early and high-quality palliative and end-of-life care in the trajectories of critically ill burned patients, leading to an improved perception of end-of-life in burn intensive care units. Further research is needed to study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units.

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Section: Concepts Models and Designs Of The Care Provisionmentioning

confidence: 99%

What do we know about experiencing end-of-life in burn intensive care units? A scoping review

et al. 2022

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“…Choices of adults regarding the end of their lives are liberally discussed at present, while legal frameworks remain controversial (6,7). Decision-making capacities of children and decisionally vulnerable adults are even more delicate, but must not be neglected (8,9).…”

Section: Vital Decisions In the Patient's Best Interestmentioning

confidence: 99%

Ethical Issues in Care and Treatment of Neuronal Ceroid Lipofuscinoses (NCL)–A Personal View

Kohlschütter

2021

Front. Neurol.

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The management of Neuronal Ceroid Lipofuscinoses (NCL), a group of genetic neurodegenerative disorders mainly affecting brain and retinas, raises difficult questions for physicians and other professionals in research, pharmaceutical industry, and public health. Ethical problems in medicine cannot be solved by rational deliberation or by following formal rules. Two topics of ethical issues in the field of NCL are presented here. One group relates to the care of individual patients and centers on a life with dementia at a young age. Advanced care planning for the end of life and the use of life-prolonging measures require challenging assumptions in the best interest of a patient. A second group of questions relates to new treatments. Impressive novel putative causal therapies, such as enzyme replacement for CLN2 disease, may be only disease-modifying and carry the risk of changing a deadly disease of short duration into one with prolonged survival and poor quality of life. The wish for better therapeutic interventions in life-limiting diseases has to take such risks, but more experience is needed before definite conclusions can be drawn. The appropriateness of presymptomatic screening for a severe disease, e.g., must be carefully evaluated to avoid the disastrous experience made with the rash start of newborn screening for Krabbe disease. The ethical issues described and commented in the article reflect the personal experience of a pediatrician who has studied clinical and research questions in NCL for four decades. They should alert various professionals to the necessity of taking their own decisions in situations that are caused by rare progressive brain diseases of young persons, as typified by the NCL.

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Physician–Patient Relationship, Assisted Suicide and the Italian Constitutional Court

et al. 2021

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End‐of‐life decision‐making and advance care directives in Italy. A report and moral appraisal of recent legal provisions

Cited by 4 publications

References 0 publications

What do we know about experiencing end-of-life in burn intensive care units? A scoping review

What do we know about experiencing end-of-life in burn intensive care units? A scoping review

Ethical Issues in Care and Treatment of Neuronal Ceroid Lipofuscinoses (NCL)–A Personal View

Physician–Patient Relationship, Assisted Suicide and the Italian Constitutional Court

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