Italy’s New Advance Directive Law

Abstract

Although all human beings share the same biology, the political context of medical practice, like all politics, is notoriously local. So, while some might be surprised to learn that Italy only adopted its first advance directive legislation in the closing days of 2017, such surprise would reflect a kind of naive parochialism. Rome, Italy, is not Washington, DC. The bill, which passed the Italian Senate in December 2017 after 3 decades of debate, assumed the force of law on January 6, 2018. The law establishes a right to refuse tests and treatments, a right to palliative care, and provides for living wills and the naming of medical proxies; assisted suicide and euthanasia remain illegal. 1 The protracted legislative course reflects a complex amalgam of culture, religion, language, politics, ethics, and medicine.

Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016

“…In this prospective observational study of 22 European ICUs, limitations in life-prolonging therapies occurred significantly more frequently, and death without limitations in lifeprolonging therapies occurred significantly less frequently in 2015-2016 compared with 1999-2000. Recent developments may account for the increase in limiting life-prolonging treatment and the decrease in failed CPR. During the time interval between the 2 studies, new laws, 5,13,14 governmental statements, 15-17 recommendations, 6,7,18 guidelines, 8,9 consensus statements by international organizations, 10,19,20 education, 21 and research 1,3,4,[22][23][24] regarding end-of-life practices have been developed. These frameworks help guide, support, and protect physicians when decisions about life-prolonging treatment are made.…”

Completion Rates of Advance Directives in a Trauma Emergency Room: Association with Age

“…erefore, an advance directive can preserve a person's autonomy and self-determination once decision-making capacity is lost. In the last two decades of this century, many countries have approved principles of advance directives and anticipated shared decision-making situations at the end of life by their legislative authorities [7,8]. In Germany, the first law to legally regulate advance directives was enacted in 2009 [8].…”

Healthcare professionals’ perceptions about the Italian law on advance directives

“…21 However, the debate on this issue was fervent for many years before becoming law, due to previous attempts at implementing regulations and various cases brought into the limelight through the media. 20,21 The Italian legal system has always paid attention to respect the person’s will and their right to participate in the decisions about their care and treatment. There were previous attempts to regulate advance directive(s) in the Italian legislative corpus.…”

“…Moreover, assisted suicide and euthanasia remain illegal in Italy and are not addressed in this law, which has fuelled ongoing debates on physicians’ right to autonomy as well as on their duty to protect human life. 19 –21…”