Advance directives in therapeutic intervention: a review of the Italian bioethical and juridical debate

Abstract

The authors present a review of the Italian bioethical and juridical debate about advance directives. The relevant points of difference between desistence from therapy and euthanasia and of the definition of the concept of therapy are also examined. The Italian Senate has passed a bill in which the value of advance health-care directives is affirmed. However, it is also affirmed that in conditions of emergency or when the subject's life is at immediate risk, the advance health-care directives should not be applied and artificial nutrition and hydration cannot be included in advance directives. In fact, these practices are thought to be of vital support and physiologically aimed at alleviating suffering until the end of life. Therefore, they cannot be the object of advance health-care directives. It is the authors' view that it is not at all desirable to trust legislative choices about a subject which continually varies in relation to scientific and clinical knowledge, options and alternatives. The physician is rather asked for a behaviour inspired by the value of the dignity and autonomy of the persons involved, by the respect of wishes previously expressed or, in any case, objectively proved.