Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Research
  • Published:
Journal of Bioethical Inquiry Aims and scope Submit manuscript

Abstract

In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of the criminal code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Atkinson Smith, M., L. Torres, and T.C. Burton. 2020. Patient rights at the end of life: The ethics of aid-in-dying. Professional Case Management 25(2): 77-84.

    Article  PubMed  Google Scholar 

  • Barutta, J., and J. Vollmann. 2015. Physician-assisted death with limited access to palliative care. Journal of Medical Ethics 41(8): 652-654.

    Article  PubMed  Google Scholar 

  • Beauchamp T.L., and J.F. Childress. 2004. Principles of biomedical ethics, 5th ed. Oxford: Oxford University Press.

    Google Scholar 

  • Ben-Moshe, N. 2019. The truth behind conscientious objection in medicine. Journal of Medical Ethics 45(6): 404-410.

    Article  PubMed  Google Scholar 

  • Bernheim, J.L., W. Distelmans, A. Mullie, and M.A. Ashby. 2014. Questions and answers on the Belgian model of integral end-of-life care: Experiment? Prototype?: “Eu-euthanasia”: The close historical, and evidently synergistic, relationship between palliative care and euthanasia in Belgium: An interview with a doctor involved in the early development of both and two of his successors. Journal of Bioethical Inquiry 11(4): 507-529.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bickenbach, J. 1998. Disability and life- ending decisions. In Physicians assisted suicide: expanding the debate, edited by M.P. Battin, R. Rhodes, and A. Silvers, 125. New York: Routledge.

  • Bo, M., C.M. Zotti, and L. Charrier. 2017. The no correlation argument: Can the morality of conscientious objection be empirically supported? The Italian case. BMC Medical Ethics 18(1): 64.

    Article  PubMed  PubMed Central  Google Scholar 

  • Botti, C, and A. Vaccari. 2019. End-of-life decision making and advance care directives in Italy. A report and moral appraisal of recent legal provisions. Bioethics 33(7): 842-848.

    Article  PubMed  Google Scholar 

  • Cavalieri, T.A., S.C. Pomerantz, J. Ciesielski, J.W. Shinkle, and L.J. Forman. 2002. Attitudes of osteopathic physicians toward physician-assisted suicide. The Journal of American Osteopathic Association 102(1): 27–34.

    Google Scholar 

  • Ciliberti, R., I. Gorini, V. Gazzaniga, F. De Stefano, and M. Gulino. 2018. The Italian law on informed consent and advance directives: New rules of conduct for the autonomy of doctors and patients in end-of-life care. Journal of Critical Care 48(December): 178-182.

    Article  PubMed  Google Scholar 

  • Colburn, B. 2019. Autonomy, voluntariness and assisted dying. Journal of Medical Ethics 46(5): 316-319.

    Article  PubMed  Google Scholar 

  • Curlin, F.A., C. Nwodim, J.L. Vance, M.H. Chin, and J.D. Lantos. 2008. To die, to sleep: US physicians’ religious and other objections to physician-assisted suicide, terminal sedation, and withdrawal of life support. The American Journal of Hospice & Palliative Care 25(2): 112–120.

    Article  Google Scholar 

  • D’Angelo, D., M. Di Nitto, D. Giannarelli, et al. 2020. Inequity in palliative care service full utilisation among patients with advanced cancer: A retrospective Cohort study. Acta Oncologica 59(6): 620-627.

    Article  PubMed  Google Scholar 

  • Di Paolo, M., F. Gori, L. Papi, and E. Turillazzi. 2019. A review and analysis of new Italian law 219/2017: Provisions for informed consent and advance directives treatment. BMC Medical Ethics 20(1): 17.

  • Douglas, C., I. Kerridge, and R. Ankeny. 2008. Managing intentions: The end-of-life administration of analgesics and sedatives, and the possibility of slow euthanasia. Bioethics 22(7): 388-396.

    Article  PubMed  Google Scholar 

  • Dugdale, L.S., B.H. Lerner, and D. Callahan. 2019. Pros and cons of physician aid in dying. Yale Journal of Biology and Medicine 92(4): 747-750.

    Google Scholar 

  • Ely, E.W., C.L. Sprung, and M. Sommerville. 2017. Conscientious objection in health care. The New England Journal of Medicine 377: 96–97.

    Article  PubMed  Google Scholar 

  • Ely, E.W., E. Azoulay, and C.L. Sprung. 2019. Eight things we would never do regarding end-of-life care in the ICU. Intensive Care Medicine 45(8): 1116-1118.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fontalis, A., E. Prousali, and K. Kulkarni. 2018. Euthanasia and assisted dying: What is the current position and what are the key arguments informing the debate? Journal of the Royal Society of Medicine 111(11): 407-413.

    Article  PubMed  PubMed Central  Google Scholar 

  • France, G., F. Taroni, and A. Donatini. 2005. The Italian health-care system. Health Economics 14(Suppl 1): S187-202.

    Article  PubMed  Google Scholar 

  • Frati, P., M. Gulino, P. Mancarella, R. Cecchi, and S. Ferracuti. 2014. Assisted suicide in the care of mentally ill patients: The Lucio Magri’s case. Journal of Forensic and Legal Medicine 21: 26-30.

    Article  PubMed  Google Scholar 

  • Friesen, P. 2020. Medically assisted dying and suicide: How are they different, and how are they similar? Hastings Center Report 50(1): 32-43.

    Article  Google Scholar 

  • Frost, T.D., D. Sinha, and B.J. Gilbert. 2014. Should assisted dying be legalised? Philosophy, Ethics, and Humanities in Medicine 9(1): 1-5.

    Article  Google Scholar 

  • Gill, C.J. 2004. Depression in the context of disability and the “right to die.” Theoretical Medicine and Bioethics 25(3): 171–198.

    Article  PubMed  Google Scholar 

  • Goligher, E.C., E.W. Ely, D.P. Sulmasy, et al. 2017. Physician-assisted suicide and euthanasia in the ICU: A dialogue on core ethical issues. Critical Care Medicine 45(2):149–155.

    Article  PubMed  Google Scholar 

  • Gristina, G.R., L. Busatta, and M. Piccinni. 2019. The Italian law on informed consent and advance directives: Its impact on intensive care units and the European legal framework. Minerva Anestesiologica 85(4): 401–411.

    Article  PubMed  Google Scholar 

  • Hains, C.A., and N.J. Hulbert-Williams. 2013. Attitudes toward euthanasia and physician-assisted suicide: A study of the multivariate effects of healthcare training, patient characteristics, religion and locus of control. Journal of Medical Ethics 39(11): 713–716.

    Article  PubMed  Google Scholar 

  • Hudson, P., R. Hudson, J. Philip, M. Boughey, B. Kelly, and C. Hertogh. 2015. Physician-assisted suicide and/or euthanasia: Pragmatic implications for palliative care. Palliative & Supportive Care 13(5): 1399–1409.

    Article  Google Scholar 

  • Jansen, L.A., S. Wall, and F.G. Miller. 2019. Drawing the line on physician-assisted death. Journal of Medical Ethics 45(3): 190–197.

    Article  PubMed  Google Scholar 

  • Kim, S.Y.H., R.G. De Vries, and J.R. Peteet. 2016. Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry 73(4): 362–368.

    Article  PubMed  PubMed Central  Google Scholar 

  • Krahn, G.L. 2010. Reflections on the debate on disability and aid in dying. Disability and Health Journal 3(1): 51–55.

    Article  PubMed  Google Scholar 

  • Lindberg, J., M. Johansson, and L. Broström. 2019. Temporising and respect for patient self-determination. Journal of Medical Ethics 45(3): 161–167.

  • Materstvedt, L.J., D. Clark, J. Ellershaw, et al. 2003 Euthanasia and physician-assisted suicide: A view from an EAPC Ethics Task Force. Palliative Medicine 17(2): 97–101.

  • Macleod, R.D., D.M. Wilson, and P. Malpas. 2012. Assisted or hastened death: The healthcare practitioner’s dilemma. Global Journal of Health Science 4(6): 87–98.

    Article  PubMed  PubMed Central  Google Scholar 

  • McClelland, W., and E.C. Goligher. 2019. Withholding or withdrawing life support versus physician-assisted death: A distinction with a difference? Current Opinion in Anaesthesiology 32(2): 184–189.

    Article  PubMed  Google Scholar 

  • McIntyre, A. 2004. The double life of double effect. Theoretical Medicine and Bioethics 25(1): 61–74.

    Article  PubMed  Google Scholar 

  • McCormack, R., M. Clifford, and M. Conroy. 2012. Attitudes of UK doctors towards euthanasia and physician-assisted suicide: A systematic literature review. Palliative Medicine 26(1): 23–33.

    Article  PubMed  Google Scholar 

  • Meaney, J., M. Casini, and A.G. Spagnolo. 2012. Objective reasons for conscientious objection in health care. The National Catholic Bioethics Quarterly 12(4): 611–620.

    Article  Google Scholar 

  • Meier, D.E., C.A. Emmons, S. Wallenstein, T. Quill, R.S. Morrison, and C.K. Cassel. 1998. A national survey of physician-assisted suicide and euthanasia in the United States. The New England Journal of Medicine 338(17): 1193–1201.

    Article  CAS  PubMed  Google Scholar 

  • Miller, F.G., R.D. Truog, and D.W. Brock. 2010. Moral fictions and medical ethics. Bioethics 24(9): 453–460.

    Article  PubMed  Google Scholar 

  • Minerva, F. 2015. Conscientious objection in Italy. Journal of Medical Ethics 41(2): 170–173.

    Article  PubMed  Google Scholar 

  • Nicolini, M.E., S.Y.H. Kim, M.E. Churchill, and C. Gastmans. 2020. Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons. Psychological Medicine 50(8): 1241–1256.

    Article  PubMed  Google Scholar 

  • Parker, M. 2004. Judging capacity: Paternalism and the risk-related standard. Journal of Law and Medicine 11(4): 482–491.

    PubMed  Google Scholar 

  • Pesut, B., S. Thorne, C.J. Schiller, M. Greig, and J. Russel. 2020. The rocks and hard places of MAiD: A qualitative study of nursing practice in the context of legislated assisted death. BMC Nursing 19: 12.

    Article  PubMed  PubMed Central  Google Scholar 

  • Petrini, C. 2019. After the Italian Constitutional Court’s ruling on the absence of criminal liability for assisted suicide: The role of ethics committees and clinical ethics. Annali dell’Istituto Superiore di Sanità 55(4): 311–313.

    PubMed  Google Scholar 

  • Quill, T.E. 2016. Responding to patients requesting physician-assisted death: Physician involvement at the very end of life. Journal of American Medical Association 315(3): 245–246.

    Article  CAS  Google Scholar 

  • Radbruch, L., C. Leget, P. Bahr, et al. Board Members of EAPC. 2016. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliative Medicine 30(2): 104–116.

  • Rhodes, R. 2019. Conscience, conscientious objections, and medicine. Theoretical Medicine and Bioethics 40(6): 487–506.

  • Riddle, A. 2017. Assisted dying & disability. Bioethics 31(6): 484–489.

    Article  PubMed  Google Scholar 

  • Rietjens, J.A., P.J. van der Maas, B.D. Onwuteaka-Philipsen, J.J. van Delden, and A. van der Heide. 2009. Two decades of research on euthanasia from the Netherlands. What have we learnt and what questions remain? Journal of Bioethical Inquiry 6(3): 271–283.

    Article  PubMed  PubMed Central  Google Scholar 

  • Romo, R.D., T.A. Allison, A.K. Smith, and M.I. Wallhagen. 2017. Sense of control in end-of-life decision-making. Journal of the American Geriatrics Society 65(3): e70–e75.

    Article  PubMed  Google Scholar 

  • Salloch, S. 2016. Same same but different: Why we should care about the distinction between professionalism and ethics. BMC Medical Ethics 17(1): 44.

    Article  PubMed  PubMed Central  Google Scholar 

  • Scaccabarozzi, G., P.G. Lovaglio, F. Limonta, M. Floriani, and G. Pellegrini. 2017. Quality assessment of palliative home care in Italy. Journal of Evaluation in Clinical Practice 23(4): 725–733.

    Article  PubMed  Google Scholar 

  • Scaccabarozzi, G., P.G. Lovaglio, F. Limonta, C. Peruselli, M. Bellentani, and M. Crippa. 2019. Monitoring the Italian home palliative care services. Healthcare 7(1): 4.

    Article  PubMed Central  Google Scholar 

  • Shariff, M.J. 2011. Navigating assisted death and end-of-life care. Canadian Medical Association Journal 183(6): 643–644.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shreves, A., and E. Marcolini. 2014. End of life/palliative care/ethics. Emergency Medicine Clinics of North America 32(4): 955–974.

    Article  PubMed  Google Scholar 

  • Singer, P.A. 2000. Medical ethics. BMJ 321: 282–285.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stayl, R.Y., and E. Emanuel. 2017. Conscientious objection in health care. The New England Journal of Medicine 377(1): 97–98.

    Google Scholar 

  • Sulmasy, D.P., I. Finlay, F. Fitzgerald, K. Foley, R. Payne, and M. Siegler. 2018. Physician-assisted suicide: Why neutrality by organized medicine is neither neutral nor appropriate. Journal of General Internal Medicine 33(8): 1394–1399.

    Article  PubMed  PubMed Central  Google Scholar 

  • Synder Sulmasy, L., and P.S. Mueller. 2017. Ethics and the legalization of physician-assisted suicide: An American College of Physicians position paper. Annals of Internal Medicine 167(8): 576–578.

    Article  Google Scholar 

  • Tuffrey-Wijne, I., L. Curfs, I. Finlay, and S. Hollins. 2018. Euthanasia and assisted suicide for people with an intellectual disability and/or autism spectrum disorder: An examination of nine relevant euthanasia cases in the Netherlands (2012-2016). BMC Medical Ethics 19(1): 17.

    Article  PubMed  PubMed Central  Google Scholar 

  • van Delden, J.J.M., and M.P. Battin. 2009. Physician-assisted death: Not just for rich countries. In Global bioethics: Issue of conscience for the twenty-first century, edited by R.M. Green, A. Donovan, and S.A. Jauss. New York: Oxford University Press.

    Google Scholar 

  • van den Block, L., R. Deschepper, J. Bilsen, N. Bossuyt, V. Van Casteren, and L. Deliens. 2009. Euthanasia and other end of life decisions and care provided in final three months of life: Nationwide retrospective study in Belgium. BMJ 339: b2772.

    Article  PubMed  PubMed Central  Google Scholar 

  • Veshi, D., E. Koka, and C. Venditti. 2019. A new law of advance directives in Italy: A critical legal analysis. Journal of Law and Medicine 26(3): 702–710.

  • Viola, R.V., N. Di Fazio, Z. Del Fante, et al. 2020. Rules on informed consent and advance directives at the end-of-life: The new Italian law. La Clinica Terapeutica 171(2): e94–e96.

    CAS  PubMed  Google Scholar 

  • Wheeler, R. 2017. The evolution of informed consent. British Journal of Surgery 104(9): 1119–1120.

    Article  CAS  Google Scholar 

  • Wicclair, M.R. 2019. Conscientious objection, moral integrity, and professional obligations. Perspectives in Biology and Medicine 62(3): 543–559.

    Article  PubMed  Google Scholar 

  • Wilkinson, D. 2017. Conscientious non-objection in intensive care. Cambridge Quarterly of Healthcare Ethics 26(1): 132–142.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zenz, J., M. Tryba, and M. Zenz. 2015. Palliative care professionals’ willingness to perform euthanasia or physician assisted suicide. BMC Palliative Care 14: 60.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy

    E. Turillazzi, A. Maiese & M. Di Paolo

  2. Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy

    P. Frati & M. Scopetti

Authors
  1. E. Turillazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Maiese
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Frati
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Scopetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Di Paolo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ET and PF designed the study. MDP carried out the main work at each step. AM and MS supported the bibliographic research and contributed to the plan of the paper. ET drafted the manuscript and made major revisions. All authors have discussed and revised the manuscript and have read and approved the final version.

Corresponding author

Correspondence to E. Turillazzi.

Ethics declarations

Competing Interests

The authors declare that they have no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Turillazzi, E., Maiese, A., Frati, P. et al. Physician–Patient Relationship, Assisted Suicide and the Italian Constitutional Court. Bioethical Inquiry 18, 671–681 (2021). https://doi.org/10.1007/s11673-021-10136-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11673-021-10136-w

Keywords

Search

Navigation