The preservation of life as a duty and a right

Main Article Content

Giuseppe Basile

Keywords

end-of-life ethics, conscientious objection, medical assistance in dying

Abstract

With considerable insight for the time, 65 years ago Pope Pius XII outlined a proposal of evaluation criteria based on the distinction between ordinary means of care, i.e. those who do not entail unreasonable sacrifices which would be unacceptable for most professionals and patients, and extraordinary care procedures which, although not mandatory, could be used if one had the intellectual, moral, spiritual, scientific and organizational awareness, capabilities and strength to put them in place. The Pope thus addressed the extremely complex set of bioethical issues stemming from the implementation of resuscitation procedures for those who have no hope to recover. The core belief was that every decision based on free consent to treatment should be made within the framework of an underlying and essential linkage between the rights and duties of doctors and those of patients. The identification of the patient as the ultimate decision-maker, when it comes to their health and the therapeutic interventions to be administered, has been the result of a cultural and legal evolution, in keeping with the principle of consent enshrined in art. 32 of the Italian Constitution, according to which “no one can be obliged to undergo any given health treatment except by law. The law cannot therefore exceed the limits imposed by “respect for all human beings”. On March 10th , 2022, the Italian Chamber of Deputies enacted the unified text C. 2-A and abb., which codified provisions on “medically assisted voluntary death” regulating the right to request medical assistance in dying, provided that specific requirements and conditions be met. This short report is meant as an attempt to put into perspective such fundamental values, against the backdrop of the therapeutic alliance between doctors and patients and the ethical, legislative, and regulatory complexities which are bound to arise.

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References

1.Address to an International Congress of Anesthesiologists by Pope Pius XII on November 24, 1957. L'Osservatore Romano, November 25-26, 1957. Available online: https://lifeissues.net/writers/doc/doc_31resuscitation.html (Accessed on 2nd October 2022).
2.Constitution of the Italian Republic. Enacted on 27th December 1947. Available online: https://www.governo.it/it/costituzione-italiana/2836 (Accessed on 25th August 2022).
3.Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine. Signed on 4th April 1997. Entered into force 1st December 1999. Chapter II, Article 5. Available online: https://rm.coe.int/168007cf98 (Accessed on 25th August 2022).
4.Italian Chamber of Deputies. Testo unificato A.C. 2-A e abb. Morte volontaria medicalmente assistita. Available online: https://www.camera.it/temiap/documentazione/temi/pdf/1310853.pdf?_1661509512920 (Accessed on 25th August 2022).

5.Ricci G, Gibelli F, Sirignano A. Editorial - From ruling No. 242/2019 of the Constitutional Court to the Italian law on medically assisted death: a complex transition. Eur Rev Med Pharmacol Sci 2022; 26: 4546–4549.

6.Fry-Bowers EK. A Matter of Conscience: Examining the Law and Policy of Conscientious Objection in Health Care. Policy Polit Nurs Pract 2020; 21: 120–126.

7.Morrell KM, Chavkin W. Conscientious objection to abortion and reproductive healthcare: a review of recent literature and implications for adolescents. Curr Opin Obstet Gynecol 2015; 27: 333–338.

8.Montanari Vergallo G, Zaami S, Di Luca NM, Marinelli E. The conscientious objection: debate on emergency contraception. Clin Ter 2017; 168:e113-9.

9.Zaami S, Signore F, Baffa A, Votino R, Marinelli E, Del Rio A. Emergency contraception: unresolved clinical, ethical and legal quandaries still linger. Panminerva Med 2021; 63: 75-85.

10.Speeches and radio messages of St. Pius XII, Nineteenth year of Pontificate, March 2, 1957 - March 1, 1958, pp. 615–621- Vatican Polyglot Typography

11.Mentil S. La riflessione bioetica di Pio XII (prefazione di A. Da Re), Edizioni Meudon, Trieste 2017, pp. 268 - ISBN 978889749721].

12.Dolci M, Favero C, Toumi W, et al. Human Endogenous Retroviruses Long Terminal Repeat Methylation, Transcription, and Protein Expression in Human Colon Cancer. Front Oncol 2020; 10: 569015. 

13.Monaco AP. Joseph Edward Murray, M.D., 1919-2012: pioneering transplant and reconstructive plastic surgeon and scientist, nobel Laureate, humanitarian--an appreciation. Transplantation 2013; 95: 903–907.

14.Signorini L, Dolci M, Favi E, Colico C, Ferraresso M, Ticozzi R, Basile G, Ferrante P, Delbue S. Viral Genomic Characterization and Replication Pattern of Human Polyomaviruses in Kidney Transplant Recipients. Viruses 2020; 12:1280.

15.Law n. 219, enacted on 22nd December 2017. Norme in materia di consenso informato e di disposizioni anticipate di trattamento. Available online: https://www.gazzettaufficiale.it/eli/id/2018/1/16/18G00006/sg (Accessed on 25th August 2022).

16.Cioffi A, Zaami S. Italian Law no. 219/2017: consequences on the informed consent of the psychiatric patient and on the therapeutic privilege. Riv Psichiatr 2020; 55: 129–130.

17.Marinelli E, Busardò FP. Assisted suicide: article 17 of the Italian Code of Medical Ethics follows in the footsteps of the Italian Constitutional Court's landmark ruling. Eur Rev Med Pharmacol Sci 2020; 24:10309–10312.

18.Montanari Vergallo G, Busardò FP, Berretta P, Marinelli E, Zaami S. Advance healthcare directives: moving towards a universally recognized right. Eur Rev Med Pharmacol Sci 2018; 22: 2915–2916.

19.Busardò FP, Bello S, Gulino M, Zaami S, Frati P. Advance health care directives and "public guardian": the Italian supreme court requests the status of current and not future inability. Biomed Res Int 2014; 2014:576391.