Bioethical reflections on medically assisted suicide

18 July 2019


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The ICB, as a follow up to its mandate to encourage public discussion on ethical issues and provide political decision-makers with consultancy, deems it necessary with this opinion to carry out a reflection on the assisted suicide following the ordinance n. 207/2018 of the Constitutional Court, which intervened on the issue, raised by the Milan Court of Assizes (ordinance dated February 14, 2018), regarding the case of Marco Cappato and the suspected constitutional illegitimacy of art. 580 of Italy’s penal code. The Committee has sought to address the issue of the assisted suicide in the awareness of detecting different positions both within the Committee itself and in society. The guidelines of the ICB (02.26.2015) art. 13, with regard to the drafting of opinions, predisposes that these be "constituted first of all by a descriptive part of the status quaestionis. In the evaluative part, when divergent orientations emerge, the plurality of the topics and the emerged positions are to be taken into account, in an open form that is compatible with the economy of the document”. The diversity of opinions, on the other hand, gives the opportunity to provide elements of reflection at the service of the choices of a society which intends to tackle an issue, such as the assisted suicide, which presents a series of problems and questions to which it is not possible to give a unified response. An issue which is considered among the most controversial of the current bioethical debate in our country. It should also be considered that personal elements and specific situations play an important role when questioning what the right to life consists of, whether the right to death exists and which ethical values to draw inspiration from as well as the dimension in which to place the intervention of a third party, in particular the doctor, called upon to respond to the patient's request. The public debate concerning assisted suicide illustrates the great difficulty in managing to reconcile two bioethically important principles, such as the safeguarding of life on the one hand and individual self-determination on the other. The opinion sought to draw the attention of society and the political world, which will have to discuss this issue following the invitation of the Constitutional Court, to what it considered to be the conceptual clarifications and the most relevant and delicate ethical issues arising from such requests: the difference between medical assistance with suicide and euthanasia; the expressed will of the individual; the professional values of the doctor and health care workers; the slippery slope argument; palliative care.

Different opinions can be found within this Committee.

Some members of the ICB are against legitimating medically assisted suicide, both ethically and legally, and converge in believing that the defence of human life must be affirmed as an essential principle in bioethics, whatever the philosophical and/or religious foundation of this value, that the mandatory duty of the physician is absolute respect for the life of patients and that "facilitating death" marks an unacceptable transformation of the paradigm of "curing and caring".

Other members of the ICB are, on the moral and juridical level, in favour of legalizing medically assisted suicide on the assumption that the value of the protection of life must be balanced with other constitutionally relevant good, such as patient self-determination and personal dignity. Such a balance must take particular account of conditions and procedures that are a real guarantee for the sick person and for the doctor.

Still others point out that, there is no immediate transmutability from the moral sphere to the legal sphere. Moreover, they highlight that, decriminalization or legalization of so-called medically assisted suicide along the lines of those carried out by some European countries, would lead to the concrete risks of the start of a slippery slope in the present reality of Italian healthcare. Despite these divergent positions, the Committee has reached the formulation of some shared recommendations, first and foremost hoping that wherever discussion on this issue may take place – including Parliament – debate on medical assisted suicide will develop in full respect of all opinions on this matter, but also with due attention to the moral, deontological and juridical- constitutional problems that it raises and with the due in-depth study required of such a lacerating issue for the human conscience. The Committee also recommends a commitment to provide adequate care for those suffering from incurable illness; it requests that adequate information be given to the patient regarding the possibilities of treatment and palliative care which are to be documented within the care report; it considers essential that every effort be made to implement the information for citizens and health professionals on the regulatory provisions concerning access to palliative care; it hopes for promotion of the broadest public participation in the ethical and legal discussion on the topic and that biomedical and psychosocial scientific research and the bioethical training of health workers in this field will be promoted.

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