14 December 2023
The National Committee for Bioethics, with the drafting of this Opinion on Palliative Care, intends to urge politics to implement it in an accomplished manner and as an integral part of the Essential Levels of Care, as these have already been recognised with the Prime Ministerial Decree of January 12th, 2017. The Opinion is also intended to be an encouragement for healthcare Organisations, training Organisations and professionals in the sector, to ensure that Palliative Care is provided with professionalism and ethical integrity, respecting the principles of universality, equity and justice, and granting each person the opportunity to deal with illness and the last stretch of the journey of life in a dignified manner and free from unnecessary suffering.
In the opening section of the Opinion, the CNB outlined the nature of Palliative Care through the fundamental definitions that have traced its evolution, configuring such care as a comprehensive approach, aimed not only at patients, but also at families dealing with chronic-evolving pathologies. Such an approach requires a deep understanding and extreme sensitivity to the different dimensions of the human experience that are intertwined with illness, recognising and responding to the complex needs that emerge in this delicate phase of life.
The second section addresses the issues that could compromise or slow down the progress and implementation of Palliative Care. Barriers to universal and equitable access to these essential services, the need for their timely activation, and the inalienable right of patients to receive comprehensive information about their care pathway are examined. The adequacy of Palliative Care in various healthcare settings, both home and hospital-based, and the influence of this care on healthcare costs were also addressed. In the Recommendations, the NCB indicated the need to pursue strategies for strengthening and enhancing Palliative Care networks and services, even in a context of scarce resources. The importance of adopting integrated and advanced management models to raise their quality and promote them as a strategic priority in the medical landscape, ensuring both clinical efficacy and the safeguarding of patients' dignity and rights, in all situations, was emphasised. The Opinion also highlighted the need for high-level training for healthcare professionals and the importance of research for the development of innovative treatments and practices, which are still sorely lacking in this area.
The NCB has intentionally focused its attention on these urgent matters to ensure that the development of Palliative Care throughout the country is considered a top priority. When we speak of the end of life, this issue intersects with others of great importance, sometimes crossed by divergences and contrasts, starting with assisted suicide and euthanasia, which are nevertheless characterised by distinct regulatory frameworks and ethical profiles. The two orientations that emerged on the relationship between Palliative Care and assisted suicide in the 2019 NCB Opinion 'Bioethical reflections on medically assisted suicide' can actually be read together to illuminate this context: in many cases the request to be helped 'to' die can be reformulated as a request to be helped not to suffer, but it is equally true that this does not apply in all situations and for all patients. It was decided to avoid, also in the structure of the text, overlapping with questions and issues that might have distracted the attention from the objective of illustrating the reasons for the necessary strengthening of Palliative Care. The possible question of anticipating death, which, moreover, is not only posed in this context, has nevertheless been addressed as a moment in the doctor-patient relationship and the associated communication responsibilities.
Two personal Remarks, published at the same time as the Opinion, were written: one by Professors Grazia Zuffa and Luca Savarino, the other by Prof. Maurizio Mori.