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
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
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DOI：
10.1016/j.jcrc.2018.08.039
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发表时间：
2018-12-01
影响因子：
3.7
通讯作者：
Gulino, Matteo
中科院分区：
文献类型：
--
作者：
Ciliberti, Rosagemma;Gorini, Ilaria;Gulino, Matteo
目的：意大利长期以来缺乏规范患者知情同意和预先指示的法律。此前所有试图就这一问题引入法律的尝试都未能取得积极成果，并引发了关于生与死的确切含义的激烈意识形态辩论。我们报告了意大利议会于2017年12月14日批准的关于知情同意和广告的新法律。材料和方法：我们分析了新法律，并讨论了与之相关的主要伦理问题，在意大利的背景下，并与国际情况进行了比较。结果：该法律规定了基本的伦理原则和重要的指导方针：尊重患者在生命各个阶段的自决权，拒绝或中断维持生命治疗（包括人工营养和水合作用）的选择权，生命终结决定的合法性，以及实施姑息治疗以减轻痛苦。新法律的效果必须在实地检验。如果在临床实践中，AD能够通过患者与其医生的关系令人满意地代表知情的个人偏好，作为个性化提前护理计划的一部分，则其目标将得以实现。今后有必要开展研究，以评估新法律在意大利的影响。(C)2018爱思唯尔公司All rights reserved.
Purpose: Italy has long lacked a law regulating patients' informed consent and advance directives (ADs). All previous attempts to introduce a law on this matter failed to reach positive outcomes, and aroused heated ideological debate over the exact meaning of life and death. We report on the new law on informed consent and ADs approved by the Italian Parliament on 14th December 2017.Materials and methods: We analyse the new law and discuss the main ethical points connected with it, in the Italian context and in comparison with the international situation.Results: The law provides for fundamental ethical principles and important guidelines: respect for patients' self-determination in all phases of life, option to refuse or interrupt life-sustaining treatments, including artificial nutrition and hydration, the legitimacy of end-of-life decisions, and the implementation of palliative care to ease suffering and pain.Conclusions: The effects of the new law must be tested in the field. Its objectives will be achieved if, in clinical practice, ADs are able to satisfactorily represent informed personal preferences through patients' relationships with their physicians, as part of personalized advance care planning. Future studies are necessary to assess the impact of the new law in Italy. (C) 2018 Elsevier Inc. All rights reserved.