Palliative Care against Medically Assisted Death? Misunderstanding and Instrumental Objections.

CONTEXT: Palliative Care (PC) and Medically Assisted Death (MAD), specifically assisted suicide and euthanasia, are distinct practices characterized by differing objectives, methods, implementation and outcomes. Representatives of PC, including scientific societies or physicians, may, in certain cases, adopt a critical stance towards MAD. OBJECTIVES: The study aims to explore the underlying reasons for such opposition. METHODS: To this end, the philosophical underpinnings and legal conditions of PC and MAD will be analyzed. RESULTS: The ethical and philosophical landscape of PC and MAD leads us to identify, on one hand, the Hippocratic paradigm and, on the other hand, what we call Socratic medicine. From a legal analysis perspective, the presence of intolerable suffering serves as a common ground between the two practices, albeit risking being the subject of misunderstandings and instrumental objections. CONCLUSION: Preventing an instrumental use of PC in relation to MAD is crucial to enable the respect and the coexistence of the two practices.

[The role of the physician in addressing suicidal ideation: an anthropological and legal comment.] / Il ruolo del medico di fronte alla scelta suicidaria: un commento antropologico-giuridico.

This editorial discusses, from an interdisciplinary legal-anthropological perspective, the essay "Medical assistance in dying: just an ethical or legal issue?" by Gristina et al. Starting from a review of the epidemiological data, the authors propose to consider suicidal ideation and suicide in patients affected by chronic-degenerative terminal diseases (CDTD) not only as a consequence of a mental disorder, but as a psychological response to the burden of illness. Their approach, we argue, requires a rethinking of the role of the physician as well as of the therapeutic alliance, which should include active listening and a co-constructed reflection on the end of life. Moreover, the essay offers a change of perspective from which to consider the current debates within the legal and professional fields, raising new challenges not only to medicine, but also to the law and to medical ethics.

[The Italian emergency medical system between evidence and risk of corporatism: the "Bologna case". Part I: the evidence / Part II: medical ethics and law.] / Il sistema sanitario di emergenza italiano tra prove e rischi di corporativismo: il "caso Bologna". Parte I: le prove / Parte II: deontologia e diritto.

Scientific issues. An effective pre-hospital emergency care needs trained health care professionals, technological and therapeutic resources, but not always the emergency systems performance is data-driven. There are three fundamental models of pre-hospital care. The first one (Anglo-American) is based on the professional paramedic provision of care. Another model (Franco-German) is built on the physician-led approach. The last one, derived from the franco-german model, is the nurse-led model described as the new profession in the pre-hospital care setting. Many studies compare the benefits of having physicians or nurses or paramedics on the field. The findings of this narrative literature review show that: 1) there is no a better model than the other; 2) the best performance depends on one hand on the expertise required case by case of those responding, on the other on the quality of dispatching process, contrary to what the Bologna's General Medical Council held; 3) regardless of the adopted model, the task shifting (the skills and expertise passed from physicians on other specialized health care workers) is considered around the world as the best way to balance health care demand and supply in the pre-hospital emergency setting. Professional ethics and legal issues. By means of the transformation of principles of medical ethics in rules binding for professionals, the code of medical ethics (CME) gains relevance within the legal system, especially through case law and disciplinary responsibility. Moreover, the CME is gaining growing attention, both at the normative and judicial levels, due to its ability to regulate important aspects of professional conduct, which may have consequences for medical practice and for the patient's fundamental rights. Notwithstanding this role, the interrelations between law and medical ethics, the binding value of the CME and the related position in the hierarchy of norms are still controversial, lacking a proper regulation and a proper set of safeguards measures. A disciplinary action against doctors acting outside the professional activities, namely as a council member proposing a legal act, must be based on solid grounds relating to the protection of fundamental rights. Such a disciplinary authority requires legal definitions, safeguards and judicial remedies beyond those being met at present. The analysis shows how specific elements and devices should still be taken into consideration from both procedural and content perspectives to shape a more coherent model of relationships between law and medical ethics.

Towards a European code of medical ethics. Ethical and legal issues.

The feasibility of a common European code of medical ethics is discussed, with consideration and evaluation of the difficulties such a project is going to face, from both the legal and ethical points of view. On the one hand, the analysis will underline the limits of a common European code of medical ethics as an instrument for harmonising national professional rules in the European context; on the other hand, we will highlight some of the potentials of this project, which could be increased and strengthened through a proper rulemaking process and through adequate and careful choice of content. We will also stress specific elements and devices that should be taken into consideration during the establishment of the code, from both procedural and content perspectives. Regarding methodological issues, the limits and potentialities of a common European code of medical ethics will be analysed from an ethical point of view and then from a legal perspective. The aim of this paper is to clarify the framework for the potential but controversial role of the code in the European context, showing the difficulties in enforcing and harmonising national ethical rules into a European code of medical ethics.