First Case of Medically Assisted Suicide in Italy Set New Legal Perspectives.

Abstract: The first act of assisted suicide in Italy was recently carried out. This event is an absolute novelty for the country, affected by recent legislative changes aimed only at introducing the right to interrupt health treatments and, therefore, carry out exclusively omissive end-of-life acts. These normative provisions lay their foundations in a cultural context centered on the protection of the right to life and health; however, the cases that have occurred over time, including the famous story of DJ Fabo, have led the Constitutional Court to re-evaluate these dictates, introducing in 2019 the right to resort to assisted suicide procedures within well-defined areas, including incurability of the condition, the serious suffering of the individual and the retained ability to stand trial. The case addressed concerns a quadriplegic subject who was the victim of a road accident. Following consultation with a specialized institution, the subject made the decision to undergo an assisted sui-cide procedure in Italy. Having obtained the authorization from the competent authorities, he started a fundraiser to finance the devices and drugs required and, finally, he died. The opening by Italy towards the assisted suicide procedure represents a great step towards a broad context, as well as a decisive act for the purpose of protecting the right to self-determination of the individual. However, the current legislative framework presents significant criticalities and shortcomings. In first place, the dissonance between the laws in force and the judicial sentences is likely to generate problems of uneven application of the rules in a country dominated by the principle of Civil Law. Furthermore, the need for the applicant to fully self-finance the procedure clearly clashes with the constitutional principle of free access to care. Then emerges the need for a guideline document regarding the completion of the procedure itself, the times, methods and drugs implied, in order to significantly reduce the decision-making process by the ethics committees that still weighs on each individual case. Finally, conside-ring what has been observed on the subject of voluntary termination of pregnancy, it is necessary to ask what will be the general orientation of the doctors called to perform the act and whether they will be given the opportunity to express their refusal. The case analyzed could represent the beginning of a new era for Italian culture, but the large-scale application of assisted suicide procedures requires the introduction of legislative provisions that definitively eliminate the critical issues that have emerged so far.

Eutanásia Voluntária Ativa, Suicídio Assistido, Ortotanásia e os Cuidados Paliativos: um panorama das discussões no Poder Legislativo Federal Brasileiro / Eutanàsia Voluntària Activa, Suïcidi Assistit, Ortotanàsia i Cures Pal·liatives: un panorama de les discussions en el Poder Legislatiu Federal brasiler / Eutanasia Voluntaria Activa, Suicidio Asistido, Ortotanasia y Cuidados Paliativos: un panorama de las discusiones en el Poder Legislativo Federal brasileño / Voluntary Active Euthanasia, Assisted Suicide, Orthothanasia and Palliative Care: An overview of the discussions in the Brazilian Federal Legislative Power

No âmbito das proposições legislativas brasileiras, buscou-se compreender os desafiose obstáculos no percurso delimitativo das práticas de fim de vida. Analisou-se 193 documentos, desde 1981 até 2020, com base na metodologia hermenêutica-dialética. Evidenciou-se distintas propostas regulamentadoras das práticas de eutanásia e ortotanásia,na relação com os cuidados paliativos. As associações dos termos “cuidados paliativos” e “ortotanásia”, em oposição à “eutanásia/suicídio assistido, revelaram a conflituosa construção de valores que perpassa nossa sociedade. Com a tramitação de projetos relacionados à ortotanásia e eutanásia, compreendemos o sentido das decisões políticas que envolvem as possibilidades de escolhas e liberdade das pessoas, entre o direito à vida e o direito à morte digna. Compreendemos a problemática da legalização da ortotanásia, como forma do poder legislativo se furtar ao debate sobre a eutanásia/suicídio assistido, como alternativa à distanásia e ao sofrimento no processo de morrer.(AU)

En el context de les propostes legislatives brasileres, busquem comprendre els reptes i obstacles en el camí cap a la delimitació de les pràctiques al final de la vida. S'han analitzat 193 documents, des de 1981 fins a 2020, basant-se en la metodologia hermenèutica-dialèctica. S'han evidenciat diferents propostes normatives per a les pràctiques d'eutanàsia i ortotanàsia, en relació als cures pal·liatius. Les associacions dels termes "cures pal·liatius" i "ortotanàsia", en oposició a "eutanàsia/suïcidi assistit", revelen la construcció conflictiva de valors que impregna la nostra societat. Amb la tramitació dels projectes relacionats amb la ortotanàsia i l'eutanàsia, entenem el sentit de les decisions polítiques que implica les possibilitats de tria i llibertat de les persones, entre el dret a la vida i el dret a una mort digna. Comprenguem el problema de la legalització de la ortotanàsia com una forma que el poder legislatiu eviti el debat sobre l'eutanàsia/suïcidi assistit, com a alternativa a la distanàsia i al patiment en el procés de morir.(AU)

En el ámbito de las propuestas legislativas brasileñas, se buscó comprender los desafíos y obstáculos en el camino de la regulación de las prácticas al final de la vida. Se analizaron 193 documentos desde 1981 hasta 2020, utilizando la metodología hermenéutica-dialéctica. Se evidenciaron diferentes propuestas regulatorias relacionadas con la eutanasia y la ortotanasia, en relación con los cuidados paliativos. La asociación de los términos "cuidados paliativos" y "ortotanasia", en contraposición a "eutanasia/suicidio asistido", reveló la conflictiva construcción de valores que atraviesa nuestra sociedad. Con la tramitación de proyectos relacionados con la ortotanasia y la eutanasia, comprendemos el sentido de las decisiones políticas que involucran las posibilidades de elección y libertad de las personas, entre el derecho a la vida y el derecho a una muerte digna. También comprendemos la problemática de la legalización de la ortotanasia como una forma de que el poder legislativo evite el debate sobre la eutanasia/suicidio asistido, como una alternativa a la distanasia y al sufrimiento en el proceso de morir.(AU)

Within the scope of Brazilian legislative proposals, we sought to understand the challenges and obstacles in the delimiting path of end-of-life practices. 193 documents were analyzed, from 1981 to 2020, based on the hermeneutic-dialectical methodology. Different regulatory proposals for the practices of euthanasia and orthothanasia, in relation to palliative care, were evidenced. The associations of the terms “palliative care” and “orthothanasia”, as opposed to “euthanasia/assisted suicide, revealed the conflicting construction of values that permeates our society. With the processing of projects related to orthothanasia and euthanasia, we understand the meaning of political decisions that involve the possibilities of choices and freedom of people, between the right to life and the right to a dignified death. We understand the problem of legalizing orthothanasia as a way for the legislative power to evade the debate on euthanasia/assisted suicide, as an alternative to dysthanasia and suffering in the dying process.(AU)

Capacidad jurídica y excepcionalidad jurídica en la Ley 3/2021, de regulación de la eutanasia. Una lectura en primera persona / Legal capacity and legal exceptionality in Law 3/2021, regulating euthanasia. A reading from a user perspective

Este artículo presenta una lectura situada a la Ley 3/2021, de 24 de marzo, de regulación de la eutanasia, desde la perspectiva de una persona usuaria de servicios de salud mental. El análisis se hace desde el marco jurídico de la Convención sobre los Derechos de las Personas con Discapacidad (CDPD), de Naciones Unidas, atendiendo especialmente a su artículo 12, de Igual reconocimiento como persona ante la ley. La lectura atiende a la adecuación (o no) del texto de la ley a la CDPD. En la discusión, se repasan los argumentos que se esgrimen desde la institución psiquiátrica no solo para oponerse al ejercicio de este nuevo derecho por parte de las personas psiquiatrizadas, sino también, por extensión, para perpetuar en el Estado español una situación de excepcionalidad jurídica en base a un criterio de trastorno mental. (AU)

This article presents a situated reading of Law 3/2021, of March 24, on the regulation of euthanasia, from the perspective of a mental health services' user. The analysis is made from the legal framework of the Convention on the Rights of Persons with Disabilities (CRPD), of the United Nations, paying special attention to its article 12, Equal recognition before the Law. The reading is focused on the adequacy (or not) of the text of the Law to the CRPD. In the discussion, the arguments put forward by the psychiatric institution are reviewed not only to oppose the exercise of this new right by psychiatrized people, but also, by extension, to perpetuate in the Spanish State a situation of Legal Exceptionality based on a criterion of mental disorder. (AU)

What About Us? Experiences of Relatives Regarding Physician-Assisted Death for Patients Suffering from Mental Illness: A Qualitative Study.

Physician-assisted death (PAD) for patients suffering from mental illness is legally permitted in the Netherlands. Although patients' relatives are not entrusted with a legal role, former research revealed that physicians take into account the patient's social context and their well-being, in deciding whether or not to grant the request. However, these studies focussed on relatives' experiences in the context of PAD concerning patients with somatic illness. To date, nothing is known on their experiences in the context of PAD concerning the mentally ill. We studied the experiences of relatives with regard to a PAD request by patients suffering from mental illness. The data for this study were collected through 12 interviews with relatives of patients who have or had a PAD request because of a mental illness. We show that relatives are ambivalent regarding the patient's request for PAD and the following trajectory. Their ambivalence is characterised by their understanding of the wish to die and at the same time hoping that the patient would make another choice. Respondents' experiences regarding the process of the PAD request varied, from positive ('intimate') to negative ('extremely hard'). Some indicated that they wished to be more involved as they believe the road towards PAD should be a joint trajectory. To leave them out during such an important event is not only painful, but also harmful to the relative as it could potentially complicate their grieving process. Professional support during or after the PAD process was wanted by some, but not by all.

Eutanasia y Psicología. Algunas claves para la intervención en Procesos Adelantados de Muerte / Euthanasia and psychology Some keys for intervention in hastened processes of death

Los países que han optado por regular los Procesos Adelantados de Muerte (PAM) van en aumento en los últimos años. Este tipo de legislaciones implican directamente a los equipos sanitarios. Los psicólogos incluidos en estos equipos están en contacto con estos procesos, por lo que se torna imprescindible dilucidar, mediante la escasa literatura existente, si los PAM presentan variables diferenciales con otros procesos de muerte, que sean necesarias tener en cuenta durante la asistencia psicológica. Esta recopilación de literatura pretende plantear las diferencias que en la actualidad están contrastadas y plantear qué opciones de intervención psicológica están a nuestra disposición para realizar el acompañamiento a estas personas, sus cuidadores y los equipos sanitarios que los asisten. (AU)

The countries that have chosen to regulate advanced death processes (PAM) have been increasing in recent years. This type of legislation directly involves health teams. The psychologists included in these teams are in contact with these processes, so it becomes essential to elucidate, through the scarce existing literature, if the PAM present differential variables with other death processes, that it is necessary to take into account during psychological assistance. This compilation of literature aims to present the differences that are currently contrasted and to propose what psychological intervention options are available to us to carry out the accompaniment of these people, their caregivers and the health teams that assist them. (AU)

The End of Life Choice Act: a proposed implementation and research agenda.

AIM: This article outlines the End of Life Choice Act 2019. It highlights some of the key implementation issues to ensure the system operates safely and equitably after the Act comes into force. It also identifies priorities for research to ensure issues are detected and provision of assisted dying (AD) is monitored. METHOD: We reviewed the End of Life Choice Act, assisted dying implementation literature and governmental reports. RESULTS: Effective system implementation depends on infrastructure, oversight and funding. In terms of service provision, we make recommendations about training for all health practitioners and providing practitioners; the nuances of discussing the "wish to hasten death"; conscientious objection; cultural safety for Maori; and minimising the complexity of delivering assisted dying practice. Structured research is needed to understand how the assisted dying system is operating. CONCLUSION: This article contributes by identifying core issues for practitioners, patients and policymakers. Implementation is an ongoing process that continues after the Act starts. Data are required to know whether access is equitable, who is choosing to make use of the law, whether providers are well informed and whether the safeguards are working as intended. The implications of how the Act is implemented are significant for patients, whanau, health professionals and society.