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Rev. bioét. derecho ; (48): 177-191, mar. 2020.
Artigo em Português | IBECS | ID: ibc-192086


Os recentes casos envolvendo a morte de crianças em razão da suspensão do suporte vital, mesmo com a oposição dos pais, demonstram a necessidade de um debate transdisciplinar sobre o conteúdo do princípio do melhor interesse da criança e a extensão dos poderes-deveres decorrentes da autoridade parental. Poderia a morte, em determinadas situações, representar o melhor interesse da criança? Partindo dos casos de Charlie Gard e Alfie Evans, este artigo tem por objetivo a busca de parâmetros para a tomada de decisões voltadas à terminalidade da vida infantil. Por meio de uma revisão bibliográfica interdisciplinar, buscam-se fundamentos para confirmar ou refutar a hipótese de que a morte pode ser configurada como o melhor interesse da criança em contextos específicos

Los recientes casos que involucran la muerte de niños en razón de la suspensión del soporte vital, incluso con la incisiva oposición de los padres, demuestran la necesidad de un debate transdisciplinario sobre el contenido del principio del mejor interés del niño y la extensión de los poderes-deberes derivados de la autoridad parental. ¿Podría la muerte, en determinadas situaciones, representar el mejor interés del niño? A partir de los casos Charlie Gard y Alfie Evans, este artículo objetiva la búsqueda de parámetros para la toma de decisiones dirigidas a la terminalidad de la vida infantil. Por medio de una revisión bibliográfica interdisciplinaria, se buscan fundamentos para confirmar o refutar la hipótesis de que la muerte puede ser configurada como el mejor interés del niño en contextos específicos

The recent cases involving the death of children due to the suspension of life support, even with the strong opposition of their parents, demonstrate the need for a transdisciplinary debate on the content of the principle of the best interests of the child and the extension of the powers-duties arising from the parental authority. Could death, in certain situations, represent the best interest of the child? Based on the cases of Charlie Gard and Alfie Evans, this article aims to search for parameters for the decision-making in situations of terminally ill infants. Through an interdisciplinary bibliographical review, it is sought the confirmation or refutation of the hypothesis that death can be configured as the best interest of the child in specific contexts

Els recents casos que involucren la mort de nens a causa de la suspensió del suport vital, fins i tot amb l'enèrgica oposició dels pares, demostren la necessitat d'un debat transdisciplinar sobre el contingut del principi del millor interès del nen i l'extensió dels poders-deures derivats de l'autoritat parental. Podria la mort, en determinades situacions, suposar el millor interès del nen? A partir dels casos Charlie Gard i Alfie Evans, aquest article objectiva la recerca de paràmetres per a la presa de decisions dirigides al final de vida infantil. Per mitjà d'una revisió bibliogràfica interdisciplinària, es pretèn confirmar o refutar la hipòtesi que la mort pot ser configurada com el millor interès del nen en contextos específics

Humanos , Masculino , Lactente , Direito a Morrer/ética , Suspensão de Tratamento/ética , Futilidade Médica/ética , Assistência Terminal/ética , Cuidados Paliativos na Terminalidade da Vida/ética , Tomada de Decisão Clínica/ética , Direito a Morrer/legislação & jurisprudência , Eutanásia Passiva/legislação & jurisprudência , Doente Terminal , Morte , Direitos do Paciente/ética , Suspensão de Tratamento/legislação & jurisprudência , Assistência Terminal/legislação & jurisprudência , Poder Familiar , Direitos Humanos/legislação & jurisprudência , Cuidados Paliativos na Terminalidade da Vida/legislação & jurisprudência
Medicina (B Aires) ; 80(1): 48-53, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32044741


Patient relatives often request withdrawal of life support, especially artificial nutrition and hydration, in cases of permanent vegetative or minimally conscious state, and resort to court in case of disagreement. Two recent cases of withdrawal authorized by the courts concerned, one from abroad and one from Argentina, have been controversial. Although it may appear inhuman to stop feeding and hydrating such patients, to continue it only prolongs a state of irreversible biological subsistence. Families tend to increasingly accept withdrawal if the patient status remains unchanged. However, concern persists regarding the suffering that patients may undergo from onset of withdrawal till death, even though such suffering is little conceivable in the absence of cortical function and conscience content. While doctors and the layman consider ethical to withdraw life support, a nonnegligible proportion of doctors consider that vegetative state patients, even more minimally conscious state patients, do experience hunger, thirst and pain. In some countries, like the United Kingdom, strict withdrawal criteria were proposed, together with pharmacological treatment schemes for the distress arising during the withdrawal period, even though its benefit is controversial. In Argentina, two scientific societies have publicly advocated withdrawal, but not issued formal guidelines. In any case, both "dignified death" Law 26.742 and the Civil Code consent withdrawal of life support, if accompanied by appropriate relief of clinical symptoms indicating suffering.

Cuidados para Prolongar a Vida/legislação & jurisprudência , Estado Vegetativo Persistente , Direito a Morrer/legislação & jurisprudência , Suspensão de Tratamento/legislação & jurisprudência , Argentina , Humanos
Recenti Prog Med ; 110(10): 462-472, 2019 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-31657811


On October 24, 2018 the Italian Constitutional Court held that the absolute ban on assisted suicide provided for by Art. 580 of the Italian criminal code is unconstitutional under certain conditions. On the one hand, this Article «serves the purpose of protecting interests that are worthy of protection by the legal system¼ (p. 6), such as life and the protection of weak and vulnerable people. On the other hand, in specific situations like the one in the DJ Fabo's case, the assistance to die «may seem to the sick person to be the only way out of being kept alive by artificial methods that are no longer desired, and which he or she has the right to refuse¼ (p. 8). In particular the Court has set four conditions under which the absolute prohibition of suicide assistance can turn to be unconstitutional, and namely in those cases in which «assisted persons are (a) affected by an illness that is incurable and (b) causes physical or psychological suffering, which they find absolutely intolerable, and who are (c) kept alive by means of life support treatments, but remain (d) capable of making free and informed decisions¼ (p. 8). In such a situation the absolute ban on suicide assistance obliges the patient to «undergo a slower process, in a scenario that corresponds less well to the patient's vision of a dignified death and which is marked by more pain and suffering for the people close to the patient¼ (p. 9). Being aware of the impact and scope of its remarks and of the values at stake, the Court decided not to immediately declare the unconstitutionality of art. 580 of the criminal code, but rather to postpone the official discussion of the questions of constitutionality to the hearing on September 24, 2019. In a «"collaborative" and "dialogical"¼ perspective, the Court thus called upon the Parliament to regulate a subject which is at the «intersection between values of primary importance, the balancing of which presupposes, in a direct and immediate way, choices that the legislator is, first of all, authorized to make¼ (p. 11). As already known, the Parliament has not passed a law on assisted suicide so far; the Court will therefore decide at the hearing on September 24 how to amend what has already defined as a «unconstitutional regulatory scheme¼ (p. 11). Against this background and considering the reasoning of the Court in December 2018, the Authors of this Document - legal scholars and professionals with long-standing experience in these topics - decided to open an interdisciplinary discussion on the main legal end-of-life issues. Starting from the Order but without limiting the analysis to it, the Working Group met on a monthly basis at the University of Trento and with the support of the Jean Monnet BioTell Project, addressing and studying in depth the large number of tricky issues raised by the Order of the Constitutional Court and linked to a possible Parliament decision. The results of these discussions have been gathered and developed in the Document together with some operational proposals, offering a "constitutionally oriented" and scientific grounded understanding of end-of-life issues. The Working Group thus aimed to contribute to the public debate suggested by the Court, which must be truly informed and plural due to the impact on institutional choices. On September 25, the Constitutional Court ruled the impunity of those who foster the suicide under the conditions expressed in the Court press release reporting the Court's judgment.

Direito a Morrer/legislação & jurisprudência , Suicídio Assistido/legislação & jurisprudência , Constituição e Estatutos , Humanos , Itália
Cuad. bioét ; 30(98): 55-64, ene.-abr. 2019.
Artigo em Espanhol | IBECS | ID: ibc-180695


El derecho a la muerte se define desde el olvido de la muerte, característica de la sociedad contemporánea. La defensa de la eutanasia, lejos de ser una contradicción con ese olvido, constituye su constatación. Afirmada como acto altruista y benevolente encubre la necesidad propia de olvidar el sufrimiento y la muerte, y la incapacidad de observar la muerte ajena. Como derecho, el derecho a la muerte se presenta como la prohibición del Derecho y la comunidad de interferir en el acto tanático para sí mismo o para otro. Pero como efecto se instaura un derecho de carácter social e indicación ética que constituye un riesgo para la vida dependiente

The right to death is defined from the oblivion of death, characteristic of contemporary society. The defense of euthanasia, far from being a contradiction with that forgetfulness, constitutes its verification. Affirmed as an altruistic and benevolent act conceals the need to forget suffering and death, and the inability to observe the death of others. As a right, the right to death is presented as the prohibition of the law and the community to interfere in the act of love for oneself or for another. But as an effect, a right of a social nature and ethical indication that constitutes a risk for dependent life is established

Humanos , Direito a Morrer/ética , Eutanásia/ética , Morte , Homicídio/ética , Ética Médica , Suicídio/ética , Direito a Morrer/legislação & jurisprudência , Homicídio/legislação & jurisprudência , Liberdade
G Ital Nefrol ; 35(6)2018 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-30550032


Transplantation represents modernity thus the laws regulating the procedure should be continuously renovated and remodeled in order to take full advantage of progress. The debate is about Law no. 219, December 22, 2017 and on Law no. 222, April 1, 1999. The quests are a) about the possibility to modify the first so that people deciding on how they want to die, may also decide about their willingness to allow the removal of their organs for transplantation and b) the possibility for donor families and recipients to have contacts after transplantation in the case both sides agree. Questions were emailed to the constitutionalist Francesco Paolo Casavola, immediate Past President of the National Committee for Bioethics, and to the philosophers Remo Bodei and Aldo Masullo. Their answers received by September 16, support the idea a) to include in the Law no. 219, 2017 the possibility to decide not only on the modality one wants to die but also on the possibility to allow his own organs to be removed for transplantation and b) to liberalize contacts between donor families and recipients when both side agree. For both changes there is enough evidence of their feasibility-necessity. The answers related to contacts between donor families and recipients support the decision of the National Committee for Bioethics on September 27, 2018. Professor Casavola also suggests that contacts should organized and supervised by the ethical committees of the hospitals where the transplantation procedure is accomplished.

Direito a Morrer/legislação & jurisprudência , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Transplantados/legislação & jurisprudência , Confidencialidade , Tomada de Decisões , Eticistas , Comitês de Ética Clínica , Prova Pericial , Família , Humanos , Relações Interpessoais , Propriedade/legislação & jurisprudência , Filosofia , Política , Direito a Morrer/ética , Doadores de Tecidos/ética , Obtenção de Tecidos e Órgãos/ética
J Law Med Ethics ; 46(3): 744-748, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30336106


Americans who are afraid of living for many years with Alzheimer's might seek a way to end their lives early, when their dementia has just entered the moderate phase. There is no legal process for doing so. In this paper I argue that advance directives, in particular, are not a legal solution for those who prefer to die rather than suffer years of dementia. The problem is that an advance directive only works to hasten death when there is a life-threatening illness for which one can refuse treatment; more often than not, Alzheimer's kills the self long before it kills the body.

Diretivas Antecipadas/legislação & jurisprudência , Doença de Alzheimer , Eutanásia Passiva/legislação & jurisprudência , Humanos , Direito a Morrer/legislação & jurisprudência , Suicídio Assistido/legislação & jurisprudência , Assistência Terminal , Estados Unidos
Rev. bioét. derecho ; (43): 261-276, jul. 2018.
Artigo em Espanhol | IBECS | ID: ibc-176777


La decisión del Tribunal Europeo de Derechos Humanos que se comenta se refiere a uno de los casos más impactantes y desgarradores de los últimos tiempos en el Reino Unido, que ha tenido una gran repercusión mediática. En ella se plantean algunas de las más importantes cuestiones que figuran en primer plano en el ámbito de la Bioética, como la muerte digna, el encarnizamiento terapéutico, la judicialización de los conflictos bioéticos, la autonomía del paciente por representación, la eutanasia pasiva en la infancia o el enfrentamiento entre dos concepciones de la bioética: la utilitarista y la personalista. Con la presente contribución, que se realiza sin ánimo de exhaustividad, me limitaré a reflexionar sobre alguno de los aspectos que me han resultado especialmente llamativos y que pueden coadyuvar a fomentar el debate sereno, libre de prejuicios y de fundamentalismos de todo tipo, que permita la formación de consensos, tal y como requiere una bioética para nuestro tiempo en las sociedades plurales y diversas en las que vivimos y en el escenario de un mundo global

The commented decision of the European Court of Human Rights refers to one of the most shocking and heartbreaking cases in recent times in the United Kingdom, which has had a great deal of media coverage. It raises some of the most important issues on Bioethics, such as dignified death, therapeutic cruelty, the judicialization of bioethical conflicts, patient’s autonomy by representation, passive euthanasia in childhood or the confrontation between two conceptions of bioethics: the utilitarian and the personalist. With this contribution, I will limit myself to reflecting on some of the aspects that can contribute to promote the debate, free of prejudices and fundamentalisms of all kinds, that will allow the formation of consensus, as bioethics requires in the scenario of a global world

La decisió del Tribunal Europeu de Drets Humans que es comenta en aquest article es refereix a un dels casos més impactants dels últims temps al Regne Unit i que ha tingut una gran repercussió mediàtica. En ella es plantegen algunes de les més importants qüestions que figuren en primer pla de la Bioètica, com ara la mort digna, l’obstinació terapèutica, la judicalització dels conflictes bioètics, l'autonomia del pacient per representació, l'eutanàsia passiva en la infància o l'enfrontament entre dues concepcions de la bioètica: la utilitarista i la personalista. Amb la present contribució, sense ànim d'exhaustivitat, em limitaré a reflexionar sobre algun dels aspectes que m'han resultat especialment cridaners i que poden coadjuvar a fomentar el debat serè, lliure de prejudicis i de fonamentalismes de tot tipus i que permeti els consensos, tal com requereix una bioètica per al nostre temps en les societats plurals i diverses en què vivim i en l'escenari d'un món global

Humanos , Masculino , Lactente , Jurisprudência , Direitos Humanos/legislação & jurisprudência , Bioética , Direito a Morrer/ética , Direito a Morrer/legislação & jurisprudência , Eutanásia/ética , Reino Unido , Eutanásia/legislação & jurisprudência , Autonomia Pessoal , Cuidados Críticos/ética , Cuidados Críticos/legislação & jurisprudência
Rev. bioét. derecho ; (43): 227-289, jul. 2018.
Artigo em Italiano | IBECS | ID: ibc-176778


Il caso del bambino inglese Charlie Gard ha dato spazio ad un numero svariato di letture e prese di posizione da parte non solo del mondo scientifico e medico, ma anche dell’opinione pubblica. Soprattutto a livello mediatico il dibattito, invece di caratterizzarsi come discussione clinica ed etica sulle questioni morali in gioco e sui processi decisionali, si è trasformato in sterile contrapposizione ideologica di principi non efficacemente compresi né tantomeno delineati. Le questioni etiche, cliniche e legali sono molte e riguardano, solo per citarne alcune, il concetto di vita degna di essere vissuta, il diritto di non soffrire, la distribuzione di risorse, il decision making clinico ed etico e la pianificazione condivisa delle cure, le cure sperimentali non autorizzate alla fine della vita, il concetto di best child interest, la futilità di trattamenti, le cure palliative, il diritto di sperare, la vulnerabilità e l’autodeterminazione. Lungi dall’esaurire la numerosità e la complessità delle questioni in gioco, l'obiettivo principale dell’articolo è quello di proporre una disamina di alcuni dei profili etici e clinici elencati, a partire dalla vicenda giudiziaria del piccolo Charlie e suggerire alcune riflessioni critiche in merito

El caso del niño inglés Charlie Gard ha generado lecturas y toma de posiciones no sólo en el ámbito científico y médico, sino también en la opinión pública. El debate en los medios, en lugar de ser una discusión clínica y ética de las cuestiones morales en juego y los procesos de toma de decisiones, se ha convertido en una estéril confrontación ideológica de principios que no se entienden ni describen de manera efectiva. Los asuntos éticos, clínicos y legales en este caso son muchos: el concepto de vida digna de ser vivida, el derecho a no sufrir, la distribución de recursos, la toma de decisiones clínicas y éticas, la planificación anticipada del cuidado, los tratamientos experimentales no autorizados al final de la vida, el concepto de mejor interés del niño, la futilidad de los tratamientos, los cuidados paliativos, el derecho a la esperanza, la vulnerabilidad y la autodeterminación. Lejos de agotar la complejidad de los temas en juego, el objetivo principal del artículo es proponer una revisión de algunos de los problemas éticos y clínicos mencionados, comenzando con la historia legal de Charlie y sugiriendo algunas reflexiones críticas al respecto

The Charlie Gard case has given space to some readings and positions taken by not only the scientific and medical world but also public opinion. Above all, at the media level, debate, instead of being characterised as a clinical and ethical discussion of moral issues at stake and decision-making processes, has become a sterile ideological confrontation of principles not effectively understood or outlined. Ethical, clinical and legal issues are many. They concern, i.e. the concept of life worth living, the right not to suffer, the distribution of resources, clinical and ethical decision-making and advance care planning, end of life issues, experimental treatment, the concept of best child interest, the futility of treatments, palliative care, the right to hope, vulnerability and self-determination. Far from the length of complexity of the issues at stake, the primary objective of the article is proposing a review of some of the ethical and clinical profiles listed, starting with the legal history of Charlie and suggesting some critical reflections about

El cas del nen anglès Charlie Gard ha generat lectures i presa de posicions no només en l'àmbit científic i mèdic, sinó també en l'opinió pública. El debat en els mitjans, en lloc de ser una discussió clínica i ètica de les qüestions morals en joc i els processos de presa de decisions, ha esdevingut una estèril confrontació ideològica de principis que ni s'entenen ni es descriuen de manera efectiva. Les qüestions ètiques, clíniques i legals en aquest cas són moltes: el concepte de vida digna de ser viscuda, el dret a no sofrir, la distribució de recursos, la presa de decisions clíniques i ètiques, la planificació anticipada de les cures, els tractaments experimentals no autoritzats al final de la vida, el concepte de millor interès del nen, la futilitat dels tractaments, les cures pal·liatives, el dret a l'esperança, la vulnerabilitat i l'autodeterminació. Lluny d'esgotar la complexitat dels temes en joc, l'objectiu principal de l'article és proposar una revisió d'alguns dels problemes ètics i clínics esmentats, començant amb la història legal de Charlie i suggerint algunes reflexions crítiques sobre aquest tema

Humanos , Masculino , Criança , Tomada de Decisões/ética , Direito a Morrer/ética , Direito a Morrer/legislação & jurisprudência , Cuidados Paliativos na Terminalidade da Vida/ética , Planejamento Antecipado de Cuidados/ética , Planejamento Antecipado de Cuidados/legislação & jurisprudência , Expectativa de Vida , Populações Vulneráveis/legislação & jurisprudência , Autonomia Pessoal
Camb Q Healthc Ethics ; 27(3): 366-375, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29845911


The issue of assisted suicide for those with a "fulfilled life" is being hotly debated in the Netherlands. A large number of Dutch people feel that elderly people (i.e., people who have reached the age of 70) with a "fulfilled life" should have access to assisted suicide. Citizens have therefore requested Parliament to expand the existing legislation that governs euthanasia and physician-assisted suicide. The Dutch constitution does not permit national legislation to be incompatible with higher international (human rights) law. An analysis of the case law of the European Court of Human Rights shows that a person's right to decide on the time and manner of his or her death should be regarded as an aspect of the right to privacy. Although no positive obligation has been imposed on parties to the European Convention for the Protection of Human Rights and Fundamental Freedoms to facilitate suicide, they may do so, provided that certain conditions are met.

Direito a Morrer/ética , Suicídio Assistido/ética , Doente Terminal , Idoso , Eutanásia/legislação & jurisprudência , Humanos , Países Baixos , Direito a Morrer/legislação & jurisprudência
Indian J Med Ethics ; 3(2): 91-94, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29724694


On Friday, March 9, 2018 the five-judge Constitution Bench (CB) of the Supreme Court of India (SCI) chaired by Dipak Misra, the Chief Justice of India, pronounced its judgment (1) (henceforth CC judgment) granting, for the first time in India, legal recognition to "advanced medical directives" or "living wills", ie, a person's decision communicated in advance on withdrawal of life-saving treatment under certain conditions, which should be respected by the treating doctor/s and the hospital. It also reiterates the legal recognition of the right to "passive euthanasia"; and draws upon Article 21 - the right to life - of the Constitution of India (henceforth Constitution) (2) interpreting robustly that the "right to life" includes the "right to die with dignity". Justices Misra and Khanwilkar disposed of the writ petition filed in 2005 by Common Cause (3) (henceforth CC petition) saying, "The directive and guidelines shall remain in force till the Parliament brings a legislation in the field" (1:p 192).

Eutanásia Passiva/legislação & jurisprudência , Testamentos Quanto à Vida/legislação & jurisprudência , Direito a Morrer/legislação & jurisprudência , Suspensão de Tratamento/legislação & jurisprudência , Diretivas Antecipadas/legislação & jurisprudência , Tomada de Decisões , Humanos , Índia , Autonomia Pessoal , Pessoalidade , Valor da Vida