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Pediatrics ; 146(Suppl 1): S3-S8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737225


One of the earliest controversies in the modern history of bioethics was known at the time as "the Hopkins Mongol case," involving an infant with Trisomy 21 and duodenal atresia whose parents declined to consent to surgery. Fluids and feeding were withheld, and the infant died of dehydration after 15 days. The child's short life had a profound impact on the author's career and that of several others and ultimately led to changes in the care of children and adults with disabilities and the way difficult end-of-life decisions are made in US hospitals today. It also contributed to the growth of the modern bioethics movement and scholarship focused on pediatric bioethics issues.

Temas Bioéticos , Tomada de Decisão Clínica/ética , Síndrome de Down/terapia , Pediatria/ética , Suspensão de Tratamento/ética , Comitês Consultivos/ética , Temas Bioéticos/história , Temas Bioéticos/legislação & jurisprudência , Crianças com Deficiência/legislação & jurisprudência , Síndrome de Down/história , Atresia Esofágica/história , Atresia Esofágica/terapia , Fundações , História do Século XX , Humanos , Recém-Nascido , Consentimento dos Pais/ética , Consentimento dos Pais/legislação & jurisprudência , Pais , Pediatria/legislação & jurisprudência , Assistência Terminal/ética , Suspensão de Tratamento/legislação & jurisprudência
Pediatrics ; 146(Suppl 1): S9-S12, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737226


The "Baby Doe" case of the early 1980s was marked by considerable controversy, primarily regarding the legal response of the federal government to the case at the time. In the decades that followed, the decision-making for children with trisomy 21, like Baby Doe, has been substantially reevaluated. The data, the assumptions about quality of life that were based on those data, and the ethical principles underpinning the decision-making in the Baby Doe case have all evolved significantly over time. The present strategies for decision-making for children with trisomy 13 and 18 appear to be following a similar pattern. The data, quality-of-life assumptions based on those data, and even the ethical principles underlying the decision-making for these children are currently being reexamined. Children with trisomy 13 and 18 are, in this regard, the next Baby Doe(s).

Tomada de Decisão Clínica/ética , Síndrome de Down/terapia , Síndrome da Trissomia do Cromossomo 13/terapia , Síndrome da Trissomía do Cromossomo 18/terapia , Desenvolvimento Infantil , Atresia Esofágica , Humanos , Recém-Nascido , Estimativa de Kaplan-Meier , Pais , Qualidade de Vida , Síndrome da Trissomia do Cromossomo 13/mortalidade , Síndrome da Trissomía do Cromossomo 18/mortalidade , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência
Pediatrics ; 146(Suppl 1): S54-S59, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737233


In 2017, the court case over medical treatment of UK infant, Charlie Gard, reached global attention. In this article, I will analyze one of the more distinctive elements of the case. The UK courts concluded that treatment of Charlie Gard was not in his best interests and that it would be permissible to withdraw life-sustaining treatment. However, in addition, the court ruled that Charlie should not be transferred overseas for the treatment that his parents sought, even though specialists in Italy and the US were willing to provide that treatment. Is it ethical to prevent parents from pursuing life-prolonging treatment overseas for their children? If so, when is it ethical to do this? I will outline arguments in defense of obstructing transfer in some situations. I will argue, however, that this is only justified if there is good reason to think that the proposed treatment would cause harm.

Temas Bioéticos , Futilidade Médica/ética , Transferência de Pacientes/ética , Suspensão de Tratamento/ética , Dissidências e Disputas , História do Século XXI , Humanos , Internacionalidade , Malformações Arteriovenosas Intracranianas/terapia , Itália , Masculino , Futilidade Médica/legislação & jurisprudência , Turismo Médico/ética , Turismo Médico/legislação & jurisprudência , Pais , Transferência de Pacientes/legislação & jurisprudência , Recusa do Médico a Tratar/ética , Recusa do Médico a Tratar/legislação & jurisprudência , Texas , Traqueostomia/ética , Traqueostomia/legislação & jurisprudência , Reino Unido , Estados Unidos , Suspensão de Tratamento/legislação & jurisprudência
Pediatrics ; 146(Suppl 1): S60-S65, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737234


Charlie Gard (August 4, 2016, to July 28, 2017) was an infant in the United Kingdom who was diagnosed with an encephalopathic form of mitochondrial DNA depletion syndrome caused by a mutation in the RRM2B gene. Charlie's parents raised £1.3 million (∼$1.6 million US) on a crowdfunding platform to travel to New York to pursue experimental nucleoside bypass treatment, which was being used to treat a myopathic form of mitochondrial DNA depletion syndrome caused by mutations in a different gene (TK2). The case made international headlines about what was in Charlie's best interest. In the medical ethics community, it raised the question of whether best interest serves as a guidance principle (a principle that provides substantive directions as to how decisions are to be made), an intervention principle (a principle specifying the conditions under which third parties are to intervene), both guidance and intervention, or neither. I show that the United Kingdom uses best interest as both guidance and intervention, and the United States uses best interest for neither. This explains why the decision to withdraw the ventilator without attempting nucleoside bypass treatment was the correct decision in the United Kingdom and why the opposite conclusion would have been reached in the United States.

Proteínas de Ciclo Celular/genética , Encefalomiopatias Mitocondriais/terapia , Defesa do Paciente/ética , Respiração Artificial/ética , Ribonucleotídeo Redutases/genética , Suspensão de Tratamento/ética , Tomada de Decisão Clínica/ética , Crowdsourcing/economia , História do Século XXI , Humanos , Lactente , Masculino , Futilidade Médica/ética , Encefalomiopatias Mitocondriais/genética , Cidade de Nova Iorque , Poder Familiar , Defesa do Paciente/legislação & jurisprudência , Transferência de Pacientes/ética , Transferência de Pacientes/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Timidina Quinase/genética , Reino Unido , Estados Unidos , Suspensão de Tratamento/legislação & jurisprudência
Pediatrics ; 146(Suppl 1): S66-S69, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737235


In all of medicine, there is perhaps nothing so distressing as bearing witness to a patient's suffering, especially if that patient is a child. We want to do everything that we can to avoid or alleviate a child's suffering, yet what do clinicians, ethicists, lawyers, or family members mean when they use the term "suffering," and how should these claims of suffering factor into pediatric decision-making? This question of suffering and what to do about it has played a key role in several prominent pediatric cases over the past decade, including the cases of Charlie Gard, Alfie Evans, and Baby Joseph. These cases have become seminal cases precisely because there is no clear resolution, and the "suffering child" continues to challenge our moral ideals of what it means to live a good life. In this article, I explore the various ways in which the concept of suffering is used in these cases, and I offer new ways in which parents, providers, and all those who work with sick children can approach the suffering child.

Tomada de Decisão Clínica/ética , Doença de Leigh , Encefalomiopatias Mitocondriais , Doenças Neurodegenerativas , Terminologia como Assunto , Suspensão de Tratamento/ética , História do Século XXI , Humanos , Lactente , Doença de Leigh/diagnóstico , Doença de Leigh/psicologia , Doença de Leigh/terapia , Masculino , Encefalomiopatias Mitocondriais/terapia , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/psicologia , Doenças Neurodegenerativas/terapia , Ontário , Pais/psicologia , Estado Vegetativo Persistente/psicologia , Estado Vegetativo Persistente/terapia , Qualidade de Vida , Respiração Artificial/ética , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Traqueostomia/psicologia , Reino Unido , Suspensão de Tratamento/legislação & jurisprudência
Rev. bioét. derecho ; (49): 7-23, jul. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192091


El objetivo de este artículo es definir y clarificar el criterio del mejor interés (CMI) como un principio ético para la toma de decisiones por representación. En primer lugar, se exponen algunas propuestas conceptuales como la de Kopelman y Buchanan y Brock. En segundo lugar, analizamos algunas críticas que se han hecho al CMI. Por último, este trabajo responde algunas críticas y hace una propuesta integradora

The aim of this paper defines and clarifies the best interest criterion (BIC) as an ethical principle to substitute decision-making. First, this work exposes some conceptual proposals such as Kopelman and Buchanan and Brock. Second, the authors analyze some criticisms that have been made to BIC. Third, we want to respond such critics and we do a conciliatory proposal

L'objectiu d'aquest article és definir I clarificar el criteri del millor interès (CMI) com un principi ètic per a la presa de decisions per representació. En primer lloc, s'exposen algunes propostes conceptuals com la de Kopelman I Buchanan I Brock. En segon lloc, analitzem algunes crítiques que s'han fet al CMI. Finalment, aquest treball dóna resposta a algunes crítiques I fa una proposta integradora

Humanos , Criança , Tomada de Decisões/ética , Pediatria/ética , Bioética , Relações Médico-Paciente/ética , Competência Mental/legislação & jurisprudência , Suspensão de Tratamento/legislação & jurisprudência , Moral
New Bioeth ; 26(2): 176-189, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32364048


The paper considers the recently published British Medical Association Guidance on ethical issues arising in relation to rationing of treatment during the COVID-19 Pandemic. It considers whether it is lawful to create policies for the rationing and withdrawal of treatment, and goes on to consider how such policies might apply in practice. Legal analysis is undertaken of certain aspects of the Guidance which appear to misunderstand the law in respect of withdrawing treatment.

Infecções por Coronavirus/terapia , Alocação de Recursos para a Atenção à Saúde/ética , Política de Saúde , Pandemias/ética , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência , Betacoronavirus , Humanos , Sociedades Médicas , Reino Unido
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
New Bioeth ; 26(1): 53-74, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32065064


French end-of-life law aims at protecting patients from unreasonable treatments, but has been used to force caregivers to prolong treatments deemed unreasonable. We describe six cases (five intensive care unit patients including two children) where families disagreed with a decision to withdraw treatments and sued medical teams. An emergent inquiry was instigated by the families. In two cases, the court rejected the families' inquiries. In two cases, the families appealed the decision, and in both the first jurisdiction decision was confirmed, compelling caregivers to pursue treatments, even though they deemed them unreasonable. We discuss how this law may be perverted. Legal procedures may result in the units' disorganisation and give rise to caregivers' stress. Families' requests may be subtended by religious beliefs. French end-of-life law has benefits in theoretically constraining physicians to withhold or withdraw disproportionate therapies. These cases underline some caveats and the perverse effects of its literal reading.

Dissidências e Disputas , Assistência Terminal/legislação & jurisprudência , Suspensão de Tratamento/legislação & jurisprudência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , França/epidemiologia , Humanos , Lactente , Unidades de Terapia Intensiva , Masculino , Assistência Terminal/ética , Suspensão de Tratamento/ética
HEC Forum ; 32(1): 13-20, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31535261


When should doctors seek protective custody to override a parent's refusal of potentially lifesaving treatment for their child? The answer to this question seemingly has different answers for different subspecialties of pediatrics. This paper specifically looks at different thresholds for physicians overriding parental refusals of life-sustaining treatment between neonatology, cardiology, and oncology. The threshold for mandating treatment of premature babies seems to be a survival rate of 25-50%. This is not the case when the treatment in question is open heart surgery for a child with congenital heart disease. Most cardiologists would not pursue legal action when parents refuse treatment, unless the anticipated survival rate after surgery is above 90%. In pediatric oncology, there are case reports of physicians requesting and obtaining protective custody for cancer treatment when the reported mortality rates are 40-50%. Such differences might be attributed to differences in care, a reasonable prioritization of quality of life over survival, or the role uncertainty plays on prognoses, especially for the extremely young. Nonetheless, other, non-medical factors may have a significant effect on inconsistencies in care across these pediatric subspecialties and require further examinations.

Cuidados para Prolongar a Vida/ética , Poder Familiar/psicologia , Suspensão de Tratamento/normas , Humanos , Recém-Nascido , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/psicologia , Neonatologia/ética , Neonatologia/legislação & jurisprudência , Relações Profissional-Paciente , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência
Nephrol Ther ; 15(7): 498-505, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31727511


For more than 10 years, nephrologists in the Grenoble-region have sought advice from the Ethical Concertation Unit in Nephrology with regards to whether to stop or continue dialysis for patients under palliative care. This process deserves a multidisciplinary debate between health professionals and qualified non-health professionals. Thus, we organized a qualitative research protocol in three parts (medical, philosophical, judicial) to explore this issue. Our study aimed to assess the impact of Ethical Concertation Unit in Nephrology's discussions regarding perception, knowledge, and judicial and ethical considerations. The practical repercussions of decision-making within medical practice, its impacts on the patient and his/her family, as well as associated-health professionals, was assessed. To achieve this, two questionnaires and an interview were organized by three Ethical Concertation Unit in Nephrology-leaders to review the viewpoints of the 22 permanent Ethical Concertation Unit in Nephrology members that had participated in 10 Ethical Concertation Unit in Nephrology sessions between 2015 and 2016 to discuss 21 case-reports. Only 13 persons (4 physicians, 6 nurses, 3 non-health professionals) agreed to respond to the questionnaires, and six physicians agreed to participate in an interview. Overall, it was found that most affected patients' physicians agreed with the multidisciplinary discussion, which included judicial and ethical perspectives, and felt reassured with regards to Ethical Concertation Unit in Nephrology's final decision. However, our study showed that Ethical Concertation Unit in Nephrology's functioning could be improved by promoting its existence more widely, by making these decisions earlier within clinical situations, to make Ethical Concertation Unit in Nephrology more accessible to health workers, to make reports easier to understand, to re-examine a posteriori some clinical situations, and to broaden the scope of multidisciplinary skills.

Protocolos Clínicos , Comissão de Ética , Nefrologia/organização & administração , Cuidados Paliativos/ética , Pesquisa Qualitativa , Diálise Renal/ética , Suspensão de Tratamento/ética , Tomada de Decisões/ética , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Comunicação Interdisciplinar , Entrevistas como Assunto , Enfermeiras e Enfermeiros/psicologia , Cuidados Paliativos/legislação & jurisprudência , Filosofia Médica , Médicos/psicologia , Inquéritos e Questionários , Suspensão de Tratamento/legislação & jurisprudência
Nurs Child Young People ; 31(5): 20-24, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31486596


Withdrawal of treatment from critically ill children is a contentious and ethically difficult area. The principle of best interests was central to three recent high-profile legal cases and raised questions about how this is demonstrated in healthcare for children whose treatment may be of no benefit to them. This article discusses the legal and ethical aspects of caring for such children. Nurses are important advocates and should balance their obligation to deliver holistic and family-centred care with that of keeping the child as the central focus, particularly with decision-making. In cases of disagreement between families and clinicians, children's voices are particularly vulnerable to being lost. Pre- and post-registration education, research and a higher profile for nurses in multidisciplinary decision-making are suggested as ways to improve the nursing contribution to this important debate.

Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência , Estado Terminal/terapia , Tomada de Decisão Compartilhada , Humanos , Relações Profissional-Família
Prim Care ; 46(3): 387-398, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31375188


In caring for dying patients, family medicine practitioners intentionally adopt care plans that affect the manner and timing of death. These decisions are morally weighty. This article provides guidance regarding the ethical and legal appropriateness of practitioner decisions near the end of life. Topics include surrogate decision making, advance care planning, medical nutrition and hydration, double effect, futile care, physician-assisted death, voluntarily stopping eating and drinking, palliative sedation to unconsciousness, and cultural humility.

Tomada de Decisões , Assistência Terminal/ética , Assistência Terminal/legislação & jurisprudência , Planejamento Antecipado de Cuidados/ética , Planejamento Antecipado de Cuidados/legislação & jurisprudência , Analgésicos Opioides/administração & dosagem , Humanos , Hipnóticos e Sedativos/administração & dosagem , Terapia Nutricional/ética , Cuidados Paliativos/ética , Cuidados Paliativos/legislação & jurisprudência , Planejamento de Assistência ao Paciente/ética , Planejamento de Assistência ao Paciente/legislação & jurisprudência , Preferência do Paciente , Atenção Primária à Saúde/ética , Atenção Primária à Saúde/legislação & jurisprudência , Prognóstico , Suicídio Assistido/ética , Suicídio Assistido/legislação & jurisprudência , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência
Geriatr Gerontol Int ; 19(9): 847-853, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31389113


AIM: The purpose of the present study was to collate examples of end-of-life care guidelines from various counties, examine their contents, and gain an overall picture of how end-of-life care guidance is offered to physicians and care providers internationally. METHODS: In this study, eight researchers worked independently to source and examine national-level end-of-life care guidelines from different countries and regions. Data collected by each researcher were gathered into a unified table. The items in the table included basic information (publisher, year, URL etc.) and more specific items, such as the presence/absence of legal information and family's role in decision-making. These data were then used to identify trends, and examine the mechanics and delivery of guidance on this topic. RESULTS: A total of 54 guidelines were included in the study. All the guidelines were published between 2000 and 2016, and 60% (n = 33) were published after 2012. The length of the guidelines varied from two to 487 pages (median 38 pages), and had different target audiences - both lay and professional. A total of 38 (70%) of the guidelines included information about the relevant laws and legal issues, 47 (87%) offered advice on withholding and withdrawing treatment, 46 (85%) discussed the family's role in decision-making and 46 (85%) emphasized the teamwork aspect of care. CONCLUSIONS: The present findings show that end-of-life care guidelines are generally made reactively in response to the trend toward patient-centered care, and that to create effective guidelines and implement them requires multilevel cooperation between governmental bodies, healthcare teams, and patients and their families. Geriatr Gerontol Int 2019; 19: 847-853.

Tomada de Decisão Clínica , Guias de Prática Clínica como Assunto , Assistência Terminal , Suspensão de Tratamento , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica/ética , Tomada de Decisão Clínica/métodos , Hidratação/métodos , Saúde Global , Humanos , Apoio Nutricional/métodos , Relações Profissional-Família , Assistência Terminal/ética , Assistência Terminal/métodos , Assistência Terminal/organização & administração , Assistência Terminal/tendências , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência
Bioethics ; 33(7): 842-848, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31264246


The present article reviews the state of public debate and legal provisions concerning end-of-life decision-making in Italy and offers an evaluation of the moral and legal issues involved. The article further examines the content of a recent law concerning informed consent and advance treatment directives, the main court pronouncements that formed the basis for the law, and developments in the public debate and important jurisprudential acts subsequent to its approval. The moral and legal grounds for a positive evaluation of this law, which attests that the patient may withhold or withdraw from life-prolonging treatment, will be offered with reference to liberal approaches and particularly to the frameworks of care and virtue ethics; but reasons will also be offered in order to consider not only the latter but also broader range of end-of-life treatment decisions as morally apt options. In this light, we argue in favour of a further development of the Italian legislation to encompass forms of assisted suicide and active euthanasia.

Diretivas Antecipadas/ética , Diretivas Antecipadas/legislação & jurisprudência , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Assistência Terminal/ética , Assistência Terminal/legislação & jurisprudência , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência , Tomada de Decisões , Humanos , Itália , Princípios Morais