Europe

In Italy, people are reluctant to talk about death and dying. Assisted dying carries a concrete risk of furthering a gap in care between rich and poor.

Simone Cernesi
General practitioner, Formigine, Modena, Italy

In Italy, the knowledge and understanding of palliative care is not widespread in the public realm, and there is a risk of confusion when talking about palliative care together with topics related to euthanasia and physician-assisted suicide. This confusion is evident in how news stories about these issues are reported.

Palliative care is underdeveloped globally, even in the most well-resourced countries, and both primary palliative care and specialist palliative care are weak across health systems.

I support the IAHPC’s position statement on the issue of euthanasia and physician-assisted suicide, and fear that brakes will be applied to the development of palliative care networks if organizations, such as health care providers, have access to simpler and less expensive solutions. I fear that this could be the case in Italy. Currently, however, euthanasia is illegal and there is no law specific to assisted suicide.

Diverging positions exist among both the public and professionals, ranging from those who completely reject physician-assisted dying, to those who contemplate a need for more information, study, and dialogue. There is a general reluctance to talk about death in Italy, and even those who may seek information are a small minority; when we talk about death, the discussions are often conditioned by person beliefs, values, and prejudices.

It may be difficult to understand that many medical practitioners here do not discuss these topics, especially as patients may have no one else to ask for help and information on death, dying, and palliative care. We, as health care providers, should not abandon those whose choices do not reflect our own beliefs, even if they ask for assistance in dying.

Undoubtedly, training is needed on handling requests for assisted dying. Greater involvement of bioethicists in support of palliative care teams is equally necessary, as is greater attention to the spiritual component of palliative care. Deepening discussions of the sociological, bioethical, and spiritual dimensions of physician-assisted dying would offer a significant contribution.

Physician-assisted dying carries a concrete risk of creating further gaps over care between the rich and the poor, and it is necessary to study how strongly positions on the subject are influenced by the background of the providers. The impact of global aging and the impact it is having, and will continue to have, on political decisions regarding euthanasia or physician-assisted suicide should also be explored, considering the scarce availability of palliative care, even in nursing homes: it is an increasingly urgent matter that national health systems need to address.

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