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What is a Biotestamento (Living Will)?

The Italian Chamber of Deputies has approved the text of a bill on the so-called biotestamento (Living Will). This bill will now be debated in the BiotestamentoSenate. A Biotestamento has nothing to do with euthanasia.

Italian legislation on Biotestamento is divided into two parts: the first, more general part, deals with giving informed consent on medical treatments and on filling in DATs (disposizioni anticipate di trattamento, the Italian for anticipated instructions for treatment), through which a person may indicate wishes in relation to the medical treatments he/she intends to be subjected to when he/she is no longer conscious due to an accident or to an illness.

What does the law provide for?

The second part of the bill, approved by the Italian Chamber of Deputies, specifically provides for:

Informed consent. This law on Biotestamento protects a person’s right to life, health, dignity and self-determination and provides that no medical treatment can be started or continued without the patient’s freely given and informed consent. All people have the right to know their health conditions and to receive exhaustive, updated and comprehensible information about the diagnosis, prognosis, benefits and risks of diagnostic tests and of prescribed medical treatments, as well as about the possible alternatives and consequences connected with a possible refusal of treatment.

Possible interruption of artificial feeding and hydration. Every adult, over the age of 18 years old, deemed to be sound of mind, has the right to fully or partially refuse any treatment or to revoke, at any time, the consent he/she gave, even should such a withdrawal of consent entail an interruption of the treatment in question. Feeding and hydration are comparable to medical treatments. It will therefore be possible to request that their administration be stopped or to refuse them.

Neglect of treatment and conscientious objection by doctors. The patient has the right to neglect medical care. Doctors will be entitled to be conscientious objectors. Therefore, if a patient asks to put an end to his/her life, doctors will not be “professionally obliged” to fulfil the patient’s wishes. The patient, however, may turn to another doctor working in the same hospital or healthcare facility.

Prohibition of futile medical care and deep sedation. Based on the new law, the doctor must endeavour to relieve the patient’s suffering, even if the patient has refused to grant or revoked his/her consent to medical care. Where a short life expectancy or imminent death prognosis has been given to a patient, the doctor must, however, abstain from unreasonably persisting in dispensing medical care. In case of illnesses resistant to medical treatments, the doctor may resort to continuous deep palliative sedation associated with pain therapy, with the patient’s consent.

Psychological support. Should the patient decide to revoke or refuse medical care, the doctor must inform the patient about the consequences of such a decision as well as about any possible alternative and he shall promote any action which may support the patient, also seeking psychological support services.

Minors and disabled persons. Minors, under the age of 18 years old, or disabled persons must receive all the information regarding health choices in such a way that is suitable for their capabilities, so that they can be in the position to express their wishes. Informed consent on medical treatments to be given to minors shall be granted or refused by the parents or legal guardian, the patient’s will must always be considered.

What are DAT? Every adult over the age of 18 years old, deemed sound of mind, expecting himself/herself no longer to be capable of self-determination in the future, may make use of the so-called DAT (disposizioni anticipate di trattamento, the Italian for anticipated instructions for treatment). By filling in the relevant paperwork, a person expresses his/her wishes related to medical treatments, including consent or refusal of artificial hydration and feeding. DATs shall be binding for the doctor unless they are manifestly inappropriate or non-compliant with the patient’s current medical condition or unless some therapies which could not be predicted or were not known at the time a person signed DATs, become available.

A person wishing to avail themselves of DATs must have them drafted as a public deed or as a certified private instrument, which may be delivered to the registry office of the municipality of residence or to healthcare facilities and hospitals, where equipped with electronic management systems.

Fiduciary. A patient may also appoint a trustee, who will represent them in all relations with the doctor and medical centres.

 

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