A living will, biotestamento, allows a person to make decisions about medical treatment
Biotestamento legislation in Italy is in two parts.
The first, more general part, deals with giving informed consent on medical treatments. The second part of the law specifically provides for a number of DATs (disposizioni anticipate di trattamento).
What are biotestamento DATs?
DATs allow a person to indicate wishes in relation to medical treatments in the event s/he is no longer conscious due to an accident or illness.
Every adult over the age of 18 years old, of sound mind, who does not expect to be capable of self-determination in the future, may make use of DATs. By filling in the relevant paperwork, a person expresses his/her wishes relating to medical treatments. These include consent or refusal of artificial hydration and feeding.
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DATs are legally binding on medical staff unless they are manifestly inappropriate or non-compliant with the patient’s current medical condition or new therapies have become available since the person signed DATs.
DATs must be in the form of a notarised deed or as a certified private instrument.
The law on Biotestamento protects a person’s right to life, health, dignity and self-determination. It stipulates that no medical treatment may start or continue without the patient’s freely given and informed consent. All patients have the right to know their health conditions. Furthermore, they must receive exhaustive, up to date and comprehensible information about the diagnosis, prognosis, benefits and risks of diagnostic tests and of prescribed medical treatments. In addition patients have a right to understand any alternative treatments available and the consequences connected with refusal of treatment.
Possible interruption of artificial feeding and hydration
Every adult, over the age of 18 years old, of mind, has the right to fully or partially refuse any treatment or to revoke consent for treatment at any time. Feeding and hydration are comparable to medical treatments. It is therefore possible to refuse them or request that they stop.
Refusal of treatment and conscientious objection by doctors
The patient has the right to refuse medical care. Doctors can however conscientiously object to this. Therefore, if a patient refuses medical care and a doctor deems this will cause death, a doctor is under no professional obligation to fulfil the patient’s wishes. The patient, however, may turn to another doctor working in the same hospital or healthcare facility.
Futile medical care and deep sedation
A doctor must endeavour to alleviate a patient’s suffering. Even if the patient has refused to grant or withdrawn his/her consent to medical care. Where there is a short life expectancy or imminent death prognosis, the doctor must, however, abstain from unreasonably persisting in dispensing medical care. In case of illnesses resistant to medical treatments, with the patient’s consent, the doctor may resort to continuous deep palliative sedation associated with pain therapy.
Should the patient decide to revoke or refuse medical care, the doctor must inform the patient of the consequences associated with this decision. The doctor must also inform the patient about any possible alternative treatments. In addition, medical staff should promote all actions to support the patient, including psychological support services.
Minors and disabled persons
In order that they can express their wishes, minors and disabled persons must receive all information in an appropriate manner. Informed consent on medical treatments for minors is contingent on consent or refusal by the parents or legal guardian. However, the patient’s wishes must also be considered.
A patient may also appoint someone to represent them in all relations with doctors and medical facilities.
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