This week, the lower house of the Italian legislature voted 278-205 to pass a bill that would exclude the possibility of starving and dehydrating vulnerable patients to death. The Advance Directives Bill opens with a specific prohibition of euthanasia or assisted suicide and requires that patients, who are not otherwise dying, not be denied food and hydration.
The bill, which has been high on the agenda of both anti- and pro-euthanasia campaigners for two years, is called in Italian, “Dichiarazione anticipata di trattamento” (Dat), or Anticipated Declarations of Treatment, also known as living wills.
The national debate in Italy over advance directives and euthanasia by omission follows the dehydration death of a young cognitively disabled woman, Eluana Englaro, in 2009. Despite the law against euthanasia, Eluana’s father, Beppino Englaro, fought for ten years through the courts to have his daughter killed by dehydration.
The case caused a national uproar when the Court of Cassation, Italy’s highest constitutional court, in November 2008 ruled that Eluana could be moved by her father’s order to a nursing home that would be willing to remove her food and hydration to cause her death. Despite the fact that Eluana was not terminally ill, this was routinely described in Italy’s national newspapers as “allowing her to die naturally.”
Since his daughter’s death, Beppino Englaro has used his notoriety to engage in a campaign to legalize euthanasia by dehydration.
Undersecretary of Health, Eugenia Roccella, announced this week that the final vote on the advance directives bill will follow third reading in the Senate, which will likely happen in October. Roccella said, “I think it is a good law and can withstand the attacks of propaganda.”
Under current Italian law, patients can refuse medical treatment even in cases where refusal could tend to shorten their lives. However, nowhere is the artificial provision of food and hydration defined either as “medical treatment” that can be withdrawn, or as a necessity of life – a legal void that euthanasia activists have been attempting to exploit. Should the bill pass, it would specifically close that loophole, which enabled the court decision that led to the death of Eluana Englaro.
The only exception the bill allows to the hydration rule is when a patient, in the extreme “terminal” stages of illness, is no longer capable of assimilating food or water. The bill also retains the right of patients to refuse extraordinary or extreme and aggressive measures of a “disproportionate or experimental nature.”
The bill establishes the principle of a “therapeutic alliance” between doctor and patient in the end stages of life. In its passage through parliament, deputies added the right for terminally ill patients or those whose death is imminent to be assisted with adequate pain management in accordance with the protocols of care.
The legislation “recognizes and protects human life as inviolable” and guarantees the right to life “in the terminal phase of life and in the event that the person is no longer capable of understanding and will, until his death ascertained.” Under the proposed law, the doctor is also obliged to inform the patient on the prohibition of euthanasia.
“Advance directives,” also called a living will or personal directive, are instructions specifying what actions should or should not be taken in the event a person is no longer capable of making decisions due to illness or incapacity. They have been widely used by the euthanasia lobby around the world as a foot-in-the-door to introduce legalized active euthanasia or euthanasia by omission.
In many countries, including Canada and Britain, provision of food and hydration is specifically defined as “medical treatment.” In the UK, advance directive laws allow, and in some cases even mandate doctors to withdraw hydration to patients whose potential “quality of life” is judged to render such treatment “futile.” A recent UK government directive made it illegal for doctors to refuse to dehydrate patients to death if the patients or their legal guardians request it.
It is interesting that today I have commented on the practise of dehydrating to death people who are supposedly living in a Persistent Vegetative State and two days ago I wrote about the success of therapies that are allowing people who are supposedly living in a Persistent Vegetative State to recover.