End-of-life: still an Italian dilemma

Excerpt

Although decisions to forego life-sustaining therapies are increasingly made, there is still wide variation to withholding and withdrawing of life-sustaining treatments in intensive care units (ICUs) across Europe [1‐3]. It is presently very clear that limiting such treatments is generally more acceptable among U.S. and Northern European societies rather than in southern European and Middle Eastern countries [1‐3]. This is probably due to the fact that end-of-life care encompasses many nonmedical aspects, such as religious beliefs, cultural expectations, legal constraints, and personal values. Religion certainly has a powerful influence in ethical decision making in this field, as religious beliefs are reflected in the clinical practice. In particular, Catholic tradition emphasizes the sanctity of human life and considers euthanasia, assisted suicide, and, in some cases, interruption of the therapy, morally unacceptable. An additional problem when discussing either stopping or withholding treatment is misunderstanding and failure of terminology; thus, terms such as withholding or withdrawing treatment, palliative therapy, and euthanasia are often erroneously confused. Moreover, the untoward terminological variation is not only seen in doctors but also in journalists and laymen. This confusion often leads to the conclusion that end-of-life in many countries is chaotic, confused, and highly variable from clinician to clinician, also within the same institution. Furthermore, the lack of communication with families and within the medical team, an uninformed public about end-of-life issues, and insufficient training of ICU staff are crucial barriers to end-of-life development [1‐3]. …