A patient obtains authorization to receive assisted suicide in Italy and opens the door to the legalization of euthanasia and assisted suicide in that country.

Once again, we find ourselves with a similar case to the one experienced in Spain with the assisted suicide of María José Carrasco in March 2021. Just after her story was published in the media, the euthanasia law was passed in Spain, with 202 votes in favor, 141 against and 2 abstentions, becoming the fifth country in the world to regulate it.

Perhaps one of the most controversial bioethical issues today is the legal regulation of euthanasia and assisted suicide. As in the case of Ms. Carrasco, another similar one is now being considered in Italy, a country where euthanasia and assisted suicide are still illegal. A patient, whose details have not been released, has obtained authorization to undergo medically assisted suicide after  the Italian Constitutional Court declared in 2019 that euthanasia is not punishable in certain cases.

The Constitutional magistrates decided that, under certain circumstances, it is not punishable to help “a patient kept alive through life support treatments and who suffers from an irreversible disease, a source of physical and psychological suffering that they consider intolerable, but who is fully capable of making free and conscious decisions” to die, reported the media.

The 43-year-old Italian citizen is quadriplegic and, as a result, has been bed-bound for a decade. He is the first patient to obtain the right to qualify for this measure. “Mario” — a fictitious name to keep the identity of the patient hidden — had been asking the hospital in the Marche region which he has attended for more than a year to “verify his health conditions in order to access, legally in Italy, a lethal drug to put an end to his suffering”, the time limit provided for by the Constitutional ruling.

After the initial refusal of the Marche regional service (ASUR), a mediation award and the final ruling of the Ancona Court, in addition to two legal warnings to the ASUR, Mario finally obtained the favorable opinion of the Ethics Committee, after a group of specialist doctors confirmed that he has the right to legal access to assisted suicide.

This authorization reopens the call by a sector of the Italian population to regulate euthanasia in Italy.

Belgium applies euthanasia to children

In related news, the Archives of Disease in Childhood: Fetal and Neonatal from BMJ Journals has published an article stating that between September 2016 and December 2017, 24 babies were euthanized in Belgium. Doctors, in agreement with their parents, intentionally gave them medication to end their lives.

The report says that a lethal injection was applied to babies with medical problems who had “no hope of a bearable future”. It should not be forgotten that Belgium legalized euthanasia in 2002, and in 2014 became the first country to legalize assisted suicide for minors.

The study also brings to light the all too common practice of euthanasia in children, even though such action is illegal. As Michael Cook of BioEdge stated “It is well-known that eligibility for euthanasia in Belgium is elastic. However, there are limits. The law only permits the euthanasia of minors who are capable of discernment and who are conscious”.

Since 2002, the number of euthanasia cases in Belgium has risen from 24 in 2002 to 2,655 in 2019, meaning that over 20,000 procedures have been carried out in these 19 years.  It should be noted that, in 2019, 450 of the euthanized persons included in these figures were not terminally ill.

Bioethical assessment

The Bioethics Observatory has addressed this issue on more than one occasion, attempting to argue the different bioethical aspects that come into play, and that, due to the current news referred to herein, is worth discussing again.

According to the recently deceased Dr. Justo Aznar, former director of the Bioethics Observatory in Valencia, “the problem begins when some aim to capitalize on emotionally charged isolated episodes and great media coverage for political ends that, conveniently, seek to raise awareness and educate society. Allowing one of its members to cause the death of another in a society under certain exceptions is a progressive erosion of the inviolable nature of human life and of the rights that protect it. If in “some cases” one could dispose of one’s own life or that of others, it would be claiming that human life can be devalued and lose the unconditionality of its respect.

Socially and legally, a paradigm shift would take place since, under certain situations of suffering, it would be accepted that life can be violated, and its violation would constitute a right. But no life is unworthy and therefore violable because of the suffering it endures. Human life will always be a good, even if the person is sick. What represents an evil is the resulting suffering that must be given meaning, reduced as far as possible, eliminated, supporting those who suffer and those who accompany them to avoid arriving at the sad situation of thinking that it is no longer worth living by taking the worst of decisions”.

According to Aznar, “when a door is opened in bioethics, we know what is going to happen at the time, but we don’t know what is going to come next, and it is very difficult to close it again”. “This is not a conjecture by those of us who are against euthanasia; we have data from the two sociological laboratories that have been and are the Netherlands and Belgium on this issue, and we know how far they have gone. Euthanasia has already been accepted for children, infants, or people with psychiatric disorders, dementia, or mental disability. This slippery slope can eventually lead to euthanasia being applied to people who do not request it, so-called involuntary euthanasia. This is happening in the Netherlands, where between 0.4% and 0.7% of euthanasia cases were of this type, or in Belgium where most of the people over 80 years of age who were euthanized had not requested it”.

It seems that the slope mentioned by Dr. Aznar might not only pave the way to request euthanasia in situations not originally covered by the legal framework of the countries in which it is legalized, but it may also become the gateway to legal regulation in countries where it has not yet been considered.

From this Bioethics Observatory, we again urge all European agencies not to give in to liberalizing pressures toward euthanasia and to promote the widespread introduction of quality palliative care, providing the human and material resources for its implementation, given the well-established experience that comprehensive palliative care is the best way to address the suffering inherent in incurable or end-of-life disease, which leads the vast majority of patients who demand euthanasia to desist from proceeding.

This is the proper way to dignify life, address suffering and vulnerability, and to humanize medicine and care.

 

Nuria Aznar and Cristina Castillo

Bioethics Observatory

Institute of Life Sciences

Catholic University of Valencia

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