THE SUSPENSION OF MEDICAL TREATMENT IN ITALY.
SOME RECENT CASES
1. The legislative framework
1.1. Foreword
In order to understand what has happened recently in Italy, in reference to cases in which
patients have expressed the will to discontinue therapy critical to their survival, one must
begin with a brief analysis of Italian legislation. Italian laws, like those of other countries,
are the result of a long legislative process that, over time, has led to the stratification and
overlapping of sometimes conflicting rules.
It is precisely because of these contrasts in norms that some known cases, of which we
will be looking at, have been judged differently (and sometimes contradictorily) by the
various judges who have taken them into consideration.
Furthermore, because of these legislative conflicts, it is still not clear what the patients'
rights are, when it comes to the possibility of refusing lifesaving care.
Therefore, I will be delving into this legal labyrinth, looking at the different laws, starting
from older ones right up to those more recent, and how they affect this issue.
1.2. The Penal Code
Some rules to which judges have referred, in passing judgment in these cases, are from
the Italian penal code, which dates back to 1930. Regarding the issues that concern us,
this code, although having undergone many changes over the years, has maintained an
underlying philosophy that reflects the value of the unavailability of life, a value that
prevails over other principles, such as those relating to individual autonomy. In fact there
are numerous articles in the penal code that could come into play in evaluating medical
decisions at the end of one’s life. Article 40, for example, states that “refraining from
preventing an event, when it is one’s duty to do so, is equivalent to causing it”.
According to the aforementioned article, and the fact that it is the physician’s
professional duty to save his patients’ lives, when a doctor lets a patient die at his request,
it is as if he were killing that patient. According to Article 40, the doctor should therefore
be charged with the crime of homicide. Article 54 further establishes that "no one shall be
punished for acts committed under the constraint of necessity to preserve himself or
others from the risk of serious personal harm”: this article is often cited in the justifying
non-compliance with the will of patients in danger of losing their lives, who are subject to
emergency therapy against their will (e.g. a Jehovah’s Witness who is subjected to a
blood transfusion). Then there are articles 575-576-577-579-580 that refer to the crime of
homicide in its various shapes, forms and aggravating circumstances. Here, I’m inclined
to cite Article 579 in particular, which condemns "consensual homicide" (under which
euthanasia falls) and Article 580, which punishes "incitement or helping in suicide "(in
this case including assisted suicide). Finally, article 593 condemns "the omission to
assist”, a crime which can implicate the assisting physician who does not intervene, in the
death of a patient who, for example, has had his or her automatic respirator switched off,
or nasogastric feeding tube removed.
1.3. The Civil Code
The Civil Code enacted in 1942, is only slightly more recent and is also affected by the
same type of approach. One needs to look no further than Art. 5, which states that "acts
of disposition of one’s own body are prohibited when causing permanent physical
damage, or are otherwise contrary to law, public order or morality." As a consequence of
this article we are also prohibited to let ourselves die, because death is obviously the
biggest among permanent physical damage.
1.4. The Constitution
The most important turning point in Italian legislation took place in 1948 when, after the
fall of the fascist regime, the Constitution of the Italian Republic was enacted.
In fact, in the new Constitution the principle of absolute unavailability of life is softened,
becoming a principle of one’s right to health protection and promotion of health as a
collective interest. Indeed the first paragraph of Article 32 states that "The Republic
protects health as a basic individual right and public interest, and guarantees free care to
those in need”. But the most significant news was that the right to refuse treatment was
ratified in the Constitution in the second paragraph of Article 32, which states, "no one
can be obliged to undergo medical treatment except under the provision of law"
clarifying that "the law cannot, under no circumstances, violate the limits of respect for
human dignity”. This turning point is extremely important in that it moves from one
regulatory framework, essentially imbued with the principle of the unavailability of life,
to a new and for the most part voluntary approach, therefore enabling the inclusion of the
principle of individual autonomy.
The reason that the Constituent Assembly came to these conclusions is due to the fact
that, among other things, the period in which the Assembly was active in drafting the
Constitution (1946-1948), massive media attention was focused on Nuremberg, where
Nazi criminals and certain doctors who had worked in the death camps were being tried.
In fact, it was during these trials that the "Nuremberg Code” was established which, first
and foremost, recognizes the patient's right to refuse treatment.
The second paragraph of Article 32 is often referred to in relation to Article 13 of the
Constitution, which does not concern specific medical treatment, but more generally, the
protection of people’s liberty: "Personal freedom is inviolable. Any form of detention,
inspection or personal search, or any other restriction of personal freedom is prohibited,
except for reasons given in a court of law and only in cases under the provision of law.
(...) ". This article, however, may be invoked even in cases where a person is forcibly
and against his or her will subjected to medical treatment, because, in order to do this, it
is necessary to deprive the said person of his or her liberty, by keeping him or her in a
medical facility, forcibly administering treatment to him or her, etc.
1.5. The Oviedo Convention
In 1997, along with the governments of the Council of Europe member states, the Italian
government signed the so-called "Oviedo Convention" (Convention on Human Rights
and Biomedicine) further confirming the patients’ right to refuse treatment1.
This Convention was subsequently ratified by Parliament in 2001 with Law No. 145.
However, being an international treaty, Government subscription and ratification by
Parliament was not sufficient for it to come into force, so a third step needed to be taken
by the Government: the submission of the ratification instrument to the Council of
Europe (the Convention body). Therefore, at present, after 12 years of underwriting and 8
years after parliamentary ratification, the Oviedo Convention has not yet come into force
in Italy.
1.6. Secondary sources of law
In addition to the previously mentioned rules, there are also so-called "secondary sources
of law”: rules that have no legal value as such, but which may nevertheless be taken into
account by judges in sentencing, even if at a different level than the others. In our case, of
these "secondary sources", the Code of Medical Deontology, which in Italy has some
interesting features, when compared with the current legislative framework, may be
included. There has indeed been much reflection on the issues pertaining to the end of
one’s life by the Italian medical profession and this reflection has resulted in the
development of a new Code of Medical Deontology, approved on December 15 2006,
just a few days before the death of Piergiorgio Welby (one of the cases discussed below).
A sort of pre-emption of still-in-progress parliamentary work was made in the approval
of this new code: while the political class was divided (and is still divided) on whether to
1
Art. 5: "An intervention in the health field can be carried out after the person concerned has given free
and informed consent. This person shall beforehand, be provided with suitable information on the purpose
and nature of the intervention as well as its consequences and risks. The person concerned may at any time
freely withdraw his or her consent".
approve a law on advance directives, a new Article (n. 38) was inserted into the new
Code of Medical Deontology entitled "The rights of citizens and advance directives." The
last paragraph of the Article obliges the physician to “consider what was previously
stated by the patient in a clear and documented manner, should the patient be unable to
express his or her own will”. Also in the 1998 version, art. 34 of the Code of Medical
Deontology, states that "the physician should not undertake diagnosis and / or treatment
without acquiring the patient’s informed consent".
2. Case studies
2.1.1. The Welby case
In 1963, at the age of 18, Piergiorgio Welby was diagnosed with " Facio-ScapuloHumeral Dystrophy”, a hereditary disease described in medical literature as the
progressive degeneration of the skeletal muscles. 1980 marked the beginning of Welby’s
most difficult years: his condition worsened and he lost his ability to walk. Thoroughly
conscious of the possible evolution of his illness, Welby made a pact with his wife Mina:
if he were to suffer a respiratory crisis, Mina would not call the emergency services.
Welby also refused to undergo a tracheotomy, which would have rendered him a slave to
a ventilator.
His wife, however, when faced with the reality of the situation was unable to find the
strength to fulfill the pact. On 14 July 1997, due to severe respiratory failure, Welby lost
consciousness, fell into a coma, and against his will, underwent a tracheotomy and was
connected to a ventilator. In September 2006, nine years after his tracheotomy, Welby
wrote a heartfelt letter to the President of the Republic, describing his situation in detail
and requesting him to put an end to his suffering. Shortly after writing the letter to the
President of the Republic, Welby asked his physician, Dr Giuseppe Casale, to cease
artificial ventilation and to disconnect the automatic respirator. The doctor, however,
refused and gave the reasons for his refusal in a written text dated 25 November 2006.
At this point Welby involved the judiciary by means of an "urgent appeal to obtain the
disconnection of the artificial respirator under terminal sedation"(28 November 2006). In
his appeal Welby's lawyers refrain from using the term "euthanasia", which Welby used
in his letter to the President of the Republic, and in so doing, the request assumes the
characteristics of a simple rejection of care, based on Article 32 of the Italian
Constitution. In an ordinance filed on 16.12.2006, judge Angela Salvio declared Welby’s
appeal to be completely unacceptable because, while recognizing the existence of
personal rights as guaranteed in Article 32 of the Constitution, the requesting of the
interruption of medical therapy, was not legally protected. Judge Salvio observed that the
positive legislation is oriented in the opposite direction (in reference to Article 5 the Civil
Code, which prohibits acts of disposition of one’s own body which result in permanent
damage and Articles 575, 576, 577 n.3, 579, 580 of the Penal Code, which punishes
homicide and assisted suicide in particular) adding that the Italian legal system lacked the
specific legislation to regulate end-of-life decisions in a clinical setting.
Since it was impossible to detach the respirator with the consent of the court, Welby
decided to proceed anyway, having found an anesthetist willing to meet its needs. The
anesthetist was dr. Mario Riccio, who went to Welby's house on 18 December 2006 to
check the evolution of the disease and to collect the patient's will who, once again,
confirmed his wish to be sedated and detached from the respirator. Two days later, in the
presence of Welby’s family members and people who had supported him in his battle for
recognition of his final decision, dr. Riccio proceeded to sedate the patient and, soon
after, detached the automatic respirator. According to the medical-legal report, Welby
died within half an hour of cardiocirculatory arrest, due to severe respiratory failure,
caused by Welby’s illness: progressive scapolohumeral dystrophy.
After Welby's death, interest in his story has continued to grow, even following
investigations conducted into dr. Riccio. An initial examination of dr. Riccio’s conduct
was carried out, from a deontological point of view, by the College of Physicians of
Cremona, to which dr. Riccio belongs. Two elements were taken into consideration:
firstly, the "clear, definite and unequivocal" desire of a patient, "perfectly capable of
consent and expression "," fully aware of the consequences of the onset of death " and
secondly the fact that the anesthetist "had not used drugs or other substances in
determining death" and that the resulting terminal sedation " pharmaceutical dosage,
method and administration time were in line with standard protocols". For these reasons,
the College of Physicians of Cremona’s Disciplinary Commission closed this case in a
decision dated 1 February 2007.
A second examination was conducted, from a penal perspective, by the Office of the
State Prosecutor in Rome, resulting in a very similar an outcome to that of the College of
Physicians of Cremona, that is, the case being dismissed (5 March 2007).
This conclusion was based on the outcome of medico-legal advice, which excludes
sedation as a significant cause of death, concluding that the only cause of death was
respiratory failure due to the disease. The request for the dismissal of the case, by
substitute prosecutor Gustavo de Marinis, was rejected on April 4 by the preliminary
investigations judge in Rome, Renato La Viola, calling on the Office of the State
Prosecutor in Rome to set up a compulsory head of imputation, soliciting the remanding
of the case by placing the doctor on the criminal offense register under the hypothesis of
"consensual homicide" (a crime under Article 579 of the Penal Code, which can result in
up to 15 years of imprisonment).
The proceedings finally came to an end on July 23 2007, with the entering of a nonsuit
regarding the doctor. Zaira Secchi, the judge presiding over the preliminary hearing in
Rome, in this case, referred to Article 32 of the Italian Constitution which clearly states
that "no one can be bound to a particular medical treatment if not under the provision of
law" as well as Article 13 which states that "personal liberty is inviolable". The entering
of a nonsuit shows that the right to refuse treatment is also confirmed by Article 5 of the
Oviedo Convention, that, "although not yet in force in our system, it is still valid as
criteria to be interpreted by the judge, foregoing principles in accordance in our
Constitution". The sentence notes that the assertion of one’s right to refuse treatment has
some records in the jurisprudence of the Constitutional Court (Const. Co. n. 45/65, n.
161/85, n. 471/90, n. 238/96), affirming that the right to refuse care is an "inviolable
personal right, immediately prescriptive and effective in our legal system, included
amongst the most highly protected individual values”. The court recognized that dr.
Riccio’s behavior was in accordance with that punishable for consensual homicide
(Article 579 of the Penal Code), but also notes that in this particular case, dr. Riccio’s
conduct was in the context of a therapeutic relationship and was therefore under the guise
of the patient’s constitutional right to refuse unwanted medical treatment. According to
the sentence, dr. Riccio’s conduct is therefore not censurable, because it is considered as
a fulfillment of duty and, as such, he is not liable, as established in article 51 of the Penal
Code.
2.1.2. Comments on the Welby case
The dialectic between Penal Code laws and Article 32 of the Constitution clearly emerges
from the Piergiorgio Welby and dr. Riccio case. In fact three different statements were
made by different judges, at different levels, clearly demonstrating the difficulties of this
issue. The three statements cover the spectrum of possible choices: 1) A first magistrate,
judge Angela Salvio, argued that the judiciary was unable to decide due to the
incoherence of the laws, and therefore relied on the intervention of parliament in order to
obtain clarification, thus allowing magistrates to make decisions on the basis of clear and
non-contradictory laws. 2) A second judge, Renato La Viola, solicited the remanding of
the case and called for the charge of "consensual homicide”. This second magistrate,
therefore, points to the criminal law provisions, applying Article 32 of the Constitution in
a purely programmatic way, 3) A third judge, Zaira Secchi, called for the dismissal of the
case under Article 32 of the Constitution, which she believes has an immediate
prescriptive legal value.
2.2.1. The Nuvoli Case
On the evening of Monday, July 23, 2007 (the same day that dr. Mario Riccio was
acquitted of "consensual homicide"), Giovanni Nuvoli, 53 years old, a former football
referee, living in Alghero, Sardinia, died, like Welby, of amyotrophic lateral sclerosis, a
disease
resulting in the progressive paralysis of all four limbs and the muscles
controlling swallowing and speech. Nuvoli had repeatedly asked doctors to unplug the
appliance that allowed him to breathe and that kept him alive. Contrary to the Welby’s
situation, his requests fell on deaf ears and the attention that his case had been attracting
had resulted in the authorities providing "fair" but constant vigilance, in order to prevent
a second Welby case from occurring. According revelations made by the radical leader
Marco Pannella, an attempt to carry out Giovanni Nuvoli’s wishes was made on July 11,
when police commissioned by the Sassari public prosecutor prevented an anesthetist from
attempting to disconnect Nuvoli’s respirator. Consequently, according to the testimony of
Nuvoli’s wife, as of 16 July, having exhausted all other possibilities, Nuvoli began to
refuse food and water, eventually dying of starvation with the respirator attached and
helped only by some sedatives.
2.2.2. Comments on the Nuvoli case
The case of Giovanni Nuvoli was not like those of Piergiorgio Welby and Eluana
Englaro, characterized by a long judicial process. Yet his story allows us to highlight an
important aspect that might have escaped us in the analysis of the Welby case: Welby did
not have permission to disconnect the respirator and his decision was made despite the
opinion of the magistrate. Nevertheless, as seen in the Nuvoli case, the judiciary, with the
help of the police is able to prevent a decision like Welby’s from being carried out.
Hence one should not jump to conclusions when considering Dr. Riccio’s acquittal, as if
it had put an end to the complicated legal issues of the suspension of medical care.
2.3. The Englaro Case.
In February 1992, 20-year-old Eluana Englaro fell into a vegetative state as a result of
injuries sustained in a car accident. Hospitalized in Lecco, she was fed with a nasogastric
tube, yet was able to breathe independently. In 1994 Eluana entered a private Catholic
nursing home in Lecco, where she was assisted by nuns. In 1999 her father, Beppino
Englaro, asked the Lecco court to suspend his daughter’s artificial feeding, but the judges
rejected the request. In this case, unlike that of Welby, the possible applicability of
Article 32 of the Constitution was under discussion. Article 32 refers specifically to the
right to refuse medical care, hence in the Englaro case the judiciary doubted whether food
and nutrition could be considered “medical treatment”. In fact, some would classify it as
nursing care or as "life-sustaining treatment". This issue has been the subject of much
debate: in 2004 the National Bioethics Committee was narrowly divided, with the
majority considering nutrition and hydration as assistance and instead the minority
judging it to all intents and purposes, as medical care.
In 2003 Beppino Englaro made another request to let his daughter Eluana die, but it was
once again rejected by the Court of Appeal.
On 16 October 2007, the Supreme Court of Cassation, with sentence number
21748/2007, again referred the decision to the Milan Court of Appeal, arguing that the
court may authorize the interruption of care under two concurrent circumstances:
1) that " the condition of vegetative state is irreversible, on the basis of a strict
clinical opinion, and there is no medical basis, following the scientific standards
recognized at the international level, that allows the supposition that the person may have
the minimum possibility of any, even if feeble, recovery of consciousness and return to a
perception of the external world ".
2) and that " such a request truly expresses the voice of the represented, on the
basis of clear, univocal and convincing evidence, obtained from his/her statements or
from his/her personality, lifestyle and convictions, corresponding to his/her way of
conceiving the very idea of personal dignity, before falling in the state of
unconsciousness".
On 9 July 2008 the Milan Court of Appeal reexamined the issue and authorized
Beppino Englaro, as Eluana’s legal guardian, to discontinue the hydration and feeding
treatment that was keeping his daughter alive.
On 16 July 2008 the Chamber of Deputies and Senate raised a clash of competence
against the Supreme Court of Cassation, claiming that the October 2007 ruling was "a
substantially legislative act, innovative in the existing legal order. " Let us not forget that
the Italian legal system is not, like the English, based on so-called "common law" and
that the judgments of the judiciary are always based on the strict enforcement of existing
laws.
Such a conflict between legislature and judiciary powers had never occurred before in
history of the Italian Republic. The Constitutional Court was called upon to settle the
issue and on 8 October 2008 it found in favor of the Supreme Court of Cassation and
Court of Appeal, not judging the Supreme Court of Cassation’s ruling to be innovative
regarding the existing legal order.
On the morning of 6 February 2009 the team of volunteers assisting Eluana Englaro
announced the beginning of a progressive reducing of her nutrition. At 14h00 on the
same day, the Council of Ministers urgently approved a decree law to prohibit the
withdrawal of nutrition and hydration of patients in a vegetative state. The President of
the Republic refused to sign the decree, considering it unconstitutional. At 20h00, the
Council of Ministers approved a draft bill with the same contents of the previously
refused decree at an emergency meeting. This draft law was immediately transmitted to
the Senate, which normally closed on Mondays, and was already in session on Monday 9
February 2009.
Eluana Englaro died at 19:35 on 9 February 2009. The news reached the Senate while
draft bill n ° 1369 on nutrition and hydration was being discussed. The Government, in
consultation with the chairman of the Senate and parliamentary groups, in consequence,
decided to withdraw the bill in order to discuss a more articulate text relative to living
wills and end-of-life cases. Despite parliament’s agreement on the urgency to discuss this
more articulate living will text, due to strongly divided opinions on this issue, a law is
now even further from seeing the light of day.
3. Towards a new law
As seen at the beginning of this article, there are two issues at stake in these cases: 1) the
collective interest in health and life of every member of society; and 2) everyone’s right
to choose freely whether or not to undergo a particular treatment.
The Italian Constitution tries to hold these values together, while the Criminal Code and
Civil Code seem to be unbalanced by one of the two sides. Therefore, one should start by
looking at the Constitution in order to resolve end-of-life legal issues in Italy. The
Constitution, in fact, is a great asset to our society, because it was not conceived to be
procedural as if it were a mere indication of the formal rules, permitting the coexistence
of individuals who respectively perceive themselves as "moral strangers". In contrast, the
first part of the Constitution affirms essential shared values and outlines a genuine "civil
code of ethics”. This is quite extraordinary, if we think that the political forces of that
time represented cultural universes that were poles apart: on the one hand, the
Communist Party, linked to the USSR, and on the other, the Christian Democrats, bound
to a Catholic world, which had not yet seen the opening of Second Ecumenical Council
of the Vatican, and various other parties in the middle, some of which assumed a liberal
viewpoint different to the above. I find it extraordinary that from these differing worlds
grew a dialog so fruitful that it resulted in the creation of a shared civil code of ethics,
codified in the first part of our Constitution, especially when considering that today,
within a political landscape with much more subtle differences, there is much stronger
opposition especially when it comes to ethical issues. Therefore, let us return to the
articles of the first part of the Constitution that are most relevant to this issue, namely
Article 32 and Article 13, to find useful elements in the construction of a shared civil
code of ethics for end-of-life cases. The first paragraph of Article 32 states, as we have
seen, that society has a collective interest in the health of each and every one of its
members. This collective interest is expressed in social life and laws in several ways:
through laws aimed at preventing accidents at work requiring one to take special
precautions, the obligatory use of seat belts when driving, the wearing of helmets when
riding motorbikes and restrictions on the use of drugs etc. To some extent all these rules
limit personal freedom, but they do so in the name of an important value: that of life and
health. We are willing to accept state interference, within limits, in our personal freedom
because it is not considered to be too intrusive and its motives are positive.
The stating of this value in the first paragraph of Article 32 is decisive because it affirms
that it is not indifferent to the community whether a person lives or dies. As is apparent
from the stenographic report on the Constituent Assembly’s work, our founding fathers
considered health care an important value that every individual should pursue, almost to
the point of prefiguring a sort of “duty to care for oneself” 2. Affirming that health is a
public interest maintains that one's life does not solely and exclusively concern only
himself: a young father who refuses life-saving treatment and in doing so leaves his
children without care; a businessman who depends solely on his entrepreneurial ability
and thereby puts his employees economically at risk; a young researcher in whom a
university has invested heavily in training, leaves without making his valuable
In fact “the Honorable Mr. Merighi proposed an additional amendment to the first paragraph of Article
32, so that a declaration of health as a public interest could be followed by the duty of the individual to
"protect his or her physical health, out of respect for the community". The Honorable Mr. Tupini observed
that this principle could be considered implicit in the formula which has since been approved hence The
Honorable Mr. Merighi renounced the amendment"(V. Falzone, F. Palermo, F. Casentino, The Constitution
of the Republic of Italy, illustrated with preparatory work, Mondadori, Milan, 1976, p. 114).
2
contribution, etc. are just some examples, but they all lead to one conclusion: our health
is not exclusively private and individual, applying only to ourselves. The “duty to care for
oneself” stems from this idea that appears in the parliamentary debate relating to the first
paragraph of Article 32 of the Constitution.
The second paragraph of Article 32, which affirms the right to refuse treatment, is not
inconsistent with the first. If, in fact, it is a civic duty to care for oneself, because health is
a collective interest, it nevertheless doesn’t require one to undergo treatment forcibly,
even providing treatment by violent means in an inhumane and degrading way, that
certainly would offend one’s human dignity. Such an intrusion would indeed constitute a
degree of intrusiveness of the personal sphere of subject that is absolutely not comparable
to the limitations imposed, for example, by the obligation to use a motorcycle helmet or a
seat belt. The second paragraph of Article 32 and Article 13 of the Constitution therefore
protect a fundamental right of the citizen, that has become one of the cornerstones of
liberal constitutions and that goes back to the “habeas corpus”, a privilege that the
English barons were able to wrest from the King John Lackland in 1215, when they
established the Magna Carta Libertatum, one of the pillars of western legal culture.
"Habeas corpus" literally means "may you have the disposition of your body" or that your
body is yours and that no one can make you do something without your consent. Nobody,
except a judge, if he or she thinks that a law has been violated, can deprive a citizen of
the power over his own body. A power that in the absence of a crime, tries to exert power
over our bodies without our consent, would be acting outside of the law and would be
considered a "tyrant." The “Habeas corpus” is therefore the safeguard of individual
freedom against the will of state. Like the value of life and health, such a right is
essential. How can we therefore reconcile the two?
Attempting to reconcile these two principles should be the main objective of an end-oflife law in Italy. The necessity for such a law is evident in the fact that due to the current
regulatory chaos, each court judges the same case or similar cases differently. But when
the law is not equal for all, we are faced with supreme injustice and it is precisely this
supreme injustice that law should remedy. But this still begs the question, how could an
ordinary law reconcile the two principles contained in Article 32 of the Constitution?
The answer perhaps lies in the following. The principle of collective health could
be protected by trying to offer other alternatives to people who’s will it is to die. Requests
regarding euthanasia often need to be decoded. If one discovers that a patient has asked to
die out of fear of suffering, he or she needs to be informed of all the possibilities offered
by palliative care. If the patient asks to die because of depression caused by the disease or
by feelings of abandonment related to his or her situation, one should offer psychological
support, and so on. In short, I would say that the protection of the principle of collective
interest for health can help to avoid situations in which the doctor does little more than
passively adhere to the wishes of the patient.
The doctor cannot limit himself to just passively performing any request, as if he were a
mere technician, obedient to requests made by the patient. The doctor, by contrast, is first
and foremost the depositary of the values of his discipline (to promote health and save
peoples’ lives) and, secondly, a spokesperson for society, which has an interest in
safeguarding the health of each and every one of its members. Hence, the doctor should
compare these values, in a frank, yet in-depth interview regarding the patient’s request to
die. Should the patient persist, the physician should refrain from forcing required therapy
on him, even if the patient is unable to actively oppose the administration of the said
therapy (as in the Welby and Nuvoli cases), or if the patient is no longer capable of
consent, but has made his wishes clear in a documented request. The latter, the law on
living wills, if approved, would most likely not allow the will of the patient to be
reconstructed through testimony (as in the Eluana Englaro case), but would require the
submission of a written will to their general practitioner or notary. On this point at least,
all parties seem to agree.