Commentary. The law on living wills establishes the right of each person to indicate beforehand what treatments they intend to accept or not accept. In the U.S., the law regarding this dates from the past century.

Italy adopts living wills, giving patients choice in treatment

It is an important day for our country, an important day for the protection of everyone’s rights. A day to remember for all of us, as from now on we will finally be able to leave instructions about the types of treatment that we are willing to accept, in case one day we are no longer able to express our wishes directly.

As a physician, I would say that it is also an important day for doctors and nurses, who are faced daily with difficult situations involving the end of life.

These nurses and doctors have relied on the support of professional ethics, the jurisprudence of recent years and international agreements, but up to now have had to work without a law that would guarantee them peace of mind in making the most complicated decision of all. Indeed, if we stop for a moment and consider it, what choice is more difficult than deciding how to act when faced with someone who is dying?

In 2006, when I had just returned to Italy after two decades abroad working as a transplant surgeon, I was elected chairman of the Senate Health Commission, and I must confess I hadn’t even imagined that, in Italy, a patient did not have the freedom to choose regarding the treatments they would undergo. That was why the first thing I did as a senator was to write a law that would allow a person to indicate they would want all existing forms of treatment, but which would also allow them to reject some of them.

After nearly 12 years, finally, the law on living wills, just approved in the Senate, establishes the right of each person to indicate beforehand what treatments they intend to accept or not accept, if one day they are in the position of not being able to express themselves. Doctors will have to follow these specifications. And it is a positive development that, after a decades-long debate (while in the U.S., where I resumed my work today, the law regarding this dates from the past century), the Italian legislature has in turn accepted what medical science has been recognizing with one voice — that therapies like artificial nutrition and hydration are of a kind that can be accepted or rejected when a person writes their own living will.

Italy is a country that is advancing at a snail’s pace, especially in the field of rights, as it was only today that it reached this very important milestone. More than two decades have passed since the beginning of the dramatic case of Eluana Englaro, which shocked the whole country when her treatment was ended, but had the merit of bringing Italians’ true attitudes toward the end of life to light, even back then. This milestone was reached today thanks to the struggles of people like Piergiorgio Welby, as well as many others who have moved us with their humble accounts of their own suffering, and, with their testimony, forced us to reflect on the need for a law to enshrine the full recognition of a right.

But I cannot say that I am satisfied today. Having returned abroad, I’m looking back from a distance at the country where I was born, and its ruling class seems to me so little focused on the real life of the people, on the sufferings of so many, and on the lives of the country’s citizens.

However, I want to put aside all gloomy reflections and just write that today, finally, is a day of victory for so many. A victory for Beppino Englaro, who, through the tragedy of his beloved daughter, has had to fight nothing short of a civil war, and not only on his own behalf. A victory for the many organizations working to change hearts and minds and demand new policy. A victory for the local mayors and administrative officials who in the past few years, while waiting for this law to be passed, have already started registers of living wills in their cities or regions, trying to fulfill the requests of so many citizens.

It’s simply not true that a law was passed that allows euthanasia: instead, a law was passed that allows you to choose your own treatment. And this is what was written in Article 32 of our Constitution in 1948: “No one can be forced to undergo a specific medical treatment unless required by law. The law cannot, under any circumstances, violate the limits imposed by the respect for the human person.” That is the reason why this is a victory for all the Italians who believe in the Constitution and in the freedom of choice.

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