Medicine and law
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The traditional approach towards end-of-life decision-making in Italy has changed. Whilst article 32 of the Italian Constitution recognizes the 'right to health' that grants patients to withhold or withdraw medical treatment, the Italian Medical Ethics Code neglects any kind of assistance during death or euthanasia. ⋯ On one hand, ethicist and lawyers, valuing the patient's autonomy, believe that letting die cannot be punished. On the other hand, however, some conservative ethicists and lawyers argue that the right to life is absolute and imperative and therefore a physician must do everything possible to protect one's life.
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Physician's attitudes towards patients with incurable cancer or at the end-of-life process--treatment of patients, withholding ventilation support, physician-assisted suicide--have changed rapidly in recent years. In cases such as incurable cancer, illnesses in the terminal phase, some neurologic diseases and AIDS, physicians and other health care workers experience dilemmas, arguments and problems on the subjects of whether or not to tell the truth or how to do it, who should inform the patient or his/her guardian, and then, how to give treatment to patients with incurable cancer or withhold ventilation support. All of these issues are affected by the country's' sociocultural and economic structures, the physician's attitudes at the end of life,the medical practice and the form of health structures. ⋯ Our study contains three clinical situations covering the following areas: (1) a patient's right to be informed of incurable cancer, (2) doctor-assisted suicide (3) the conflicting rights of patients, doctors and the family in issues such as refusing ventilatory support or witholding treatment. The four-point Likert Scale was used to mark the responses to the statements. The significant cultural, social and economic differences that exist in health care services between regions in our country affect physician-patient communication and end of life decision-making, as reflected in the process of obtaining informed consent.
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There are currently high profile debates about legal and ethical aspects of end of life care and treatment in the U. K. and Brazil. Unlike some other jurisdictions, neither country has legalised assisted dying or euthanasia. We argue that it is timely to consider the issues from the perspectives of an evolving concept in bioethics, that of solidarity.