https://doi.org/10.4081/mem.2013.111

La sedazione palliativa tra etica e diritto: la situazione italiana

Vol. 62 No. 1 (2013)
Published: February 28, 2013
Cure palliative, terapia del dolore, eutanasia, fine vita, sedazione terminale/palliativa / Palliative care, pain therapy, euthanasia, end of life, terminal/palliative sedation
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Authors

Fabio Persano
fabio.persano@rm.unicatt.it
Dottore di ricerca in Bioetica, Istituto di Bioetica, Facoltà di Medicina e chirurgia "A. Gemelli", Università Cattolica del Sacro Cuore, Roma, Italy.
In materia di Legge 38/2010 sulle cure palliative e la terapia del dolore, va segnalato il fatto che il legislatore non ha preso esplicitamente posizione riguardo alla sedazione terminale. Questa pratica (che consiste nella riduzione intenzionale della vigilanza con mezzi farmacologici, fino alla perdita della coscienza, allo scopo di ridurre o abolire la percezione di un sintomo - altrimenti intollerabile per il paziente - nonostante siano stati messi in opera i mezzi più adeguati per il controllo del sintomo, che risulta, quindi, refrattario) presenta due importanti problemi etici, consistenti nella necessaria soppressione della coscienza e nel possibile abbreviamento della vita del malato. La soluzione proposta dalla bioetica personalista (l'applicazione del principio del duplice effetto, per il quale un atto è etico anche se da esso ne consegue pure un male non voluto, a determinate condizioni) viene qui riproposta ed eletta a soluzione plausibile anche sul piano giuridico, attraverso una correzione del tradizionale concetto penalistico di dolo. L'articolo è arricchito da ampi riferimenti alle linee guida della Società Italiana di Cure Palliative e contiene le raccomandazioni per la pratica clinica della sedazione terminale elaborate dal Policlinico Gemelli di Roma.
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With reference to the Law 38/2010 on palliative care and pain therapy, it should be noted that the legislature has not adopted a position about the palliative sedation. This practice (which consists of the intentional reduction of vigilance up to unconsciousness by pharmacological means, to reduce or abolish the perception of a symptom - otherwise intolerable for the patient - even though the most appropriate means have used for the control of the symptom, which is, therefore, refractory) raises two important ethical issues, that concern the necessary suppression of consciousness and the abbreviation of life. The solution of the Personalistic Bioethics (the application of the principle of double effect, for which an act is ethical even if it causes unintended evils, under certain conditions) is here reproposed, presenting it as plausible solution also for the legal level, through a correction of the traditional concept of malice. Furthermore, the article includes extensive references to the guidelines of the Italian Society of Palliative Care as well as to recommendations of the University Hospital "A. Gemelli" of Rome on terminal sedation

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How to Cite

Persano, F. (2013). La sedazione palliativa tra etica e diritto: la situazione italiana. Medicina E Morale, 62(1). https://doi.org/10.4081/mem.2013.111

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