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A national survey of Italian physicians’ attitudes towards end-of-life decisions following the death of Eluana Englaro

  • Legal and Ethical Issues
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Abstract

Background

Ethical issues regarding patient care have recently been raised in Italy by the case of Eluana Englaro, a 36-year-old woman who remained in a persistent vegetative state (PVS) for 17 years. There are no specific laws on the books in Italy regarding euthanasia and physician-assisted suicide. In November 2008, a controversial decision by the Italian Supreme Court granted the woman’s father his wish to discontinue nutrition and hydration provided to her. Because of this historic decision, the authors carried out a survey of Italian physicians’ beliefs regarding end-of-life practices.

Methods

A questionnaire was e-mailed to 70,000 physicians working for the Italian Public Health System and University Medical Hospitals.

Results

A total of 22,219 doctors responded to the questionnaire (32.3%), of whom 17,252 (77.6%) had some experience in treating PVS patients. Nearly 70% of responding doctors were aware of PVS diagnostic criteria; most of them (61%) considered tube feeding to be a medical therapy, and 66% of respondents believed that withdrawal of assisted nutrition and hydration (ANH) might be appropriate depending on the patient’s wishes. Moreover, even though 50% of doctors surveyed were not in favor of euthanasia, a significant percentage (42%) did approve of it, while 8% of this sample was uncertain.

Conclusions

Italian doctors probably have the least experience in end-of-life decisions in Europe, therefore this national survey is a great chance to understand their authentic opinions regarding such remarkable issues. There is broad consensus that a clear legislative position regarding euthanasia and ANH is needed.

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Acknowledgment

Supported by a grant from Associazione Consulcesi Health. The views expressed in this paper are those of the authors and do not necessarily reflect those of the University of Bari or Roma “La Sapienza.” We thank Prof. Michael Kolk for helpful criticism. We thank the thousands of physicians who provided the study data.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

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Authors and Affiliations

  1. Section of Legal Medicine, Department of Internal Medicine and Public Medicine, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy

    Biagio Solarino & Alessandro Dell’Erba

  2. Department of Emergency Medicine and Organ Transplantation, University of Bari, Ospedale Policlinico, Piazza Giulio Cesare 11, Bari, Italy

    Francesco Bruno

  3. Cardiac Surgery Unit-Polo Pontino, Department of Heart and Great Vessels “Attilio Reale”, University of Rome “Sapienza”, Viale del Policlinico 155, 00161, Rome, Italy

    Giacomo Frati

  4. Department of Legal Medicine, University of Rome “Sapienza”, Viale Regina Elena 336, 00161, Rome, Italy

    Paola Frati

  5. IRCCS “INM Neuromed” Pozzilli, Isernia, Italy

    Giacomo Frati & Paola Frati

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  1. Biagio Solarino
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  2. Francesco Bruno
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Correspondence to Biagio Solarino.

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Solarino, B., Bruno, F., Frati, G. et al. A national survey of Italian physicians’ attitudes towards end-of-life decisions following the death of Eluana Englaro. Intensive Care Med 37, 542–549 (2011). https://doi.org/10.1007/s00134-011-2132-5

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  • DOI: https://doi.org/10.1007/s00134-011-2132-5

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