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authors: Tamayo-Velázquez MI, Simón-Lorda P, Ruiz D.
last update: 05/09/2010
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In May of 2007, Italy officially reached more than 59.4 millionpersons. Italy currently has the fourth largest population in the European Union, and the 22nd largest population in the world. Italy's population density at 196.1 persons per kilometre is the 5th highest in the European Union. The highest density is in northwestern Italy, as two regions out of twenty (Lombardy and Piedmont) combined, contain one quarter of the Italian population.
A complete description of the Italian Health Care System available at:
World Health Organization - Regional Office for Europe
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Advance Directives are not yet regulated by law in Italy.
The Italian legal system does not regulate living wills. According to some laws there is the possibility, for the patient, of appointing a proxy decision maker (Fiduciario / Delegato) and write an AD addressed to said person and a judge, but in practice decisions, if the patient is not competent, are taken by relatives.
Several bills relating to ADs have been put forward in Italy in recent years.
In Italian ADs can me named as:
- Testamento biológico
- Testamento di vita
- Dichiarazioni anticipate
- Direttive anticipate
- Volontà previe di trattamento
- Dichiarazione de volontà anticipata
- Dichiarazione anticipata de volontà
- Direttiva di istruzioni
- Direttiva anticipate di cura
Although citizens can fill out ADs they have only an indicative value, and since there is no official registry of ADs, it is not possible to know the number of citizens that complete an AD in Italy.
In December 2003, the National Bioethics Committee drew up and approved an Advance Directive Statement relating to treatment.
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Advance Directives are not yet regulated by law in Italy.
According to the law Legge 9 gennaio 2004, n. 6 “Introduzione nel libro primo, titolo XII, del codice civile del capo I, relativo all'istituzione dell'amministrazione di sostegno e modifica degli articoli 388, 414, 417, 418, 424, 426, 427 e 429 del codice civile in materia di interdizioni e di inabilitazione, nonche' relative norme di attuazione, di coordinamento e finali”, it is possible to name a healthcare proxy (Fiduciario / Delegato) in writing, but in practice if the patient is not competent decisions are taken by relatives, even if they disagree with the patient’s wills, or even if they have had bad or difficult relationships during all their life.
Several bills relating to ADs have been put forward in Italy in recent years.
Some examples of proposal are the followings:,
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It is possible to register an AD through different organizations that provide advise, information and support to complete and register such declaration, however the documents will still remain legally unbinding.
In December 2003, the National Bioethics Committee drew up and approved an Advance Directive Statement relating to treatment. This is available online.
Since they are not regulated by law andthere is no official registry of ADs, it is not possible to know the number ofpeople who write down their ADs in Italy. it is estimated that very few (less than 1%),because advanced directives are not legally binding in Italy.
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More information about Advance Directives in Italy can be found in the following organizations:
- Associazione Libera Uscita www.liberauscita.it . This is a secular and apolitical association that aims to encourage debate on dignity in life and death.
- Comité Nacional de Bioética[National Bioethics Committee] http://www.governo.it/bioetica/.The National Bioethics Committee was established by a decree signed by thePresident of the Council of Ministers on 28 March 1990. In this link it ispossible to find different articles and documents on ADs:
- Associazione Coscioni. www.lucacoscioni.it . This association, which aims to support scientific research, was founded in 2002 with the aim of promoting freedom of treatment and scientific research. Information on ADs can befound at these links:
- EXIT. www.exit-italia.it . An Italian association in favour of the right to a dignified death. This association’s objectives include debating the issue of euthanasia in Italy, the consolidation of the Organizational Structure through Regional Zone Coordination, Participation, as MEMBERSHIP to the World and European Federationof RTD – societies and a bill on Euthanasia and Legalization of Living Wills inItaly.
- Buon Diritto. Associazione per le libertà. www.abuondiritto.it . This association was founded in 2001 with the aim of promoting issues of public relevance relating to exercising rights recognised in legal system, but which are notsufficiently supported. Some information on ADs can be found at this link www.abuondiritto.it/dettagli.php?ID=2736
- eDott è il portaledi GlaxoSmithKline SpA dedicato al Medico Italiano, principalmente al Medico diMedicina Generale, nato nell’anno 2000 .
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- Publications
Books
Articles
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Baccin G. [End of life and advancecare directives]. Prof Inferm . 2010 Jan-Mar;63(1):1-2.
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Ferrario SR, Zotti AM, PasettiC, Comazzi F, Giorgi I, Negri M, Omarini G, Omarini P. Communicating medical information: a littlelesson from Italian patients. G Ital Med Lav Ergon . 2009 Jul-Sep;31(3Suppl B):B12-6.
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Paterlini M. Italy urged to give end-of-life bill more timefor debate. Lancet . 2009 Apr 25;373(9673):1413.
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Sansoni J, Inguì M,Mitello L. [Early treatment directives: someconsiderations] . Prof Inferm . 2009 Jan-Mar;62(1):3-8.
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Temporelli LC,Bettinardi O, Rossi Ferrario S, Zotti AM. [Perception and opinions on the right of choicein medical field: what caregivers teach us on the communication] . G Ital Med LavErgon . 2008 Jul-Sep;30(3 Suppl B):B22-6.
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Turoldo, F. “Report on Advance Directives in Italy Country Reports on Advance Directives , eds. N. Biller-Andorno,S. Bauer and R. Andorno. (Zurich: Institute of Biomedical Ethics, 2008)
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CataniaC, Zagonel V, Fosser V, La Verde N, Bertetto O, Iacono C, Venturini M, Radice D, AdamoliL, Boccardo F. Opinions concerning euthanasia, life-sustainingtreatment and acceleration of death: results of an Italian Association ofMedical Oncology (AIOM) survey. Ann Oncol . 2008Nov;19(11):1947-54.
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Gambaro G. [Advance directives for health care: lawinitiatives in the current legislature.] G ItalNefrol . 2007 Maggio-Giugno;24(3):240-254.
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Canova C, Miccinesi G,Bensenati P, Franchini S, Piffer S, Simonato L, Tessari R, Valenti D, Paci E. [End-of-life medical decisions: study ofphysician's opinions in four Italian centres] . Epidemiol Prev . 2006Jul-Oct;30(4-5):269-78.
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Turone F. Italy debates end of life decisions. BMJ . 2006 Oct 333(7571):719.
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CanovaC, Miccinesi G, Bensenati P, Franchini S, Piffer S, Simonato L, Tessari R,Valenti D, Paci E. End-of-life medical decisions: study of physician's opinionsin four Italian centres. Epidemiol Prev. 2006 Jul-Oct;30(4-5):269-78
V. Bonito. Ledichiarazioni anticipate di trattamento in neurologia. Neurol Sci. 2005;26:S121–S12
- Canova C, Miccinesi G, Bensenati P, Franchini S, Piffer S, Simonato L, Tessari R, Valenti D, Paci E. End-of-life medical decisions: study of physician's opinions in four Italian centres. Epidemiol Prev. 2006 Jul-Oct;30(4-5):269-78
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Links
Other resources  COMITATO_NAZIONALE_PER_LA_BIOETICA_Dichiarazioni_anticipate_trattamento.pdf (Italian; 99,3 Kb) PDF document- SOCIETA_ITALIANA_di_CURE_PALLIATIVE_Direttive_Anticipate.pdf (Italian; 212 Kb) PDF document
- Direttive_Comitato_Nazionale_di_Bioetica.pdf (Italian; 47 Kb) PDF document
- Carta VOlonta Anticipate.pdf (Italian; 88 Kb) PDF document
- codice_di_deontologia_medica_16_12_2006.pdf (Italian; 191 Kb) PDF document
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