Testamento biologico e problemi del fine-vita: verso un bilanciamento di valori o un nuovo dogma della volontà?

The A. correlates informed consent and living will with the principle of respect for a person receiving medical treatment (art. 32 Cost.), remarking that consenting or refusing medical treatment defines a precise problem context. This approach — connecting rules and principles with a problem context — is presented as a methodological requirement in order to avoid any fundamentalist tendency such as, in this field, the tendency to exploit informed consent and living will in order to render self-determination a nihilistic dogma and a basis for euthanasia (in the proper sense) and assisted suicide. From the point of view of the Italian constitution, self-determination must be conceived according to a frame of reference of liberalism and solidarity, respecting all interested parties involved and thus obliging no one to engage in an act that is contrary to their conscience or to the ends of their professional activity. In the process of therapeutic decisions informed consent must be the result of an integration of two points of view, the one of the physician who proposes an appropriate cure and the one of the patient who has the right to choose to consent or refuse. But, the right to refuse medical treatment does not imply the right to impose on the doctor any performance inappropriate or even in contrast to his professional code of conduct. This line is a boundary and, regarding the end of life-issues, it is important to develop a solving methodology regarding hard cases that may justify also withdrawing treatment, but without implying confusion with request for euthanasia. After having exemplified certain differences, the A. distinguishes between a competent patient and an incompetent patient criticising that “no differenceideology” which claims to obscure the differences and thus imposes fictions that are more or less transparent. The A. exams the main topics related to living will deriving from the non actuality of the declarations. Finally, he criticises the tendency to equalize the living will and pure hypothetical wishes that judges or physicians construct from a previous patient lifestyle or behaviour, although without a precise intention to declare his or her wishes for the future.