Pain therapy and euthanasia: Italians and the end of life

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The Terry Schiavo case has sparked intense debate on euthanasia in the United States and throughout the world. Numerous moral, ethical and legal issues have been raised. If a person is in the vegetative state, and has no hope of improvement, should he or she be kept alive? Who should decide whether the treatment necessary for his or her survival should continue, or whether it should cease? These and other questions have galvanized public opinion, and diverse positions have been taken up. The Osservatorio Scienza e Società survey carried out by Observa asked a number of specific questions in order to determine the opinions of Italians on these issues. The following summary of the survey results begins by examining Italian public opinion on pain and the way in which incurable diseases should be handled.

As regards suffering, and possible remedies to alleviate it, the majority of Italians are in favour of the use pain-reducing drugs. More than half the interviewees believed that morphine should be used to alleviate pain (54%). Agreement on the use of morphine increases with age: from 29.5% among young people to 60.7% in the 45-64 age group. Younger Italians give twice as much importance to psychological support for the terminally ill as do Italians aged over forty-five.

Also schooling influences public opinion. People with higher educational levels are more in favour of the use of pain-killers (67.1%). By contrast, less-educated Italians believe that the sick should be given psychological support (45.3%).

Religious faith exerts a significant influence as well. The use of morphine to alleviate pain was preferred mainly by non-Catholic interviewees (67.5%), although Catholics and non-believers recorded only slightly lower percentages (53.9% and 55.6%). The situation changes as regards support for the severely ill: this option was mainly preferred by Catholics.

Next to be considered is the circumstance in which a terminal patient is close to death. The main question in this case is whether the life should be terminated of an incurably ill yet conscious person who expressly asks to die. The majority – four out of ten – of Italians do not believe that such a person’s wish to die should be granted, and that he or she should be kept alive with every means possible. The other positions recorded percentages below 30%.

The opinion on who should take such decisions was clear-cut: seven out of ten interviewees said that the decision should be taken by the patient, 15% by his/her next of kin, and 6.3% by the doctor.

But what, interviewees were asked, should be done when the incurably ill person is no longer conscious – this being the situation of Terry Schiavo? the majority of interviewees were in favour of keeping the person alive at all costs (40.1%); just one-third believed that his or her life support should be discontinued (27%), and 21% that the person’s life should be terminated with pharmaceutical means. The interviewees who maintained that a terminally ill patient should be kept alive at all costs were mainly Catholics (42.8%) and women (43.4%).

If the patient is unable to express what s/he wants, the question of who should take the decision on his or her behalf becomes particularly pressing. Some 57.8% of interviewees said that the patient’s desires expressed when s/he was still conscious should be respected. A substantial proportion assigned responsibility to the patient’s next of kin, compared with the 9% who said that it was the doctor’s responsibility.

Overall, the attitude of Italians to the situation of severe illness prior to death is that life-prolonging treatment should continue as long as possible. This opinion also suggests that collective responsibility should be taken for the individual. This is in accordance with norms and obligations incumbent upon the state with regard to citizens, whose entitlement to health is enshrined in the Italian Constitution. However the crucial decision on the removal of life support pertains to the patient him/herself, which evinces that social and familial bonds cannot prevail over the right to individual self-determination.

However, these opinions are accompanied by wide margins of uncertainty, especially as regards distinguishing between the consciousness and non-consciousness of the terminally ill person. In this case the diversity of positions suggests that the issue of incurable illness should be addressed with instruments discussed in recent months – the ‘living will’ and forms of legal support – in order to clarify the boundaries between pain therapy, therapeutic obstinacy, and euthanasia.

This article was published by La Stampa’s TuttoScienzeTecnologia on the 14th of september, 2005.

The survey was conducted by means of CATI-method telephone interviews with a sample of 1029 subjects, stratified by gender, age, and geographical area of residence, and representing the Italian population aged 15 and over.