Rivista Italiana di Medicina Legale e del Diritto in campo sanitario

Rivista: Rivista Italiana di Medicina Legale (e del Diritto in campo sanitario)
Anno: 2018
Fascicolo: n. 3
Editore: Giuffrè Editore Spa
ISSN: 1124-3376
Autori: Veshi Denard, Koka Enkelejda, Venditti Carlo
Titolo: L’IMPORTANZA DEL FIDUCIARIO NELLE DECISIONI DI FINE VITA IN ALCUNI PAESI DELL’EUROPA OCCIDENTALE *)
Pagine: pp. 904-914
Keywords: Direttive anticipate, autonomia, legge, rapporto di fiducia paziente-fiduciario, fiduciario

Il contributo ripercorre l’istituzionalizzazione del ruolo del « fiduciario » con riferimento alle decisioni attinenti al tema del « fine vita ». Offerta una panoramica in relazione al tema dell’autonomia del paziente analizzando in modo particolare i due tipi di « patient autonomy » – il modello individualistico e quello relazionale – gli autori si soffermano su esempi di nomina di soggetti « fiduciari », disciplinati dalle singole realtà nazionali. Si va dalla disciplina delle « direttive anticipate » nei paesi di lingua latina (Italia, Francia, Portogallo e Spagna) passando per quelli di matrice anglosassone (Regno Unito ed Irlanda del Nord) e, da ultimo, per quelli di origine germanica (Austria, Germania e Svizzera). Inoltre, gli autori esaminano gli interventi legislativi recenti in Italia (legge 219/2017) e le modifiche del Code de la Santé Publique francese di marzo 2015 e febbraio 2016, che hanno ulteriormente valorizzato il ruolo del fiduciario rispetto alla disciplina precedente. Lo scopo del contributo è di mettere in evidenza come alcune realtà nazionali abbiano già colto le criticità insite nel « testamento biologico » ritenendo così utile valorizzare il ruolo del « fiduciario » la cui fisionomia si salda al rapporto fiduciario fra lo stesso ed il paziente. Tutte le parti coinvolte, inclusi medici, pazienti, le loro famiglie e i loro parenti, possono contribuire al processo della decisione di fine vita. I medici farebbero affidamento sulle famiglie dei pazienti e sui loro parenti per salvaguardare il benessere dei pazienti. Inoltre, i pazienti farebbero affidamento sui loro fiduciari per comunicare con i loro medici nel caso in cui fossero incoscienti.

L’IMPORTANZA DEL FIDUCIARIO NELLE DECISIONI DI FINE VITA IN ALCUNI PAESI DELL’EUROPA OCCIDENTALE *)


*) Questo articolo è stato finanziato dal fondo per le pubblicazioni presso l’Università di Haifa, Israele.
**) This paper is funded by ‘Article Publication Grant’ of the University of Haifa, Israel.
*) Section 1 and 4 are written by Dr. Denard Veshi. Sections 2 and 2.1 are written by Prof. Carlo Venditti. Section 3 is written by Dr. Enkelejda Koka.
1) World Health Organization, in European Health Report 2012: Charting the Way to Well-being, 2012, WHO Regional Office for Europe, Copenhagen. http://www.euro.who.int/__data/assets/pdf_file/0004/197113/EHR2012-Eng.pdf.
2) Swetz K.M., Matlock D.D., Ottenberg A.L., Mueller P.S., Advance directives, advance care planning, and shared decision making: promoting synergy over exclusivity in contemporary context, in  J. Pain Symptom Manage, 2014, 47:e1-e3; Tibaldi G., Salvador-Carulla L., Garcia-Gutierrez C.J., From treatment adherence to advanced shared decision making: new professional strategies and attitudes in mental health care, in Curr. Clin. Pharmacol., 2011, 6:91-99.
3) Medtech Europe, The European Medical Technology Industry in Figures, in MedTech Europe, 2015, Brussels.
4) Constitutional Court, decisions of 24 October 2007, no. 348 and no. 349. The Court recognized that, under Article 11 of the Italian Constitution, EU Treaties are legally binding and supreme.
5) President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, ‘Making Health Care Decisions’, 1982 [online] http://kie.georgetown.edu/nrcbl/documents/pcemr/makingdecisions.pdf; Bundesärztekammer, Zentrale Ethikkommission bei der Bundesärztekammer, ‘Empfehlungen der Bundesärztekammer und der Zentralen Ethikkommission bei der Bundesärztekammer zum Umgang mit Vorsorgevollmacht und Patientenverf ̈ugung in der ärztlichen Praxis’, 2013 [online] http://www.bundesaerztekammer.de/downloads/Empfehlungen_BAeKZEKO_Vorsorgevollmacht_Patientenverfuegung_19082013l.pdf.
6) The term « living will » can be confusing, because wills take effect only after the testator’s death and are directed at other people. However A.D. s are intended to conform physicians’ acts to patients’ wishes while they are still alive. Spoto G., Direttive anticipate, testamento biologico e tutela della vita, in Eur dir pri., 2005, I, 179-204.
7) British Medical Association, BMA statement on advance directives, BMA, London, 1992.
8) Fagerlin A., Ditto P.H., Hawkins N.A., Schneider C.E., Smucker W.D., The use of advance directives in end-of-life decision making: Problems and possibilities, in Am Behav Sci., 2002, 46, 268-283; Neitzke G., Umgang mit Patientenverfügungen in der Praxis, in Public Health Forum, 2013, 21:12-13, doi: 10.1016/j.phf.2013.06.009.
9) Article 10 of the Medical Capacity Act in England establishes the concept of donee.
10) Buchanan A.E., Brock D.W., Deciding for others: the ethics of surrogate decision making, Cambridge University Press, Cambridge, 1989.
11) Olick R.S., On the Scope and Limits of Advance Directives and Prospective Autonomy. In Advance Directives, Springer, Netherlands, 2014; Wallace S.K., Martin C.G., Shaw A.D., Price K.J., Influence of an advance directive on the initiation of life support technology in critically ill cancer patients, in Crit Care Med., 2001, 29:2294-2298.
12) Berger J.T., Majerovitz D., Stability of preferences for treatment among nursing home residents, Gerontologist, 1998, 38:217-223; Danis M., Garrett J., Harris R., Patrick D.L., Stability of choices about life-sustaining treatments, in Ann. Intern. Med., 1994, 120:567-573; Carmel S., Mutran E.J. Stability of elderly persons’ expressed preferences regarding the use of life-sustaining treatments, in Soc. Sci. Med., 1999; 49, 303-311; Ditto P.H., Smucker W.D., Jacobson J.H., Houts J.A., Fagerlin R.M., Coppola A., Gready K.M., Mitchell R., Stability of older adults’ preferences for life-sustaining medical treatment, in Health Psychol, 2003, 22: 605.
13) Baier A., Moral prejudices: Essays on ethics, in Harvard University Press, Harvard, 1995.
14) Lagerspetz O., The Notion of Trust in Philosophical Psychology, in Commonality and Particularity in Ethics, 1997, pp. 95-117, Palgrave Macmillan UK.
15) Baier A., op. cit.
16) Powell T., Extubating Mrs. K: Psychological aspects of surrogate decision making, in J Law Med Ethics, 1999, 27:81-86.
17) Kapp M.B., Commentary: Anxieties as a legal impediment to the doctor-proxy relationship, in J. Law Med Ethics, 1999, 27:69-73; Sabatino C.P., The legal and functional status of the medical proxy: suggestions for statutory reform, in J. Law Med Ethics, 1999, 27:52-68.
18) Macintyre A., After Virtue: A Study in Moral Theory, in University of Notre Dame Press, 1984, Notre Dame.
19) MANCA TESTO
20) Steinbock B (Ed.), The Oxford handbook of bioethics, in Oxford University Press, 2007, Oxford.
21) Brody H., Stories of sickness, in Oxford University Press, 2002, Oxford.
22) Blustein J., Choosing for others as continuing a life story: The problem of personal identity revisited, in J. Law Med Ethics., 1999, 27:20-31.
23) Beauchamp T.L., Childress J.F., Principles of biomedical ethics, in Oxford University Press, 2001, Oxford.
24) Woods S., Death’S Dominion: Ethics At The End Of Life: Ethics at the end of life, McGraw-Hill Education, London, 2006.
25) Degner L.F., Sloan Ja., Venkatesh P., The control preferences scale, in CJNR, 1997, 29:3.
26) Owens J., Creating an impersonal NHS? Personalization, choice and the erosion of intimacy, in Health Expect., 2015, 18:22-31; Entwistle V.A., Carter S.M., Cribb A., Mccaffery K., Supporting patient autonomy: the importance of clinician-patient relationships, in J. Gen Intern Med., 2010, 25:741-745.
27) Gomes B., Calanzani N., Higginson I.J., Local preferences and place of death in regions within England 2010., in Cicely Saunders International, 2011, London.
28) Sheldon S., Thomson M., Feminist perspectives on health care law, in Routledge-Cavendish, 1998, New York.
29) Venkatasalu M.R., Seymour J., Arthur T., Understanding the meaning of end-of-life discussions and related decisions among older South Asians living in East London: a qualitative inquiry, in BMJ Support Palliat Care, 2011; 1, 79-80; Worth A., Irshad T., Bhopal R., Brown D., Lawton J., Grant E., Murray S., Kendall M., Adam J., Gardee R., Sheikh A., Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study, in BMJ, 2009, 338: b183.
30) Howarth G, Death and dying: A sociological introduction, in Polity, 2007, Cambridge.
31) Lavoie M., Blondeau D., Picard-Morin J., The autonomy experience of patients in palliative care, in  JHPN, 2011, 13:47-53.
32) Broom A., Kirby E., The end of life and the family: hospice patients’ views on dying as relational, in Sociol Health Illn., 2013, 35:499-513.
33) Rini C., Jandorf L., Goldsmith R.E., Manne Sh.L., Harpaz N., Itzkowitz S.H.., Interpersonal influences on patients’ surgical decision making: the role of close others, in Int. J. Behav. Med., 2011, 34:396-407; Corrigan P., How stigma interferes with mental health care, in Am. Psychol., 2004; 59:614; Lewis M.A., Rook K.S., Social control in personal relationships: impact on health behaviors and psychological distress, in Health Psychol., 1999, 18:63.
34) Thomas C., Morris S.M., Clark D., Place of death: preferences among cancer patients and their carers, in Soc. Sci. Med., 2004, 58:2431-2444.
35) Wilson F., Ingleton C.H., Gott M., Gardiner C., Autonomy and choice in palliative care: time for a new model?, in J. Adv. Nurs., 2014, 70:1020-1029.
36) Hunt M.R., Ells C., Partners towards autonomy: risky choices and relational autonomy in rehabilitation care, in Disabil Rehabil., 2011, 33:961-967.
37) Zelderloo L., Autonomy, belonging and interdependency, in IJIC, 2009m 9(5).
38) Mackenzie C., Stoljar N. (Eds.), Relational autonomy: Feminist perspectives on automony, agency, and the social self, in Oxford University Press on Demand, 2000.
39) Baier A., Postures Of The Mind: Essays On Mind And Morals, in U of Minnesota Press., 1985, Minnesota.
40) Mackenzie C., Stoljar N., op. cit.
41) Sheldon S., Thomson M., op. cit.
42) Hunt Mr., Ells C., op. cit.
43) Veshi D., Comments on the Lambert case: the rulings of the French Conseil d’État and the European Court of Human Rights, in Med Health Care Philos, 2017, 20:187-193.
44) British Medical Association, Withholding and Withdrawing Life-prolonging Medical Treatment: Guidance for Decision Making, in Blackwell Publishing, 2007, Oxford.
45) Veshi D., Neitzke G., Advance directives in some western european countries: a legal and ethical comparison between Spain, France, England, and Germany, in Eur J Health Law, 2015, 22: 321-345.
46) The Italian Parliament has two chambers: the Chamber of Deputies and the Senate. In Italy, a draft bill becomes law only if the two chambers approve it in the identical text.
47) Veshi D., op. cit.
48) Council of Europe, Explanatory report Recommendation CM/Rec (2009) 11, par. 98.
49) This is why during the parliamentary discussion regarding the Mental Capacity Act, the Joint Committee decided to give the opportunity to the donor to nominate more than one surrogate. This Committee has also allowed the judge to nominate more than one deputy in case of total absence of the surrogate (Joint Committee on the Draft Mental Incapacity Bill 2003).
50) Veshi D., op. cit.
51) Veshi D., Neitzke G., op. cit.
52) Veshi D., Studio relativo alla applicazione della Raccomandazione CM / Rec (2009) 11 negli Stati di lingua latina (Italia, Francia, Portogallo e Spagna), tedesca (Austria, Germania e Svizzera) e inglese (Irlanda e Regno Unito di Gran Bretagna e Irlanda del Nord, in RIML, 2015, 3: 1277-1294.
53) European Court of Human Rights, application no. 61827/00; application no. 53924/00; application no. 44009/05.
54) Sahm S, Will R., Hommel G., Attitudes towards and barriers to writing advance directives amongst cancer patients, healthy controls, and medical staff, in J. Med. Ethics., 2005, 31:437-440.
55) Jox R.J., Michalowski S., Lorenz J., Schildmann J., Substitute decision making in medicine: comparative analysis of the ethico-legal discourse in England and Germany, in Med. Health Care Philos., 2008, 11:153-163.
56) Kim S.Y.H., Kim H.M., Langa K.M., Karlawish L.H.T., Knopman D.S., Appelbaum P.S., Surrogate consent for dementia research A national survey of older Americans, in Neurology 2009, 72:149-155.
57) Probst M., Knittel B., Gesetzliche Vertretung durch Angehörige-Alternative zur Betreuung?, in ZRP, 2001, 55-60.
58) Budroni H., The family as proxy.Pflege Zeit, 2014; 10:600-603; Bundesministerium der Justiz, “Verfahren nach Betreuungsgesetz 1992-2009.” http://www.bmj.de/SharedDocs/Downloads/DE/pdfs/Betreuungsgesetz_Verfahren.html); Cohen-Mansfield J., Rabinovich B.A., Lipson S., Fein A., Gerber B., Weisman S.H., Pawlson L.G., The decision to execute a durable power of attorney for health care and preferences regarding the utilization of life-sustaining treatments in nursing home residents, in Arch. Intern. Med., 1991, 151:289-294.
59) Bundesministerium der Justiz, op. cit.
60) Karasz A., Sacajiu G., Kogan M., Watkins L., The rational choice model in family decision making at the end of life, in J. Clin. Ethics., 2010, 21:189-200.
61) Cohen-Mansfield J., op. cit.
62) Menaca A., Evansa N., Andrew E.V.W., Toscani F., Finetti S., Gómez-Batiste X., Irene J.Higginson, Harding R., Pool R., Gysels M., End-of-life care across Southern Europe: a critical review of cultural similarities and differences between Italy, Spain and Portugal, in  Crit Rev Oncol Hematol, 2012, 82:387-401.
63) Costantini M., Beccaro M., Higginson I.J., Cancer trajectories at the end of life: is there an effect of age and gender?, in BMC Cancer., 2008, 8:127; Rossi P.G., Beccaro M., Miccinesi G., Borgia P., Costantini M., Chini F., Baiocchi D., De Giacomi G., Grimaldi M., Montella M., The Isdoc Working Group, Dying of cancer in Italy: impact on family and caregiver. The Italian Survey of Dying of Cancer, in J. Epidemiol Community Health, 2007, 61:547-554.
64) Court of Cassation, decision no. 21748 of October 16 th, 2007.
65) Application no. 46043/14 decided on June 5 th, 2015.
66) Court of first instance of Reims, 10 March 2016, also approved by the Court of Appeal of Reims, 8 July 2016 and the Court of Cassation, 8 December 2016.
67) Peter K., Jacob R., The Barcelona Declaration. Towards an Integrated Approach to Basic Ethical Principles, in Synthesis Phylosophica, 2008, 46: 239-251.
68) Rendtorff J.D., Basic ethical principles in European bioethics and biolaw: autonomy, dignity, integrity and vulnerability-towards a foundation of bioethics and biolaw, in Med. Health Care Philos, 2002, 5:235-244.
69) Kemp P., Rendtorff J.D., op. cit.
*) Questo articolo è stato finanziato dal fondo per le pubblicazioni presso l’Università di Haifa, Israele.
**) This paper is funded by ‘Article Publication Grant’ of the University of Haifa, Israel.
*) Section 1 and 4 are written by Dr. Denard Veshi. Sections 2 and 2.1 are written by Prof. Carlo Venditti. Section 3 is written by Dr. Enkelejda Koka.
1) World Health Organization, in European Health Report 2012: Charting the Way to Well-being, 2012, WHO Regional Office for Europe, Copenhagen. http://www.euro.who.int/__data/assets/pdf_file/0004/197113/EHR2012-Eng.pdf.
2) Swetz K.M., Matlock D.D., Ottenberg A.L., Mueller P.S., Advance directives, advance care planning, and shared decision making: promoting synergy over exclusivity in contemporary context, in  J. Pain Symptom Manage, 2014, 47:e1-e3; Tibaldi G., Salvador-Carulla L., Garcia-Gutierrez C.J., From treatment adherence to advanced shared decision making: new professional strategies and attitudes in mental health care, in Curr. Clin. Pharmacol., 2011, 6:91-99.
3) Medtech Europe, The European Medical Technology Industry in Figures, in MedTech Europe, 2015, Brussels.
4) Constitutional Court, decisions of 24 October 2007, no. 348 and no. 349. The Court recognized that, under Article 11 of the Italian Constitution, EU Treaties are legally binding and supreme.
5) President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, ‘Making Health Care Decisions’, 1982 [online] http://kie.georgetown.edu/nrcbl/documents/pcemr/makingdecisions.pdf; Bundesärztekammer, Zentrale Ethikkommission bei der Bundesärztekammer, ‘Empfehlungen der Bundesärztekammer und der Zentralen Ethikkommission bei der Bundesärztekammer zum Umgang mit Vorsorgevollmacht und Patientenverf ̈ugung in der ärztlichen Praxis’, 2013 [online] http://www.bundesaerztekammer.de/downloads/Empfehlungen_BAeKZEKO_Vorsorgevollmacht_Patientenverfuegung_19082013l.pdf.
6) The term « living will » can be confusing, because wills take effect only after the testator’s death and are directed at other people. However A.D. s are intended to conform physicians’ acts to patients’ wishes while they are still alive. Spoto G., Direttive anticipate, testamento biologico e tutela della vita, in Eur dir pri., 2005, I, 179-204.
7) British Medical Association, BMA statement on advance directives, BMA, London, 1992.
8) Fagerlin A., Ditto P.H., Hawkins N.A., Schneider C.E., Smucker W.D., The use of advance directives in end-of-life decision making: Problems and possibilities, in Am Behav Sci., 2002, 46, 268-283; Neitzke G., Umgang mit Patientenverfügungen in der Praxis, in Public Health Forum, 2013, 21:12-13, doi: 10.1016/j.phf.2013.06.009.
9) Article 10 of the Medical Capacity Act in England establishes the concept of donee.
10) Buchanan A.E., Brock D.W., Deciding for others: the ethics of surrogate decision making, Cambridge University Press, Cambridge, 1989.
11) Olick R.S., On the Scope and Limits of Advance Directives and Prospective Autonomy. In Advance Directives, Springer, Netherlands, 2014; Wallace S.K., Martin C.G., Shaw A.D., Price K.J., Influence of an advance directive on the initiation of life support technology in critically ill cancer patients, in Crit Care Med., 2001, 29:2294-2298.
12) Berger J.T., Majerovitz D., Stability of preferences for treatment among nursing home residents, Gerontologist, 1998, 38:217-223; Danis M., Garrett J., Harris R., Patrick D.L., Stability of choices about life-sustaining treatments, in Ann. Intern. Med., 1994, 120:567-573; Carmel S., Mutran E.J. Stability of elderly persons’ expressed preferences regarding the use of life-sustaining treatments, in Soc. Sci. Med., 1999; 49, 303-311; Ditto P.H., Smucker W.D., Jacobson J.H., Houts J.A., Fagerlin R.M., Coppola A., Gready K.M., Mitchell R., Stability of older adults’ preferences for life-sustaining medical treatment, in Health Psychol, 2003, 22: 605.
13) Baier A., Moral prejudices: Essays on ethics, in Harvard University Press, Harvard, 1995.
14) Lagerspetz O., The Notion of Trust in Philosophical Psychology, in Commonality and Particularity in Ethics, 1997, pp. 95-117, Palgrave Macmillan UK.
15) Baier A., op. cit.
16) Powell T., Extubating Mrs. K: Psychological aspects of surrogate decision making, in J Law Med Ethics, 1999, 27:81-86.
17) Kapp M.B., Commentary: Anxieties as a legal impediment to the doctor-proxy relationship, in J. Law Med Ethics, 1999, 27:69-73; Sabatino C.P., The legal and functional status of the medical proxy: suggestions for statutory reform, in J. Law Med Ethics, 1999, 27:52-68.
18) Macintyre A., After Virtue: A Study in Moral Theory, in University of Notre Dame Press, 1984, Notre Dame.
19) MANCA TESTO
20) Steinbock B (Ed.), The Oxford handbook of bioethics, in Oxford University Press, 2007, Oxford.
21) Brody H., Stories of sickness, in Oxford University Press, 2002, Oxford.
22) Blustein J., Choosing for others as continuing a life story: The problem of personal identity revisited, in J. Law Med Ethics., 1999, 27:20-31.
23) Beauchamp T.L., Childress J.F., Principles of biomedical ethics, in Oxford University Press, 2001, Oxford.
24) Woods S., Death’S Dominion: Ethics At The End Of Life: Ethics at the end of life, McGraw-Hill Education, London, 2006.
25) Degner L.F., Sloan Ja., Venkatesh P., The control preferences scale, in CJNR, 1997, 29:3.
26) Owens J., Creating an impersonal NHS? Personalization, choice and the erosion of intimacy, in Health Expect., 2015, 18:22-31; Entwistle V.A., Carter S.M., Cribb A., Mccaffery K., Supporting patient autonomy: the importance of clinician-patient relationships, in J. Gen Intern Med., 2010, 25:741-745.
27) Gomes B., Calanzani N., Higginson I.J., Local preferences and place of death in regions within England 2010., in Cicely Saunders International, 2011, London.
28) Sheldon S., Thomson M., Feminist perspectives on health care law, in Routledge-Cavendish, 1998, New York.
29) Venkatasalu M.R., Seymour J., Arthur T., Understanding the meaning of end-of-life discussions and related decisions among older South Asians living in East London: a qualitative inquiry, in BMJ Support Palliat Care, 2011; 1, 79-80; Worth A., Irshad T., Bhopal R., Brown D., Lawton J., Grant E., Murray S., Kendall M., Adam J., Gardee R., Sheikh A., Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study, in BMJ, 2009, 338: b183.
30) Howarth G, Death and dying: A sociological introduction, in Polity, 2007, Cambridge.
31) Lavoie M., Blondeau D., Picard-Morin J., The autonomy experience of patients in palliative care, in  JHPN, 2011, 13:47-53.
32) Broom A., Kirby E., The end of life and the family: hospice patients’ views on dying as relational, in Sociol Health Illn., 2013, 35:499-513.
33) Rini C., Jandorf L., Goldsmith R.E., Manne Sh.L., Harpaz N., Itzkowitz S.H.., Interpersonal influences on patients’ surgical decision making: the role of close others, in Int. J. Behav. Med., 2011, 34:396-407; Corrigan P., How stigma interferes with mental health care, in Am. Psychol., 2004; 59:614; Lewis M.A., Rook K.S., Social control in personal relationships: impact on health behaviors and psychological distress, in Health Psychol., 1999, 18:63.
34) Thomas C., Morris S.M., Clark D., Place of death: preferences among cancer patients and their carers, in Soc. Sci. Med., 2004, 58:2431-2444.
35) Wilson F., Ingleton C.H., Gott M., Gardiner C., Autonomy and choice in palliative care: time for a new model?, in J. Adv. Nurs., 2014, 70:1020-1029.
36) Hunt M.R., Ells C., Partners towards autonomy: risky choices and relational autonomy in rehabilitation care, in Disabil Rehabil., 2011, 33:961-967.
37) Zelderloo L., Autonomy, belonging and interdependency, in IJIC, 2009m 9(5).
38) Mackenzie C., Stoljar N. (Eds.), Relational autonomy: Feminist perspectives on automony, agency, and the social self, in Oxford University Press on Demand, 2000.
39) Baier A., Postures Of The Mind: Essays On Mind And Morals, in U of Minnesota Press., 1985, Minnesota.
40) Mackenzie C., Stoljar N., op. cit.
41) Sheldon S., Thomson M., op. cit.
42) Hunt Mr., Ells C., op. cit.
43) Veshi D., Comments on the Lambert case: the rulings of the French Conseil d’État and the European Court of Human Rights, in Med Health Care Philos, 2017, 20:187-193.
44) British Medical Association, Withholding and Withdrawing Life-prolonging Medical Treatment: Guidance for Decision Making, in Blackwell Publishing, 2007, Oxford.
45) Veshi D., Neitzke G., Advance directives in some western european countries: a legal and ethical comparison between Spain, France, England, and Germany, in Eur J Health Law, 2015, 22: 321-345.
46) The Italian Parliament has two chambers: the Chamber of Deputies and the Senate. In Italy, a draft bill becomes law only if the two chambers approve it in the identical text.
47) Veshi D., op. cit.
48) Council of Europe, Explanatory report Recommendation CM/Rec (2009) 11, par. 98.
49) This is why during the parliamentary discussion regarding the Mental Capacity Act, the Joint Committee decided to give the opportunity to the donor to nominate more than one surrogate. This Committee has also allowed the judge to nominate more than one deputy in case of total absence of the surrogate (Joint Committee on the Draft Mental Incapacity Bill 2003).
50) Veshi D., op. cit.
51) Veshi D., Neitzke G., op. cit.
52) Veshi D., Studio relativo alla applicazione della Raccomandazione CM / Rec (2009) 11 negli Stati di lingua latina (Italia, Francia, Portogallo e Spagna), tedesca (Austria, Germania e Svizzera) e inglese (Irlanda e Regno Unito di Gran Bretagna e Irlanda del Nord, in RIML, 2015, 3: 1277-1294.
53) European Court of Human Rights, application no. 61827/00; application no. 53924/00; application no. 44009/05.
54) Sahm S, Will R., Hommel G., Attitudes towards and barriers to writing advance directives amongst cancer patients, healthy controls, and medical staff, in J. Med. Ethics., 2005, 31:437-440.
55) Jox R.J., Michalowski S., Lorenz J., Schildmann J., Substitute decision making in medicine: comparative analysis of the ethico-legal discourse in England and Germany, in Med. Health Care Philos., 2008, 11:153-163.
56) Kim S.Y.H., Kim H.M., Langa K.M., Karlawish L.H.T., Knopman D.S., Appelbaum P.S., Surrogate consent for dementia research A national survey of older Americans, in Neurology 2009, 72:149-155.
57) Probst M., Knittel B., Gesetzliche Vertretung durch Angehörige-Alternative zur Betreuung?, in ZRP, 2001, 55-60.
58) Budroni H., The family as proxy.Pflege Zeit, 2014; 10:600-603; Bundesministerium der Justiz, “Verfahren nach Betreuungsgesetz 1992-2009.” http://www.bmj.de/SharedDocs/Downloads/DE/pdfs/Betreuungsgesetz_Verfahren.html); Cohen-Mansfield J., Rabinovich B.A., Lipson S., Fein A., Gerber B., Weisman S.H., Pawlson L.G., The decision to execute a durable power of attorney for health care and preferences regarding the utilization of life-sustaining treatments in nursing home residents, in Arch. Intern. Med., 1991, 151:289-294.
59) Bundesministerium der Justiz, op. cit.
60) Karasz A., Sacajiu G., Kogan M., Watkins L., The rational choice model in family decision making at the end of life, in J. Clin. Ethics., 2010, 21:189-200.
61) Cohen-Mansfield J., op. cit.
62) Menaca A., Evansa N., Andrew E.V.W., Toscani F., Finetti S., Gómez-Batiste X., Irene J.Higginson, Harding R., Pool R., Gysels M., End-of-life care across Southern Europe: a critical review of cultural similarities and differences between Italy, Spain and Portugal, in  Crit Rev Oncol Hematol, 2012, 82:387-401.
63) Costantini M., Beccaro M., Higginson I.J., Cancer trajectories at the end of life: is there an effect of age and gender?, in BMC Cancer., 2008, 8:127; Rossi P.G., Beccaro M., Miccinesi G., Borgia P., Costantini M., Chini F., Baiocchi D., De Giacomi G., Grimaldi M., Montella M., The Isdoc Working Group, Dying of cancer in Italy: impact on family and caregiver. The Italian Survey of Dying of Cancer, in J. Epidemiol Community Health, 2007, 61:547-554.
64) Court of Cassation, decision no. 21748 of October 16 th, 2007.
65) Application no. 46043/14 decided on June 5 th, 2015.
66) Court of first instance of Reims, 10 March 2016, also approved by the Court of Appeal of Reims, 8 July 2016 and the Court of Cassation, 8 December 2016.
67) Peter K., Jacob R., The Barcelona Declaration. Towards an Integrated Approach to Basic Ethical Principles, in Synthesis Phylosophica, 2008, 46: 239-251.
68) Rendtorff J.D., Basic ethical principles in European bioethics and biolaw: autonomy, dignity, integrity and vulnerability-towards a foundation of bioethics and biolaw, in Med. Health Care Philos, 2002, 5:235-244.
69) Kemp P., Rendtorff J.D., op. cit.
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