Piergiorgio Welby
Piergiorgio Welby is dead. He died because his physicians honoured his clear will to end his life that had become intolerable for him in the natural course of degenerative disease of the neuromuscular system for which there is no cure so far. They cut off the artificial ventilation that had maintained his failing respiration.
Conventional medical ethics demand the maintenance of life support as long as a patient ist not brain-dead, on the basis of the assumption that a cure for the disease responsible for the failure of physiological functions might be available in a foreseeable future. In the conscious patient with a chronic condition which steadily continues to deteriorate, the situation is different. Even if there is non cure in sight, some, but not all patients with similar conditions are able to adapt to their situation (tetraplegics, but also some persons with degenerative neuromuscular disease, such as famous astrophysicist Stephen Hawking). What if a patient is uncapable in the long run to cope mentally with her/his condition? Is it correct to view the decision to commit suicide per se as the result of a pathological process that could be treated successfully, e.g. depression?
Where are the limits of coercion that can be used in order to maintain life when a fully conscious person, capable of reasoning, clearly declares that she/he is no longer willing to undergo the treatment imposed by the failure of her/his physiological functions? Where is the line between a treatement that is lived as torture by the patient and the obligation of the health care provider to respect
codified ethics and legal rules?
These questions are now raised in Italy and will produce a useful debate on the responsibility of legislators in medical and bio-ethics, as well as the responsibility of the individual health care provider and the freedom of choice of the conscious patient. The outcome of the debate will show us if respect for the individual person is strong enough to block attempts by fundamentalist religious authorities and political movements to enforce therapies that eventually become equivalents of torture.