ROME – Daniel Sulmasy spoke last month before the Italian Senate at a hearing on possible legislation about advance directives in Italy. The country currently has no law authorizing documents such as living wills or durable powers of attorney for healthcare.
Dan, who is a physician and professor of bioethics at St. Vincent’s Hospital, Manhattan, and New York Medical College, was one of three foreign experts asked to present before the Senate of the Republic of Italy on March 29. He served as the spokesperson for the three.
In his talk, titled “Advance Directives as an Extension of the Tradition of Forgoing Extraordinary Means of Care,” Dan described advance directives as an extension of the moral tradition of forgoing extraordinary means of care.
“They have nothing to do with debates about euthanasia,” Dan said. “Extraordinary means are optional means. Treatments become extraordinary if they are futile or if the burdens outweigh the benefits. By tradition, the person who judges an intervention extraordinary is the patient, not the doctor.“
Dan’s abstract stated that if a patient is unable to speak, the family has traditionally decided healthcare options. With so much new technology, there are innumerable decisions to be made for patients who cannot speak for themselve, he said.
Advance directives are useful instruments for re-asserting traditional moral approaches to the forgoing of extraordinary means. He said that the term ‘Accanimentolinguistically’ distorts the tradition and narrows choices that traditionally have been open to patients and families.
Advance directives, especially health care proxies, are an aid to families and friends who, in conjunction with physicians, must make these difficult decisions for their loved ones, Dan said. This intervention will end with a description of two cases illustrating the clinical usefulness of advance directives — one involving a ventilator for a brain damaged homeless person and the other the use of a feeding tube in a patient at the very terminal stages of Alzheimer’s disease.
Dan presented his information and opinions in Italian, which he said was “a real challenge but also great fun.” He said that his remarks seemed well-received.
“A bipartisan drafting committee will now craft legislation,” Dan said, adding that,” there is bipartisan support and chances of passage appear good.”
Dan said that the current chair of the senate’s health committee, Senator Ignazio Marino, is a surgeon who trained in the U.S.
“I suspect that he read some of my articles while he was here, and that may be how I was asked to participate in this presentation,” Dan said.