ABSTRACT

In the last decade, an extensive debate on the topic of end of life decisions has developed in Western countries, obtaining a worldwide media relevance. Philosophers, theologians, legal experts and doctors focus their attention on the three thorny issues of the topic: forgoing treatments, euthanasia and assisted suicide. A thorough and respectful discussion on these issues should include all stakeholders – above all palliative care physicians – and should be encouraged in order to understand the views in favor or against the three practices, checking the different moral positions, and analyzing the cultural, social and legal aspects in the background on one hand, and, on the other, their impact on the health care systems. At present, in the fields of communications and politics, the debate related to the topic of these end of life practices is characterized by a confusion of terms and meanings. As an outcome, the term “euthanasia” is misused as a “container” including forgoing treatments, euthanasia and assisted suicide, while palliative sedation is wrongly considered as a procedure to cause death. This confusing approach does not permit to understand the real issues at the stake, keeping the debate at the tabloid level. Conversely, sharing the precise meaning of the words is the only way to provide tools to make rational, autonomous and responsible decisions, allowing individual informed choices in compliance with the principle of autonomy. This article is not aimed to take a moral stand in favor or against forgoing treatments, euthanasia and assisted suicide. Through an analysis based on scientific criteria, the authors firstly review the definitions of these three practices, examining the concepts enclosed in each term; secondly, they offer a glance on the legal approach to end of life issues in western countries; lastly, they investigate the relationship between these practices and palliative care culture in light of the medical societies official statements. The authors chosen to examine the topic of forgoing treatments, euthanasia and assisted suicide from a scientific point of view, because the clinical approach, taking into account the biological context of disease related to the human and social domains, seems to be able to better gather all the aspects of end of life practices, providing useful information to deal with them also in a philosophical or juridical perspective.