The state of knowledge of young Italian medicolegal doctors on the law of provisions for informed consent and advance treatment directives: a multi-centric survey two years after the enactment of Law 219 of 2017.

Main Article Content

Matteo Bolcato
Alessandro Feola
Matteo Sanavio
Alberto Amadasi
Stefano Crenna
Gianluca Landi
Camilla Tettamanti

Keywords

informed consent, self-determination, advance directives, shared care plan, conscientious objection, legal medicine

Abstract

Background. On 22 December 2017, Law number 219 was approved in Italy entitled “Provisions for informed consent and advance treatment directives”. We aim to examine the knowledge of these provisions of Italian medico legal fellows, and the ability of Italian university healthcare facilities to implement the principles of the new law.


Methods. A survey was conducted by means of a questionnaire sent to members of a scientific society. The society had 357 members and represents more than 75% of the Italian doctors in training and 32 university healthcare facilities in Italy. 27 facilities and 45% of the society’s members participated in this enquiry.


Results. The majority (68%) of those interviewed felt they had acquired an adequate knowledge of the Law but only 60% of them were able to indicate how for filing legally valid advance directives (60% vs. 40%) and only 37% knew how drafting a shared care plan. 89% of the pool felt that legal recognition of a patient’s self-determination was useful for enhancing the care relationship. The 74% of the facilities analyzed have organized training activities regarding the contents of the law but only 26% have updated their procedures on the practical implementation of the law and their informed consent forms. 60% of the facilities perform medico legal consultation activities and in 15% of the facilities, there has been resistance to the application of the law.


Conclusion. Many of the facilities have performed training activities but lack effective implementation of the activities required. With increased knowledge and organization this could be overcome.

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References

[1] Solarino B, Bruno F, Frati G, Dell'Erba A, Frati P. A national survey of the attitudes of Italian physicians towards end-of-life decisions following the death of Eluana Englaro. Intensive Care Med 2011; 37(3): 542-49.
[2] Moreschi C, Da Broi U, Rodriguez D, Froldi R, Porzionato A, Macchi V, De Caro R. The Eluana Englaro Case: cause of death after the withdrawal of artificial nutrition and hydration in a subject in a permanent vegetative state and with quadriplegia. Forensic Sci Int 2013; 231(1-3): e24-9.
[3] Rubulotta F, Rubulotta G, Santonocito C, Ferla L, Celestre C, Occhipinti G, Ramsay G. End-of-life care is still a challenge for Italy. Minerva Anestesiol 2010; 76 (3): 203-8.
[4] Gristina GR, De Gaudio R, Mazzon D, Curtis JR. End of life care in Italian intensive care units: where are we now?. Minerva Anestesiol 2011; 77(9): 911-20.
[5] Striano P, Bifulco F, Servillo G. The saga of Eluana Englaro: another tragedy feeding the media. Intensive Care Med 2009; 35(6): 1129-31.
[6] Ciliberti R, Bonsignore A, Panici MT, Pedrucci T, De Sterfano F. Advance treatment directives from the Italian legislation perspective and medico-legal implications. Riv It Med Leg 2012; 4: 1479.
[7] Testoni I, Sposito DD, De Cataldo L, Ronconi L. Life at all costs? Italian social representations of end -of-life decisions after President Napolitano’s speech - margin notes on withdrawing artificial nutrition and hydration. Nutritional Therapy and Metabolism 2014; 32: 121-35.
[8] Marchese V, Bolcato M, Tozzo P, Rodriguez D. Amministrazione di sostegno e direttive anticipate di trattamento. Riv It Med Leg 2016; 3: 1053-1054.
[9] Fucci S. La relazione medico-paziente alla luce del nuovo codice deontologico del 18/05/2014. Decidere in Medicina. Riv It Med Leg 2014; 5: 48-55.
[10] Rodriguez D. Il rifiuto delle cure nella prospettiva del Codice di Deontologia Medica: una guida per la pratica clinica? Riv It Med Leg 2014; 36(2): 563-591.
[11] Anzani G. Consenso ai trattamenti medici e scelte di fine vita, Danno e Resp. Damages and Liability 2008; 10: 957-64.
[12] Barni M, Pomara C, Turillazzi E. Direttive, anzi dichiarazioni anticipate di trattamento: le insidie di un viraggio semantico. Riv It Med Leg 2004; 26(3-4): 577-602.
[13] Correnti FR, Fineschi V, Frati P, Giulino M. Direttive anticipate di trattamento e amministrazione di sostegno: la Corte di Cassazione richiede lo stato d’incapacità attuale e non futuro. Resp Civ Prev 2014; 79(1): 695-703.
[14] Cacace S. Il rifiuto del trattamento sanitario, a scanso d’ogni equivoco. Riv It Med Leg 2014; 36(2): 547-562.
[15] Bolcato M, Fassina G, Rodriguez D, Russo M, Aprile M. The contribution of legal medicine in clinical risk management. BMC Health Serv Res 2019; 19(1): 85.
[16] Bevilacqua G, Bolcato M, Rodriguez D, Aprile A. Shared care plan: an extraordinary tool for the personalisation of medicine and respect for self-determination. Acta Biomed. 2020Apr.29;92(1).
[17] Ciliberti R, Gorini I, Gazzaniga V, De Stefano F , Gulino M. The Italian Law on Informed Consent and Advance Directives: New Rules of Conduct for the Autonomy of Doctors and Patients in End-Of-Life Care. J Crit Care. 2018 Dec;48:178-182
[18] Viola RV, Di Fazio N, Del Fante Z, Fazio V, Volonnino G, Romano S, Quattrocchi A, Arcangeli M.Rules on informed consent and advance directives at the end-of-life: the new Italian law. Clin Ter. 2020 Mar-Apr;171(2):e94-e96.
[19] Ciliberti R, Gulino M, Gorino I. New Italian Law About End of Life: Self-Determination and Shared Care Pathway. Recenti Prog Med. 2018 May;109(5):267-271.
[20] Bolcato M, Russo M, Sanavio M, Rodriguez D, Aprile A. The clinical legal medicine: a need for quality of care and patient’s safety. A single center five-year experience. Acta Biomed. 2020Apr.29;91(4).
[21] Di Paolo M, Gori F, Papi L, Turillazzi E. A review and analysis of new Italian Law 219/2017: 'provisions for informed consent and advance directives treatment'. BMC Med Ethics 2019; 20(1): 17.
[22] Di Luca A, del Rio A, Bosco M, di Luca NM. Law on advance health care directives: a medical perspective. Clin Ter 2018; 169 (2): e77-81.
[23] Vallini A. Pianificazione delle cure, medicina palliativa. i nuovi paradigmi del “fine vita”. Riv It Med Leg 2016; 3: 1140-1141.
[24] Vettori N. Il diritto alla salute alla fine della vita: obblighi e responsabilità dell’amministrazione sanitaria. Riv It Med Leg 2016; 4: 1463-1480.
[25] Ciliberti R, Baldelli I, Gallo F, Patuzzo S, De Stefano F, Bonsignore A. Physicians' perception of the importance of ethical and deontological issues in a major Italian Province: pilot questionnaire and its validation. Acta Biomed. 2019 Jan 21;90(1):56-67.
[26] Stellato K, Romanò M. Information to be provided to patients and their caregivers. The Italian Law 219/2017 on informed consent, advance directives, and do not attempt resuscitation order. G Ital Cardiol (Rome). 2020;21(4):306-308.

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