Introduction: Physician-assisted suicide is one of the most controversial issues in contemporary bioethical debate. It concerns the support provided by a healthcare professional to a patient wishing to end their life due to serious and irreversible medical conditions. The topic involves significant ethical, legal, and healthcare-related aspects, particularly regarding the principle of patient self-determination and the role of healthcare professionals in end-of-life decisions. In the Italian context, the practice is still a matter of debate and is primarily regulated by case law, in the absence of comprehensive national legislation. Objective: This thesis aims to analyze the main scientific evidence relating to physician-assisted suicide, with particular attention to the role of nurses in the care process, their professional experiences, and the ethical and emotional implications associated with this practice, in order to highlight critical issues and emerging needs in clinical practice. Materials and Methods: A narrative review of the literature was conducted by consulting major biomedical databases, including PubMed/MEDLINE and Google Scholar, supplemented by analysis of scientific journals, institutional documents, and national and international regulatory sources. The research question was formulated according to the PICO methodology, considering the population of patients with serious and irreversible diseases involved in end-of-life decisions; the intervention was physician-assisted suicide; the comparison was palliative care and other therapeutic support modalities; and the outcome was an understanding of the ethical, regulatory, and healthcare implications for healthcare professionals. Results: The literature analyzed highlights how physician-assisted suicide is regulated differently in different countries and how the role of nurses in the care process is particularly complex. Nurses are often the healthcare professionals closest to the patient in the final stages of life and may be the first to receive requests for assisted dying. Their involvement is characterized by significant emotional, ethical, and professional implications, related to managing the patient's suffering, communicating with the family, and the moral dilemmas associated with the practice, in addition to the need to balance professional responsibility and personal values. Conclusions: Physician-assisted suicide is a complex phenomenon that requires a multidisciplinary approach capable of integrating ethical, legal, and healthcare aspects. Regulation of the practice varies across countries, reflecting different cultural and regulatory orientations, while in Italy, uncertainty persists due to the lack of comprehensive legislation and reliance on case law. From a bioethical perspective, a tension emerges between the principle of patient self-determination and the duty to protect life, necessitating a balance that takes into account the dignity of the person and their vulnerability. In this context, the role of nurses is central yet delicate: they, often closest to the patient in the final stages, find themselves managing complex requests with significant emotional, ethical, and professional implications, as well as potential conflicts related to conscientious objection. It is therefore essential to strengthen training and ensure ethical and psychological support tools, along with the development of a clearer regulatory framework, to protect patients and professionals and ensure dignified care. Keywords: Physician-assisted suicide; End-of-life decisions; Bioethics; Nursing role; Conscientious objection; Palliative care.
Introduzione: Il suicidio medicalmente assistito rappresenta una delle tematiche più controverse nel dibattito bioetico contemporaneo e riguarda il supporto fornito da un professionista sanitario a un paziente che desidera porre fine alla propria vita in presenza di condizioni cliniche gravi e irreversibili. Il tema implica rilevanti aspetti etici, giuridici e assistenziali, soprattutto in relazione al principio di autodeterminazione del paziente e al ruolo dei professionisti sanitari nelle decisioni di fine vita. Nel contesto italiano, la pratica è ancora oggetto di dibattito ed è regolata principalmente da interventi giurisprudenziali, in assenza di una normativa organica nazionale. Obiettivo: Questa tesi ha come obiettivo analizzare le principali evidenze scientifiche relative al suicidio medicalmente assistito, con particolare attenzione al ruolo degli infermieri nel processo assistenziale, alle loro esperienze professionali e alle implicazioni etiche ed emotive associate a questa pratica, al fine di evidenziare criticità e bisogni emergenti nella pratica clinica. Materiali e Metodi: È stata condotta una revisione narrativa della letteratura attraverso la consultazione delle principali banche dati scientifiche biomediche, tra cui PubMed/MEDLINE e Google Scholar, integrata con l’analisi di riviste scientifiche, documenti istituzionali e fonti normative nazionali e internazionali. Il quesito di ricerca è stato formulato secondo la metodologia PICO, considerando come popolazione i pazienti affetti da patologie gravi e irreversibili coinvolti in decisioni di fine vita, come intervento il suicidio medicalmente assistito, come confronto le cure palliative e le altre modalità di accompagnamento terapeutico, e come outcome la comprensione delle implicazioni etiche, normative e assistenziali per i professionisti sanitari. Risultati: La letteratura analizzata evidenzia come il suicidio medicalmente assistito sia regolamentato in modo differente nei vari Paesi e come il ruolo degli infermieri nel processo assistenziale risulti particolarmente complesso. Gli infermieri sono spesso i professionisti sanitari più vicini al paziente nelle fasi finali della vita e possono essere i primi a ricevere richieste relative alla morte assistita. Il loro coinvolgimento è caratterizzato da rilevanti implicazioni emotive, etiche e professionali, legate alla gestione della sofferenza del paziente, alla comunicazione con la famiglia e ai dilemmi morali connessi alla pratica, oltre alla necessità di bilanciare responsabilità professionale e valori personali. Conclusioni: Il suicidio medicalmente assistito è un fenomeno complesso che richiede un approccio multidisciplinare capace di integrare aspetti etici, giuridici e assistenziali. La regolamentazione della pratica varia tra i diversi Paesi, riflettendo differenti orientamenti culturali e normativi, mentre nel contesto italiano persiste una situazione di incertezza legata all’assenza di una normativa organica e alla dipendenza da interventi giurisprudenziali. Dal punto di vista bioetico emerge una tensione tra il principio di autodeterminazione del paziente e il dovere di tutela della vita, rendendo necessario un equilibrio che tenga conto della dignità della persona e della sua vulnerabilità. In questo contesto, il ruolo degli infermieri è centrale ma delicato: essi, spesso più vicini al paziente nelle fasi finali, si trovano a gestire richieste complesse con rilevanti implicazioni emotive, etiche e professionali, oltre a possibili conflitti legati all’obiezione di coscienza. Risulta quindi fondamentale rafforzare la formazione e garantire strumenti di supporto etico e psicologico, insieme allo sviluppo di un quadro normativo più chiaro, per tutelare pazienti e professionisti e garantire un’assistenza dignitosa. Parole chiave: Suicidio medicalmente assistito; Decisioni di fine vita; Bioetica; Ruolo infermieristico; Obiezione di coscienza; Cure palliative.
Il diritto di scegliere: il suicidio medicalmente assistito tra profili giuridici, bioetici e le implicazioni per la pratica infermieristica.
CICCIOLI, JENNY
2024/2025
Abstract
Introduction: Physician-assisted suicide is one of the most controversial issues in contemporary bioethical debate. It concerns the support provided by a healthcare professional to a patient wishing to end their life due to serious and irreversible medical conditions. The topic involves significant ethical, legal, and healthcare-related aspects, particularly regarding the principle of patient self-determination and the role of healthcare professionals in end-of-life decisions. In the Italian context, the practice is still a matter of debate and is primarily regulated by case law, in the absence of comprehensive national legislation. Objective: This thesis aims to analyze the main scientific evidence relating to physician-assisted suicide, with particular attention to the role of nurses in the care process, their professional experiences, and the ethical and emotional implications associated with this practice, in order to highlight critical issues and emerging needs in clinical practice. Materials and Methods: A narrative review of the literature was conducted by consulting major biomedical databases, including PubMed/MEDLINE and Google Scholar, supplemented by analysis of scientific journals, institutional documents, and national and international regulatory sources. The research question was formulated according to the PICO methodology, considering the population of patients with serious and irreversible diseases involved in end-of-life decisions; the intervention was physician-assisted suicide; the comparison was palliative care and other therapeutic support modalities; and the outcome was an understanding of the ethical, regulatory, and healthcare implications for healthcare professionals. Results: The literature analyzed highlights how physician-assisted suicide is regulated differently in different countries and how the role of nurses in the care process is particularly complex. Nurses are often the healthcare professionals closest to the patient in the final stages of life and may be the first to receive requests for assisted dying. Their involvement is characterized by significant emotional, ethical, and professional implications, related to managing the patient's suffering, communicating with the family, and the moral dilemmas associated with the practice, in addition to the need to balance professional responsibility and personal values. Conclusions: Physician-assisted suicide is a complex phenomenon that requires a multidisciplinary approach capable of integrating ethical, legal, and healthcare aspects. Regulation of the practice varies across countries, reflecting different cultural and regulatory orientations, while in Italy, uncertainty persists due to the lack of comprehensive legislation and reliance on case law. From a bioethical perspective, a tension emerges between the principle of patient self-determination and the duty to protect life, necessitating a balance that takes into account the dignity of the person and their vulnerability. In this context, the role of nurses is central yet delicate: they, often closest to the patient in the final stages, find themselves managing complex requests with significant emotional, ethical, and professional implications, as well as potential conflicts related to conscientious objection. It is therefore essential to strengthen training and ensure ethical and psychological support tools, along with the development of a clearer regulatory framework, to protect patients and professionals and ensure dignified care. Keywords: Physician-assisted suicide; End-of-life decisions; Bioethics; Nursing role; Conscientious objection; Palliative care.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/26571