The Concept of Autonomy in End-of-Life Decisions: Ethical and Legal Regulation regarding Advance Directives

In this thesis the concept of autonomy in end-of-life decisions is analyzed through ethical and legal comparative approaches. The definition of advance directives – living wills and the appointment of a legal proxy – is studied. In addition, Recommendation CM/Rec (2009) 11 and the “Guide on the decision-making process regarding medical treatment in end-of-life situations” is examined. Currently, end-of-life decisions are part of the exclusive competence of national parliaments. Thus, different parliaments have adopted different policies underpinned by different moral principles. What follows is an absence of a common European legal framework. National laws on advance directives in various Western European countries – such as Romance-speaking countries (Italy, France, Portugal, and Spain), English-speaking countries (Ireland and the United Kingdom of Great Britain and Northern Ireland), and German-speaking countries (Austria, Germany, and Switzerland) – are examined. This thesis seeks to analyse national norms governing advance directives by hypothesising the reasons for the lack of a common attitude towards end-of-life decisions. Particular attention is paid to the current Italian situation regarding end-of-life decisions since Italy is one of the few Western European countries that does not have a specific law governing end-of-life situations. Herein, the Italian bill no. 2350 “Provisions relating to therapeutic alliance, informed consent, and advance directives for treatments” – approved in different texts in 2009 by the Senate and in 2011 by the Chamber of Deputies – is criticized because its norms are considered controversial. Additionally, the judicial interpretation of amended Articles 404–413 of the Italian Civil Code is examined. The aim of the thesis is to identify the common European standards in end-of-life decisions. Moreover, similarities and differences between different policies will be pointed out. Furthermore, possible suggestions for modifying the Italian bill 2350 by taking the experience of other Western European countries into consideration will be made.