The presidency of the Council of Ministers and the Ministry of Health they filed at Tar dell’Emilia Romagna an appeal against the Region, and in particular against the Health of the Person health management, to request the annulment of the Council resolutions which implemented medically assisted suicide in Emilia-Romagna.
INSIGHTS
In February the regional council of Stefano Bonaccini had approved two resolutions for access to medically assisted suicide, with the aim, the Region explained, of filling Parliament’s gap in the matter and of putting healthcare companies in a position to guarantee the right of patients sanctioned by the ruling of the Constitutional Court (n.242/2019).
Guidelines have been sent to healthcare companies that establish end-of-life processes and timing, a maximum of 42 days from the patient’s request to the possible execution of a pharmacological procedure. Among the contested elements is also the establishment of Corecthe Regional Committee for Clinical Ethics, which is called upon to express an opinion – even if non-binding – on patient requests.
End of life, what do the Emilia-Romagna resolutions provide?
But what do these resolutions consist of? The Regional Council of Emilia-Romagna reiterated last February 29 that the structures of the regional public health service must apply ruling number 242 of 2019 of the Constitutional Court on end of lifeto guarantee the patient who requests it the right to resort to medically assisted suicide in strict compliance with the restricted cases indicated by the High Court.
It does so by integrating and strengthening the reasons for the resolution of 5 February, in light of the investigations carried out, therefore without modifying the structure of what has already been established.
In Emilia-Romagna it is therefore confirmed that the Committee for ethics in the clinic already established at the AUSL-IRCCS of Reggio Emilia, whose experience has been given regional value (COREC), will be the third collegial consultation body for requests of those who find themselves in the conditions established by the Constitutional Court and have requested medically assisted suicide, thus ensuring uniformity of evaluation throughout the territory.
The criteria indicated by the Court are mandatory to avoid any arbitrariness: the patient must be suffering from an irreversible pathology, resulting in physical or psychological suffering that the patient considers intolerable, who is kept alive by life support treatments and is fully capable of taking free and informed decisions.
The Territorial Ethics Committees (CET), referred to by the National Bioethics Committee as a possible body called to express opinions on the request for medically assisted suicide, “may” be indicated to express an opinion on the matter, but this is not a necessary choice where there are specific bodies for ethics in the clinic, as is the case in Emilia-Romagna. Reasons further explained in the supplementary act approved by the Council led by President Stefano Bonaccini.
Committees for ethics in the clinic and territorial ethics committees
After the sentence, the need to identify this collegial body immediately emerged: in Emilia-Romagna there were ethics committees, indicated as possible bodies to use by the Presidency of the National Bioethics Committee, but it must be considered that they were created, as also required by the European Regulations , for the essential scientific function of evaluating studies and trials in the field of drugs and clinics, and do not have sufficient specific and diverse interdisciplinary skills required for purely ethical issues. Skills for which the Court’s ruling already indicated the need for specific integration.
Hence the decision of the Emilia-Romagna Region, which had already begun in 2016 to reorganize the organization of the committees in its territory, to start experimenting with the Reggio Emilia Local Health Authority in 2020 on a specific consultative body for ethics, independent and multidisciplinary: the Committee for Ethics in Clinics (CEC). In February 2022, President Bonaccini, in response to the request from the Ministry of Health on the topic of medically assisted suicide, had already indicated this body, and not the territorial ethics committees, as the only one with competence for the entire regional territory. This position was also supported by the Regions in the Health Commission of the Conference of Regions in May of that same year.
In fact, the CETs have the main objective of evaluating studies and clinical trials on medicinal products for human use with the aim of authorizing their placing on the market and clinical trials more generally: their purposes appear unrelated to those of assisted suicide. In this regard, the Ministry of Health has put a firm point on the debate with the decree of January 2023: the CETs can also exercise consultative functions in relation to ethical issues connected with clinical research and healthcare activities, where not already attributed to specific organisms.
Rather, it is the CECs, where present, as in the case of the Emilia-Romagna Region, that are competent in matters of assisted suicide. Furthermore, a single CEC for the entire Region (hence the new acronym COREC which underlines its uniqueness in the territory) guarantees uniformity of evaluation.
The Regional Committee for Clinical Ethics (COREC), roles and responsibilities
Health professionals can turn to COREC in the presence of difficult decision-making processes and conflicts of values. COREC, in fact, deals with formulating opinions in relation to questions and choices of an ethical nature attributable to both healthcare and organizational activities, providing an evaluation of ethically complex cases, both already concluded and in progress, preparing training activities on the topics of ethics and bioethics dedicated to healthcare personnel, promote and implement awareness initiatives on ethical and bioethical issues aimed at citizens.
COREC is then called upon to liaise with the clinical ethics committees present on the national territory and with the National Bioethics Committee. The organization of COREC ensures its professional competence, multidisciplinarity, lack of hierarchical subordination towards the structure in which it operates and the absence of conflicts of interest of the committee members with respect to the issues submitted.
The internal and external members of COREC do not receive compensation.
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