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End of life, the Emilia-Romagna Region confirms its choice — Health

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End of life, the Emilia-Romagna Region confirms its choice — Health

The role of the Regional Committee for Clinical Ethics (COREC) was reiterated. In fact, as early as February 2022, the Region had indicated that the third collegial body requested by the High Court for consultation, and of reference for ethical problems to safeguard vulnerable subjects in medically assisted suicide, should be a specific committee for ethics in the clinic is unique throughout the regional territory, and not the CETs. This position is also possible in light of the ministerial decrees of January 2023 which came into force after the Court’s ruling

February 29, 2024 – Choice confirmed, strengthened motivations. The Regional Council of Emilia-Romagna reiterates that already today the structures of the regional public health service must apply sentence number 242 of 2019 of the Constitutional Court at the end of life, to 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 system of what has already been established.

In Emilia-Romagna it is therefore confirmed that it will be the Committee for Ethics in the Clinic already established at the AUSL-IRCCS of Reggio Emilia, whose experience was given regional value (COREC), the organism third-party collegial consultation for the requests of those who find themselves in the conditions established by the Constitutional Court and have requested medically assisted suicide, thus ensuring throughout the territory uniformity of evaluation. The criteria indicated by the Court are mandatory to avoid any arbitrariness: the patient must be suffering from a irreversible pathologyfrom which they derive physical or psychological suffering that the patient considers intolerablewho is kept alive by life-sustaining treatments and so be it fully capable of making free and informed decisions.

I Territorial ethics committees (CET), recalled 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 specific ethics bodies exist in the clinic, as happens in Emilia-Romagna. Motivations further explained in the supplementary act approved by the Council led by the president Stefano Bonaccini.

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“While waiting for a national law for a topic of such great importance and sensitivity – reiterates the councilor for health policies, Raffaele Donini– we confirm our commitment to implement what was requested by the High Court. We have strengthened the reasons, focusing on all the legal passages supporting this position. We remind you that the Regions are called upon to apply the provisions of the Court. It was a duty to put the healthcare system in a position to fulfill this obligation in the best possible way, as also requested by the Ministry of Health“.

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 be used 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 the evaluation of studies and trials on drugs and clinics, and 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 started in 2016 to reorganize the organization of the committees in its territory, to start in 2020 with the ASL of Reggio Emilia the experimentation of a dedicated, independent and multidisciplinary ethics advisory body: the Clinical Ethics Committee (CEC). In February 2022 the president Bonacciniin 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. Position also supported by the Regions at 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 carry out consultative functions in relation to ethical issues connected with clinical research and healthcare activities, where not already attributed to specific organisms.

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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 area) 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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