title: A national survey of Italian physicians' attitudes towards end-of-life decisions following the death of Eluana Englaro.
abstract: BACKGROUND
  Ethical issues regarding patient care have recently been raised in Italy by the case of Eluana Englaro, a 36-year-old woman who remained in a persistent vegetative state (PVS) for 17 years. There are no specific laws on the books in Italy regarding euthanasia and physician-assisted suicide. In November 2008, a controversial decision by the Italian Supreme Court granted the woman's father his wish to discontinue nutrition and hydration provided to her. Because of this historic decision, the authors carried out a survey of Italian physicians' beliefs regarding end-of-life practices.
  
  
  METHODS
  A questionnaire was e-mailed to 70,000 physicians working for the Italian Public Health System and University Medical Hospitals.
  
  
  RESULTS
  A total of 22,219 doctors responded to the questionnaire (32.3%), of whom 17,252 (77.6%) had some experience in treating PVS patients. Nearly 70% of responding doctors were aware of PVS diagnostic criteria; most of them (61%) considered tube feeding to be a medical therapy, and 66% of respondents believed that withdrawal of assisted nutrition and hydration (ANH) might be appropriate depending on the patient's wishes. Moreover, even though 50% of doctors surveyed were not in favor of euthanasia, a significant percentage (42%) did approve of it, while 8% of this sample was uncertain.
  
  
  CONCLUSIONS
  Italian doctors probably have the least experience in end-of-life decisions in Europe, therefore this national survey is a great chance to understand their authentic opinions regarding such remarkable issues. There is broad consensus that a clear legislative position regarding euthanasia and ANH is needed.
authors.affiliation: Section of Legal Medicine, Department of Internal Medicine and Public Medicine, University of Bari, Bari, Italy. bisola@tin.it
authors.forename: Biagio
authors.initials: B
authors.lastname: Solarino
authors.forename: Francesco
authors.initials: F
authors.lastname: Bruno
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Alessandro
authors.initials: A
authors.lastname: Dell'erba
authors.forename: Paola
authors.initials: P
authors.lastname: Frati
mesh_terms: D000328:Adult; D016223:Advance Directives; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making / Q000941:ethics*; D005066:Euthanasia, Passive / Q000941:ethics / Q000331:legislation & jurisprudence; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State; D010819:Physician's Role; D010820:Physicians / Q000523:psychology*; D013727:Terminal Care / Q000941:ethics* / Q000331:legislation & jurisprudence