title: [A position paper on end of life shared between those who believe and those who don't believe: a dialogue is possible].
abstract: In the modern medicine a sound evidence is available today supporting the four fundamental principles representing the best scientific and ethical approach to end of life issues: shared decision making process in a doctor-patient relationship centered care; rejection of dying process marked by the suffering and disproportionate treatments; withholding/withdrawing these treatments and palliative sedation as main contributions to suppress the patients' suffering and pain at the end of life; clear-cut difference between these clinical and ethical options and euthanasia. In some European countries, such as Germany, France, UK, and Spain, these principles are included in a well set legislation regarding the end of life issue, but this is not the case of our country. Despite this failure, in Italy, doctors, patients, and their families, need a law aimed to deal with the complex issues of end of life care as a whole. Therefore, the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) together with Italian Society of Palliative Care (SICP), shared with the Foundation "Courtyard of the Gentiles" - Department of the Pontifical Council for the Culture - the project to appoint a panel of religious and non-religious experts (physicians, philosophers, legal experts, and politicians) in order to draw up and offer to the political consideration a shared position paper, containing all the ethical and legal principles aimed to outline a more complete regulation of end of life in our country. The "Courtyard of the Gentiles" - whose aim is to promote the dialogue in regard to the issues of contemporary society between those who believe and those who don't believe, with a view to connect political and cultural institutions - appointed the panel in April 2014 and the shared position paper was formally presented on 17 September 2015, in a public conference in the Senate. The physicians who have been part of the panel, affirmed that all the problems related to the legal approach to the decision making process at the end of life may be solved only through a regulation of the doctor-patient relationship centered care. The aim of this regulation will be to set goals, rules, and limits of therapies, patients and doctors rights, procedures able to support and safeguard the good clinical practice, giving to patients and doctors an ethic reference point in the context of a law's guarantee. The fundamental principles of the regulation of the doctor-patient relationship centered care will rest on the contents of code of medical ethics, the safeguard of dignity, autonomy, and health of human beings. In conclusion, we hope to have supplied a useful contribution to draw up in the next future a law able to guarantee the autonomy of doctor-patient relationship, respecting different cultures and religious or non-religious approaches to life and death, as well as the different biography and biology of everyone. Our first goal was to comprehensively address the issue of end of life, understanding the concerns of patients and their families in a very problematic stage of their life, and offering to the doctors a valuable tool for dealing with the increasing complex connection between disease, death and modern medical practice on one hand, and related human fortunes on the other hand.
authors.forename: Giuseppe R
authors.initials: GR
authors.lastname: Gristina
mesh_terms: D003657:Decision Making; D006801:Humans; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D010817:Physician-Patient Relations; D012068:Religion and Medicine; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D028761:Withholding Treatment; D003245:Consensus Statements as Topic