Considerazioni medico-legali sulla mozione del Comitato Nazionale per la Bioetica sull’accanimento clinico nei confronti di bambini con limitate aspettative di vita

The motion approved by the Italian National Bioethics Committee January 30th,2020, entitled “Aggressive treatments or unreasonable obstinacy in medical care of children with short life expectancy”, sets out 12 recommendations for physicians who take care of these children and have the duty to communicate with their parents. The intent of this motion is to give the family the necessary information and support during the decision-making process. Each recommendation is analytically commented. Recommendation 1 advocates the adoption of shared decision-making by the entire healthcare team; promotes the relief of pain and suffering; inhibits disproportionate and ineffective medical treatments; opposes a defensive medicine. Recommendation 2 asks for the promulgation of a national law that establishes clinical ethics committees in Children’s Hospitals. Recommendation 3 implies that parents or legal guardians should be involved in the decision-making process of physicians and clinical ethics committees. Recommendation 4 states that a second opinion may be requested by both the parents and the physicians. Recommendation 5 admits an appeal to the judge in the event of an irreconcilable conflict between the health care team and the family. Recommendation 6 endorses the medical accompaniment of the dying patient, also by means of continuous deep sedation and analgesia. Recommendation 7 enunciates the principle that patients shall have the right to access to palliative care. Recommendation 8 confirms the necessity to strengthen research focused on pediatric pain and suffering. Recommendation 9 excludes that excessive medical treatment may be justified by the need to carry out experiments or research projects. Recommendation 10 concerns the training of physician, other healthcare workers and psychologists in order to support children’s parents both emotionally and practically. Recommendation 11 exhorts to encourage the interaction between parents and seriously ill children. Recommendation 12 assigns a prominent role to parents’ associations for ill children