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Medical decisions at the end of life: epidemiological and psychiatric aspects

  • Fabrizio Starace (a1)


Objective — Despite the ongoing moral and legal debate, there is still a paucity of empirical literature on the actual occurrence of Medical Decisions at the End of Life (MDEL). Moreover, the psychiatrist's role in this scenario is still unclear. Methods — This paper systematically reviews currently available literature on euthanasia (EU) and physician assisted suicide (PAS). Published articles were selected if they reported either: 1) prevalence estimates of patients' requests of EU/PAS; and/or 2) prevalence estimates of physicians' actual EU/PAS practices. Papers exploring the issue of MDEL-related psychiatric consultation have been also included in the review. Results — The empirical evidence reported in this paper shows that EU/PAS demands and acts are not uncommon in medical practice. A conservative estimate indicates that at least 10% of physicians have granted a request of EU/PAS. The involvement of consultation-liaison psychiatrists in MDELs seems to be relatively rare. Conclusions — Euthanasia and other MDELs require physicians' thoughtful evaluation of criteria guiding professional decision-making. To this purpose, epidemiological and psychosocial research can offer a valuable contribution.

Scopo — Il dibattito attuale sulle decisioni mediche di fine vita (DMFV) è caratterizzato da toni ed argomentazioni prevalentemente filosofici e confessionali. Scarsa attenzione è stata sinora rivolta a chiarire la reale diffusione di queste pratiche ed ancor meno esplorato risulta il ruolo che lo psichiatra e chiamato a svolgere in tale delicato contesto. Metodo — È stata condotta una revisione sistematica della letteratura degli ultimi dieci anni sulle DMFV, selezionando gli studi che riportavano: 1) stime della frequenza con cui i medici avevano ricevuto richieste di eutanasia (EU) e di assistenza al suicidio (SA); e/o 2) stime della frequenza con cui i medici avevano realmente praticato EU/SA. Sono stati inoltre passati in rassegna i lavori nei quali erano considerati i problemi relativi alia consulenza psichiatrica. Risultati — I risultati delle indagini esaminate documentano che le DMFV sono molto phi frequenti di quanto comunemente si ritenga. Una stima conservativa indica che almeno un medico su dieci ha praticato l'EU/SA. Una scarsa considerazione della consulenza psichiatrica è l'atteggiamento prevalente rilevato nei rari studi condotti sul tema. Conclusioni — L'eutanasia e le altre DMFV impongono alia coscienza ed alia pratica medica una riflessione profonda sui criteri che guidano l'agire umano e professionale degli operatori sanitari. Il contributo che la ricerca epidemiologica e psicosociale puo offrire al dibattito bioetico è indispensabile.


Corresponding author

Indirizzo per la corrispondenza: Dr. F. Starace, CERIFARC, Assessorato alia Sanità Regione Campania, Via S. Lucia 81, 80100 Napoli. Fax +39 081 7962533 E-mail:


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Medical decisions at the end of life: epidemiological and psychiatric aspects

  • Fabrizio Starace (a1)


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