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The politics of death

Eluana Englaro lay in a persistent vegetative state for almost seventeen years. Her family fought a long battle to allow her to die a dignified death, and finally secured the right to medically assisted suicide. The 38-year-old Italian died on February 10 2009.

The debate over Eluana Englaro sparked conflicts in Italy on an institutional level. As a last-ditch effort Prime Minister Silvio Berlusconi's government attempted to prevent her feeding tubes from being removed after Milan's Court of Appeal had approved the move.

Candles in front of a photo of Eluana at the entrance of the "La Quiete" clinic entrance, in Udine, northern Italy, February 8, 2009. Photo: AP/Franco Debernardi

The political intrigues surrounding her death were strongly criticised by the national press. In its commentary of February 10, the left-liberal Italian paper La Repubblica predicted sombre times for the country's democracy. "With the instrumentalisation of a national and family tragedy, with the dark echo of those who would turn death into politics, the most dangerous phase for the fate of the republic in Italy's recent history began yesterday." On the same day Claudio Magris spoke in the liberal-conservative daily Corriere della Sera of the deep wounds inflicted on the country by "the ignoble attacks on the fundamental principles of the state".

The business paper Il Sole 24 Ore wrote on February 7 that "the time is ripe for an institutional crisis". The prime minister, the paper wrote, has never made a secret of his disrespect for the limits of his mandate. "The diarchy at the pinnacle of the state provided for by the constitution has never been acceptable in Berlusconi's eyes." The liberal daily La Stampa accentuated on the same day the political influence of the Church, writing that the pressure exerted on Berlusconi shows "the will of the Catholic Church, or more accurately of the Vatican, to demonstrate the extent of its power over Italy's political class."

The attacks of the Church

For more than two years a draft law on medically assisted suicide has slumbered in the Italian parliament, which has continually postponed discussing it for fear of the Church's reaction. The Englaro case has revived the issue, while also rendering it more emotional. Supporters of assisted suicide like the famous doctor and cancer researcher Umberto Veronesi have highlighted questions of rationality. Veronesi wrote in La Repubblica on February 6: "The strong wave of emotionality which accompanies the case of Eluana Englaro threatens to detract attention from the true problem. The laws of our country allow every citizen to deny medical treatment, including the so-called support therapies of parenteral nutrition and blood transfusion. Now, however, people are attempting to violate this noble right to self-determination."

The Church responded with vehemence. In an interview in the Corriere della Sera on February 7, Cardinal Camillo Ruini called assisted suicide "murder": "Silvio Berlusconi's decree must be respected. Letting Eluana die, or to put it bluntly letting her starve and die of thirst, means, regardless of the aims of those who wish it, objectively killing a human being." Similarly, in an interview with La Repubblica newspaper on February 5, Cardinal Severino Poletto of Turin called on Catholic doctors to resist.

A debate that divides Europe

The issue not only divides Italy however, but all of Europe. Active assisted suicide is illegal in practically every country, and passive assisted suicide is prohibited in most. In 2000 the Netherlands was the first EU country to legalise assisted suicide, followed by Belgium and Luxembourg. In Germany only passive assisted suicide is permitted, as the left-leaning daily die tageszeitung stressed on February 2: "If the case of Eluana Englaro were to be decided according to German law, things would be relatively straightforward: she would be allowed to die." The newspaper also pointed to legal grey areas: "Again and again doctors and lawyers complain that they lack clear legal regulations on the handling of patients in the last phase of their lives." So called advance directives, with which people may determine the form of treatment they wish to receive, are meant to assist in such cases. The German parliament will vote on three different parliamentary proposals in April, the article writes.

France, for its part, passed a regulation in 2005 which Le Monde newspaper called a "French variant of passive assisted suicide" on March 19 2008. "The existing law, which was unanimously adopted in April 2005, was a huge step forward. Although it rejects 'assisted dying' it permits 'allowing someone to die'." In September 2008 the Spanish government announced a reform of the legal basis for assisted suicide. El Mundo wrote on November 14: "The [Spanish] law on patient autonomy passed by the government of [former prime minister José María] Aznar gives citizens the right to refuse medical treatment. In accordance with this law we believe it is fitting to comply with every conscious and well-reflected request on the part of patients who do not want to be kept alive artificially or with special treatment."

Switzerland the last hope for many

In Switzerland assisted suicide is permitted. Nevertheless a study on assisted suicide conducted from 2001 to 2004 on behalf of the University of Zurich showed that it was often carried out on patients who were not afflicted with fatal illnesses. The Swiss government consequently considered introducing "stricter requirements for organisations involved in assisted suicide". Eveline Widmer-Schlumpf, head of the Swiss Department of Justice, has stressed that the state must honour its responsibilities concerning the protection of life. The medical newspaper Ärzteblatt wrote on February 2, 2009: "Organisations like 'Exit' and 'Dignitas' have given a dimension to assisted suicide which warrants asking whether article 115 of the Swiss penal code is sufficiently strong."

Discussion on Italy on advance directives continues. On February 15 the left-liberal daily La Repubblica termed the new law – which excludes a priori the refusal of life-prolonging measures such as artificial respiration and parenteral nutrition – a fraud "which robs citizens of the right to decide over their lives, and prescribes them the duty to survive. …. Lawmakers should … limit themselves to making accessible the necessary information and modalities so that citizens can decide for themselves over their fates."

Eva Clausen

Eva Clausen is euro|topics correspondent in Italy, where she works as a freelance journalist. She has worked among others for RAI, Neue Zürcher Zeitung, Handelsblatt, ...
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