Euthanasia: The right to die

Italy is all too familiar with conflicts between Church and state and usually the stakes have been very temporal political power rather than spiritual authority or transcendental peace. In the drama which played out in a nursing home in northeastern Italy and in the Senate, there was also the tragedy of a woman, Eluana Englaro, who had been in a coma for 17 years, her life and her right to die, her father's concern for his daughter and her wishes and his own fortitude in the face of terrible pressures.

In practice there were three separate issues which were and still are being debated here. The first was whether there is or should be a "right to die" in Italy and if so, how that right should be applied.
The second was what sort of role the Vatican and the Roman Catholic Church in Italy should have in Italian politics and civil society. And finally, there is the perennial battle between the powers of the state, an ongoing dialectic everywhere but both sensitive and acute in Italy where the prime minister Silvio Berlusconi already has a concentration of power unique in a democratic country. The facts are straightforward enough. Eluana Englaro was in a permanent vegetative state after a car accident in 1992. Her father, Beppino argued that she had expressed the wish not to be kept alive in a coma and sought permission from the courts to carry out that wish by removing her feeding tubes. Last year first the Court of Appeal and then Italy's supreme court, the Court of Cassation allowed suit. The government had also filed a suit claiming that the decision changed existing laws; the suit was rejected.

In 2006 a muscular dystropy sufferer, Piergiorgio Welby sought to end his life by assisted suicide. Welby appealed to President Napolitano who in turn asked the Parliament to address the issue. Welby was helped to die (and the physician was not prosecuted) but although some bills were put forward, no law has been passed. Last month Mr Englaro moved his daughter from Lombardy to Friuli because the Lombard health authorities refused to remove Eluana's feeding tubes. On 6 February—some days after the reduction of treatment had begun—Berlusconi used a press conference called to illustrate the economic stimulus package to tell the world that President Giorgio Napolitano had refused to sign a decree law which would have obliged physicians to maintain artificial nutrition and hydration in coma cases.

After criticising the president and calling the constitution "Soviet," Berlusconi promised that he would rush the same text through parliament as a regular bill. The Vatican secretary of state also
called Napolitano to put pressure on him "about the case of the woman who might be facing death by thirst and starvation". Berlusconi also used language to suggest that Eluana still had a "normal" life by saying that she could still "procreate" and had "regular periods". The bill was sent to the Senate committee on 9 Feb and was about to be discussed by the full assembly when her death was announced. The response was immediate and forceful with one centre-right senator saying that "Eluana was murdered" and another saying that it had been "illegal euthanasia" and accusing the President of the responsibility. The following day the Italian Bishops' Conference's newspaper Avvenire ran an editorial "Eluana was killed".

The revised bill before Parliament allows for a living will but obliges physicians to maintain artificial nutrition and hydration. It will pass with the full support of the centre-right and many Catholics from the centre-left. Beppino Englaro called it  "barbaric" and on Saturday he spoke on a  telephone link to demonstrators in Rome reiterating his position with great dignity. His aim was and still is even after the death of his daughter, to give Italians the right to choose how their lives should end. But even though opinion polls suggest that a majority of Italians agree with him, the immediate legal consequences will be the opposite.

The Englaro case could have been the cue to start a serious debate in Italy on how and when life should end and over time. But for the moment, it looks as though the Catholic heirarchy will succeed in limiting the rights of patients or their relatives to refuse treatment, and Berlusconi will succeed in reversing a Supreme Court verdict and showing that he can trump both President and the Courts. Even his almost necrophiliac remark that Eluana could still procreate raised few eyebrows.