Rights to health

Against a backdrop of unparalleled developments in medical science and biotechnology, a patient's right to self-determination is increasingly under threat. In an age when many different forms of freedom are being proclaimed, that of the choice of medical treatment, it seems, is being jeopardised by the power of machines, the standardisation of procedures and an ever more sophisticated and yet separate body of medical knowledge. This makes it necessary to move in three directions.

The first is to strengthen the therapeutic alliance between doctor and patient so as to allow a genuine interpersonal exchange and the matching of treatments – including palliative care and the medical use of psychoactive substances such as cannabis – to the needs of the patient; an alliance which includes family members and strikes a balance between scientific knowledge and biographical knowledge and between professional competence and social life. The second perspective regards the legal recognition of the patient's wishes in choices that he or she may not be fully capable of making in future. The binding nature of advance directives should be supplemented and balanced with clauses allowing for both their periodic updating in the light of progress in medical science and the intervention of one or more fiduciaries for the adaptation of decisions made previously by the patient. Finally, action needs to be taken to contrast two increasingly evident trends: the medicalisation of two crucial stages of our existence, birth and death, and, closely interwoven with this, a new form of “loneliness of the dying”.

It is in this general context that a balanced approach to the questions of assisted suicide and euthanasia – a choice permissible under extreme conditions and with strictly defined limits – must be found.