Italy faces constitutional crisis over coma woman

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Italy faces constitutional crisis over coma woman

February 8, 2009 -- The Italian government has been plunged into a constitutional crisis over the fate of a 38-year-old woman who has been in a coma for the past 17 years. Eluana Englaro was left in a vegetative state after a car crash in 1992. After a decade-long court battle, doctors reduced her nutrition on Friday in preparation for removing her feeding tubes, which her father claims would be in accordance with her wishes.

But in an extraordinary turn of events, the country's prime minister, Silvio Berlusconi, after consultation with the Vatican, has issued an emergency decree stating that food and water cannot be suspended for any patient depending upon them, reversing the earlier court ruling. On issuing the emergency decree, Berlusconi declared: "This is murder. I would be failing to rescue her. I'm not a Pontius Pilate."

Justifying his campaign to save Englaro's life, the prime minister added that, physically at least, she was "in the condition to have babies", a remark described by La Stampa newspaper as "shocking". Giorgio Napolitano, Italy's president, has refused to sign the decree, but if it is ratified by the Italian parliament doctors may be obliged to resume the feeding of Eluana early this week.

But, in a moving interview with the Observer, Eluana's father Beppino said last week that the doctors were carrying out his daughter's wishes by allowing her to die. "If she couldn't be what she was (before the accident in 1992) then she would not have wanted to live".

The case has deeply divided Italian society and raised concerns over the influence of the Vatican. Yesterday Pope Benedict indirectly referred to Englaro in a message delivered to mark the World Day of the Sick, stating that society had a duty to defend "the absolute and supreme dignity of every human being" even when "weak and shrouded in the mystery of suffering". But even some of Berlusconi's political allies, including the president of the lower house of parliament, Gianfranco Fini, have stated that the supreme court ruling should be obeyed and Englaro should be allowed to die.

Opposition leader Walter Veltroni, of the centre-left Democratic party, said the government should leave the Englaro family in peace and warned that Berlusconi's intervention "could cause a very dangerous constitutional crisis". Last night demonstrations in support of Eluana's right to die and the supreme court ruling were taking place across Italy.

Meanwhile, doctors are continuing to act according to the original supreme court ruling. On Friday morning in the La Quiete clinic in Udine, northern Italy, they began reducing the amount of food in Eluana Englaro's feeding tube, according to a precise medical protocol that will see nutrition gradually replaced with sedative and anti-convulsant medication. Experts say that within four to five days her condition may have deteriorated to an irreversible extent, though it might be two weeks or more before her heart stops. The process means the Englaro family and their doctors are now in a race against time as they try to end Eluana's life before the Berlusconi government and its backers in the Vatican halt the process.

Beppino, 67, was last night in the family home in Lecco, 30 miles north of Milan, caring for his wife and Eluana's mother, Saturna, who is gravely ill with cancer. After a long, agonising fight to allow his daughter to die, he described the government's last-ditch attempts as "a grotesque attack on my family".

Prior to issuing the decree, Berlusconi was involved in frantic telephone exchanges with the Vatican head of state, Cardinal Tarcisio Bertone, who implored the prime minister to prevent Eluana's death. The cardinal reportedly told Berlusconi: "We have to stop this crime against humanity."

Doctors have confirmed that, after 17 years and with such catastrophic brain damage, Eluana will never regain consciousness or awareness. The anaesthetist caring for her, Professor Antonio de Monte, said: "Eluana died 17 years ago."

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A father's plea: let my daughter die in peace

February 8, 2009 -- Some 17 years ago Eluana Englaro was a pretty, wild-haired 21-year-old with an unmapped life ahead of her. Today the former language student lies, eyes open but unseeing, in a persistent vegetative state in a hospital bed while the whole of Italy argues over her fate.

To live to see the death of your child is perhaps the most terrible thing that can happen to anyone, but Beppino Englaro has fought against Italy's most senior politicians and the Catholic church for more than a decade to allow his only child to pass away in dignity. This weekend that process has finally begun; Eluana's feeding tubes were removed by her doctors on Friday morning. But it could take up to three weeks for Eluana to die, and the legal wrangling is far from over. Italy's prime minister, Silvio Berlusconi, is threatening to pitch his country into a constitutional crisis by pushing through a decree that would see Eluana's sedation stopped and the tubes reconnected. The country's president, Giorgio Napolitano, has refused to sign it. The Vatican has made its implacable opposition to Beppino Englaro's wishes clear.

Haggard and exhausted, Englaro calls the last-minute political intervention "an inconceivable violence".

It was in the early hours of Saturday, 18 January 1992, as Eluana was driving back from a party at a friend's house, that she lost control of her father's car on an icy road. It smashed into a lamp-post. Eluana was rushed to the nearest hospital, in Lecco, northern Italy, but slipped into a coma, and scans revealed a devastating degree of brain damage.

After four weeks, doctors deemed her to be in a persistent vegetative state. After a year, the young woman, "a sunny personality; extremely popular, opinionated from a young age and very proud" was declared to be in a permanent vegetative state. Since then, breathing independently, she has aged in hospital beds, fed and hydrated by tubes.

Eluana's plight has become a landmark right-to-die case, shining an uncomfortably bright light on two different Italys: the liberal and secular and the conservative, influenced by the Vatican, in which government ministers refuse to respect even supreme court rulings on matters of conscience.

Eluana's 67-year-old father is a small, slightly-built man. The long battle has taken a toll. Englaro's eyes are often fixed on the distance and he is never far from anger. More than a decade of campaigning has left him with the politician's trick of turning any question into a means of expounding his own message.

The family home, a modern apartment in Lecco by the side of Lake Como, is dominated by a large sitting room with a glorious view of snow-covered mountains on the far shore. The room itself has none of the usual clutter or ornamentation of a home, just a few stacks of bound, yellowing newspapers by the fireplace and a cabinet covered with pictures of Eluana, a raven-haired young woman with her mother's classic Italian looks.

Her father spreads out a further selection of photographs of his smiling daughter on a glass coffee table as he explains to the Observer why he wants her to be allowed to die.

He wants the release of three people from their own purgatories: Eluana, himself and his wife, Saturna. Mrs Englaro, who is now suffering from cancer, is rarely seen or heard in the campaign to "free" her daughter, although her husband says she is wholeheartedly behind it. "She was completely destroyed by what happened to Eluana. She doesn't want to talk to anyone about it."

Mother and daughter were extremely close. Saturna often looked after Eluana alone when her husband had to travel for work.

"Do you understand that concept of needing to be free? Do you?" says Englaro. "Because it's what this is all about. It's in the blood and the DNA of this family. I know what Eluana would have wanted in this situation because she's already told us."

A year and a day before her own accident, a friend of Eluana called Alessandro crashed his motorbike, suffering serious brain damage. In great distress, Eluana told her father: "If something like that ever happened to me, you have to do something. If I can't be what I am now, I'd prefer to be left to die. I don't want to be resuscitated and left in a condition like that."

Alessandro remained severely incapacitated and died 10 years later. Others who knew Eluana have confirmed the sentiment. Her younger cousin Germana, who adored Eluana, would also write to the courts, in March 2003, calling for her cousin "with the marvellous smile" to be allowed to die. "This voice asks for her to be released," she wrote.

Eluana's three best friends, Laura, Francesca and Cristina, reacted in different ways to the tragedy. In the first months Cristina went to visit her frequently, spending hours talking to her unresponsive friend, although she found it "intensely painful".

Francesca saw Eluana once after the accident and refused to visit again. Many years later, in 2006, when her testimony regarding Eluana's wishes was requested for an important court hearing, she gave it promptly.

Laura did, too: "I wanted Eluana back, not for her to die, but when, after the prognosis said her state was permanent and her condition was judged irreversible, without hope, my desire to see Eluana's wishes and not my own prevailed," she said.

All three, then, testified that Eluana had said that in the event of such a tragedy that is what she would want to happen.

Such testimonies have been key to Englaro's legal battle. Another is the assertion that nutrition and hydration for people in PVS can be considered artificial medical treatments that are not in the patient's best interest - a decision the House of Lords arrived at more than 15 years ago in the case of Hillsborough victim Tony Bland, who was allowed to die in 1993.

Englaro began his fight in the local courts in Lecco five years after Eluana's accident. It had seemed to have concluded last November, when Italy's highest court, the court of cassation, decreed that feeding could be stopped.....

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The Vatican, fearing Italy was moving towards legalised euthanasia, took an increasingly vocal interest as the publicity around the case grew. The Vatican's spokesman on health issues, Cardinal Javier Lozano Barragán, said removal of feeding tubes amounted to "monstrous and inhuman murder". Avvenire, the church's daily newspaper, accused Italy's highest court of "necrophilia".

But such outbursts have backfired, adding to the impression among ordinary Italians of a church becoming increasingly out of touch. A poll in January of more than 1,000 readers of La Stampa newspaper found that 85% thought Eluana should be allowed to die. But in November, as Englaro was arranging for his daughter to be transferred to a clinic in his native Udine, which had offered to help Eluana die, another setback emerged. Astonishingly, at least for foreign observers, Italy's conservative welfare minister Maurizio Sacconi, "following his conscience", stepped in and threatened any clinic that helped Eluana to die with financial ruin, or in his words "unimaginable consequences". Mercedes Bresso, governor of nearby Piedmont, said the case had "become unbearable for a civilised country, from a legal and human point of view".

But in Italy rules are made to be broken - or ignored. Berlusconi has led by example, having introduced a handy new immunity law to extricate himself from ominous corruption charges. Opponents of Eluana's right to die are making noises about new legislation that would outlaw the withholding of treatment. "This is not a particularly civil country, nor a democratic one," says Englaro. "That is the real tragedy of this family. For 17 years nobody has listened to us. To me or to Eluana. It's black or white. If she couldn't be what she was then, she would not have wanted to live."

Englaro has written a book, Eluana: La Libertà e La Vita, in which he attacks doctors for aggressively treating his daughter for the first month after her accident, a period when theoretically they might have salvaged some degree of awareness from her crushed brain. These are "institutional criminals" for resuscitating people to effectively create "the artificial condition" of a vegetative state. Better for Eluana had they not intervened at all, he believes.

Englaro is not a religious man. "If there is a God, I don't need an intermediary such as the church to speak for me," he says. His greatest anger is not reserved for the Vatican, which "in a free country has a right to its opinions", but for politicians and doctors.

While Italy's medical community is split over Eluana's case, the prognosis is not in doubt. Occasionally signs of consciousness are seen in vegetative patients within the first two years of the condition's onset. But, as time goes by, the chances of recovery become ever more slim. After so many years the hope that Eluana will emerge from her coma is not raised by even those politicians and church figures who most fiercely oppose her right to die.

It is only natural to wonder what Eluana looks like now. Englaro's pictures of Eluana as a pretty teenager might not be helping his cause. By only allowing people to see Eluana as she was, he is maintaining the idea of the princess in the fairytale, waiting for the right moment to reawaken. But taking a photo of the 38-year-old Eluana is dismissed out of hand. "No, there's a limit," he says. "There are some things you don't transgress."

He does not go to see his daughter that often, he says. Anyway, visits are an "invasion" because she would not have wanted to be seen like that. And when he does go: "I see a person who has suffered the worst sort of violation that anyone could ever suffer."

It seems that Eluana may soon die at La Quiete in Udine - a private institution that is not at the mercy of Sacconi, or state funding - where the senior anaesthetist, Dr Amato de Monte, will aid her death. "I'm not an executioner," he said. "Eluana died 17 years ago." Even hospitals which refused to take on Eluana cannot conceal their sympathy. Giuseppe Galanzino, director of Turin's Molinette hospital, said: "If I was Eluana's father, I'd have died from a broken heart by now."

Englaro says he wants his daughter to be free to pass away before he does, but he remains constantly wary of last-minute reprieves. "This is Italy: let's wait and see what finally happens."

It would certainly be the end of something that has dominated his life for more than a decade: "This is everything. I think about it every moment of the day. People might say I'm obsessed; I don't care. I'll continue until it's done."

Eluana's body would be cremated and go to the family tomb in Udine. But how will he feel after all this time, when Eluana finally dies? "I really don't know," he says quietly. Looking into the distance, he repeats: "I don't know how I'll feel."

On Friday morning doctors in the La Quiete clinic began reducing the amount of food in Eluana Englaro's feeding tube, according to a precise medical protocol that will see nutrition gradually replaced with sedative drugs. But even then, Berlusconi was having telephone exchanges with a senior Vatican figure, Cardinal Tarcisio Bertone, who implored the prime minister to intervene with a ministerial decree to prevent her death. "We have to stop this crime against humanity," he told Berlusconi.

However, head of state Giorgio Napolitano refused late on Friday to sign such a decree. Politically the centre-left, headed by opposition leader Walter Veltroni, has demanded that the wishes of the family - and Italy's highest court - be respected. Even some of Berlusconi's political allies, including the environment minister, Stefania Prestigiacomo, and the president of the lower house of parliament, Gianfranco Fini, have backed the court of cassation ruling, although Sacconi was yesterday still seeking legal loopholes that might allow him to declare the hospital's activity illegal. Rarely has the fate of one person so clearly exposed the faultlines that run through Italian society, with politicians, campaigners and the church battling for the country's soul.

Englaro does not want his broken family to become an example for the dozens of other families who are probably in a similar position: "If they don't overcome their problem, it's because they don't care or aren't trying hard enough. I don't want to be a spokesman for anyone."

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The Pope should let Eluana die in peace

February 8, 2009 -- It is not surprising that the Italian courts should have taken longer to reach the judgment that Eluana Englaro should be allowed to die than it took for the House of Lords to reach the same judgment in the case of Tony Bland in 1993. The religious environment is quite different and, in such matters of life and death, religion is bound to play a part. Yet the cases were very much alike. Both were young people disastrously injured in accidents. Both had been diagnosed as being in a permanent vegetative state, Englaro for as long as 17 years, Bland for only two.

In both cases, too, the family and friends wanted them to be allowed to die. In Bland's case, it was the medical profession who argued that it was their duty to keep him alive. The appellate court found, however, that it was lawful to withdraw treatment from a patient when that treatment was futile, that is doing him no good, and that therefore artificial nutrition and hydration might lawfully be withdrawn. The Italian court of appeal presumably relied, in the end, on the same argument. The Pope, in seeking to overturn this judgment, was doing so in the name of the principle of the sanctity of life, an essentially religious principle and was thus going far in the direction of turning Italy into a theocracy in which, if a law is not accepted by religion, it is not a law.

But what about the patient herself and her family? Does the principle of the sanctity of life, whether or not it is enshrined in law, have such moral force as to override all considerations of compassion or common sense? No one in Italy or England or in any part of the civilised world would deny that human life is of enormous value - but there is no human life unless it is lived by somebody. It is not some abstract stuff called Life that we value, but the people who live and enjoy it. Life is nothing but in its being lived.

When there is no hope of a patient's living his life any more, then other values must be weighed against the value of that life, including the suffering of his relatives. The idea that one's child in such a state may even outlive one's self is intolerable. This is what must be considered in the prolongation of futile treatment.

And the sanctity of life is seldom invoked except in cases when shortening a pitiful life is contemplated. Roman Catholics believe that the life of every embryo is sacred from the moment of its conception, but they do not believe that the principle should entail that just wars may not be fought, in which many human lives will be lost. If human life were really sacred it would be at least doubtful whether one might properly kill someone in fear that you would yourself be killed. Such exceptions to the sanctity principle have long been allowed by the church. It is not then held that since life was a gift from God, it is for God alone to take it away. And if that were an absolute principle, what would be the morality of prolonging a human life by medical intervention, when God had visited the human being with a heart attack or an infection that would once have been fatal?

We may and should uphold freedom of religion. We may be prepared to argue with our last breath that people should hold what beliefs they like and follow the practices of their faith. But faith should not be imposed on those who do not share it. Above all, we must resist the theory that religious beliefs, however strongly held, should take precedence over the law. The law holds society together and, being human, we must live in society. It is to be hoped that Italy remains a humane as well as a human society.

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Vatican backs fight to save coma woman

February 9, 2009 -- The Vatican yesterday expressed "deep appreciation" for Silvio Berlusconi's efforts to rush through the Italian parliament legislation that would keep alive a woman who has been in a coma for the past 17 years.

The case of 34-year-old Eluana Englaro, which has been compared to that of the American Terri Schiavo, has divided Italy and prompted a constitutional showdown between the prime minister's rightwing government and the president and judiciary. In the latest move, the health minister said yesterday that a clinic in Udine where Englaro had been taken to die was not legally entitled to look after her.

The minister, Maurizio Sacconi, said a court ruling that Englaro's feeding tubes could be removed by her father had spoken of "a hospice or health facility, whereas here all we have are rooms on loan". The head of the clinic replied that the only anomaly was that volunteers were looking after Englaro.

On Friday, Italy's president, Giorgio Napolitano, refused to sign a government decree to overturn the court ruling. He said the judges' decision was final and had to be respected. But on Saturday the government announced that it was converting the decree into a bill, and intended to speed it through parliament this week.

One of Berlusconi's leading critics, Antonio Di Pietro, leader of the Italy of Principles party, accused the prime minister of trying to "split the country further, make it unstable and ungovernable, so as to then say he'll take care of things, just like [Benito] Mussolini did".

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'Right to die' coma woman Eluana Englaro dies

February 9, 2009 -- An comatose Italian woman whose “right to die” has triggered a constitutional crisis and provoked an intervention from the Pope has died, it was confirmed tonight.

The death of Eluana Englaro, 38, was announced by doctors at the clinic in Udine where she was being treated even as the country's Senate debated a decree which would have stopped her life support being switched off.

Ms Englaro had been in a vegetative state for 17 years after a car accident.

The centre Right government of Silvio Berlusconi had wanted to make it illegal for carers of people ''unable to take care of themselves'' to suspend artificial feeding.

Mr Berlusconi launched the effort after President Napolitano refused to sign an emergency decree on the grounds of unconstitutionality, saying it clashed with November's supreme court ruling giving Ms Englaro's father Beppino permission to find doctors who would end her life. The Vatican and Catholic Church fiercely opposed the ruling.

Ms Englaro had been in a vegetative state for 17 years after a car accident.

Maurizio Sacconi, the Minister of Health, issued a statement to express "the profound sorrow of all Italians".

The Englaro case has become a symbol for the Vatican’s “pro-life” campaign but also for right-to-die campaigners. Cardinal Angelo Bagnasco, head of the Italian Episcopal Conference, said that refusing food and water to Ms Englaro was murder. “A light is going out, the light of a life,” he said.

Pope Benedict had asked the faithful to pray “for those who are gravely ill but cannot in any way provide for themselves and are totally dependent on the care of others”. He did not refer directly to Ms Englaro but reaffirmed “the absolute and supreme dignity of every human being”.

The tussle over Ms Englaro’s life has revived accusations that the Vatican is dictating Italian policy. Mr Berlusconi, who had previously stayed out of the controversy, reacted after Cardinal Tarcisio Bertone, the Vatican Secretary of State, implored him to “stop this crime against humanity”.

Mr Berlusconi said he believed that he represented the feelings of most Italians. Opinion polls, however, suggest that Italians are divided, with 47 per cent in favour of Ms Englaro’s “right to die”, 47 per cent against, and 6 per cent undecided.

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This is perfect for a current events report in my health class