Institutional portal - Municipality of Milan

The most favorable regions are Basilicata, Piedmont and Lombardy, but only three out of 10 Italians are thinking about the end of life: two years after its approval, the law is still little known. Vidas opens the first dedicated branch. Rabaiotti: “The Municipality does its part, correct information is the basis of a free and informed choice”

Milan, 13 December 2019 – In Italy only 3 out of 10 people have faced the problem of planning their end of life and just 0,7% of the population has drawn up the DAT, or Advance Treatment Instructions. A figure which in Lombardy rises to 3%. The most sensitive to the topic are women aged between 26 and 40. This was revealed, two years after the approval of law 219/2017 on DAT, which took place in December 2017, by the first national research on the population's perception regarding the Living Will disseminated by Vidas, an association that since 1982 has offered socio-health assistance to people with incurable diseases, and carried out in the months of June and July by the strategic consultancy company Focus management on a statistically significant sample of the Italian population made up of 1.602 adult citizens.

The Municipality of Milan, among the first in Italy, already opened an information desk in 2013, also useful for finding forms and designed above all to act as a spur to the approval of a specific law on the subject, as in fact happened later, in December 2017. In recent years, the Casa dei Diritti in via De Amicis, in particular, has represented the space for thousands of Milanese to obtain correct information and to deepen their knowledge of the topic by participating in dozens of meetings organized together with bodies and organizations that are they deal with it, from Vidas to the Bioethics Council to the Veronesi Foundation.
With the same objectives, an email address is also always active, declarationvolonta@comune.milano.it, to which qualified administrative personnel respond. Since the law came into force, around 5 thousand Milanese people, with an average age of 62, have been able to deposit their DAT at the appropriate office. desk in via Larga, open every morning.

“Correct information, at the basis of a free and informed choice, as this research also highlights, is unfortunately still too scarce – intervenes the councilor for social and housing policies Gabriele Rabaiotti -. The Municipality of Milan is trying to do its part: it was among the first in Italy, well before the law came into force, to make an information, orientation and administrative guidance desk available to citizens. We have an email inbox that performs the same functions, and all Milanese who choose to do so can deposit their DAT at the dedicated desk in via Larga. For us this means being guarantors of the fundamental rights already protected by the Constitution, giving our citizens the possibility of choice and self-determination".

The living will, although considered the means to guarantee the right to a dignified death (4,8 on a scale from 1 to 7) and to protect the person's wishes (4,8), is still surrounded by the fear of possible abuse and of the abandonment of the sick (4,1). The main fear (4,6) is that it could introduce the right to death (assisted suicide and euthanasia) into our legal system.
In particular, the research shows that Italians' knowledge on this topic is still rather superficial: in fact, only 19% declare they are well informed about the legislation, while 28% have never heard of it. However, the future could hold surprises because Italians are on average in favor of the living will: among those who are aware of the existence of the law (72%) but have not signed the DAT, those who are convinced reach 51,4%, those against 27,3%. .21,3% and the undecided at XNUMX%.

The best prepared and in favor are mostly citizens residing in the north-west regions, aged between 26 and 40 and with a medium-high level of education. The least informed are the over 70s who live in the south. Measuring the level of favor in drawing up the living will with a scale from 1 to 7, where 1 is "absolutely against" and 7 is "absolutely in favor", the national average value stands at 4,5. The most favorable regions are Basilicata (5,3), Piedmont (4,9) and Lombardy (4,7).
For 32% the best time to sign your provisions is as soon as possible, even in perfect health, while for 25% it is appropriate in the case of serious illness. 
According to those interviewed, the main obstacles to the diffusion of the Living Will are attributable to the nature of the topic, understood both as a frightening topic (25,8%) and as a difficult and personal choice (37,5). Even the strong Catholic influence in our country is perceived as an impediment by 39,6% of people, while 23,2% complain of poor information from the media. However, those who got informed did so through television (67,8%) and newspapers (42,6).

“What is worrying is not the number of DATs already deposited with the Municipalities, especially since the law guarantees the right to self-determination and does not oblige anyone to draft the document – ​​explains Barbara Rizzi, scientific director of Vidas – but that too many municipalities still do not have equipped themselves for their collection. From my medical point of view, even more worrying is the lack of knowledge of the law in the healthcare world and in particular among doctors, from primary care doctors to emergency room doctors and resuscitation anesthetists. The former, as trusted doctors, should be the point of reference for every citizen in matters of health and therefore also for the drafting of the DAT. The latter, as they are involved in the management of emergencies and post-acute situations, should first ask themselves whether the patient they are treating and who is no longer able to express his wishes has expressed them in advance".

For this reason, Vidas is committed to promoting knowledge of law 219 on multiple fronts through training courses for professionals such as journalists and social and health workers and information seminars open to the public. For the same reasons, the Biotestamento Help Desk has just been inaugurated in Milan, a place where it is possible to receive specific advice on those health treatments that may be included in the drafting of the DAT by an expert doctor and psychologist. The desk is located at the association's headquarters in via Ugo Ojetti 66, and is open every Wednesday, from 17pm to 19pm, by appointment by calling 02 725 111 or writing to biotestamento@vidas.it. Vidas also organizes training courses to promote knowledge of 219 aimed at professionals, such as health and social workers and journalists, and information seminars open to the public.

“The research highlights that Foundations and non-profit associations are the actors considered most reliable for conveying information on the Biowill (5,13 on a scale from 1 to 7) – clarifies Erika Mallarini, associate partner of Focus Management spa – followed by representatives ministerial (5,01),  experts from the healthcare world (4,95) and non-famous people (4,89) who tell their personal experiences. Politicians are perceived as untrustworthy to talk about a purely personal matter. To overcome fears and preconceptions and stimulate mature, free and informed reflection among citizens, it is crucial to bring the topic to the attention of the masses in the media, traditional ones first and foremost, by disseminating clear and exhaustive information to simplify the decision-making process through the involvement of people. authoritative and expert".

“The Church speaks of 'conscientious choice' – says Don Paolo Fontana, pastoral manager of Health for the Diocese of Milan – and by this we mean the respect due to the decisions of each person, in any case and, in our context, the magisterial reference dates back to 1980, with the Declaration on euthanasia which bears the title 'Iura et bona' of the Congregation for the Doctrine of the Faith. The question is what content to give to self-determination: given that the choices of each individual must always be respected, everyone's conscience is related to others in a structural way. It is in relationships that people, and even more so when they are weaker and more fragile, as happens in illness, make truly personal decisions. Thus, self-narration, with family members and healthcare staff, allows us to place the right awareness in the choices that the patient makes. The Living Will, compared to the 'now for then' decisions of a healthy person, has major structural limits: the law is much more significant in article 5 when it focuses on 'shared care planning' because it creates the conditions for a sharing of choices between the patient, family and relational network, and the medical team treating him".

“The research – declares Emilia De Biasi, former senator and rapporteur of the Provisions in the last legislature – highlights the problem of poor information on the law and its accessibility. A law lives if it can be enforced. Therefore the problems are different: information that requires an alliance between institutions, politics and the world of communication and volunteering, but also the institutional paths that make the legislative dictate a reality. The news of these days could be a turning point: the signature by the Minister of Health of the decree implementing the national database for the registration of DAT finally allows the law to be fully operational. The database will be fed with the data collected by the municipalities of residence, by the notaries and by the regions which have regulated the collection of copies of the data with their own data. We can look to the future with greater serenity if we manage to network private and voluntary institutional places, and if we know how to build a virtuous alliance with the world of information. With one objective above all: to ensure that the citizen is aware of his right, knows how to demand it in the certainty that his will is respected throughout the national territory".