Uninformed consent: Who knows what Ivan Ilyich would have thought?

Uninformed consent: Who knows what Ivan Ilyich would have thought?
Commentary
A D’Imperio, M Ienca, A Maiese, V Fazio, R La Russa
La Clinica Terapeutica, 1 July 2021, 172(4) pp 264-267
Open Access
Abstract
In the modern era, when prolonging life is not an option, the end-of-life discussions are unavoidably influenced by Neuroethics. Despite this, it is interestingly evident how the sentiments of a terminal patient of 1885 and a physician of 2020, are still comparable. This paper presents the arguments behind the so-called “Therapeutic Misconception” and the aim of palliative care to provide dying patients support. It is essential to address priorities of informed consent, signed before any remedy is provided. A key component of the newest Neuroscience research is the analysis of motivation and free will. So, it is necessary to comprehend if the patient struggles to feel at peace with these aspects of his “right to die”: Is he free to choose or is he influenced by the doctors? Is this confusion an example of “Therapeutic Misconception”? Is his Informed Consent totally “Informed”? In order to broaden our understanding, we account for many critical situations, such as the mentally impaired Psychiatric patients or the famous Italian case of Eluana Englaro. In addition, we suggested some current approaches such as Artificial Intelligence, useful in preserving some cognitive functions the patient may have lost. Furthermore, research in this field is very critical and in some Catholic countries like Italy, people faced difficulties accepting the idea of the “Anticipated directives”. In general, whatever the mental status and whatever the terminal state, the patients seem still far from handling their own auto-determination and their Consent, even if the ultimate goal is to die with dignity.

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