Health protection in the Italian Constitution: how it works

HEALTH PROTECTION IN THE CONSTITUTION

Which articles of the Constitution govern the protection of health? –
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In Title II of the first part of the Italian Constitution dedicated to ethical social relations (art.29-34) three aspects are taken into consideration which are of considerable importance both for the individual and for the community: family, health and school.

The rights recognized in these articles form part of those inviolable principles, set forth in Article 2, guaranteed to man, as an individual and as a member of “social formations”.

The article governing health protection is Article 32 and is divided into two paragraphs. the paragraph 1 stipulate that the Italian Republic considers the protection of health as a fundamental right of the individual and an interest of the community.

The fact that health is a collective interest has been an important step forward since before the turn of the 20th century, it was thought that health was only in the interests of the individual. By the 1900s, however, it became clear that health is about the community as it is. the disease has both a social cost (given by the fact that the individual does not participate in social life) both one economic cost (because the individual does not participate in the productive activity and in addition costs must be incurred for his recovery).

Both an inviolable right and a collective interest, it is up to the State to undertake to achieve the well-being of the citizen insofar as it concerns, beyond the individual sphere, also the collective sphere.

1978 HEALTH REFORM AND SSN

To guarantee this right to health, the State must endeavor to remove the socio-economic constraints that prevent the individual from being treatedfor which the health service must be a public service capable of guaranteeing all citizens the services necessary for individual and collective well-being.

Significant innovations have been introduced with the 1978 health reform (Law 181/1978). In fact, whereas in years past health services were provided by the social security system whereby citizens received health care from appointed public bodies mutual on the basis of the contributions paid by them, with the reform the social security systemon the basis of which free healthcare belongs indiscriminately to every citizen and is ensured by a single service, namely the National Health Service to which all the existing public health structures belong.

Also in paragraph 1, it is stated that the Italian Republic guarantees free medical care to the indigent. This principle is still provided for by the 1978 health reformwhich established that all citizens are guaranteed equal treatment by guaranteeing them the right to pharmaceutical and health services, which are free or semi-free (ticket) depending on age and income.

To the second paragraph of article 32 it is stated that no citizen may be subjected to health care against their willwith the exception of cases provided for by law, which can in no way violate the limits imposed by respect for the human person. Even if the right to health is a social right, the individual is free to refuse interventions on his own person, in particular in the case of drug treatments or experimental therapies. Treatment can only be imposed if there is certainty that the subject benefits directly and indirectly if it also benefits the community..

COMPULSORY HEALTH CARE

Among the cases provided for by law in which the citizen may be subjected to health care against his will are those:

  • from contagious diseases,
  • from compulsory medical treatment which concerns people with mental disorders and which provides for forced hospitalization because they represent a danger to the community,
  • of some vaccinations in the field of public health prevention.

With regard to the question of health protection, over the years two interesting debates have developed: one concerning the question of legalization of euthanasiathe other concerning the living will.

I’euthanasia it is the act by which one helps to put an end to the life of another person, in order to avoid unnecessary suffering due to often terminal illnesses such as tumors or an irreversible coma. Euthanasia is therefore a form of death decided by the patient or by a third party if he is no longer able to make this decision independently.

EUTHANASIA AND LIVING WILL

In Italy, euthanasia is a crime aggravated by the state of kinship with the deceased because it is believed that there may be economic interests on the part of those who commit the act.

The decision to practice euthanasia is also highly debated from a medical point of view, the Hippocratic oath binding doctors. It provides that physicians must preserve human life by providing care and treatment bearing in mind, however, that thetherapeutic persistence, that is to say, it is forbidden to try excessively to preserve the life of a patient to the point of making him a kind of human guinea pig. Additionally, the Hippocratic Oath prohibits the administration of lethal drugs to patients, even if they are terminally ill. Although in Italy euthanasia is a criminal offence, in other countries it has been for some time legalized (countries such as Holland, Belgium, Luxembourg, Switzerland, France and in general the countries of Northern Europe).

The other debate concerns the living will. It is a document with which a person capable of understanding and willing can indicate, at a time when he is able to make an informed decision, what therapies he intends or does not intend to accept if in the future he finds himself in a state of incapacity and impossibility to express his will.

The doctor, in making therapeutic choices about a person who has lost the capacity to understand and to want, will have preliminary indications that can serve as a guidethus preserving the possibility of respecting the will of the patient even when he is no longer able to communicate it.

Currently in Italy there are still no laws regulating euthanasia and living wills, so the debate on these issues is still open and there are still many contradictory opinions.

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