End-of-Life Decisions in Albania: The Call for an Ethical Revision
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End‑of‑Life Decisions in Albania: The Call for an Ethical Revision Denard Veshi1 · Ervin Pupe2 · Carlo Venditti3 · Ilir Kalemaj1 · Enkelejda Koka1 · Michele Biring‑Pani1 · Hektor Ruci1
© Springer Nature B.V. 2020
Abstract While in Western European countries, the end-of-life decisions have become a matter of public policy, this paper provides a detailed analysis of end-of-life decisions in Albania by focusing on instructional medical directives. The manuscript investigates the Albanian legal system, the documents published by the National Ethics Committee and the National Committee of Health, as the two main advisory public bodies on health issues, as well as the national medical jurisprudence and the Code of Medical Ethics. After emphasizing the importance of instructional medical directives and considering the international literature that has underlined the ethical principle of patient autonomy, this paper provides some policy suggestions. In the conclusion, this contribution highlights the importance of ad hoc rules governing instructional medical directives as well as the ethical principles and international literature as an instrument to fill the gap in the national system. In addition, particular attention is given to the application of ethical principles in end-of-life decisions in the current pandemic situation. Keywords Albania · End-of-life decisions · Instructional medical directives · Code of medical ethics · Patient autonomy
Introduction In recent decades, the patient-physician relationship has been transformed in Albania. From a communist ideology, also expressed in medicine, to a neoliberal approach to the ethical principle of patient autonomy where the main focus is the broader concept of wellbeing (Swetz et al 2014; Tibaldi et al 2011), which is considered in this paper as conceptually broader than just the notion of physical
* Denard Veshi [email protected] Extended author information available on the last page of the article
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health since it includes the subjective idea of what constitutes health (Veshi 2017), without including the political function of it. In Europe, while withholding or withdrawing treatment from a conscious patient is considered legal (ECtHR, Pretty v. the UK, application no. 2346/02, par. 63), different approaches have been applied for withholding or withdrawing treatment from an unconscious patient, physician-assisted suicide (PAS), or euthanasia (or “mercy killing”). The majority of the members of the European Council (Andorno 2008) as well as all the English-, German-, and Romance-speaking countries (Koka and Veshi 2019) recognize the right to also not be treated (the right to withhold or withdraw medical treatment) by unconscious patients. Furthermore, several Western European countries—such as the Netherlands, Belgium, and Luxemburg, Germany, or Switzerland—have legalized forms of PAS or euthanasia. More recently, in September 2019, the Italian Constitutional Court has recognized some type of PAS by declaring the un
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