Having recently returned to the fore the "Welby case, it seems useful to publish this wonderful open letter to Dr. Giuseppe Casale . The doctor of the late Welby shows how he has been - at the same time - the victim and architect of a battle instrumental in all complain but really trying at all costs.
Mi sono trovato di fronte un uomo malato che vive in un appartamento di una periferia romana, al quarto piano con un ascensore stretto. E' in una piccola stanza, di fronte a lui solo un televisore. L'unica finestra è lontana dal letto, per cui non riesce a guardare fuori. L'unica persona ad assisterlo giorno e notte è la moglie, supportata da un'assistenza sociale attivata dal Comune per poche ore a settimana.
Ho visto il Sig. Welby solo due volte. Lui è attaccato dal 1997 al respiratore e dal 2002 ne è completamente dipendente. Non ha una nutrizione artificiale e nemmeno un sondino nasogastrico, come erroneamente è stato riportato da un esponente del partito radical in the TV show "Focus." It feeds a few months with only semi-liquid diet.
In the second and last visit I made on 25 November, whereas the underlying disease (muscular dystrophy), I found that his physical condition would not be of such gravity as to suppose that he was dying. Mr. Welby urinated course. Evacuate only by emptying every two or three days, aided by his wife. The assessment of physical pain that he reported was very mild, not taking medication for this symptom.
I certainly detected a lot of psychological pain and anger and even more profound spiritual pain. When I speak of the pain I do not mean a spiritual pain that concerns their faith, but a pain in intimate, deep and existential gripped can any of us, believer and atheist. 'S when you can not give more meaning to life as such.
The Mr. Welby was addressed by the Luca Coscioni all'Antea. I've seen as I mentioned only twice. Given the situation I proposed the clinical and social care at our medical facility Hospice Antea, but it is refused. So I suggested to assist in the home, as we usually do with our Palliative Care Unit of home, assuring a strong presence of our operators, which also includes psychological and spiritual leaders. Mr. Welby could not grant this motion.
So I proposed an anxiolytic and antidepressant therapy, inasmuch as only a mild tranquilizer in the evening, but he refused.
At this point the only solution was to offer sedation, also because this was his request, but mainly because it was l'unico strumento in mio possesso per curare la sua sofferenza.
Lui aveva molta difficoltà a deglutire e le vene superficiali erano difficilmente reperibili e sclerotizzate, per cui ho proposto una sedazione per via sottocutanea, ma la richiesta del Signor Welby diventò molto specifica : "Voglio essere sedato e contemporaneamente staccato dal respiratore".
Ho risposto che non potevo in quanto la sua era una vera e propria richiesta di eutanasia, e che comunque le modalità che gli avevo offerto erano una valida alternativa alla sofferenza. Gli ho assicurato che gli sarei stato vicino quando la morte lo avrebbe raggiunto naturalmente and I accompanied him until the last minute, and that he would die peacefully.
addition, the medical point of view, I believed that during the sedation would be the death which occurred in a few days, for the normal development of the disease, and also because He rejected any form of aggressive treatment, including the use of needles for intravenous nutrition and nasogastric tube for enteral feeding, .
sedation carried out by me, I repeat, would be administered not only to make him suffer and not to accelerate or even cause death.
In this way the artificial respirator would have had if not a small part of the irreversible process that would face. This would have been made respecting the right to self-determination and at the same time would be prevented by any form of therapeutic obstinacy on his person, as well, his refusal to accept any means of artificially prolonging his life. I remember however that the sedation is not a definitive measure, but is reversible since the patient can be awakened if and when the need arises, although in this case would have been enough unlikely that this could happen.
I am convinced that if Mr. Welby had approached us before accepting palliative care, we would have had the opportunity to ensure better quality of life, helping him to reconsider life more worth living, even as a patient.
After my proposal Mr. Welby reiterated what was already said: "I want to be sedated and immediately be disconnected from the respirator."
I should point out that if I had done so, though against my will and my medical and ethical man, my name, doors, and that of all palliative care would have been exploited in the media and political battle waged in the name of euthanasia. Battle of why I consider that Mr Welby is now the creator and the victim at the same time.
And this can not and do not want to happen ever. I am opposed to euthanasia, as well as for ethical reasons, no man can and must take the life of another man, also because there are means to help people not feel alone, abandoned, not to suffer. Means likely to help avoid any suffering to enhance every moment of life: palliative care, palliative care physician and that I, I proposed that are considered most appropriate. If implemented in their deeper meaning and trained personnel, will cancel the request for euthanasia. And do not say this as an axiom, but based on experience gained through the assistance provided to the ante more than 10,000 terminally ill patients not only with cancer.
remember that the World Health Organization Palliative Care considers the most appropriate way to care for patients undergoing terminale.per accompany those who are suffering with dignity alla morte. Le Cure Palliative, mi piace sottolineare, sono contro qualsiasi forma di accanimento terapeutico e contro l'eutanasia.
Purtroppo bisogna rilevare che nella società attuale si fa evidentemente prima a parlare di eutanasia, che prendersi cura degli oltre 140.000 malati terminali stimati in Italia ogni anno, quindi investire sulla formazione del personale e sulla realizzazione di centri e reti socio-sanitarie per le Cure Palliative.
Mi dispiace, come medico e uomo, che mentre scrivo il Sig. Piergiorgio Welby stia soffrendo, e insieme a lui la wife Mina. I just feel sorry that he could not help, as I do every day, for many people, from children to the nineties, under similar conditions and sometimes more severe than his, with the team through dell'Antea and Palliative Care.
Giuseppe Casale
Coordinator Palliative Care Unit ANTEA
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