Alimentazione e idratazione artificiale come problema di giustizia

The paper examines the bioethical aspects related to artificial nourishment and hydration. As a first step, a clear distinction between nutrition and feeding is presented. Following this distinction, the article analyses the notion of artificiality and evaluates its appropriateness. The enquiry clarifies also that “artificiality” per se does not constitute a bioethical problem. Through the examination of official documents (opinion of Italian National Bioethics Committee, Siaarti guidelines), the paper analyses the theoretical nodes which the debate is focused on; it clarifies whether artificial nourishment and hydration is a therapy or not; it investigates the possibility that it can constitute overtreatment and if so, what criteria should be used in order to define it. The article argues that dispensing with objective criteria for the identification of over-treatment leads to severe discrimination. Particularly, the analysis focuses on vegetative state condition. By reference to the documents it becomes clear that vegetative state condition represents the paradigm through which the abandonment of objective criteria such as that of proportionality in favour of subjective ones is introduced. This opens the way to a therapeutic and care abandonment of patients with psychological and neurodegenerative pathologies. The conclusion makes clear that a relevant question of justice hides behind the apparent privacy of some decisions, which is put to the test precisely by conditions of extreme disability.