End-of-life care: life-sustaining treatment is necessary to make assisted suicide lawful

The Court also emphasised the need to strike a balance between the principle of the dignity of the person, personal freedom and the freedom of self-determination in the context of medical treatment, and the legal system’s duty to protect life. This applies both to the risk of ‘abusive conduct by third parties to the detriment of the individual who chooses to end their own life’ and to the danger of ‘indirect social pressure being exerted on others people who are ill or simply elderly and lonely, who might come to believe that they have now become a burden on their families and on society as a whole, and thus decide to take their own lives prematurely”. This balancing act, the Court concluded, is primarily a matter for the legislature.

The Constitutional Court, in its judgment number 148 – also filed today – has upheld the framework of Sardinian Regional Law number 26 of 2025 on assisted suicide, rejecting the State’s objections, but has declared certain provisions of the law to be unconstitutional.

As already held in Judgment No. 204 of 2025 concerning Law No. 16 of 2025 of the Region of Tuscany, which was challenged by the State on substantially similar grounds, the Sardinian regional law also concerns the protection of health, being limited to regulating the activities of local health authorities.

However, the Court explains that numerous provisions of the regional law have unlawfully encroached upon areas of competence reserved for national legislation. The Constitutional Court has declared Article 2, paragraph 1, to be unconstitutional, on the basis of which ‘persons meeting the requirements set out in the case law of the Constitutional Court’ are eligible for the benefits and entitlements provided for by the regional law.

The provision infringes the State’s exclusive legislative competence in matters of civil and criminal law, in that, by referring to the rulings on assisted suicide, “it brings about a revision of the legal principles contained therein, which has the effect of defining, within regional legislation and thereby tightening, the requirements for access to assisted suicide and, indirectly, the scope of the defence under Article 580 of the Criminal Code as identified by the judgments of this Court”. Indeed, with regard to the delicate balance of interests surrounding medically assisted suicide, regional legislation “cannot claim to act in a supplementary capacity to national legislation, so to speak, by ‘appropriating’ the legal principles identified by this Court”, thereby enshrining them in its own provisions.

Article 4 has been declared unconstitutional insofar as it “sets strict time limits for the conduct” of the procedure by which the multidisciplinary committee verifies whether the requirements for access to medically assisted suicide are met, following consultation with the local ethics committee.

The Court held that the State’s legislative competence in matters of civil law had been infringed, as such time limits involve decisions that require uniform treatment throughout the country.

Furthermore, these stringent provisions conflict with the fundamental principles set out in Law No. 219 of 2017, which instead emphasise and promote the “so-called therapeutic alliance”; consequently, whilst recognising the need for the applicant’s case to be taken on promptly,applicant’s request, “the possibility must always be allowed to carry out all those clinical and diagnostic investigations which the Commission – a multidisciplinary body involving various areas of expertise (including psychiatric, palliative, psychological, forensic medical, etc.) – deems appropriate”.

The judgement also referred to “the right of the individual to receive effective treatment, in accordance with the principles of science and medical practice, including through the practical provision of effective palliative care'”.

In contrast to the fundamental principles governing the protection of health under current national legislation, as interpreted in the light of constitutional case-law, Article 4, paragraph 12 has also been declared unconstitutional. This provision, by granting a person who meets the eligibility criteria for medically assisted suicide the possibility to ‘decide at any time to suspend or cancel the provision of treatment’, proves to be ‘entirely inconsistent with the very structure of medically assisted suicide’, in which “there is strictly speaking no ‘administration’ of treatment that can be suspended or cancelled (as is the case with active euthanasia, which under Italian law constitutes the offence of murder with the consent of the victim), but rather assistance provided by healthcare professionals to a person who must themselves carry out the final act that directly causes their own death”.

The following have also been declared unconstitutional: Article 5, under which regional health authorities provide technical and pharmacological support and medical assistance for the preparation for self-administration of the authorised medicinal product, and Article 4, paragraph 10, which is intended to ensure that this procedure takes place within seven days of the request.

In upholding the findings of Judgment No. 132 of 2025, the Court held that legislative competence in the field of health protection had been infringed, since, through these provisions, the Region had not merely laid down detailed regulations, but “in fact appropriated the fundamental principles, thereby inflicting a breach of the reservation established by Article 117, paragraph 3, of the Constitution, which reserves their determination to State legislation”.

The other provisions contained in the regional law, however, were deemed to be free from any objections. The Court held that the exercise of concurrent jurisdiction in the field of health protection cannot be regarded as precluded by the fact that the State has not yet enacted a law providing for a comprehensive framework, across the whole of the national territory, governing access to medically assisted suicide. Indeed, within the limits specified above, the fundamental principles governing this matter can already be inferred from existing legislation, interpreted in the light of the Court’s judgments.