End-of-life care is a right for only one in four Italians, and national legislation is a puzzle

With the go-ahead from Veneto for the law on procedures for medically assisted suicide, the debate on end-of-life issues has been reignited. Following Veneto’s approval – the first centre-right region to do so – the number of regions in Italia that have regulated this has risen to four: the law has also been passed in Tuscany, Sardinia and Emilia-Romagna. In practice, for almost 15 million Italians – one in four Italians – the procedures for accessing the right to end-of-life care have been regulated in accordance with the criteria established by the Constitutional Court in its landmark 2019 ruling (and subsequent rulings), specifically: an irreversible medical condition, intolerable suffering, dependence on life-sustaining treatment, and the capacity to make a free and informed decision.

In these four regions, the procedure has been set out, including the process for submitting a request for assisted suicide, the timeframes and the bodies responsible for assessing eligibility. For those living in the rest of Italia, there are sometimes administrative regulations governing the matter, but in practice cases are dealt with on a case-by-case basis, with the risk of lengthy delays and the matter being passed back and forth between local health authorities. There is also a real possibility of receiving a different response depending on the region in which one lives. All eyes are also on Parliament, from which a law has been awaited for seven years – a goal that, for the time being, remains a conundrum.

There have been eight decisions by the Constitutional Court: Order 207 of 2018 and seven judgements, from 2019 to 2026. The process began in 2017, when Marco Cappato accompanied DJ Fabo, Fabiano Antoniani, to Switzerland for assisted suicide and subsequently turned himself in to the authorities. In that case, in Order No. 207 of 2018, the Constitutional Court identified a possible conflict with the Constitution regarding the absolute ban on assisted suicide and gave Parliament approximately one year to take action, postponing the hearing until September 2019. No legislation was passed, and in Judgment 242 of 2019, the Court ruled that assisted suicide is not a criminal offence provided certain specific conditions are met: an irreversible medical condition, intolerable suffering, dependence on life-sustaining treatment, and the capacity to make a free and informed decision. Furthermore, the procedures set out in Law 219 of 2017 must be followed and the requirements verified by the National Health Service.

Since then, the Constitutional Court has defined the scope of this provision. Judgment 135 of 2024 clarified the concept of life-sustaining treatment; Judgment 66 of 2025 specified that the requirement may also apply to those who refuse treatment necessary for survival. Ruling 132, on the other hand, addressed the procedures for self-administering medication. The issue then moved to the regional level: in Ruling 204 of 2025, the Court recognised that the Regions have discretion over organisational and procedural aspects. Decision No. 148 of 2026 intervened in the law passed by Sardinia, declaring certain provisions that exceeded those limits to be unlawful. Finally, in Decision No. 152 of 2026, the Constitutional Court confirmed that dependence on life-sustaining treatment remains a requirement for the exemption from criminal liability set out in Decision No. 242.

“In the absence of a national law, almost seven years after Constitutional Court ruling No. 242/2019, the procedures are entrusted to the regional health services: Four regions have enacted legislation setting out organisational procedures, others have adopted administrative acts, whilst others still deal with cases on a case-by-case basis. As a result, the same request may receive different responses depending on the region and the professional in charge. When it comes to a fundamental right, in a procedure that does not allow for subsequent corrections, the lack of uniformity in the guarantees provided is unacceptable”. This is explained in a statement by the Italian Society of Psychiatric Epidemiology and theLuca Coscioni Association, which have sent the regional health departments a technical protocol setting out, in practical terms, how to assess the capacity to make free and informed decisions in requests for medically assisted suicide. “The assessment of decision-making capacity is the only prerequisite requiring a clinical evaluation of a psychopathological nature and is, at the same time, the one lacking shared methodological guidelines,” argues the Luca Coscioni Association – The protocol proposed by SIEP fills this gap: no psychiatric diagnosis in itself constitutes grounds for exclusion; the assessment is individualised and carried out using validated tools; at least two interviews are required, held several days apart, one of which must be a private consultation without third parties present; the opinion of a second independent psychiatrist is mandatory where the psychiatric component is significant; any judgement of unsuitability must be justified in writing”.