Constitutional Court

The Constitutional Court’s deliberations on ‘life-sustaining treatment’ draw to a close; 11 patients appear in court for the first time

Doubts over a key issue. A ruling of unconstitutionality would lead to an expansion of the group of patients eligible for the treatment

by Patrizia Maciocchi

23 June 2026

Foto IPP/Fabio Cimaglia Roma 13/02/2021 Nella foto: Piazza del Quirinale con la facciata del Palazzo della Consulta sede della Corte Costituzionale - IPP

6' min read

Translated by AI

Versione italiana

Key points

The conditions laid down in the Cappato judgement
Life-sustaining treatment and the Bologna investigating magistrate’s referral
Constitutionality concerns and previous rulings
Patients admitted to the hearing

6' min read

Translated by AI

Versione italiana

The end-of-life issue is once again before the Constitutional Court for the eighth time. But for the first time, at today’s hearing, the judges are called upon to clarify the concept of ‘life-sustaining treatment’; also unprecedented is the presence of 11 patients, 8 against and 3 in favour. The doubts centre on a fundamental issue, because a ruling declaring the law unconstitutional is bound to expand the number of patients who could access to assisted suicide.

The conditions laid down by the Cappato judgement

In its ruling No. 242 of 2019 (the Cappato ruling) – which to date has enabled 17 terminally ill patients in Italia to receive assisted suicide – the Constitutional Court has laid down the conditions that must be met by a patient requesting access to the procedure:

suffering from an irreversible condition that is considered incurable;
to be suffering physical or psychological suffering which they themselves deem to be entirely intolerable;
to be dependent on ‘life-sustaining treatment’;
and, finally, retain the capacity to make free and informed decisions.

In the case of Stefano (a fictitious name chosen by the Luca Coscioni Association), who suffers from multisystemic atrophy, an irreversible neurodegenerative condition, the health authority denied that the life-sustaining measures keeping him alive – oxygen therapy, a urinary catheter and the constant administration of insulin – could be considered genuine ‘life-sustaining treatment’ because discontinuing them would not have led to his death within a short period of time.

Life-sustaining treatment and the referral by the Bologna investigating judge

The case was referred to the Constitutional Court by the pre-trial judge in Bologna, to whom the case of a woman suffering from an irreversible condition – but not being kept alive by life-sustaining treatment such as mechanical ventilation – had been submitted. The woman was accompanied to Switzerland to undergo assisted suicide by a number of activists from the Luca Coscioni Association, including Marco Cappato, who voluntarily reported themselves to the authorities for the offence of aiding suicide, given that the patient’s condition did not fall within the scope of automatic exemption from criminal liability defined by the 2019 constitutional ruling.

Following a request from the Public Prosecutor’s Office to dismiss the case, the Preliminary Investigating Judge in Bologna has decided to stay the proceedings and refer the case to the Constitutional Court. The investigating judge considers that Articles 2, 3, 13 and 32 of the Constitution have been violated on the grounds of unequal treatment and infringement of the right to therapeutic self-determination in cases involving seriously ill patients, but who are not dependent on life-support machinery; and that the European Convention on Human Rights (Article 8 of the Convention) has been breached in relation to the protection of the right to respect for private and family life.

Today, at the public hearing, the reporting judges Viganò and Antonini will speak, and the parties will be represented by lawyers Maria Elisa D’Amico, Francesco Di Paola, Filomena Gallo, Benedetta Liberali, Mario Esposito and Carmelo Leotta. The State will be represented by lawyers Ruggero Di Martino and Gianna Maria De Socio. The Court is also expected to rule on the Sardinian law on assisted suicide, which is opposed by the Government.

Constitutionality concerns and previous rulings

The investigating judge brings his concerns regarding a legal contradiction to the attention of the judge presiding over the case: if a doctor can legally comply with a patient’s refusal of treatment whilst connected to life-support machinery, thereby allowing this to lead to death, why cannot they help a patient in an equally serious condition whose only ‘fault’ is not being dependent on mechanical support? According to the judge in Bologna, the restrictive interpretation of this requirement violates the constitutional principles of equality, dignity and self-determination for people finding themselves in similar situations. Imposing the requirement of life-sustaining support creates discrimination between patients who are suffering in the same way and, as also highlighted by the National Bioethics Committee, paradoxically risks forcing a patient to undergo invasive treatments for the sole purpose of subsequently refusing them in order to gain access to the procedure. According to the Court of Bologna, what should count is the nature of the illness and the severity of the pain, not the type of treatment received.

The Constitutional Court has already ruled twice (judgements 135/2024 and 66/2025) on life-sustaining treatment, but in relation to the right to refuse medical treatment, and with interpretative decisions that have left scope for different applications. In judgement 135/2024, the Constitutional Court clarified that the concept of ‘life-saving treatment’ includes not only treatments that constitute a genuine ‘replacement’ of a vital function which the body is now entirely incapable of maintaining independently, but also medical devices, ongoing pharmacological therapies and constant assistance from third parties. In its subsequent judgment (66/2025), the Constitutional Court affirmed the legitimacy of the provision which makes the non-punishability of assisted suicide conditional upon the requirement of life-sustaining support.

In this context, and with no legislation in place, patients are at the mercy of discretionary decisions. The Regions have taken a piecemeal approach in attempting to intervene, but only within the narrow scope of their own powers. They can do nothing, therefore, regarding the requirement for life-sustaining treatment, which can only be removed or ‘authentically’ interpreted by the national legislature.

Patients admitted to the hearing

For the first time, eight patients, represented by their lawyers, have been admitted to the hearing: eight who oppose assisted dying and three who are instead calling for the constitutionality issue to be upheld, with a view to legislation that allows for a broader interpretation of the requirement. Opposing, however, a broad interpretation of the condition of life-sustaining treatment, as laid down in the Cappato judgement, will be eight patients suffering from irreversible illnesses, who are fully capable of understanding and making decisions. None of the patients present, however, is – as they state – ready to die at this stage.

“We don’t want to have a gun on the coffee table, which we might use when we’re in trouble”. This is the position of the eight patients with irreversible conditions who, before the Constitutional Court, are opposing an extension of the criteria for assisted dying, as explained by their lawyer, Mario Esposito, on the sidelines of today’s public hearing. The lawyer went on to add: “Assisted suicide may conceal an alternative way of getting rid of people deemed useless by society; this is demonstrated by data from countries where it is permitted.”

They have travelled to the Constitutional Court to be physically present at a debate that directly concerns their future. They are brothers Marco and Carlo Gentili, both suffering from ALS, and Roberto, a cancer patient – the three people calling for a broadening of the eligibility criteria for access to end-of-life care, supported by the Coscioni Association. They attended the hearing in a dedicated room and made statements afterwards, using the device they use to communicate. “We have been living with ALS since childhood,” say the Gentili brothers. “We are entirely dependent on the care of our mother and the people who help us every day.” They clarify that “we do not want to die today”, but believe that “the recognition of a fundamental freedom should not depend on a specific medical treatment” and ask that, should they choose to end their suffering, their situation be assessed “without discrimination based on the type of illness or the treatment received”. Roberto, on the other hand, suffers from a cancer that makes it difficult for him “to bear life due to the loss of autonomy and dignity”. He considers it “inevitable” to think about “ending my life. Italia needs a clear law – he emphasises – “that unambiguously paves the way for ending one’s own life when it involves unbearable suffering and a loss of autonomy and dignity”.

For the attention of the judges an ethical issue which divides institutions, the political sphere and citizens alike. The Church’s position is clear, as reiterated yesterday by Pope Leo XIV. The Pontiff , during an audience with the Jerome Lejeune Foundation – renowned for its research into Down’s syndrome – emphasised that a person’s worth does not depend on what they achieve or produce. For this reason, “no doctor should ever presume, on the basis of laboratory algorithms, to decide on the life of an embryo or an elderly person! Medicine must never become the servant of a planned death”. On the political front, the majority parties are focusing on promoting palliative care, challenging and blocking initiatives by the regions that seek to circumvent the absence of a national law. Their bill has returned to committee in recent weeks, following the approval of a motion to suspend proceedings. The opposition, for its part, has tabled a unified bill, which is currently stalled in the Senate. Against this backdrop, the Constitutional Court’s umpteenth warning to Parliament to break the deadlock is almost inevitable.