End-of-life bill arrives in Italy. From France to England: how it works in Europe

In Italy, the law on the end of life takes a step forward in the Senate. The life bill, proposed on Tuesday 1 July by the majority rapporteurs, was adopted as the basic text from which consideration in the Senate will begin, after months of stop-and-go. Put to a vote by the Justice and Health commissions, it was approved by the centre-right, with all the oppositions opposed. The committees also established that amendments to the text could be submitted by 8 July. The measure is expected in the parliament on 17 July.

For more than a year, five bills had been tabled (by majority and opposition) without ever turning into a shared one. This task was entrusted to the select committee in December, but it was laboriously at work. Hence the majority's 'blitz', which put its proposal of four articles down on paper. It is scheduled to be examined in the House on 17 July. The first article recognises the right to life as the 'presupposition of all rights in the order' and the protection of the life of every person 'without distinction' of age, health and social conditions.

Gone, therefore, is the expression 'from conception to natural death', which had infuriated the opposition, convinced that it was an attack on abortion. The treatment will not be paid for by the National Health Service: neither doctors nor instruments nor drugs from the 'public' may be used for this purpose. It is confirmed that whoever helps a person in end-of-life treatment does not commit a crime and is not punishable. It will be the National Evaluation Committee - and no longer the Ethics Committee - that will assess whether patients meet the requirements. But compared to the draft, the timeframe is shortened: a total of 90 days instead of 120. The time for resubmitting an application if the first one was rejected also drops significantly: from four years six months. The government appointment of the Committee remains (with decrees from the Prime Minister), an aspect that the Left considers 'too politicised'. Finally, palliative care will not be compulsory but made available and Article 3 regulates how to guarantee access to it, to try to avoid disparities between regions.

Not only Italy is moving to adopt new rules on 'medically assisted suicide', i.e. the situation in which a person autonomously and voluntarily induces his or her own death through the self-administration, orally or intravenously, of the lethal drug. At present, according to the latest update of the Luca Coscioni Association, there are 23 states in which medically assisted suicide is permitted. These include, to remain within Europe, Germany, Switzerland, Austria, Belgium, Spain and Portugal. In Italy it is legal for people dependent on life-support treatment. By contrast, it is not permitted in 101 states. These include, still remaining in Europe, France, the United Kingdom, Poland, Finland, Norway, Sweden and Ireland, and the Russian Federation.

In France, end-of-life rules are mainly based on the Claeys-Leonetti law of 2016, which updated an earlier law of 2005. These laws define the legal framework for the end of life in France, without legalising euthanasia or assisted suicide. In 2024, President Emmanuel Macron announced his intention to present a new draft law on the end of life, with the possibility of legalising a regulated form of assisted suicide. The Assemblée nationale recently approved two end-of-life bills at first reading: the first, unanimously, on guaranteeing access to palliative care everywhere in France and the second on 'aid to dying'. Now the Senate's green light is missing. Among the solutions envisaged, the patient must be a French national or an official resident, must be suffering from a serious and incurable illness that causes unbearable suffering, and must express the will to die in a conscious situation, if possible with a written request. It is therefore the sick person who must make the request. The request will be examined by a medical board of three people, the patient has 48 hours to change his or her mind, the doctor 15 days to respond to the request, and must take into account not only the 'quantity' of life remaining but also its 'quality'.