End of life, the process starts in Parliament: what it involves and how it works

The centre-right accelerates on the end of life. The bill, proposed on Tuesday 1 July by the majority rapporteurs, has been adopted as the basic text from which examination in the Senate will begin, after months of stop-and-go. This comes on the same day that Prime Minister Giorgia Meloni will meet Pope Leo XIV for the first time in audience and immediately afterwards the Secretary of State, Cardinal Pietro Parolin. Ethical issues - first and foremost, the new law on assisted suicide - together with international conflicts will be at the centre of this meeting in which the prime minister, in addition to reiterating her commitment to peace, will reassure the Vatican that there will be no leap forward towards euthanasia. Yesterday evening, the select committee of the Justice and Social Affairs commissions reviewed the bill that could land in the Senate chamber on 17 July.

The text worked on by the two rapporteurs Pierantonio Zanettin (Fi) and Ignazio Zullo (Fdi) has been partially corrected as requested by the oppositions, for example by reducing to 180 days the initial deadline of four years to be able to ask the brand new 'National Evaluation Committee' of 7 members - composed of a jurist, bioethicist, anaesthetist, palliativist, psychiatrist, psychologist and nurse - appointed by Palazzo Chigi to access the treatment if the first application was refused. But on other fronts, the new text risks triggering a bitter clash with the oppositions that have been on the warpath for weeks. One of the most complex issues is the role of the National Health Service: for the centre-right, assisted suicide cannot become a service provided by the NHS. And in fact the bill states that 'the personnel on duty, the instruments and the drugs, which the National Health System has at its disposal for any reason, cannot be used for the purpose of facilitating the end-of-life purpose'. This means that if the terminally ill patient is in a hospital or in a public nursing home, he or she can have access to assisted suicide - if authorised by the Committee - on one condition: that the patient must 'do it yourself' by paying for the equipment, the lethal drug, and the doctor (who can also be from the SSN, but on 'overtime'), unless he or she finds 'hospitality' in private facilities. In short, end-of-life care in public hospitals is in danger of becoming practically impossible.

The other crucial point is that of palliative care, which must always be made available (even if it cannot be compulsory) and where the regions are not yet equipped - at least half are lagging behind in the availability of these therapies - 'substitutive powers' may be triggered with the appointment by the government, in the event of the absence of a regional plan, of 'a commissioner ad acta until the standard' of care is reached. Not only: 'If the Region has not achieved the palliative care strengthening objectives set in the plan submitted for the previous year, the Minister of Health,' the draft reads, 'shall assign a deadline of no more than six months for achieving them'. The text then introduces a new article in the penal code on assisted suicide that reiterates how 'it is not punishable' if the 'intention' has been formed 'freely, autonomously and consciously' and if the person is 'included in the palliative care pathway, kept alive by treatments substituting vital functions and affected by an irreversible pathology, source of intolerable physical and psychological suffering, but fully capable of understanding and willing'. So far, only a few patients have been able to access it in line with the conditions set by the Constitutional Court, while yesterday Martina Oppelli, the 49-year-old woman who has been suffering from multipl sclerosis for twenty years, filed a new objection after the third denial by her Asl because she has no life-support treatment in progress.