End of life, oncologists want a law and 63% are in favour of euthanasia

90 per cent of the clinicians surveyed by Aiom ask for clear rules on patient management and 32 per cent state that they are not sufficiently prepared to assist the cancer patient in the final stages also due to the absence of widespread palliative care

by Barbara Gobbi

19 September 2025

5' min read

Translated by AI

Versione italiana

Key points

A law
Application: practices in the SSN
For 50% euthanasia only under certain circumstances
The Importance of Dat
The request: palliative sedation for all
The importance of early palliative care

5' min read

Translated by AI

Versione italiana

More than six out of ten doctors, albeit with important 'distinctions', are in favour of euthanasia in cancer patients, and meanwhile 90% believe that a law on the end of life is necessary also to put an end to the uncertainties that clinicians have to face on a daily basis. In these net percentages, there is a 32% who declare that they 'do not feel sufficiently prepared' to assist the cancer patient in the last phase of the treatment pathway, while six out of ten white coats say that they carry out cancer treatments in the last month of life.

These are the - partly shocking - results of a survey of 562 clinicians promoted by the Italian Association of Medical Oncology (Aiom) and the Aiom Foundation and presented in Lecce at a conference on Ethics Days, dedicated to 'End of life: care beyond illness'.

A law is needed

"The end of life has been at the centre of the parliamentary debate in recent months, which is why we promoted the survey to analyse the opinion of clinicians," explains Francesco Perrone, President of Aiom. "What emerges strongly is the need for the legislator to define a regulation on the subject as soon as possible, also clarifying the role of artificial hydration and nutrition, which for 50% of clinicians constitute medical treatments and for the other half support therapies. We are faced with 'grey areas', which contribute to fuelling uncertainty.

In order to analyse the opinion of clinicians and the organisational methods implemented on the subject of early palliative care, shared care planning, palliative sedation, therapeutic desistance, and medical aid in dying, Aiom and the Aiom Foundation have promoted a survey that has also involved the other scientific societies with an interest in these issues: the Association of Radiotherapy and Clinical Oncology Airo, the Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care Siaarti, the Society of Oncological Surgery Sico, the Society of Palliative Care Sicp and the Italian Society of Psycho-Oncology Sipo.

The request: practices in the SSN

According to the oncologists, the current unified text of the bill on medically assisted death ("Amendment to Article 580 of the Criminal Code and further provisions implementing Constitutional Court ruling No. 242 of 22 November 2019") contains several critical issues, highlighted by Aiom and the scientific societies of anaesthetists and palliativists. "The proposed legislation," Perrone continues, "excludes the National Health Service from the implementation phase of the procedure and the person called upon to assist the person, prescribe or provide the drugs, or supervise the sequence of events is not indicated, exposing them to potential selection by patient census and unacceptable disparities. The costs for these practices should not be borne by citizens. Only the National Health Service can guarantee all the competences and integrated pathways, including simultaneous palliative care.

For 50% euthanasia only in certain circumstances

«Le richieste di aiuto medico nel morire da parte dei pazienti oncologici sono poche rispetto all’alta incidenza dei tumori in Italia, che nel 2024 hanno fatto registrare 390.100 nuovi casi – afferma Saverio Cinieri, Presidente di Fondazione Aiom -. Ma Aiom e Fondazione Aiom hanno sempre attribuito grande rilievo al tema. Il sondaggio evidenzia che il 63% dei clinici è a favore dell’eutanasia. È importante mettere in luce che il 50% lo è in presenza di determinate circostanze, in particolare in caso di sofferenza inaccettabile, scelta consapevole o aspettativa di vita breve. Si tratta di condizioni in linea con i criteri stabiliti dalla Corte Costituzionale, cioè grave sofferenza fisica o psicologica, capacità di prendere decisioni libere e consapevoli, patologia irreversibile e dipendenza da trattamenti di sostegno vitale. Solo i clinici, che hanno un rapporto di cura continuativo con il paziente, sono in grado di esprimere una valutazione al riguardo in tempi brevi».

The Importance of Dat

"The recent amendments to the bill,' continues Cinieri, 'envisage that the verification of the requirements will pass through a double screening: first the territorial ethics committees, with a non-binding opinion within 60 days, then the National Coordination Centre, with a mandatory opinion within a further 60 days, which can be extended by 30 for 'justified and proven needs'. This double step can prolong the procedure by up to five months. In this way, a timely taking charge, which is fundamental in the end-of-life phase, is not guaranteed. There is in fact a real risk of very long waiting times, incompatible with the conditions of those who suffer, potentially not respecting the law on advance treatment provisions'.

For 92% of the clinicians, shared care planning, as provided for by the law on advance treatment provisions (No 219 of 2017), is feasible with cancer patients. However, in daily clinical practice, only 9% always implement it. In the presence of advance treatment provisions, 72% believe that they must always comply with the patient's wishes. 85% inform the cancer patient at an advanced stage of the prognosis of the disease (28% always, 43% fairly often and 14% occasionally).

The request: palliative sedation for all

"Only 29% of clinicians say that palliative sedation, where indicated, is always carried out,' explains Vittorina Zagonel, former director of Oncology 1 at the Veneto Oncology Institute in Padua. 'Palliative care must be made available to all cancer patients at the same time as cancer treatment, including palliative sedation in the last part of the pathway. Although it cannot be imposed as mandatory, it is a right of all citizens and it is desirable that it should constitute 'a pre-requisite for the patient's choice of any alternative pathway', as established by the Constitutional Court. Palliative care avoids futile treatment and guarantees personalised assistance to the patient and his family until the end of life.

The importance of early palliative care

In base al sondaggio, nell’82% dei casi, nella struttura è presente una Unità o Servizio di cure palliative e nel 77% vengono garantite le cure simultanee (cure palliative precoci). «Obiettivo ideale sarebbe quello di implementare i gruppi di cure simultanee, ancora assenti in circa il 20% dei centri – sottolinea Massimo Di Maio, Presidente eletto Aiom -. Un’integrazione precoce di interventi di supporto, in un’ottica di cure simultanee, ha un impatto positivo sulla qualità e quantità di vita del paziente oncologico e sui risultati attesi dalle terapie». Nel 2010 fu pubblicato, sul “New England Journal of Medicine”, l’articolo che ha cambiato il modo di concepire le cure palliative. «Lo studio ha dimostrato che, in pazienti con tumore del polmone non a piccole cellule metastatico, le cure palliative precoci possono migliorare non solo la qualità della vita ma anche la sopravvivenza, proponendo, di fatto, un nuovo modello di integrazione fra cure palliative e cure attive – conclude Mass

Finally, for Massimo Di Maio, 'precision medicine should also be applied in palliation, as highlighted in an article published in 'Esmo Open', by choosing the right moment, represented by the diagnosis of advanced disease. These treatments should therefore not only be used in the last days of life, when there are no more active treatment options, but represent a valuable resource from the moment of diagnosis of advanced cancer, because they can improve quality of life and survival'.