No national law, so the regions try to guarantee the right to the end of life

The battle over the end of life is once again shifting to the national level and could see a tug-of-war between the government and various regions in the coming months. Triggering this duel are the operating rules that Emilia-Romagna gave itself in February to make up for a regulatory vacuum on assisted suicide. Against the region led by Stefano Bonaccini, the government, together with the Prime Minister's Office and the Ministry of Health, filed a appeal to the TAR to block the council's resolutions that identified, among other things, the guidelines for local health authorities, with procedures and timeframes for any requests for medically assisted suicide. But in addition to Emilia, there are other regions that are working on this dossier, given that in the absence of a national law, there is a lack of operational rules to concretely implement the decision of the Constitutional Court that has in fact sanctioned the right to assisted suicide.

Four people have so far been granted access to assisted voluntary death in Italy, three of them followed by the Luca Coscioni Association's legal team. The first, in June 2022, was Federico Carboni, who received no assistance from the National Health Service and died after more than 20 months of waiting and court battles. In July 2023 in Veneto, on the other hand, 'Gloria' died with a drug and a machine provided by the SSN. The first person to be fully assisted by the National Health Service was 'Anna', from Trieste, who died in December 2023. Finally, in Tuscany, a few months ago in Piombino (Li), she was assisted to voluntary death. Today patients, who are very often terminally ill, are forced to appeal to the courts to get an answer from the Asl, which in the absence of precise rules do not know how to behave. And so the end of life in Italy still remains a tortuous obstacle course with very few cases reaching the end. The vulnus is always the same and that is a legislative vacuum that has now become a chasm after the sentence 242 of 2019 of the Constitutional Court that declared the illegitimacy of a part of the Penal Code that condemns medically assisted suicide assistance

In Italy, euthanasia is a crime, while the right to assisted suicide, in which it is the patient who self-administers the lethal drug and not a doctor, is sanctioned by the ruling of the Constitutional Court, when certain conditions are met that the patient is suffering from an irreversible illness, that this pathology is a source of intolerable suffering, that the patient is capable of making free and conscious decisions, and finally that the patient is dependent on life-support treatment: while initially this term was understood to mean only feeding, breathing and hydration, later chemotherapy was also recognised by the courts. The crux of the matter is that while the path to the end of life has already been defined by the 2019 ruling, the steps and fulfilments that the patient who wants to resort to assisted suicide must follow are not as well defined. Lacking a national law regulating these steps, the Regions have decided to intervene: 'Today, even in the absence of a national law, those who live in conditions of unbearable physical or psychological suffering already have the right to obtain medical aid for voluntary death, the so-called assisted suicide, and a regional law may suffice to guarantee certain times for the verification and implementation procedure envisaged by the Constitutional Court,' assures the Luca Coscioni association.

To regulate in detail the path to the end of life with two resolutions that have ended up in the crosshairs of the government, which has decided to appeal to the Tar requesting the annulment "for lack of power" has been so far only the Emilia Romagna region: On 9 February last, the Bonaccini Council completed the process of applying the Dj Fabo/Cappato ruling by setting up the Regional Committee for Ethics in the Clinic, whose tasks include - the Region states - 'ethical advice on individual cases, the expression of non-binding opinions on requests for medically assisted suicide and on bioethical aspects connected with health and social-health activities'. In addition, the technical-operative instructions sent by the Department of Health Policies to the Local Health Authorities have been drawn up: guidelines with operational indications for the management of requests for medically assisted suicide, from the receipt of the patient's request and throughout the entire process, through the establishment of special Area Vasta Assessment Committees.

In Campania, two regional councillors (Luigi Abbate and Maria Muscarà) filed the bill last March. On 11 April, the Regional Council's Commission for Health and Social Security hinged on the examination of the proposal and decided to set up a round table to carry out an in-depth technical and legal examination of the matter. In Friuli in August 2023, with more than 8,000 signatures out of the 5,000 required, the bill was filed in the region led by Massimiliano Fedriga. On 10 April, this was discussed and rejected by the third regional commission on grounds not related to the content of the bill. In Piedmont, on the other hand, the proposal was deposited by popular vote with 11,000 signatures out of the 8,000 required. After a couple of months of expert hearings, the text arrived in the Chamber on 22 March. The Regional Council, with 35 votes (22 in favour, 12 against and 1 abstention) voted in favour of the 'preliminary question of constitutionality' posed by the majority, a technicality - albeit permitted by the regulation - used in an instrumental manner to prevent the proposal from being discussed on its merits, despite the fact that it had already been deemed admissible by the Regional Council's Commission of Guarantees with a decision ratified by the Assembly in November 2023. The majority supporting President Cirio thus thwarted the signatures of the citizens of Piedmont. The Veneto was then the first region to discuss the law deposited with 9,000 signatures out of the 7,000 required. The debate took place on 16 January. With 25 votes in favour, 22 against and 3 abstentions, Veneto did not approve the law. An absolute majority was required for approval: out of 50 present, 26 yes votes were needed.