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That is why a law on end-of-life care must not overlook the right to treatment

A law is needed to establish clear rules, but no debate on self-determination can ignore the right to palliative care

by Maddalena Floriani*

24 September 2026

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3' min read

Translated by AI

Versione italiana

3' min read

Translated by AI

Versione italiana

When a disease is no longer curable, the person can still be treated. To talk about end-of-life care without mentioning palliative care is to address only part of the issue. Palliative care is not a sign of giving up; it is the clinical, civil and ethical response to humanity’s most ancient and inescapable need: to care for patients when a cure is no longer possible. Palliative medicine addresses all aspects of human suffering – physical suffering first and foremost, but also psychological, social and spiritual suffering.

The right to palliative care is a right that is formally recognised and underpinned by a robust regulatory framework, which includes tools for planning, needs assessment, monitoring and financial sustainability. Law 38/2010 represented an extraordinary achievement for our country; however, the system is not yet able to guarantee uniform protection of this right, and there remains a significant gap between the recognition of the right and its effective implementation.

A further, crucial step regarding end-of-life care is represented by Law 219/2017, which governs informed consent and Advance Healthcare Directives and introduces shared care planning. The principle of self-determination, which is rooted in constitutional principles, can be translated in practice into a care plan developed jointly by the doctor and the patient, with both parties defining the objectives of care when a cure is no longer possible.

Access to palliative care is not guaranteed to all Italian citizens, with the same timings and the same quality. Such a sensitive issue cannot depend on where a person lives or on the interpretation of a single healthcare institution. It is precisely the failure to address the overall suffering of patients that makes it essential to include the culture and clinical practice of palliative care – which must be genuinely accessible – within the debate on end-of-life care.

There is also a second, more complex issue: the culture of limits in medicine.

Although Law 219 clearly addresses the issue of disproportionate treatment, a law on its own cannot change a professional culture. The extraordinary progress of medicine and the vast array of technological innovations often overshadow the principles of proportionality and appropriateness in care. Society and the medical profession still face difficulties in addressing the issues of prognosis and the limits of treatment. It is crucial to promote a culture capable of shifting the focus from the disease to the person, from the technical possibility of intervention to the appropriateness of the intervention, and from the quantity of time to the quality of life.

A request for euthanasia must be treated with the utmost respect, whilst ensuring that the person is fully aware of all other options and has access to them if they so wish. The responsibility for seeking treatment must not fall on the patient; it must fall on the system, which must be able to guarantee that care. Can a person who is entitled to palliative care but is unable to receive it truly be considered free to choose to request medically assisted dying?

Establishing a legal framework for end-of-life care is essential to ensure that people are not left to cope alone, because the absence of legislation does not eliminate the problem; it simply shifts the burden onto patients, their families and doctors. A law on end-of-life care will only be truly balanced if it manages to reconcile self-determination with collective responsibility, and individual freedom with the protection of the vulnerable.

As the Floriani ETS Foundation, we therefore hope that palliative care will no longer be a missed opportunity: alongside the right to choose, the right to receive treatment must be safeguarded.

Vice-President of the Floriani ETS Foundation

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That is why a law on end-of-life care must not overlook the right to treatment

A law is needed to establish clear rules, but no debate on self-determination can ignore the right to palliative care

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