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On the one hand, the Council has been called upon to give its opinion four years after the historic ruling which opened up assisted suicide in Italy; on the other, a group of Regions that will try to legislate even after the stop in Veneto. In the middle there are the patients, very often terminally ill, forced to appeal to the courts to get a response from the local health authorities who, 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 that is difficult to circumvent with very few cases reaching the end.
The legislative vacuum on the matter
The vulnerability is always the same, that is, a legislative void that has now become a chasm after sentence 242 of 2019 of the Constitutional Court which declared the illegitimacy of a part of the Criminal Code which condemns assistance in medically assisted suicide. In the previous legislature we had almost reached the finish line but the unified text, approved by the Chamber after almost 4 years in the Social Affairs Committee, did not have time to receive the green light from the Senate. Therefore, what still regulates the matter today is the sentence that acquitted Marco Cappato of the charge of incitement to suicide for having accompanied Fabiano Antoniani, known as DJ Fabo, to Switzerland.
The current rules and the Consulta
In Italy, euthanasia constitutes a crime while the right to assisted suicide is sanctioned by the ruling of the Council, in which the patient self-administers the lethal drug and not a doctor, when certain conditions are met: that the patient is suffering from an irreversible disease, that this pathology is a source of intolerable suffering, that the patient is capable of making free and informed decisions. The last condition, the most problematic, is that the patient is dependent on life support treatment: while at the beginning this term meant only nutrition, breathing and hydration, later chemotherapy was also recognized by the courts. Now precisely because of this last requirement – dependence on life support treatment – the judge of the preliminary investigations of Florence Agnese Di Girolamo has postponed the question is brought back to the Council to decide in fact whether this requirement can be discriminatory because it could lead to an “unreasonable difference in treatment” between “substantially identical concrete situations”. The difference in discipline when there is life support and when there is not is under scrutiny, which could be “unreasonable”.
Pressing at regional level
If the end-of-life path has already been defined by the 2019 ruling, the stages and obligations that the patient who wants to resort to assisted suicide must follow are not equally defined. This is where the legislative attempt in the Veneto region was born, which was then wrecked in recent days. The rules, proposed by the Coscioni association and rejected by the Veneto regional council by a single vote, provide in particular certain times for medically assisted suicide: no more than 27 days from the submission of the application to the performance of the service, of which the first 20 for evaluate the person’s requirements. Furthermore, it specifies the role of the health service and in particular that of the local health authorities. In fact, the Council has not established a “right to provision” of suicide assistance by public health facilities, to which it has instead attributed as a guarantee an activity to verify the existence of these conditions, including an evaluation by the ethics committee. At the moment there are at least ten Regions which, after having deposited their signatures, are preparing to discuss the bill in the Chamber. After Veneto there is Lombardy which will decide on admissibility by 12 February, but also Piedmont, Emilia Romagna, Abruzzo and Friuli Venezia Giulia which have considered that the end-of-life regulations fall within regional competences. Then there are also Sardinia, Basilicata and Lazio where the bill was deposited through the initiative of the regional councilors or on the initiative of the Municipalities. Similar proposals have been filed in Puglia, Marche and Calabria.
The path of national law
Before the Regions’ attempt, Parliament also came close to legislating with the bill on “voluntary medically assisted death” approved in the last legislature by the Chamber in March 2022, but not passed by the Senate due to the early end of the Executive led by Mario Draghi. If Parliament therefore wanted to take this matter back into its own hands to pass a law that can no longer be postponed, that is where it could start. Even if Cappato, the father of this battle, is critical: «Many now in the Democratic Party support the bill of their parliamentarian Alfredo Bazoli, which actually aims to restrict existing rights. Instead of debating purges, what we as the Luca Coscioni Association propose to the Democratic Party is to abandon the Bazoli proposal and to mobilize to have certain times and procedures approved in the Regions”. «Among other things, the next regional council to decide will be that of Emilia-Romagna: what better occasion?» asks the coordinator of the association Luca Coscioni. Meanwhile, there are over 186 thousand Italians who, based on the 2017 law on living wills, have left their Advance Healthcare Treatment Orders, in anticipation of a possible inability to self-determination.