There is no national law, so the Regions try to guarantee the right to end of life

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The battle over the end of life moves once again to the national level and could see a tug of war between the Government and various Regions in the coming months. This duel was triggered by the operational rules that Emilia-Romagna adopted in February to make up for a regulatory gap on assisted suicide. Against the Region led by Stefano Bonaccini, the government, with the Presidency of the Council and the Ministry of Health, presented an appeal to the TAR to block the resolutions of the Council which identified, among other things, the guidelines for local health companies, with procedures and times for any requests for medically assisted suicide. But beyond Emilia there are other Regions that are working on this dossier given that in the absence of a national law there are no operational rules to concretely implement the Council’s decision which effectively established the right to assisted suicide

The current situation in Italy after the ruling of the Consulta

So far, four people have obtained access to voluntary assisted dying in Italy, 3 of which are followed by the legal board of the Luca Coscioni Association. The first, in June 2022, was Federico Carboni, who did not receive any assistance from the National Health Service and died after more than 20 months of waiting and legal battles in the courts. In July 2023 in Veneto, however, ‘Gloria’ died with a drug and a machine provided by the NHS. The first person to have been completely 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 obtained aid in voluntary death. Today patients, very often terminally ill, are 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 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

The void of national law and the pressure of the Regions

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 and finally that the patient is dependent on life support treatment: while at the beginning this term meant only nutrition, breathing and hydration, more chemotherapy was also recognized late by the courts. The crux concerns the fact that 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. In the absence of a national law that regulates 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 suicide assisted, to guarantee certain times for the verification and implementation procedure envisaged by the Constitutional Court, a regional law may be sufficient”, assures the Luca Coscioni association.

The case of Emilia Romagna ended up in the government’s sights

To regulate in detail the end-of-life process with two resolutions that have ended up in the sights of the Government which has decided to appeal to the TAR requesting annulment “due to lack of power” has so far only been Emilia Romagna: on 9 February last the Council Bonaccini has completed the process for the application of the Dj Fabo/Cappato ruling by establishing the Regional Committee for ethics in the clinic, among whose tasks there are – specifies the Region – «ethical consultancy on individual cases, the expression of opinions binding obligations relating to requests for medically assisted suicide and the bioethical aspects connected to health and social-healthcare activities”. Furthermore, the technical-operational instructions sent by the Department of Health Policies to the local health authorities were drawn up: guidelines with operational indications for the management of requests for medically assisted suicide, from receipt of the patient’s request and throughout the entire process, through the establishment of specific Vast Area Evaluation Commissions.

The exam started in Campania, stopped in Friuli, Piedmont and Veneto

In Campania last March two regional councilors (Luigi Abbate and Maria Muscarà) filed the bill. On 11 April the Health and Social Security Commission of the Regional Council began the examination of the proposal and decided to set up a table to proceed with a technical-legal analysis of the matter. In Friuli in August 2023, with over 8,000 signatures out of the 5,000 needed, in the region led by Massimiliano Fedriga the bill was filed. On 10 April this was discussed and rejected by the third regional commission for reasons not related to the content of the proposed law. In Piedmont instead the proposal was deposited by popular vote with 11 thousand signatures out of the 8 thousand needed. After a couple of months of expert hearings, the text arrived in the Chamber on March 22nd. The Regional Council, with 35 voters (22 in favour, 12 against and 1 abstention) voted favorably on the “prejudicial question of constitutionality” posed by the majority, a technicality – although permitted by the regulation – used in an instrumental way to prevent discussion on the merits the proposal, despite the fact that it had already been deemed admissible by the Guarantee Commission of the Regional Council with a decision ratified by the Assembly in November 2023. The majority that supports President Cirio has thus nullified the signatures of the Piedmontese citizens. The Veneto then it was the first Region to discuss the law filed with 9,000 signatures out of the 7,000 needed. The discussion took place on January 16th. With 25 votes in favour, 22 against and 3 abstentions, Veneto did not approve the law. For approval, an absolute majority was needed: out of 50 present, 26 yes votes were needed.