The end of life returns to the center of public debate after the unprecedented hearing of the Constitutional Court which saw eleven patients as protagonists, eight against and three in favor of an expansion of assisted suicide. To shed light on a complex issue, which intertwines law, bioethics and human suffering, we interviewed Laura Palazzani, professor of Philosophy of Law at LUMSA.
Today the Constitutional Court returned to dealing with the end of life, with an unprecedented hearing which saw eleven patients as protagonists. What exactly is happening and why is this step so important?
«The Constitutional Court is called again to evaluate the issue of assisted suicide in Italy, in particular with respect to article 580 of the Criminal Code, i.e. the crime of aiding suicide. Since 2019, with sentence no. 242, the Court excluded the punishability of aiding suicide only in the presence of precise conditions: irreversible pathology, intolerable physical and psychological suffering, autonomy of the applicant, dependence on life support treatments”.
For the first time, eleven patients directly involved were admitted to the hearing, eight against and three in favor. The importance of this hearing is expressed on various levels.
«First of all, it makes it clear that the issue does not just concern abstract principles, but concrete people, with real suffering and different positions. This is nothing new for bioethics which has always been and must be aware of not just being an abstract theory, but also a human understanding of complex clinical cases and often unprecedented circumstances. Scientific and technological progress opens up new treatment opportunities, but also produces living conditions that some patients experience dramatically. The eleven patients intend to go beyond words and show the Court judges what happens in clinical reality and express their voice in a strong way.
Secondly, the task of the Court becomes clear: that of balancing, on the one hand, the protection of the possible choice of those who experience suffering that they consider unbearable; on the other, the protection of vulnerable people from the risk that death becomes a social response to the lack of care, assistance, social and psychological support.
Finally, this hearing recalls the need for the legislator to intervene: in the absence of an organic law, it continues to be the judges who define, case by case, the boundaries of the end of life and the regional laws. And the sick continue to experience these conditions in legal uncertainty.”
Eight patients opposed an expansion of assisted suicide, while three were in favor. How do you comment on this rift between the people directly involved? What does it tell us about the complexity of the topic?
«This split shows the complexity and non-uniqueness of cases on a concrete level. Even among people experiencing similar clinical conditions, very different ethical conceptions and lived experiences, of fears and hopes, can emerge. Some may perceive assisted suicide as an extreme form of control over their suffering, which they do not accept; others, however, prefer to live and experience it as a risk, the sign of a society that offers death before fully guaranteeing care, assistance and accompaniment.
This is nothing new: it’s been happening for a long time. Consider the Welby case: when Welby, suffering from ALS, asked to be removed from the artificial ventilator in order to die, other ALS patients appealed for better quality care.
The experience depends on many factors: religious, cultural, but also social, psychological and physiological. There are those who manage to find a reason for living even in illness and suffering; those who consider life an unavailable good and perceive living as a responsibility towards others and themselves; those who live them as a testimony of faith; those who instead experience every moment, in the closure of hope, as an unacceptable coercion and torture.
The topic reveals the complexity of clinical circumstances: clinical ethics committees are clear examples of the need that such complex topics require a place and time for interdisciplinary and pluralist reflection, which takes into account different dimensions (medical, psychological, social, ethical and legal).
This plurality that exists in the facts also recalls the essential and no further delayable need of the institutions for an interdisciplinary and pluralist dialogue, who knows how not to impose a vision on others, but to find sharing, to write legal rules. The institutions should listen to both positions: on the one hand those who ask not to be forced to experience suffering perceived as intolerable and live every day like torture; on the other, those who fear that opening up to assisted suicide could increase the pressure on the most vulnerable. The real challenge is to avoid both ‘therapeutic abandonment’ and ‘social abandonment’, guaranteeing everyone palliative care to alleviate suffering, health and social assistance, psychological support, adapted to the concrete needs of the sick.”
Some of the eight patients opposed declared, through their lawyer: “It would be like giving us a loaded gun to keep on the bedside table. We don’t want the freedom to die, but the freedom to be treated.” How do you comment on this sentence?
«The phrase is very strong because it shifts the focus of the discussion from the “right to die” to the “right not to be left alone in illness”. Whoever pronounces it expresses what has been discussed for some time, on a philosophical level, in bioethics: the fear that the availability of assisted suicide could transform, for some fragile people, not into a true freedom, but into an implicit and indirect pressure: if the treatment is insufficient, if the assistance weighs on the family, if there is a lack of social, psychological and palliative support, then the choice to die risks appearing as the only way out. The fear of ‘having to die’, which arises from feeling ‘guilty’ for not choosing death, because one feels ‘a burden’ compared to others; of having to justify to others why one prefers to live, compared to the possible alternative of dying.
The image of the “loaded gun on the bedside table” expresses the fear that the State will offer death before and instead of fully guaranteeing treatment. In this sense, the phrase recalls a public responsibility: a just society should first ensure real and effective access to care, assistance, relational and solidarity support.
It should also be remembered the opposite case, which happened, of someone who asked for assisted suicide, obtained the dose to die and ‘kept it on the bedside table’, without using it, being reassured by the fact that in the event of extreme drama he has a way out, but still accepting life in the conditions that remain for him to live”.
What exactly is meant by “life support” and why is the Constitutional Court called upon to decide whether this requirement is discriminatory compared to the other criteria already established in 2019?
«The expression “life support” refers to the set of interventions and treatments used to keep alive a patient whose functions are compromised and no longer guaranteed independently by the body.
In 2019 (judgment no. 242) the Court seemed to understand the expression in a narrow sense, i.e. life-sustaining technologies such as artificial hydration, nutrition and respiration. In 2024 (sentence no. 135) it broadened the interpretation to pharmacology and healthcare without which a person would not be able to maintain essential functions for life, such as the insertion of catheters, the suction of mucus from the bronchial tracts or other normally healthcare practices, even if physically carried out by family members or caregivers.
Why is there discussion today about whether it is discriminatory? Because there are very seriously ill patients, with irreversible pathologies and intolerable suffering, fully capable of making decisions, but who do not depend on life support intervention. According to those calling for expansion, excluding them would mean creating a disparity: two people can be equally suffering and lucid, but one can access assisted suicide because it depends on life-sustaining treatment, the other cannot.
The Court defined this requirement, among others (incurable disease, unbearable suffering, autonomy) by linking it to article 32 of the Constitution (the right to refuse or interrupt healthcare treatment, even if necessary for survival), further clarified by Law 219/2017, which recognizes the refusal and renunciation of healthcare treatment, choosing to let oneself die by interrupting that treatment; assisted suicide is a step further (from letting people die to causing death). The reference to the requirement is permitted, in extreme cases, to avoid that the only alternative is a slower or more traumatic death, in some clinical circumstances.
The delicate point is precisely this: if the requirement remains, assisted suicide remains linked to the refusal of treatment; if it is eliminated, we move on to a broader logic, based above all on suffering, on the irreversibility of the disease and on self-determination. This is why the decision is so important: it does not just concern a technical definition, but the boundary between the right to refuse healthcare treatments and recognition of more general access to assisted death.
I would add that the Court is called upon to balance two opposing risks: on the one hand, discriminating against equally suffering patients; on the other, widening access too much without adequate guarantees.”
Why does Parliament continue to postpone a law on the end of life, always leaving the Constitutional Court to intervene? What does Italy risk by remaining without an organic law?
«Parliament postpones because the end of life is one of the most divisive issues from an ethical, cultural and political point of view. For this reason, every attempt to draft the law encounters difficult mediations, slowdowns, postponements and clashes between those who want to regulate access to assisted suicide and those who fear that a law could lead to a ‘normalisation’ of so-called medically assisted death. The problem is that, while Parliament postpones, concrete cases still arise and increase. This creates an institutional paradox: the Court can correct constitutional gaps or illegitimacies, but cannot fully replace the legislator. In fact, in the press release on sentence no. 66 of 2025, the Court renewed its appeals to the legislator (already expressed since 2019).
The main risk, remaining without an organic law, is uncertainty. Patients, families, doctors, ethics committees and healthcare companies find themselves moving within a framework built by sentences, not by detailed rules. This can produce different times, different interpretations and even territorial disparities. Some Regions have started to proceed with their own laws, highlighting the fragmentation: each territory tries to regulate itself while waiting for a national law.
However, I would add an important point: an organic law should not limit itself to saying “yes” or “no” to assisted suicide. Above all, it should seriously guarantee palliative care, pain therapy, social and home assistance, psychological support and rigorous checks. Otherwise the risk is twofold: on the one hand the abandonment of those who ask for help to die, on the other the abandonment of those who instead ask for help to live and be treated. There are patients who experience extremely difficult situations and who deserve the same attention that is due to those who decide differently about their existence.”
