End of life, historic hearing in the Constitutional Court on euthanasia

1. Today, at Palazzo della Consulta, we are once again discussing “end of life ” , not “death”. It is inappropriate, in fact, to overlap the two themes. “Death” is an event that marks the end of life, sealing the human experience or – for the believer – starting the great move to another place. The “end of life” , on the other hand, is a process that takes place within life, during which the subject still has a say in his own existence. The mystery of death is after death, not before. That before is, on the contrary, an integral human experience: of life and pain, of rights and prohibitions, of courage and unhappiness. This is why it is a space for legal regulation: let’s follow the map.

2. Nowhere else, but in Italy, “ end-of-life ” choices are crushed between two crimes: the consenting murder ( art. 579 of the Criminal Code ) and the instigation or assistance to suicide ( art. 580 of the Criminal Code ). The report of the Minister of Justice at the time (1929, VIII of the Fascist era) explains the rationale: to preserve “the physical existence of the person ” as the “prevalent social interest” of a regime whose strength depended, first and foremost, on demography. The Constitutional Court intervened on this issue with some jurisprudential inlays inspired by the protection of human life, an essential condition for the exercise of every other constitutional right. Hence, the public duty to ensure it through the law: even if they are two crimes of the Rocco code , now reinterpreted in terms of protecting the most fragile and vulnerable subjects to possible pressures, direct or indirect, that lead to irreparable choices.

Today, as yesterday, therefore, the answer to the fundamental question (" Whose life does my life belong to?" ) contradicts the rhetorical nature of the question: it does not belong to me who lives it, but to someone else. The other than me who decides on my life is the parliamentary majority: historically, that is, " the (fascist) Parliament of 19 October 1930" and, by omission, all subsequent republican Parliaments ( Paolo Flores d'Arcai s). It is a dangerous answer. It carries the risk that a contingent political majority imposes on everyone its own ethics on the subject of " end of life", under the banner of " I do not want, therefore no one can ", thus losing the distinction between law and morality that is proper to a secular State.

3. The Constitution, rigid and guaranteed, acts as a barrier to such excesses. First of all, with art. 32, paragraph 2, the basis of the principle of self-determination ("No one may be forced to undergo a specific health treatment unless provided for by law"). Words matter. The law does not speak of treatments or therapies, but of "health treatment " which is a broader concept: it includes, for example, blood sampling, intravenous injections, insertion of a nasogastric tube. The reference to the law does not imply that any health treatment imposed by law is legitimate. It is only legitimate if motivated by reasons of public health (and if respectful of personal dignity, as required by paragraph 3): this is the exemplary case of mandatory vaccination.

Then, art. 13 of the Constitution comes into play ( «Personal freedom is inviolable» ). Born as a limit to coercive power to guarantee the integrity of those subjected to state apparatuses, today habeas corpus is also something else: it represents for the individual «the essential basis of the freedom to dispose of his bodily dimension», founding the self-government of the person ( Stefano Canestrari ). These are the Pillars of Hercules for legislative choices on the “end of life” . As explained by the Consulta, «no one can be “obliged” – and much less physically “forced” – to undergo a health treatment on and in his own body. The execution of such a treatment would violate […] the same fundamental right to the physical integrity of the person» ( sentence no. 135/2024 ). All this legally differentiates the possible forms of leave from life: let's review them.

4. "I want to die," says the patient. And in saying this he claims a suicidal choice for himself. For most of us it is always possible to carry it out: suicide, in fact, is not punished, not even in the form of an attempted crime. It is a de facto freedom. What the legal system recognizes and guarantees, however, is the right to renounce or refuse, at any time, medical treatments even if necessary to save one's life. For example? A blood transfusion cannot be imposed on someone who, for religious reasons, refuses it for himself. Nor can a limb be cut off from a diabetic who prefers to die rather than live in an amputated body. Nor can chemotherapy be given to a woman with cancer who refuses it so as not to compromise the health of her unborn child. In all these cases, the principle of informed consent, governed by law no. 217 of 2019 , applies within the therapeutic alliance between doctor and patient.

5. " Let me die", says the patient condemned by an irreversible pathology. It is an invocation that has long gone unheard for two reasons: the "idiotic Prometheanism" of therapeutic obstinacy ( Vincenzo Paglia ) and the punishment of those who facilitate "in any way" (art. 580 cp) the suicidal will of others. Called into question thanks to the civil disobedience of Marco Cappato, it is here that the Constitutional Court has worked in inlay, excluding - under certain conditions - the punishability of assisted suicide ( sentence no. 242/209 ) and widening the group of patients who can access medically assisted suicide ( sentences nos. 135/2024, 66/2025 ). Making up for the deliberate inertia of Parliament, some Regions have implemented the constitutional ruling with flexible regulations (to the future state law), aimed at guaranteeing certain times and homogeneous procedures for the patients concerned. The Tuscan law (n. 16 of 2025) will be discussed soon by the Constitutional Court: the State, in fact, has contested its constitutionality for invasion of those of its powers that, to date, it has not intended to exercise. Again, " I do not want to, therefore no one can".

6. " Help me die," says the patient. And by saying this he is asking for something that the legal system prevents by punishing the killing of a consenting person: in fact, another person's life is an unavailable asset. An attempt has already been made to surgically act on art. 579 of the Criminal Code by means of a referendum, but the question was rejected by the Constitutional Court with a decision that was at the very least controversial ( sentence no. 50/2022 ). Today, it is precisely this article that is returning to the Constitutional Court, the subject of a quaestio promoted by the Court of Florence. It arises from the case of a patient with progressive multiple sclerosis who is in the conditions established by sentence no. 242/2019 , but is unable to take the lethal drug herself. Paralyzed from the neck down, she could administer it intravenously by activating a device with the movement of the muscles of the mouth or the eyeballs or with a vocal command, but there are no similar devices on the market. She wants to say goodbye to life with dignity, putting an end to her unbearable ordeal, but she can't do it alone. She needs the help that her doctor is willing to give her. Helping her, however, would mean committing a crime punishable by 6 to 15 years in prison.

It is a normative situation of dubious constitutionality, because the incrimination unreasonably conditions the patient's self-determination ( articles 2, 13, 32 of the Constitution ), creating a disparity of treatment between patients ( article 3 of the Constitution ). That right of the patient remains dependent on a completely accidental circumstance, being prejudiced precisely in the most serious and painful states of the disease. The risk is that the subject is induced to anticipate the choice of suicide, fearing the unpredictable course of the pathology. In its current scope, therefore, article 579 of the Criminal Code transforms the right to life into the duty to live it, until the end, in conditions contrary to the dignity and will of the patient.

7. The outcome of today's hearing will weigh on the parliamentary process - which has started off on the wrong foot in recent days - towards a law that has been missing for too long. Stay tuned.