After years, Italy finally has a draft law on end-of-life. But it displeases almost everyone

It took six years, several governments, sensational episodes of civil disobedience, State-Regional disputes and endless controversies, but Italy now has a bill on the end of life , after the requests of the Constitutional Court contained in the ruling of 22 November 2019, in which a legislative intervention on the matter by Parliament was requested. The draft, however, has already raised a chorus of detractors ranging from the opposition to the Luca Coscioni association. Secretary Filomena Gallo has already said that the bill is "already old and goes against what has already been decided by the Constitutional Court" .

In particular, Gallo added, "the idea of ​​excluding the National Health Service , to which the Constitutional Court has given a specific task of verification and assistance, falls within the reasons why a law of this type would be immediately contestable ."

The Council had outlined the boundaries of the matter, establishing its pillars : the applicant had to be an adult, affected by an irreversible pathology, causing unbearable physical and psychological suffering; he/she had to be included in a palliative care path, kept alive with substitutive treatments and fully capable of understanding and willing.

Today, the draft law proposed by the majority – under discussion at the Senate select committee meeting – introduces a further element: “the National Ethical Evaluation Committee will be responsible for examining the requests of people who ask to access medically assisted suicide”. The Committee will have 60 days to express its opinion, which can be extended by another 60. If it is found that the required requirements are not met, the person will not be able to submit further requests in the following 48 months, as they will be declared “inadmissible” . In other words, without the green light from this Commission, the request for end-of-life will be frozen for four years .

Also according to the draft, the National Ethical Evaluation Committee – which thus becomes the central body in the procedure – will be composed of seven members : a jurist chosen from university professors of legal subjects or lawyers authorized to practice, a bioethics expert, a specialist in anesthesia and resuscitation, a doctor expert in palliative care, a psychiatrist, a psychologist and a nurse. They will be appointed by decree of the President of the Council, who will also designate the president, vice president and secretary.

The members of the Committee will remain in office for five years and may be reappointed for two more terms, which need not be consecutive.

As regards palliative care, the bill provides for the establishment of an observatory at Agenas (National Agency for Regional Health Services), charged with sending an annual report to the Prime Minister, the Ministry of Health and the Presidents of the Chamber and Senate. This report will contain the analysis of regional projects, highlighting those Regions that " have not presented the project to strengthen palliative care , including pediatric, home and for any pathology".

The Regions, for their part, will be required to achieve the objectives set for palliative care by 2028, with reference to 90% of the population concerned . Any residual sums allocated to the Regions for such care cannot be used for other purposes and must be returned to the State.

We will see what fate the bill will have, but for now the opposition remains very critical. For Marilina Castellone and Anna Bilotti, senators of the 5 Star Movement in the restricted committee, the problems begin from the first article, where reference is made to the "protection of life starting from conception". Unacceptable, moreover, "the provision of a government-appointed ethics committee , which opens up a disturbing scenario in which, based on the government in office, the position on such delicate issues will be more or less permissive". Not to mention that "with regard to palliative care, the path in which the majority would like to insert patients is not foreseen by the ruling of the Consulta, ending up calling into question some rights".

A negative opinion, although more nuanced, also from the Democratic Party . For Senator Alfredo Bazoli, vice president of the Democratic group in the Senate, "there is still much to do for broad consensus" . In particular, the points relating to "the composition and tasks of the National Ethics Committee, the role of the National Health Service and attending physicians, and some conditions for access to assisted suicide are excessively restrictive" are lacking. And he adds: "As we have reported to the rapporteurs, who have committed to presenting an amended and integrated text next week in view of the commission, I hope it is still possible to arrive at an acceptable text. We will see what they propose to us next week".

The majority, obviously, declares itself satisfied: "In my opinion, it is a draft text with a good balance , it is not aligned with anyone. It takes into account the principles of the Constitutional Court and in the text palliative care is the object of great attention, no longer just on paper", states the president of the Senate Justice Commission, Giulia Bongiorno.