Assisted Suicide: The Constitutional Court Expands the Concept of “Life-Sustaining Treatments”

There Constitutional Court has expanded the concept of “life-sustaining treatments”: it is a step forward for access to end-of-life care and assisted suicide. “The requirement has not been eliminated”, explains Filomena Gallo, national secretary of the Coscioni association, “but despite the objections that the Government has made through the State Attorney’s Office, the group of people who can access assisted suicide is being expanded. The Constitutional Court has clarified that for treatments it does not only mean life-saving machinery and technical intervention, but also, for example, the aspiration of mucus from the bronchial passages, manual evacuation and continuous assistance by someone who is not part of the health personnel. The Court took into consideration the different situations of patients affected by progressive pathologies”.

The judges had been called to rule on thehelp provided in December 2022 by Marco Cappatolegal representative of the Civil Aid Association, by Chiara Lalli and Felicetta Maltese, who, with an act of civil disobedience, They accompanied Massimiliano, a Tuscan suffering from multiple sclerosis, to Switzerlandso that he could resort to assisted suicide. The 44-year-old was not dependent on so-called “life-sustaining treatment” (such as devices, drugs or medical machinery with the function of slowing down the progression of the disease and therefore death), but his survival depended entirely on assistance of third parties. For this reason, in Italy, access to assisted suicide would have been hindered. And it was precisely this procedure on the help provided to Massimiliano the opportunity to redefine the contours of the “vital support” criterion.

In our country, in fact, assisted suicide was made legal by sentence number 242 of 2019 on the “Cappato\Antoniani” case (Dj Fabo). The Court recalls the continuing absence of a law regulating the matter, and reiterates that the requirements for access to assisted suicide remain valid and are those established by the ruling.. These are the conditions: the request must be from a person who is kept alive by life-sustaining treatments and suffering from an irreversible pathology, a source of physical or psychological suffering that he or she considers intolerable, but fully capable of making free and informed decisions, provided that such conditions and the methods of execution have been verified by a public structure of the national health service, following the opinion of the territorially competent ethics committee.

Only in Italy, and in no other country in the world, is assisted suicide tied to the fact that the patient is kept alive by life-sustaining treatment. But a requirement of this type, as the Coscioni Association has been pointing out for some time, lends itself to an ambiguous interpretation and with potential discriminatory effects, because of which many Italians – like Massimiliano – have been forced to go to Switzerland. “Think of the majority of cancer patients, even terminal ones, who want to put an end to their suffering, but cannot access assisted suicide because they are not dependent on life-sustaining treatment in the strict sense,” explained Filomena Gallo, national secretary of the Luca Coscioni Association.

The ruling says that the meaning of patient dependence on life-sustaining treatments must be properly interpreted in accordance with the rationale underlying the Cappato Dj Fabo ruling. This ruling is based on the recognition of the fundamental right of the patient to refuse any medical treatment performed on his or her body, regardless of its degree of technical complexity and invasiveness. The notion therefore also includes procedures (for example, manual evacuation, insertion of catheters or aspiration of mucus from the bronchial passages) normally performed by health personnel, but which can also be learned by family members or caregivers who assist the patient, provided that their interruption would predictably cause the patient’s death within a short period of time. The Court specified that, for the purposes of access to assisted suicide, there can be no distinction between the situation of a patient who has already been subjected to life-sustaining treatments, whose interruption he can request, and that of a patient who has not yet been subjected to them, but now requires such treatments to support his vital functions.