Assisted Suicide for Irreversible Patients on Life Support? The Intricate Italian Journey Towards Conforming with the Legislation of Spain, Austria, and Portugal

TL;DR

This paper examines Italy's legal approach to assisted suicide, comparing it with Spain, Portugal, and Austria to assess consistency and suggest improvements.

Contribution

The paper provides a comparative legal analysis of assisted suicide regulations in four European countries, focusing on Italy's evolving stance.

Findings

The Italian Constitutional Court clarified that life-sustaining treatments include non-mechanical interventions like manual bowel evacuation.

Italy's current assisted suicide regulation is deemed inconsistent compared to similar legal systems in Spain, Portugal, and Austria.

The Court balances self-determination with the protection of life, rejecting claims of infringement in its personalist ethical framework.

Abstract

Background/Objectives: In 2019, the Italian Constitutional Court (ICC) stated that the principles of equality, dignity, and self-determination enshrined in the constitution require that assisted suicide be considered lawful under certain conditions, including that the patient is kept alive through life-sustaining treatments. In fact, since such patients could already die by refusing treatment, assisted suicide is ethical as it allows them to die more quickly and with dignity. The paper aims to analyze the requirement of life-sustaining treatments from a legal and comparative perspective. Methods: The authors performed the search on Italian legal databases as well as on Scopus and PubMed and by comparing Italian regulations with those of Spain, Portugal, and Austria, which are similar to the Italian one in their fundamentally restrictive nature. The authors have delved into the Italian legal system through an analytical method of interpretation of the normative texts and used the comparative method to investigate which of the legal systems considered is more permissive. Results: According to the ICC, continuing to prohibit assisted suicide for patients who do not require life-sustaining treatments is not discriminatory: these patients cannot be equated with others, as only in the former case does refusing treatment lead to death. From its personalist ethical framework, the ICC also rejected the claim that the patient’s self-determination is being infringed upon: self-determination must be balanced with the protection of life, which is a fundamental value. However, in 2024, the ICC clarified that life-sustaining treatments are not limited to those directly supporting vital functions through medical machines, but also include all treatments without which the person would die in a short time, such as manual bowel evacuation. Conclusions: The current Italian regulation seems inconsistent. It would be preferable to regulate assisted suicide by referencing the models of Spain, Portugal, and Austria.