End-of-life choice: Laura Santi and assisted suicide in Italy

Translated by Silvia Toro

"Life is just one and I keep it dearly, I have always kept it dearly. To have the freedom of dying is something enormous, but I would like to make the others understand that it can't be abused. Now I am free of deciding of my own existence. I am free to understand to what extent I am willing to face the progression of a disrupting illness that is not stopping […] It is like leaning out from a guardrail and seeing the void: you look at it, asking yourself if you want to die tomorrow. No, thanks, not tomorrow. And maybe not even the day after tomorrow, maybe not even in a week. This is the guardrail, this is freedom".

On July 22, 2025 the journalist Laura Santi, almost entirely paralyzed because of her 25-year-long battle with ALS, decided to assess to medically assisted suicide. In November, last year she obtained the approval, after three painful years from the first request. The choice of not getting access immediately to assisted suicide consisted in using her freedom, leaning from that guardrail knowing that she could overcome it, but deciding not to, not yet, with a dilemma she tells in her mind: Having a "desperate hunger for life" and a body that everyday "asks me to stop".

In occasion of her death, the journalist decided to launch an appeal to lawmakers, who are discussing a bill on end-of-life possibility in these days, which are object of heavy criticism: in a video she asked to publish after hear departure, Santi asks to reject this law draft, for the sake of "the common sense of human beings", defining it as "not an attempt of regulating assisted suicide, but of excluding this right" and prays them to take care of lives of the most unhealthy people.

Right to end-of-life choice in Italy

In Italy, there is currently no law on euthanasia, which is still illegal, but there is the possibility of resorting to medically assisted suicide.

These are two different practices: With euthanasia we mean "the act of intentionally procuring without pain a way to die to a person who is conscious about it and is able to understand the consequences of her actions, after explicitly asking for it", and is considered as illegal under the terms of the article 579, homicide of a consenting person.

With assisted suicide, on the other end, we mean "the act by which the person making the request, while still in full possession of their cognitive faculties, takes on their own the lethal drug to end their pain". This process became feasible with the Sentence of the Constitutional Court n. 242 of 2019, aka "Cappato sentence", because it is the one that discharged the pro-suicide activist Marco Cappato from the charge of incitement to suicide. He was charged with this after helping Fabiano Antoniani (known as DJ Fabo) reach Switzerland, where the man, who had been left quadriplegic following a car accident, was able to choose to end his life.

During the sentence, the four requirements a person who asks for assisted suicide must have in order to obtain it, were established:

1. Irreversibility of the disease
2. Presence of physical or psychological suffering that is intolerable for the patient
3. Dependence on life-sustaining treatments
4. Being able to make free and informed decisions

The Legal Health Authority of the territory must verify these requirements and then chose the drug and modality of self-administration; the relation must them be sent to the ethical committee: only after this approval, the ill person can decide if and when access to suicide. It should be emphasized that these are very lengthy procedures, which are difficult for applicants to endure, not only because they prolong physical pain, but also because—as Laura Santi strongly points out—it ignores completely the freedom of choice.

In 2021, there was much discussion about euthanasia because the Luca Coscioni Association (ALC) had proposed a referendum of legalizing euthanasia, which could partially repeal the art. 579. As Laura Santi also pointed out in an intimate interview with journalist Mario Calabresi, self-administration of the lethal drug is not a given for those who request it, because the person is not always physically able to take anything.

The signature collection was a success, but in February 2022, the referendum process was blocked by the Constitutional Court, which deemed the question inadmissible: it was considered that the repeal itself carried the risk of being unconstitutional because “it would have exposed vulnerable individuals to pressure or abuse, making the legislation incompatible with the minimum protection of life required by the Constitution.”

The Court's decision has been widely criticized, primarily because the ruling on the possible unconstitutionality of the question was issued during the admissibility assessment phase: the anticipation of this ruling is not provided for in the constitutional procedure for referendums, and the Constitution itself already indicates, in Article 75, which subjects are inadmissible in referendums (“for tax and budgetary laws [ see art. 81], of amnesty and pardon [see art. 79], on authorization and to ratify international treaties [see art. 80]”).

La proposta per il disegno di legge sul fine vita

The proposal for the end-of-life bill

The bill that Laura Santi is against to in her video addressed to parliamentarians has also been widely criticized by the Luca Coscioni Association and many legal experts: the text of the bill introduces the mandatory use of palliative care before access to suicide (which for now is provided as an option to be explained to the applicant); prohibits the use of National Health System personnel and equipment, entrusting decisions on applicants to a government body; and above all, according to an ALC press release, it limits the right to suicide only “to people who are dependent on treatments that replace vital functions” rather than “life-sustaining treatments” (as previously provided for by the Constitutional Court). This excludes people who, following medical advice, have refused life-sustaining treatment and people who are totally dependent on assistance and treatment provided by family members or caregivers, who, in some cases, have already obtained voluntary assistance in dying from the National Health Service." According to Cappato, this would lead not only to the privatization of assisted suicide, but to its outright prohibition.

The Association claims another alternative, a regional law proposal named "Immediately free", which is already filed in 18 regions. For now, only Tuscany has approved a regional law on end-of-life care for the first time; meanwhile, Laura Santi's Umbria has reached the threshold of signatures needed to proceed with approval.

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