Translated by Mariateresa Tauro
On 25th March, in Tuscany, Libera (a pseudonym used to protect her privacy), a 55-year-old woman suffering from multiple sclerosis, voluntarily ended her life through assisted suicide, almost two years after the regional health authority had approved her access to the procedure.
The woman had been suffering with multiple sclerosis since 2007, a chronic, inflammatory and neurodegenerative autoimmune disease that affects the central nervous system (i.e. the brain, spinal cord and optic nerves). In her case, the disease progressed very rapidly, leading to a state of spastic tetraparesis that permanently compromised all four limbs.
In 2024, she had applied for medically assisted suicide, a procedure which in Italy is governed by Constitutional Court ruling 242/2019, the so-called “Cappato/Antoniani ruling”, and which requires four conditions to be met in order to qualify: the person must be fully capable of understanding and consenting, must have an irreversible condition causing severe physical or mental suffering, and must be surviving only through life-sustaining treatment.
Ruling 242/2019 itself stipulates that assisted suicide may only take place through the self-administration of the lethal drug by the person requesting it. Here lies the difference with euthanasia, which would involve the administration of the drug by a qualified doctor in cases where the person is physically unable to administer it themselves. In Italy, this is not permitted, as it would constitute the offence defined in Article 579 of the Criminal Code as the killing of a consenting person, punishable by imprisonment for a term of between 6 and 15 years.
Libera’s medical condition – complete paralysis affecting all her limbs – prevented her from self-administering the medication, forcing her to embark on a long and arduous legal battle. Initially, the Tuscany Local Health Authority had rejected her request, but Libera managed to secure approval following a series of legal pressures and requests for a review of her case. However, the health authority claimed it could not carry out the “practical” phase, leaving the woman responsible for both purchasing the medication and finding the necessary equipment for self-administration, given her physical incapacity. According to the local health authority, no equipment existed that would allow “Libera” to self-administer the medication.
Invoking the right to self-determination, in 2025, “Libera” had asked the Court of Florence to allow her to undergo euthanasia – that is, with the active assistance of a doctor in ending her life – but the request was rejected. It was last November, partly thanks to the involvement of the Luca Coscioni Association, that the matter reached the Constitutional Court, which indicated that it was necessary to ascertain whether suitable means existed to ensure that self-administration could still be carried out. Consequently, the National Research Council was tasked with designing a device suitable for self-administration.
The CNR has thus succeeded in building and testing a machine specifically for her which uses the patient’s eye movements to control an infusion pump, through which the medication is administered. Using eye tracking, a technology capable of following eye movements, last Wednesday, ‘Libera’ was able to interact with an interface and virtually press the button to start the intravenous infusion, finally exercising her right to self-determine her own death with dignity, even if this is so difficult to achieve in practice. This is the first time a tool of this kind has been used in Italy.
The story of “Libera” reminds us, as she herself pointed out, that allowing access to assisted suicide without taking its limitations into account – particularly for people who are physically unable to administer the medication themselves due to the very illness that led them to seek it – makes it rather difficult to exercise that right.
She left these words: ‘I hope with all my heart that no one will ever again have to wait two years to exercise a right that is already theirs. No one should have to fight for so long for something that should be guaranteed.’
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