The possibility to choose

In December 2017, the Italian Parliament approved a new law on living wills, Law n. 219/2017, known as the Advance Healthcare Directive (DAT). It entered into force on 31 January 2018.

This law gives all adults of full mental capacity the possibility to formally give indications regarding the medical treatments that they want to receive in case they are no longer able to make that choice at the necessary time because of illness or mental incapacity.

The law represents a great achievement for the many associations and parties that for years have been fighting and campaigning for it. Associazione Luca Coscioni, a member of the Italian Coalition for Civil Liberties and Rights, is one of the most active NGOs in this field. Its website contains all the important information on the DAT and on drafting and filing a living will.

How to draft a living will

A living will can be drafted in three ways:

• By a handwritten document;
• By filling out a living will form, which is available on the Associazione Luca Coscioni's website (and can be adapted according to individual needs);
• If the person's physical conditions does not allow the living will to be written, it is possible to express one's wishes and needs through a video recording or with technological devices designed for people who have difficulty communicating.

In this way, Italian citizens can write their own advance healthcare directives in case of a future illness. It is always possible modify, revoke and reconfirm it.

The law provides the possibility to nominate a fiduciary: anyone can choose a person (such as a family member) who, thanks to his favored position, can rightly interpret the healthcare directive in light of medical and scientific evolution.

It is important to underline the fact that through the living will it is not possible to demand medical treatments that are against the law. This means that the document cannot provide medical treatments that are illegal under Italian law, for example Article 5 of the Civil Code prescribes that it is forbidden to cause the permanent reduction of the person's physical integrity if this is not essential to save the person's life.

After writing the biological will, it is possible to convert it into an official record and file it to the public administration, for example the mayor of the city of residence, or to a notary. Also, if the region of residence regulates the collection and the storage of living wills, it is possible to file it to the relevant healthcare facility.

Next step: regulating euthanasia

Notwithstanding the great step forward the law represents, a law to regulate euthanasia is still missing.

Today, the term ‘euthanasia’ encompasses all medical active or passive interventions that are able to interrupt the physical and mental pain of a terminally ill person, given their unequivocal consent. In Italy, in its active form, euthanasia is still considered murder.

Once more, it’s Associazione Luca Coscioni that presented an citizens' initiative to regulate euthanasia that was signed by 70,000 people; however, several political parties and the Holy See strongly disagreed with any euthanasia normative regulation. At the moment, many of those who wish to undergo euthanasia (and have sufficient means) decide to travel out of Italy, especially to Switzerland, where the practice is legal.

The right to self-determination means that anyone in a state of suffering caused by an illness may decide to terminate life in a dignified and safe way.