Why Forza Italia will fight for end-of-life care. At any cost

End-of-life care is one of those issues where politicians should feel, even before the temptation to speak, a duty to listen and to choose their words carefully. Not because silence is a virtue, nor because ambiguity can be mistaken for prudence, but because it is precisely when a subject touches on people’s personal lives – affecting their real suffering, families gripped by grief, and the most intimate relationship between freedom, community solidarity, care and dignity – that clarity becomes indispensable. However, this clarity must be measured, respectful and never ideological.

As a member of Forza Italia, I make no secret of the fact that I believe Parliament must now pass a national law on end-of-life care. Not just any law for the sake of it, nor an ‘emotional shortcut’, but a serious, balanced framework capable of addressing the Constitutional Court’s recommendations and sparing the country the risk of patchy regulation and widespread ‘corruption’ within the National Health Service with regard to its institutional duties.

Our party has chosen not to shy away from a difficult issue, certainly one of the most sensitive of this parliamentary term. The work we are carrying out has a concrete parliamentary framework in the Zanettin-Zullo bill, which we do not regard as a starting point merely for the sake of principle, but because it stems from a genuine effort at synthesis and can form the basis for serious debate. Of course, it can be amended, corrected or supplemented, but it would be a mistake to scrap everything, start from scratch, and embark on a never-ending process destined only to result in stagnation.

Forza Italia has not changed; it is still the movement founded and shaped by Silvio Berlusconi according to principles rooted in Catholic, liberal and reformist culture.

This identity prevents us from erecting ideological barriers, just as it prevents us from pursuing paths that are alien to us. Our compass is not set on radicalisation, but rather on reconciliation; we are not driven by the intention to fuel irreconcilable divisions, but to seek pragmatic solutions that respect the individual; we do not wish to transform individual rights into absolute dogmas detached from the concept of responsibility, but to defend freedom within a legal, public and subsidiary framework capable of protecting the most vulnerable.

The issue of end-of-life care is a reality. It is evident in the difficult decisions that already affect the relationship between doctors, patients and their families; in the rulings of the Constitutional Court; and in the questionable legislative and administrative initiatives of certain regions. It is also evident in the expectations of citizens who ask the state, first and foremost, to support them during their most painful moments through home care, palliative care and dedicated facilities.

The issue, then, concerns the model we wish to introduce into our legal system. Do we wish to see a right to assisted suicide gradually established through inconsistent regional legislation, accompanied by a duty on the part of the National Health Service to provide a service leading to death? Or do we want clear and well-defined national legislation that sets out the limits of non-punishability in extreme cases, thereby preventing assistance in dying from becoming a routine function of the public health service?

The difference is certainly not technical, but cultural, institutional and anthropological. The National Health Service is, in fact, one of the Republic’s greatest moral and civic institutions, established to treat, support, alleviate, rehabilitate and care for people. If we were to carelessly introduce into its mission the idea that death could become a service to which one is entitled, we would risk distorting the meaning of the therapeutic alliance, encouraging the entrenchment of a throwaway culture, and undermining the life-affirming ethos that must remain at the heart of public healthcare.

A sick person must never feel that they are a cost, a burden or a vulnerable individual to be dismissed. In a society that already faces profound loneliness, rapid ageing, chronic illness, disability and families often left to cope on their own, the state’s role cannot be to make it easier for vulnerable people to ‘step aside’, but to strengthen the support network that sustains them.

This does not mean ignoring suffering or defending aggressive medical treatment, which no genuinely human and Christian perspective can consider right. Rather, it means rejecting two extremes: on the one hand, the idea that every request for assistance in dying represents the banner of an absolute and immediately enforceable freedom; on the other, the idea that the state, and politics, can simply turn a blind eye, delegating the matter to the judiciary, to local authorities, to the vagaries of practice or to the silence of families.

The Constitutional Court has outlined a scope of non-punishability in clearly defined circumstances, and the legislator cannot pretend that this provision does not exist. However, we must ensure that an amendment to the Criminal Code is not transformed, through administrative or regional channels, into a general right to medically assisted dying and, indeed, into a corresponding structural obligation on the part of the health service. A national law can and must clarify the boundaries, establish safeguards, prevent premature action, protect patients, safeguard doctors, preserve the identity of the National Health Service, and at the same time avoid the regulatory chaos that currently threatens to ensue.

For this reason, I consider it essential to establish a framework that rigorously distinguishes between the public duty to care for and support patients, and the non-punishment, in exceptional cases, of voluntary, unpaid behaviour that is subject to strict controls. Medically assisted dying must not be trivialised, and I believe it should be considered only as a last resort, when every possible form of support has been offered, when palliative care and pain management have been genuinely guaranteed, when the person’s wishes are freely given, informed, current and verifiable, and when there is serious – and certainly not merely formal – public oversight.

The issue of the National Health Service is therefore crucial, and we cannot consider a law on end-of-life care without first discussing, together, the right to treatment. The real scandal in Italy is not that assisted dying is not accessible enough, but that too many people do not have full, timely and consistent access to palliative care, home care, pain management, psychological support and support for their families. It is unacceptable that there are areas where the palliative care network functions effectively and others where people are left to fend for themselves, and that the right not to suffer unnecessarily is still more often proclaimed than guaranteed.

A truly humane society does not tell those who are suffering: ‘You may die’. Instead, it affirms first and foremost: ‘You will not be left alone’, ‘Your life retains its value even when you depend on others’, ‘Your frailty does not exclude you from the community’, ‘We are here for you, with care, presence, expertise and closeness’.

Only once these words have been grounded in reality can we tackle the issue of borderline cases, without hypocrisy and without taking shortcuts.

I am strengthened in this line of reasoning by the conviction that freedom is never genuine when it stems from abandonment: a person who is left alone, who is not properly cared for, and who lacks psychological support, risks being driven towards an extreme choice due to a lack of alternatives. And the principle of subsidiarity, which is part of our political culture, is fundamental in this regard. No state, on its own, can fully address suffering. We need hospitals, doctors, nurses, families, volunteers, religious communities, local networks, associations and a sense of community. We need a society that does not reduce compassion to a mere procedure. But precisely because suffering cannot be bureaucratised, the state must play its part effectively: guaranteeing care, establishing rules, preventing abuse, ensuring national consistency, supporting carers, and not allowing regional differences to become moral inequalities.

Today, the parliamentary majority supporting the government bears a particular responsibility, and an issue as sensitive as end-of-life care must not become a source of internal strife or tactical manoeuvring.

The concerns expressed within the Catholic community, the liberal community, the healthcare professions and families affected by painful circumstances deserve to be listened to with respect. However, listening must not lead to endless postponement, but rather to the establishment of a reasonable compromise – one that does not compromise on standards – that will stand the test of time.

In this process, Forza Italia can play a positive role for the country and for the coalition, demonstrating – by virtue of its liberal and reformist profile – that the centre-right is not a prisoner of rigid ideologies, but is capable of managing even the most difficult ethical conflicts; that defending life does not mean ignoring freedom; and that recognising a space for freedom does not mean undermining life.

For this reason, the amendments we have proposed – in particular regarding the (non-)role of the National Health Service and the voluntary and free nature of the same medical procedure within private practice, with implicit respect for conscientious objection and the non-involvement of healthcare institutions – should be interpreted as a serious attempt at mediation.

No legislation can erase the tragedy of individual stories. The law does not serve to eliminate tragedy from human existence, but to prevent it from being governed by chance, loneliness, inequality or arbitrariness. It serves to provide citizens with a clear framework, doctors with firm guarantees, families with a path not marked by the unexpected, and institutions with transparent accountability.

A national law on end-of-life care, if well-drafted, would not constitute a capitulation to the culture of death; on the contrary, it would represent the most serious means of preventing the regulatory vacuum – currently filled by regional disorder – from effectively bringing about that very culture. It should clearly affirm that the state remains committed to care, that the National Health Service does not lose sight of its vital mission, and that extreme cases require extreme rules, not extreme slogans.

This is the balance we must strive to achieve. When it comes to matters of life and death, we need neither fear nor propaganda, but conscience, the rule of law, humanity and institutions that are up to the task.