On Tuesday, Italy witnessed the first medically assisted suicide fully organized by the regional healthcare system. This concerns Domenico Zuccarelli, 59, a native of Giussano in Lombardy. The man suffered from a progressive form of multiple sclerosis and submitted a request for medically assisted suicide to the Territorial Social and Health Enterprise (Asst) of Western Milan on November 8, 2025. After more than nine months and with the involvement of the Luca Coscioni Association, the entire decision-making process and its implementation took place within the Lombardy regional healthcare service, creating a precedent: until now, territorial state services were limited to verifying compliance with requirements, which was conducted by an ethics committee. Euthanasia in Italy remains illegal when it comes to its "active" form, that is, the direct administration of a substance that ends a person's life. However, following the Constitutional Court ruling No. 242/2019, medically assisted suicide is permitted, which represents indirect assistance from a physician under certain conditions and in strictly defined cases. According to this ruling, both medically assisted suicide and refusal of treatment are considered inherent rights, but there is still no national law that guarantees them. For this reason, many regions have begun to develop their own regulations: the latest was Emilia-Romagna, which passed a law last July. Meanwhile, in Europe, countries are taking different paths - from decriminalization laws to recognition of active euthanasia or only its passive form, as well as bills that are still under consideration. ## ## The Case in Lombardy and Other Italian Regions The story of Domenico Zuccarelli has become another step in the development of guidelines that the Lombardy authorities are shaping on a case-by-case basis in the absence of a general regulatory framework. "Today in Lombardy, there is thus a specifically designated route: from submitting a request for verification to protection against delays, up to taking on procedures, accompaniment, and choosing a location by the regional healthcare service. This is no longer just a declaration of principle, but a path fully traversed within the state system, which from today will become clearer for those who follow this path," stated the Luca Coscioni Association, which was involved in this case. The legal team defending Zuccarelli, led by lawyer and national secretary of the Association Filomena Gallo, submitted numerous appeals and complaints due to the delay in analyzing the case, which, according to regional recommendations, should not have taken more than four months, while the wait stretched to nine. At the end of May, an urgent complaint demanded not only to complete the procedure but also, if the criteria established by the Constitutional Court were met, to organize the stage of its practical implementation. On May 18, an interdisciplinary medical commission deemed the request justified and determined the course of action, including medications, dosages, and the mechanism of administration. The procedure was then completed by the same territorial services - they selected voluntary medical personnel and a venue. As noted by the Association, this is already the third case of access to such a procedure in Lombardy, made possible by the Constitutional Court ruling. Three regions, on the contrary, decided to have their own law based on the Liberi Subito initiative. The first was Tuscany, which at the beginning of 2025 approved regulations that describe the sequence of steps and timelines for processing requests for medically assisted suicide, including the establishment of an interdisciplinary commission to evaluate each request; the second was Sardinia, where the law stipulates that other competent health structures must provide the necessary tools and access to the medication. Emilia-Romagna adopted a similar law on July 23, becoming the third region in the country with a specific regulation on end-of-life. ## Different Approaches in Europe The Netherlands was the first in the world to adopt a euthanasia law, legalizing both active euthanasia and medically assisted suicide in 2002. In 2005, they also approved the so-called "Groningen Protocol," which allows for pediatric euthanasia and establishes its rules and criteria. In 2002, Belgium also decriminalized euthanasia, and in 2016 expanded it to minors. Luxembourg legalized euthanasia in 2009, while Spain became the fourth country to decriminalize active euthanasia in 2021, although assisted suicide has been permitted there since 1995. In Spain, however, the discussion has reignited after the death of Noelia Castillo - a 25-year-old woman who fought for the right to euthanasia after a lengthy legal battle with her father in March of this year. Austria legalized voluntary assisted suicide in 2022, while Switzerland permits both this practice and passive euthanasia, that is, the cessation of treatment. Legislation allows for self-administration of the medication for foreign nationals, as occurred in the complex case of Italian Fabiano Antoniani, known as DJ Fabo, in 2017. In other countries, debates continue, and various initiatives are being proposed: in Portugal and Slovenia, relevant proposals have been rejected, while in France, a law on assisted dying approved by parliament in mid-July was published in the Official Journal on Wednesday.
