Blandi Lorenzo, Tolentino Russell, Basile Giuseppe, Tronconi Livio Pietro, Signorelli Carlo, Bolcato Vittorio
School of Public Health, Vita-Salute San Raffaele University, 20132 Milan, Italy.
Centre for Evidence-Based Medicine, University of Oxford, Oxford OX1 2JD, UK.
Healthcare (Basel). 2025 May 7;13(9):1091. doi: 10.3390/healthcare13091091.
Medical assistance in dying (MAID) remains a sensitive and evolving issue in Europe, frequently linked with discussions about human freedom, life dignity, and healthcare policy. While national consensus in Italy is absent, the Region of Tuscany has enacted Law No. 16/2025, which establishes a MAID procedure based on recent Constitutional Court rulings. The commentary aims to provide a preliminary analysis of the new law, addressing ethical, medico-legal, and social issues that emerge in relation to the Italian and global debate on the topic. The law establishes a three-stage process based on four eligibility criteria: irreversible disease, psycho-physical suffering, life-support dependence, and informed consent. However, Tuscany's model poses medico-legal and ethical concerns, particularly about the boundaries of regional legislative competence, the duties of healthcare professionals, and the possibility of intra-national inequity or "health migration." In addition, critical organisational implications derived from informed consent and lethal drug self-administration impede clinical implementation in some individuals with mental or neurological disorders. The lack of clarity in the different steps of the procedure, the uncertain supervision system, and the potential consequences for specific categories of vulnerable people underline the need for comprehensive national regulation. A future regulatory framework must balance procedural clarity with individual autonomy and equitable access, bringing Italy in line with larger European context for end-of-life care.
在欧洲，医疗协助死亡（MAID）仍然是一个敏感且不断发展的问题，常常与关于人类自由、生命尊严和医疗政策的讨论联系在一起。虽然意大利缺乏全国性共识，但托斯卡纳大区已颁布第16/2025号法律，该法律根据宪法法院最近的裁决确立了医疗协助死亡程序。本评论旨在对新法律进行初步分析，探讨与意大利及全球关于该主题的辩论相关的伦理、法医学和社会问题。该法律基于四项资格标准确立了一个三阶段程序：不可逆转的疾病、身心痛苦、依赖生命维持、以及知情同意。然而，托斯卡纳的模式引发了法医学和伦理方面的担忧，特别是关于地区立法权限的界限、医疗保健专业人员的职责，以及国内不平等或“健康移民”的可能性。此外，知情同意和致命药物自我给药所产生的关键组织影响阻碍了一些患有精神或神经疾病的个体的临床实施。程序不同步骤缺乏明确性、监督系统不确定以及对特定弱势群体的潜在后果凸显了全面国家监管的必要性。未来的监管框架必须在程序明确性与个人自主权和公平获取之间取得平衡，使意大利在临终关怀方面与更广泛的欧洲背景保持一致。
