Umbria is officially the fifth Italian region to adopt an end-of-life law. It happened on 22 October, when the regional assembly voted to approve (with 11 votes in favour, 6 against and 3 abstentions) the citizen-initiated proposal Liberi Subito, promoted by the Associazione Luca Coscioni, which had arrived in the Umbrian assembly backed by 4,801 signatures collected from citizens. Before Umbria came Tuscany, Sardinia, Emilia-Romagna and Veneto: the latter had been the first centre-right region to pass the law.

What the Liberi Subito law provides for

The text does not introduce a new right, but simply organises the implementation, within the regional health service, of the conditions established by the Constitutional Court in the "Cappato-Antoniani" ruling of 2019, the case best known by the name of Dj Fabo: the presence of an irreversible pathology, intolerable suffering, dependence on life-sustaining treatments, and the capacity to decide freely and consciously. If all four of these conditions are met, it is possible to access assisted suicide by submitting an application to a permanent multidisciplinary commission that must be established by law.

In the Umbrian case, the proposal bears the name of Laura Santi, a journalist from Perugia with progressive multiple sclerosis, who died in 2025 after self-administering a lethal drug: in order to have her eligibility verified, Laura Santi had waited two years and eight months. It was she who had launched and led the campaign in Umbria alongside her husband, Stefano Massoli.

Filomena Gallo and Marco Cappato, national secretary and treasurer of the Associazione Luca Coscioni, thanked the signatories, the councillors who approved the text, and Santi herself. "While Parliament continues to bury its head in the sand, it is the regions that can establish clear, uniform and transparent procedures, to provide guarantees to people who are suffering and to healthcare staff."

Parliament is at a standstill

On the subject of Parliament, indeed, a comprehensive national law does not yet exist, despite the Constitutional Court having practically ordered both the Chamber and the Senate to fill the legislative void. At present, two bills have been tabled in the Senate, and both are stalled: the Bazoli bill (PD) incorporates the four requirements of the ruling and provides for a public, free-of-charge pathway funded by the national health service, but it is a minority text; the Zanettin-Zullo bill (Forza Italia and Fratelli d'Italia) takes a more restrictive approach: access limited to terminally ill patients with a short-term unfavourable prognosis, a mandatory prior recourse to palliative care, and a reduced role for the national health service, which would not cover the necessary costs. In June, the Senate chamber voted to suspend consideration of the Bazoli bill, which was referred back to the joint Justice and Health committees. Since then, proceedings have been essentially at a standstill: after the summer recess the committee has not been convened again, and the Government has yet to provide guidance on the opinions requested.

​

Into the legislative vacuum the regions have stepped in, but not without limitations. The Government challenged the Tuscan law and, with ruling no. 204/2025, the Constitutional Court sided with the regions on the principle: they may adopt organisational and procedural measures even in the absence of a national law. However, it declared several provisions unconstitutional, on the grounds that they encroached on the State's exclusive powers. These included the submission of an application by a proxy and the tight deadlines for verifying eligibility. The Council of Ministers also challenged the Emilia-Romagna law, on 24 September.

A patchwork map

For this reason, the question of competence remains at the heart of the debate. The regional president, Stefania Proietti, did not take part in the vote: she explained that the process, though legitimate, should first and foremost be pursued at state and national level. "A matter of this ethical, human and constitutional importance," said the president, "deserves a response from Parliament. The rulings of the Constitutional Court have defined a framework that institutions must respect, but the need remains for national legislation capable of guaranteeing equal conditions for all citizens." In the meantime, the Associazione Coscioni is aiming to extend Liberi Subito to other regions: the bill is currently under discussion in the Autonomous Province of Trento, while it has been withdrawn in Bolzano. In Campania, Lazio, Liguria, Lombardia, Marche, Molise, Piemonte, Puglia and Sicilia the necessary signatures have been collected, the bill has been filed and is awaiting the start of the legislative process; in Calabria the signature-gathering campaign is under way, while nothing has yet happened in Abruzzo, Basilicata, Friuli-Venezia Giulia and Valle d'Aosta.