Can a Regional Law Regulate End-of-Life Care in Italy? Ethical and Medico-Legal Perspectives

Recent Italian developments in end-of-life governance have intensified debate on self-determination, medically assisted suicide, and the constitutional limits of healthcare regulation. This article is a narrative review combined with doctrinal legal analysis and medico-legal commentary. It examines Tuscany’s Regional Law No. 16 of 14 March 2025 within the broader Italian framework shaped by Law No. 219/2017, Constitutional Court Judgment No. 242/2019, and the subsequent constitutional review culminating in Judgment No. 204/2025. The article pursues three aims: to reconstruct the national legal framework governing end-of-life decision-making in Italy; to analyse the structure and constitutional implications of the Tuscan statute; and to assess the medico-legal relevance of the persistent uncertainty surrounding life-sustaining treatments as an eligibility criterion. The analysis highlights two distinct but interconnected issues: the constitutional boundary between regional healthcare organisation and matters requiring nationally uniform safeguards, and the unresolved interpretation of life-sustaining treatments in clinical and legal practice. In light of Judgment No. 204/2025, the article argues that regional procedural intervention may reduce administrative uncertainty, but cannot replace coherent parliamentary legislation capable of clarifying substantive criteria, limiting territorial variability, and reinforcing the role of palliative care within end-of-life pathways.