The right to choose one’s care, respect for patients’ wishes, and support during the final stage of life came under discussion as the Grand and General Council (Consiglio Grande e Generale) held a second reading of the bill. The citizen-initiated legislation on end-of-life care has drawn support even from those who contest some of its provisions.
What chiefly divides the chamber are the practical arrangements for implementing advance treatment directives (DAT) — whose official form has been postponed to a later decree — and the costs involved in registering them.
The bill, titled “Advance healthcare treatment directives and decision-making in the care of disabling illnesses and end-of-life patients,” addresses living wills, the doctor-patient relationship, and palliative care.
It does not introduce euthanasia nor regulate assisted suicide, as several speakers reiterated during the debate.
Proceedings were suspended at 8pm, with the debate set to resume the following day at 9am.
Following the majority and minority reports, Secretary of State Massimo Andrea Ugolini defended the outcome reached in committee: “I believe the bill approved by the Fourth Commission represents a major step forward for the country on end-of-life matters and living wills.”
He thanked Patrizia Busignani and the Emma Rossi association, and reaffirmed the commitment to establishing a hospice — both a temporary and a permanent solution — with support from the San Marino Oncology Association (Associazione Oncologica Sammarinese).
“It is our intention to accompany this law with a dedicated facility capable of caring for people during the final and deeply delicate phase of their lives.”
For Andrea Ugolini (PDCS), the starting point is the care relationship itself: “This is a law that allows and protects, not one that imposes.”
The councillor pointed to the right to refuse treatment and the need to avoid both excessive medical intervention and the abandonment of care.
He also explained that a doctor, in agreement with the patient’s designated representative, may set aside advance directives when new therapies offer genuine prospects of improvement.
It was precisely the certainty and enforceability of advance directives that drew several objections from Repubblica Futura.
Antonella Mularoni (RF) objected to the absence of the official form: “There is no DAT form, so the statements I’ve heard today, suggesting that anyone can now express their wishes, don’t reflect the actual situation.”
She also raised concerns about the registration fee of at least 70 euros, which would need to be paid again in case of any amendment.
Miriam Farinelli (RF) called for clearer guarantees on the weight given to patients’ directives: “In our view, there are murky aspects: it’s unclear whether advance treatment directives will carry binding force or not, since they would need to be balanced against the agreed treatment plan.”
Her group also called for greater attention to the wishes of minors — in relation to their age and maturity — and to the situation of pregnant women.
A practical concern was raised by Gaetano Troina (D-ML), who focused on the option of filing directives with a notary: “If this person were to become incapacitated, how would one trace which notary received these declarations, when, and what they actually contain?”
Rete announced it would vote in favor, despite criticizing the final stage of the process.
“In our view, this could have been done better — more could have been achieved — but we will support it and vote in favor, even though we were not involved at all in the final stretch,” said Emanuele Santi. The councillor recalled the movement’s decision to leave room for the citizens’ initiative and insisted that the 60-day deadline for the form be respected: “This is no small matter: the form must clearly represent and express the principles set out in the law, and we intend to see that happen.”
The majority defended the compromise reached.
Maria Donatella Merlini (PSD) acknowledged the gap between initial positions but argued it was necessary to arrive at a law: “We could have stood still, each side clinging to its own position, debating the perfect text for years to come.
Instead, we chose to build a workable, balanced and enforceable law — one capable of introducing rights and safeguards that our legal system has never recognized until now.”
Giuseppe Maria Morganti (Libera) voiced support for recognizing patients’ wishes and strengthening palliative care.
Matteo Rossi (PSD) identified the exclusion of euthanasia and assisted suicide as the element that made agreement possible across differing views: “This is a law about dignity in dying, not about active euthanasia.”
On the timeline for the form, he assured: “As the Party of Socialists and Democrats, just as we have done throughout this process, we will keep watch and push to ensure the form arrives even before the 60-day deadline, if possible.”
Marinella Loredana Chiaruzzi (PDCS) explained the rationale behind assigning the task to the Social Security Institute (ISS): “One reason is that, should the document — and therefore the form — need to be revised or updated, having it drafted by a specialized office within the Institute makes the process of change far more streamlined.”
She also noted that consultation with the promoting committee remains mandatory.
For Andrea Menicucci (RF), however, the postponement represents Parliament relinquishing part of its own responsibility.
Sara Conti (RF) recalled the principle that should guide the legislation: “A law on end-of-life care is not meant to impose a choice — quite the opposite: it exists to guarantee every citizen’s right to self-determination.”
Maria Katia Savoretti (RF) returned to proposals that had been rejected regarding minors, individuals unable to make decisions, and pregnant women, as well as the issue of costs: “We wanted to see a tax exemption put in place, whereas you have introduced a fee that, while modest, still amounts to 70 euros, on top of registration costs.”
The debate also made room for the human dimension of supporting patients and their families. Carlotta Andruccioli (D-ML) welcomed the recognition of palliative care as a right and the ability for patients to express their wishes, easing the burden of decision-making on families.
She also pointed to the role of the death doula, who provides emotional support without replacing medical staff.
Barbara Bollini (PDCS) closed by emphasizing the trust between doctor and patient and the importance of assessing each clinical situation individually, avoiding disproportionate treatment. “But I believe a councillor’s first duty is to be able to separate personal convictions from the responsibility of legislating for all citizens.”
