Intended for healthcare professionals


Quadriplegic man is first person to be allowed to die by assisted suicide in Italy

BMJ 2021; 375 doi: (Published 26 November 2021) Cite this as: BMJ 2021;375:n2927
  1. Marta Paterlini
  1. Stockholm

A 43 year old man has become the first person in Italy to be granted permission to have a legal death by assisted suicide.

The ethics committee of the local healthcare system of the Marche region authorised the action for the man, referred to as “Mario,” who is quadriplegic and has been unable to move for 10 years following a car collision. He has been asking the local hospital for over a year to put an end to his suffering. The Luca Coscioni Association, a non-profit organisation dedicated to promoting end-of-life choice in Italy, has been helping him in his bid.

The ethics committee confirmed that Mario is eligible for assisted suicide after certifying that he met four conditions which were established as a prerequisite for assisted suicide by the Constitutional Court in 2019.

The criteria were set during a case against Mario Cappato, spokesman for the Luca Coscioni Association, who had taken a paralysed man to Switzerland for an assisted death. On that occasion the court ruled that assisted suicide was permissible when a person meets four conditions—that the person is being kept alive by life sustaining treatments, has irreversible pathology, the suffering is considered to be unbearable, and the patient is fully capable of making free and informed decisions.

However, the decision by the Marche ethics committee has run into problems around which drugs should be used to end the man’s life, which threaten to delay Mario’s wishes. Mario has himself proposed taking thiopentone sodium to end his life, but the ethics committee has raised doubts about its suitability and said that it was not for the patient to decide on the matter.

According to Cappato, “The decision should be taken by the national healthcare system, which is more competent on medical matters than a court.” He said, “Italy has a legislative vacuum” and does not currently have a law on assisted suicide, meaning that every case must be dealt with locally with criteria that are not always clear.

Since 2017 living wills have been available in Italy to allow people to choose what medical intervention they wish to receive or not receive at the end of their life, including whether or not they want to be fed and artificially hydrated.

“This law did not legalise euthanasia nor assisted suicide,” said Cappato, who has collected over one million signatures for a referendum on legal euthanasia, which now needs authorisation from the Supreme Court.

The passage of the bill through parliament to legalise assisted suicide has been postponed many times because of opposition from centre right MPs and the referendum could take place before the law is passed.

Filippo Anelli, president of the National Federation of Surgeons and Dentists (FNOMCeO), told The BMJ, “We will wait for the final law to assess its consistency with the principles constitutional and our code of ethics.”


  • Correction: On 18 January 2023 we corrected the headline (“Quadriplegic” not “Paraplegic”).