Key milestones in the debate on end-of-life issues in Italy: the ELISI project

Over the past fifty years, the Italian debate on end-of-life issues has steadily intensified, shaped by the continuous interaction of clinical, legal, ethical, and social dimensions. Yet, navigating the complex landscape of laws, guidelines, opinions, and practices remains challenging, and interpreting events in light of shared principles, as well as identifying key gaps, is far from straightforward. This study, developed within the framework of the ELISI project – Attitudes towards End-of-Life Issues in Italy, funded by the European Union and the Italian Ministry of University and Research (PRIN 2022), aims to identify and analyse the landmarks that have contributed to redefining the regulatory framework and clinical practice concerning end-of-life decisions in Italy. By engaging project participants and a multidisciplinary panel of external experts, 216 suggestions were collected and subsequently assessed according to predefined inclusion and exclusion criteria. The analysis identified 26 landmarks, classified as either Milestones or Turning Points, highlighting a complex process of evolution of the debate. The findings underscore the prominence of issues such as informed consent, Advance Directives, and palliative care, while revealing ongoing regulatory and practical difficulties, notably the absence of a comprehensive framework for medically assisted suicide. This study offers a diachronic reconstruction of the main developments shaping the Italian debate and serves as a tool to foster a more open, informed, and non-polarized interdisciplinary dialogue on these topics.