Assisted suicide, the case of ‘Mario’, all the stages of the story

The Luca Coscioni Association traces the case of ‘Mario’, a quadriplegic patient from the Marches, who following the ruling of the Council on the ‘Cappato Case’ asked his Health Authority of reference to have the conditions foreseen by the sentence recognized for access to assisted death in Italy. First case in our country of assisted suicide, Mario died this morning at 11.05. Mario (whose real name is Federico Carboni) was born in 1978, lives in a small town in the Marche region and, since 2010, due to a serious road accident that caused him to fracture his spine, resulting in injury to the spinal cord. , is quadriplegic and suffers from other serious diseases. His conditions are irreversible. Mario tried all possible ways to recover part of his health but nothing helped.In 2020 ‘Mario’ writes to Marco Cappato, treasurer of the Luca Coscioni Association, to receive information on assisted suicide in Switzerland and thus learns that he could ask for the suspension of treatments, after activating a palliative course and deep sedation; that he can draw up the Advance Processing Provisions (Dat) so that his wishes are always respected even if he is no longer able to communicate. He also discovers that the intervention of the Constitutional Court with the Cappato ruling allows legal aid for suicide under certain conditions also in Italy. Mario then draws up the living will and on 27 August 2020 he decides to write to his Asur of reference to obtain the provisions of the Council and avoid having to go to Switzerland to obtain access to assisted death. He therefore asks that the existence of the conditions provided for by the Constitutional Court be verified.Asur responds to Mario’s request on 1 October 2020 with a denial without even activating the procedures indicated by the Constitutional Court which established that in order to comply with the request of the person concerned – by virtue of rules already in force in our legal system – it is necessary to verify the conditions (person kept alive by life-sustaining treatments, suffering from an irreversible pathology, source of intolerable suffering, but fully capable of making free and conscious decisions) by of a public structure of the National Health Service, subject to the opinion of the territorially competent ethics committee. The Asur, however, denies Mario even the activation of the verification procedures. Following the response of the Asur, Mario requests legal help from the Luca Coscioni Association to bring the Asur to court and obtain an order aimed at seeing that what is respected. provided for by the Constitutional Court ruling Mario, assisted by the lawyers of the Committee of Jurists for Freedoms of the Luca Coscioni Association (Legal College composed of the lawyers Filomena Gallo, Massimo Clara, Angelo Calandrini, Cinzia Ammirati, Francesca Re, Rocco Berardo and Giordano Gagliardini ), therefore asks the judge to order the single regional health authority of the Marches to carry out checks on his condition and verify the procedures for proceeding – with the opinion of the ethics committee – to prescribe the drug to put an end to suffering with access to the so-called assisted death. With a ruling made known at the end of March 2021, the court of Ancona denies the possibility to Mar I have access to assisted death in Italy. The court, while acknowledging that the patient has the requisites established by the Constitutional Court in judgment 242/19, states that “there are no […] reasons to believe that, by identifying the cases in which aid for suicide can now be considered lawful, the Court has also founded the patient’s right, where such hypotheses occur, to obtain the collaboration of health professionals in implementing his decision to put an end to its own existence; nor can it be considered that the recognition of the invoked right is a direct consequence of the identification of the new hypothesis of non-punishment, taking into account the multifunctional nature of the exceptions not always instrumental to the exercise of a right “. Following a complaint from the decision of the ordinary court of Ancona, the same court in collegiate composition, overturns the previous decision by imposing, with this ordinance, the single regional health authority of the Marche to verify whether in Mario’s case the conditions for access to assisted suicide were respected and to ascertain whether modality, method and drug chosen were suitable to guarantee him the fastest, painless and dignified death possible. The College of the court of Ancona orders Asur to proceed in application of the Cappato / Antoniani sentence of the Constitutional Court (242/2019). July 2021 Mario warns the single regional health authority of the Marches. After 30 days from the warning, Mario through his legal board coordinated by the lawyer Filomena Gallo hinges a series of judicial and extrajudicial actions so that his right is affirmed.On August 27, 2021 a warning is served on the Government: Mario asked that the Government activates all the powers he holds to implement his right to have legal access to assisted suicide already sanctioned by the Constitutional Court sentence number 242/2019. define a calendar of appointments aimed at verifying the conditions, which included, during the month of September, a series of interviews with psychologists, palliative doctors and neurologists, in order to carry out the preparatory assessments required by the Marche Region Ethics Committee, to issue the his opinion. The checks carried out scrupulously by the interdisciplinary team, on 14 October 2021, Mario is notified of the dispatch of the collegial report drawn up by the interdisciplinary team of Area Vasta 2, competent at the Cerm. absence of any communication relating to developments relating above all to the opinion that the Ethics Committee should have issued, Mario on 15 November 2021 sent a new warning to request the procedure. On November 23, 2021, Mario receives the opinion of the Ethics Committee, which finds the presence of the four conditions established by the Constitutional Court, at the same time noting the impossibility of being able to express himself on the lethal drug as no verification had been made on the method, on the quantity and methods of administration. For the first time, a patient in Italy receives confirmation of the conditions laid down by the constitutional judgment which makes the aid to medically assisted suicide lawful.Upon Mario’s indication, the legal board sends yet another warning so that the single regional health agency provides for the verification of the executive procedures as ordered by the court of Ancona. The Healthcare Company had not expressed its opinion on this aspect, nor did the Ethics Committee, in its appointment to the Company, mention this fundamental step, not only ordered by the court but also prescribed by the sentence of the Constitutional Court. The board of law, in the formal notice, also provides the opinion of a biased consultant, Dr. Mario Riccio, doctor of Piergiorgio Welby, with whom the methods of self-administration of the drug suitable for Mario are detailed, based on his conditions . An opinion produced for the sole purpose of facilitating the procedures, since the sentence of the Constitutional Court places the sole task of verifying these procedures on the public structure of the National Health Service after obtaining the opinion of the territorially competent ethics committee. On December 17, 2021, Mario’s legal defense team denounced the same Committee and the Marche Region Health Authority for the crime of torture, as well as for the crime of omitting official acts and all other related crimes that could be configured , due to the continuous obstructions and omissions, which manifested themselves in the form of failure to verify the drug and its methods of administration. chosen. The commission, composed of two directors of complex operational units (Anesthesia-Intensive Care and Forensic Medicine), two directors of simple departmental operational units (Palliative care and Pharmacy), a full professor of Pharmacology and an Asur executive, after an extensive discussion and he unanimously replied in a precise and detailed manner. Regarding the modality, method and drug chosen by Mario: “Thiopentone sodium appears suitable for guaranteeing a quick (minutes) and painless death at a dosage of no less than 3-5 grams for an adult weighing 70 kg. The method of administration is that of self-administration by intravenous infusion. ”The choice of drug and methods were the missing piece left open after the green light of the regional ethics committee. The validation of the drug and the methods of self-administration finally creates a precedent that will allow those who find themselves and will find themselves in a situation similar to that of Mario to obtain, if they ask for it, help for voluntary death. ‘Mario’ from 9 February 2022 is free to choose when to put an end to his suffering, in Italy, with his loved ones next to him, without the help provided constituting a crime pursuant to article 580 of the criminal code as a result of sentence 242/19 of the Constitutional Court.