Palliative care is a cornerstone of healthcare for patients with chronic, degenerative or terminal diseases. And although it does not aim to cure, it pursues an equally noble goal: to improve patients’ quality of life by managing pain and symptoms, while offering precious psychological support and accompanying both the patient and his or her family on this difficult journey. Italy marked a significant turning point with Law 38/2010, which formally recognised the right to access palliative care and pain management. However, fourteen years after its adoption, regional disparities persist throughout the country. In fact, while some regions benefit from well-structured and efficient healthcare networks, in others access to this essential treatment remains scarce, with critical situations affecting paediatric patients in particular.
What is the state of the art in this area today? Recent data released by the Ministry of Health and AGENAS (the National Agency for Regional Health Services, a public body that works with the Ministry and the regions to improve the quality and efficiency of the national health service) reveal a complex picture. Although the palliative care network is present in all regions, there are significant disparities in terms of resources, facilities and qualified staff. This network is currently based on three pillars: hospices, residential facilities that receive patients in advanced stages of the disease; home palliative care, provided by specialised teams that bring care directly to the patient’s home; and pain management centres, dedicated to controlling painful symptoms, including in the non-terminal phase.
While services cover the whole territory in northern regions, significant logistical barriers remain in central and southern regions, with long waiting lists and inadequate access in terms of needs.
Paediatric palliative care is a particularly sensitive area and presents an even more complex challenge. Young patients with terminal illnesses require highly specialised care, often very different from that provided to adults. Unfortunately, there are very few paediatric hospices in Italy, while home care is frequently under-resourced.
Some regions have successfully implemented pioneering initiatives, such as the Casa del Bambino in Lombardy, the Padua Children’s Hospice with its home care network, or the home care network in Emilia-Romagna. However, too many regions in Italy still lack dedicated care units, leaving families to face an already extremely difficult journey alone, without the support they would need. The distribution of palliative care services across the country is a ‘fragmented patchwork’, with marked inequalities between regions. In northern Italy, Lombardy, Piedmont, Veneto and Emilia-Romagna are the regions with the most developed health networks. Lombardy distinguishes itself with more than 70 accredited hospices, while Emilia-Romagna stands out for its provision of home care. In the central regions, Tuscany and Lazio have made great strides, although the latter region continues to lag behind in the suburban areas. Umbria and Marche have also significantly expanded their network of hospices and home care. The picture is even worse in the south and on the islands. Campania, Calabria and Sicily remain characterised by incomplete networks, with a limited presence of hospices and a critical shortage of specialised healthcare staff locally. There are encouraging signs from Puglia and Basilicata, where upgrading projects are showing promising results. The same geographical pattern is reflected in paediatric care: the north offers more structured services, while in the south families often have to travel long distances to access health facilities.
Looking ahead, while regulatory progress has been made, a number of key challenges remain. The development of regional networks, with a particular focus on southern regions, is essential. Training new healthcare professionals is key, as is improving paediatric palliative care through the establishment of additional dedicated hospices and the provision of appropriate home-based services. Greater integration with the National Health Service is also needed to ensure more equitable access.
Palliative care must be recognised as a fundamental human right and not just a public health service. Ensuring that all citizens, irrespective of age, can face the final stage of life with dignity and without suffering should be a paramount priority of the healthcare system.
Despite the significant advances achieved thus far, Italy continues to face considerable challenges in ensuring equitable and comprehensive access to these vital services. The overarching objective must be met: namely, to eradicate regional disparities and guarantee that every patient, regardless of their place of residence, receives the highest attainable quality of life until the very end.
In the light of the ongoing cultural, bioethical and regulatory debate surrounding euthanasia and assisted dying, one final reflection deserves to be shared. Requests for these practices are often motivated by fear of pain, loneliness and lack of access to appropriate care. The effective implementation of palliative care has a crucial role to play in this context. The provision of adequate pain relief and comprehensive support, not only to the sick but also to their families, can drastically reduce the sense of abandonment and despair that leads some people to see the end of life as the only way out. Evidence from countries around the world confirms this correlation. When palliative care is easily accessible and well-structured, requests for euthanasia drop significantly. If palliative care were truly within everyone’s reach, the demand for euthanasia and assisted dying would take on a radically different meaning, because the patient would no longer feel abandoned and without other options. Therefore, improving these services is not only a health issue, but a true act of civilisation and social justice.
