[Palliative care and physician-assisted suicide: the risks of the axiological conflict.]

In the seven years since the Italian Constitutional Court's ruling no. 242/2019 conditionally legalized Physician Assisted Suicide (PAS), the ensuing legislative void has given rise to significant legal and ethical ambiguities. Within this context, the Italian Society of Palliative Care (ISPC) has issued a formal position paper, recommending that palliative care specialists abstain from direct involvement in the implementation of PAS. The ISPC's primary concern is that associating PAS procedure with Palliative Care (PC) could compromise its core public identity, potentially deterring patients who could benefit from palliative services but do not wish to consider PAS.

This article critically examines the relationship between medicine, PC, and PAS in Italy. It situates the ISPC's stance within the broader crisis of a modern medical paradigm predominantly focused on "curative" interventions at the expense of holistic, person-centered care. PC, conversely, embodies a paradigm shift by addressing the multidimensional nature of suffering (physical, psychological, social) and by upholding patient self-determination as a central tenet.

The article critiques this position, arguing that by formally disengaging from PAS, the PC medicine runs the risk of: 1) contradicting its foundational mission and regressing to the ancillary role historically assigned to it by conventional medicine; 2) embracing a corporatist, guild-like view of its professional function; 3) failing to challenge the prevailing performance-driven and market-oriented model of medicine with its robust alternative cultural framework; 4) reinforcing the cultural stigma against a self-determined death, thereby undermining its core mandate to promote patient autonomy.

The argument of this paper is that rather than viewing PC and PAS as mutually exclusive, the act of accompanying a patient through the PAS process can be understood as the ultimate expression of a compassionate medical practice - one that honors the patient's deeply held values and choices. The core challenge, therefore, is not merely procedural but profoundly cultural. It requires moving beyond a technocratic, profit-oriented medical model and confronting the societal tendency to sanitize or deny death. The ultimate goal must be to guarantee all patients continuous, comprehensive support throughout their illness trajectory, fully respecting their individual choices.