These days, the news filling the tabloids revolves around the assisted suicide of the twin sisters Alice and Ellen Kessler, united in pregnancy, in life, and ultimately in their departure. Almost like a fantasy tale with soft tones and a noir shadow, they decided, at the age of 89, to continue their journey bound by an indissoluble tie – that invisible umbilical cord strengthened by unparalleled determination.

They became famous in Italy during the early days of RAI’s first variety shows, capturing and holding the attention of audiences with their endless legs and radiant, dazzling smiles. Moving in perfect synchrony, as if linked by an impalpable thread (perhaps indeed that same cord that once tied them together), they enchanted viewers encountering the magic of television for the first time.

As in a theatrical script, the scene set for 17 November 2025 unfolded in Grünwald near Munich. And as in Shakespeare’s finest pages, the ending went as it had to, but every page leading to it had been written and followed faithfully by the sisters.

Here we enter the heart of the matter, trying to analyse not so much the event itself – on which everyone is free to express their own opinion – but rather the procedural path that must be followed, and the countries where, and under what conditions, such an event may legally take place.

Let us begin with Germany, where this sad event occurred. In this country, assisted suicide is permitted only when specific circumstances are met: acting responsibly, clear manifestation of one’s will, full legal capacity, “acting responsibly and of one’s own free will,” being of legal age, the presence of “sufficient space for an individual to exercise their right to a self-determined death” and to decide to “end their life on their own terms,” and full capacity of understanding and intent.

Another key point is the prohibition for the assistant or doctor (which would otherwise be euthanasia) to personally carry out the act that causes death. The patient must be the one who activates the valve; the doctor only prepares the drug mixture.

Although there is no specific legislation on the matter, the German Constitutional Court in 2020 issued a ruling validating the legitimacy of the choice, provided the parameters listed above are met.

German media report that the sisters followed the entire procedure impeccably. They were visited by a legal professional who had to verify that their decision had matured over sufficient time, that they were free to decide for themselves, and that they did not suffer from psychiatric disorders.

European countries where assisted suicide is legal

Contrary to what some might assume, it is not enough to possess the personal requirements for assisted suicide. A law, regulation or ruling that decriminalises the act must also exist, even in cases of declared self-determination.

Across Europe, countries differ in their approaches to the issue, and a clear distinction is often made between euthanasia (when a doctor administers the lethal drug directly) and assisted suicide (when the patient self-administers the drug).

The Netherlands were the first country in the world to decriminalise euthanasia in 2002, followed by Belgium – the only EU country where foreigners may also exercise this right. In 2021, Spain enacted a law regulating both active euthanasia and assisted suicide under specific conditions.

Switzerland was the first country in the world to legitimise assisted suicide, again under certain conditions. It is also legal in Luxembourg since 2009, in Austria since 2022, and in Portugal since 2023.

Thus, given the clear difference between the two “practices” – euthanasia and assisted suicide – in the first case it is the doctor who administers the lethal drug, while in the second the applicant opens the valve, thus relieving the doctor of the manual act. It must also be emphasised that the concept of euthanasia does not include the withholding or withdrawal of no-longer-useful treatments (regulated in Italy by Law 219/2017) nor deep palliative sedation.

Similarly, the decision to forgo therapeutic obstinacy – disproportionate and burdensome interventions that prolong life without real benefit – must not be confused with euthanasia.

Euthanasia and Assisted Suicide in Italy

Euthanasia is effectively prohibited in Italy. However, according to Constitutional Court ruling 242/2019, medically assisted suicide is permitted, but only under the following four conditions:

• The presence of an irreversible illness
• Severe physical or psychological suffering
• Full capacity to make free and informed decisions
• Dependency on life-sustaining treatments

There is no national law that clearly defines procedures, timing, or operational modalities to access assisted suicide.

It appears that the first regional end-of-life law was approved by Tuscany, providing guidelines intended to guarantee access to assisted suicide in accordance with the 2019 constitutional ruling, defining requirements, timelines and operative modalities. It is natural to view this region as a pioneer, considering that it was also the first (then still a State) to abolish the death penalty on 30 November 1786 with the “Leopoldine Code.”

The 242/2019 ruling was issued following a case that drew widespread public attention. F.A., known as DJ Fabo, became quadriplegic after a road accident and, while maintaining full intellectual capacity, decided to seek assisted suicide in a Swiss clinic in 2017.

In Italy, the following conditions must also be met:

• The person must be capable of self-determination
• They must suffer from an irreversible illness causing intolerable physical or psychological pain
• They must be dependent on life-sustaining treatments

The Luca Coscioni Association denounces that Italy is the only country requiring dependency on life-sustaining treatments to access assisted suicide, a requirement that limits access for certain illnesses, including terminal cancer, where patients are not strictly dependent on such treatments.

Among the requirements listed above, one condition finds unanimous agreement: the capacity for personal self-determination.

Today, the term self-determination is used more and more frequently – but what does it mean?

1. The act by which a person determines themselves according to their own will and rules; it is an expression of human freedom and therefore of responsibility and accountability for their choices and actions.

2. In international law (self-determination of peoples) the recognised possibility for peoples to decide their political condition.

These are the dictionary definitions; but in simple terms: being free to choose and the architect of one’s own actions, applying this principle in all areas of life, building one’s rules on deep self-awareness, values, inclinations, resources, limits, rights and duties.

Self-determination remains a sine qua non condition, meaningful not only for assisted suicide but for everyday life – at work, in family, in leisure, and even in the choice of death. A self-determined person knows what they want and what they are worth.

Leaving to future generations the complex judgment of cases in which the patient is unable to physically perform the act required for assisted suicide – and must therefore necessarily rely on someone else to act for them, which would constitute euthanasia – placing the executor in an ethically and personally burdensome position (homicide, applicable also to executioners in countries where the death penalty still exists), we may conclude that, beyond any ethical, political or religious considerations, where full mental capacity and complete self-determination exist – perhaps the only indisputable facts – the choice to end one’s life should not, under any circumstance, be obstructed.

Giuseppe Filippi