Italy – End of Life Issues

What end of life care options are available in Italy, and how does the system work?

Italy’s national public health service, the Servizio Sanitario Nazionale (SSN), delivers end-of-life care through a combination of hospital departments, outpatient facilities, home care programmes, and residential hospices. Palliative support can be provided across inpatient, outpatient, and community settings. The overarching aim is to allow seriously ill patients to remain in their preferred environment for as long as possible, with growing emphasis placed on home-based care alongside institutional provision.

A national palliative care policy has existed since the late 1990s and has driven growth in services including hospices, day care centres, and hospital-based palliative units. Care is administered regionally through local health authorities known as Aziende Sanitarie Locali (ASL). Although legislation has been passed to guarantee palliative care provision, its quality and availability vary considerably from one region to another. In practice, services in northern Italy — notably Lombardy, Emilia-Romagna, and Veneto — tend to be more developed than those in parts of the south.

Access to specialist end-of-life care is usually initiated through a referral by your medico di base (general practitioner). The GP works alongside the local ASL, which evaluates the patient’s needs and organises the appropriate level of support — whether enhanced home care, a day hospice programme, or full residential hospice admission. Expats who are enrolled with the SSN follow the same route as Italian residents.

What is palliative care in Italy, and who is eligible for it?

The formal regulation of palliative care in Italy was established by Law 38/2010, which defines it as a range of interventions for individuals suffering from a disease with an unfavourable prognosis that no longer responds to curative treatment. The law guarantees every person the right to access palliative care and pain therapy. For expats, eligibility depends primarily on being enrolled in the SSN as a legal resident of Italy.

Italy’s National Health Service (SSN), established by legislation in 1978, provides universal coverage automatically extended to all citizens and legally resident foreign nationals. This means that registered expats — whether from EU or non-EU countries — enjoy the same entitlements to palliative care as Italian citizens. Non-residents or visitors who are not enrolled in the SSN will generally require private health insurance to access these services.

Palliative care in Italy encompasses far more than physical pain relief; it also addresses psychological, social, and spiritual needs for both the patient and their loved ones. The Italian Society of Palliative Care (SICP), founded in Milan in 1986, acknowledges that palliative care must meet the complex demands of advanced and terminal illness through sustained clinical, psychological, social, and spiritual support. The standard entry point is a referral from a specialist — such as an oncologist, neurologist, or cardiologist — or from a GP.

Are there hospices in Italy, and how do you access them?

In 1999, national legislation created a new category of residential facility called a “hospice” — an alternative to, or complement of, home care, dedicated to terminally ill patients and their families. Italian hospices are distinct from care homes or nursing facilities: they are designed specifically for people in the final stage of a life-limiting illness, with comfort and quality of life at the centre of care rather than curative treatment. This model is conceptually similar to hospice provision in countries such as the United Kingdom or Canada.

There are approximately 240 hospices across Italy, providing a total of 2,777 beds and recording over 42,000 admissions annually. Among Italian regions, Lombardy has the greatest number of hospice beds per 100,000 inhabitants (8.3), followed by Lazio (6.9) and Emilia-Romagna (6.5). Provision is considerably more limited in southern Italy and in rural areas.

To be admitted to a hospice, a patient requires a referral from their treating specialist or GP. This request is then submitted to the local ASL, which assesses clinical eligibility and manages the waiting list. Home-based care, residential care, and semi-residential long-term care are all covered under the SSN, with delivery coordinated by local health units; admission is determined solely on clinical grounds and all eligible patients may apply. A number of hospices in Italy also benefit from the involvement of voluntary organisations coordinated through the Palliative Care Federation (Federazione Cure Palliative, FCP).

Is palliative or hospice care covered by public health insurance or the national health system in Italy, or does it need to be funded privately?

Residents of Italy receive largely free primary care, hospital inpatient services, and health screenings; the standard range of statutory benefits also encompasses maternity care, specialist consultations, home care, hospice care, preventive medicine, and prescription medicines. This means that for residents enrolled in the SSN, both palliative and hospice care are included within the publicly funded package of services — access to palliative care is not subject to a separate means-tested assessment.

Patients do pay co-payments for specialist appointments, certain procedures, and some outpatient medications; however, patients with chronic conditions, as well as young children and older adults in lower-income households, are exempt from these charges. Because palliative care is typically associated with a serious formal diagnosis, many patients find that co-payments are waived or substantially reduced once their condition is officially recognised within the system.

Expats who are not registered with the SSN — such as those on short-stay visas or those who have not yet completed residency enrolment — will need to fund palliative and hospice care privately or claim through an international health insurance policy. Many expats choose to rely on the SSN for major care needs while supplementing this with private insurance for faster access, greater flexibility, and reassurance. If you find yourself facing end-of-life circumstances before completing your SSN registration, contact your insurer and the local ASL without delay.

What legal documents should expats have in place before the end of life in Italy — such as a living will, advance directive, power of attorney, or healthcare proxy — and how do these work?

The so-called “End of Life” law — Law 219/2017, also referred to as the “living will” law — came into effect in January 2018, introducing the “advance treatment statement” (known by the Italian acronym DAT, from Disposizioni Anticipate di Trattamento). This is a written document in which a person sets out which medical treatments they wish to receive, and which they wish to refuse, in the event they later lose the capacity to make such decisions due to illness or incapacity.

Within a DAT, a person may explicitly decline specific interventions — for example, artificial feeding and hydration. The DAT must be prepared in writing, either before a notary or before the civil registrar at the local Comune. Once completed, it is entered into a national database that treating physicians can access. Any adult with legal capacity may draw up a DAT, including foreign nationals who are resident in Italy.

In addition to the DAT, expats should consider establishing a general procura (power of attorney) for financial and administrative matters, as well as designating a healthcare representative — known in Italian as a fiduciario — directly within the DAT document itself. The fiduciario acts on your behalf in dealings with medical staff when you no longer have capacity. Unlike some other legal systems where these instruments are separate documents, in Italy the healthcare representative is formally appointed within the DAT. Having these documents prepared with the assistance of a bilingual Italian notary (notaio) is strongly advisable to ensure their legal validity and correct registration.

Are documents such as advance directives or powers of attorney made in another country legally recognised in Italy?

The recognition of foreign legal documents in Italy is not automatic and depends on the nature of the document, the country in which it was made, and whether it has been properly authenticated. Italy is a party to the Hague Convention on apostilles, meaning that documents issued in another signatory state can be legalised by means of an apostille stamp and, where necessary, a certified Italian translation.

A foreign advance directive or living will may be considered by Italian medical professionals, especially if it has been apostilled and translated into Italian. However, Italy’s own DAT framework under Law 219/2017 is the authoritative legal instrument, and foreign documents do not carry the same standing as a properly registered Italian DAT. If you hold an advance directive from another country, it is strongly advisable to also complete an Italian DAT so that your wishes are clearly recorded in the national registry and readily accessible to any treating physician.

For financial powers of attorney, Italian notaries and courts will generally accept foreign documents that have been apostilled and provided with a notarially certified translation, though this process can be lengthy and occasionally contested. If you hold assets or manage affairs in Italy, it is worth granting a fresh Italian procura notarile (notarised power of attorney) to a trusted individual, in addition to any document originating from your home country. Always seek tailored advice from a qualified Italian notary or lawyer for your specific situation.

What are the laws around euthanasia or assisted dying in Italy?

Euthanasia — the deliberate termination of a patient’s life by another person — remains unlawful in Italy. The legal position on assisted dying, where the patient self-administers a lethal substance prescribed by a physician, is more nuanced following a succession of rulings by the Italian Constitutional Court.

Through its order of 2018 and subsequent ruling of 2019, the Court established highly restrictive criteria for assisted suicide. By 2024, however, the Court had extended the permissible circumstances to include cases where the patient’s suffering, though severe, did not necessarily involve conventional life-sustaining machinery, thereby modestly broadening the applicable conditions. Despite this, a comprehensive legislative framework governing assisted dying does not yet exist in Italy — Parliament has been repeatedly urged by the Court to act, but legislation has continued to stall.

For assisted dying to be considered, the patient must be an adult, legally capable, and acting autonomously and free from external pressure; the information provided must include details of the palliative care options available; and the illness must give rise to intolerable suffering. In practice, the threshold remains extremely high, and each case is assessed individually. Italy represents a distinctive context in which a deeply rooted Catholic cultural tradition exerts considerable influence over public and institutional attitudes to end-of-life matters. Expats with firm views on this subject should ensure their DAT clearly reflects their preferences concerning life-sustaining treatment and palliative sedation, as these fall within the established legal framework.

What are the local customs, traditions, and religious practices around death and dying in Italy?

Italy has a predominantly Catholic cultural heritage which shapes many end-of-life and funeral customs, though practices differ considerably across regions and between families. The Catholic Church endorses palliative care as a compassionate response to human suffering and generally supports the use of pain management in the final stages of life, including palliative sedation, while firmly opposing euthanasia.

It is common in Italian families for relatives to gather around the dying person in their final hours, whether at home or in hospital. A priest may be called to administer the Unzione degli infermi (Anointing of the Sick), one of the sacraments of the Catholic Church. After death, the body is usually laid out either at home or in a dedicated chapel (camera ardente) at the hospital or funeral home, where a vigil (veglia funebre) is held during which family, friends, and neighbours pay their respects — typically over one to two days.

A Funeral Mass forms the central element of Catholic burial rites and is generally celebrated in the deceased’s local parish church. Mourners customarily dress in black. Burial in communal Catholic cemeteries is the most widespread practice, though cremation is gaining greater acceptance. Non-Catholic and secular funeral services are readily available, particularly in larger cities. For deceased individuals or families belonging to other faith traditions, funeral directors in major urban centres — including Rome, Milan, and Florence — will generally have experience organising Jewish, Islamic, Protestant, or non-religious services.

What must you do when someone dies in Italy? Who do you notify, how quickly, and in what order?

The steps below apply whenever a death occurs in Italy, whether at home, in a hospital, in a hospice, or elsewhere. Prompt action is essential: Italian law imposes strict deadlines for several of the required notifications.

1. Secure a medical certification of death: Contact a doctor immediately — or call the emergency services on 118 if no doctor is available — to certify the death. Where death occurs in a hospital or hospice, the attending physician will issue the death certificate (certificato di morte or scheda ISTAT) as a standard procedure.
2. Leave the body undisturbed for at least 24 hours: Italian law requires that a full 24 hours pass from the moment of death before the body may be prepared for burial or repatriation. This waiting period is a legal requirement without exception.
3. Register the death at the local Comune: The death must be registered within 24 hours at the civil registry office (Ufficio di Stato Civile) of the municipality in which the death took place. This is typically handled by a family member, the funeral director, or — in the case of a hospital death — a hospital administrator.
4. Appoint a licensed funeral director (impresa funebre): Engage a funeral director as early as possible. They will assist you through the administrative requirements, help obtain copies of the death certificate, and coordinate transport of the remains. They also serve as your principal point of contact for burial, cremation, or repatriation arrangements.
5. Obtain certified copies of the death certificate: Although the death is registered with the Italian Comune, certified copies are not issued automatically. Request them directly from the Comune or through the funeral director, and obtain multiple copies, as each institution involved — the consulate, insurers, banks, and the tax authority — will require its own original certified copy.
6. Notify the home country’s consulate or embassy (for foreign nationals): Contact the relevant diplomatic mission as promptly as possible — ideally on the same day as the death. Most maintain a 24-hour emergency line. They will guide you on consular registration of the death and advise on repatriation procedures if applicable.
7. Inform relevant insurers and financial institutions: Notify the deceased’s health insurer, life insurer, pension provider, and bank. Many insurance policies include repatriation assistance; contacting the insurer’s emergency line without delay is important.
8. Initiate estate administration: Once the immediate practical arrangements are in hand, engage an Italian lawyer or notary to begin the succession process. Whether or not a will exists, a Dichiarazione di Successione (Declaration of Succession) must be submitted to the Italian Tax Agency (Agenzia delle Entrate) within 12 months of the death.

How is a death officially registered in Italy, and what documents are needed?

Death registration in Italy is handled by the civil registry office (Ufficio di Stato Civile) at the local Comune (municipality). The process is obligatory and subject to strict time limits. Where death occurs in a hospital or hospice, the institution will often initiate the notification itself, but the family should always verify that this has been completed.

The documents typically required to complete registration include: the medical death certificate signed by the attending physician; the deceased’s identity documents (passport or Italian identity card); and, for foreign nationals, evidence of their legal status in Italy where this is available. The Comune then issues the official atto di morte (death act), which forms the foundation document for all subsequent legal, financial, and consular processes.

Although the death is always registered with the Italian Comune, certified copies of the death certificate are not produced automatically — next of kin must request them directly from the Comune or through the funeral director. It is advisable to request multiple certified copies at the time of registration, since Italian administrative procedures typically require a separate original certified copy for each institution involved — the consulate, insurers, banks, and the tax authority will each need one.

What happens if a foreign national dies in Italy — what are the specific steps for notifying their home country’s embassy or consulate, and what role does the consulate play?

When a foreign national dies in Italy, the consulate or embassy of their home country plays an important coordinating role. It does not supplant Italian legal processes, but it can help the family navigate them and facilitate the issue of documents recognised in the home country.

Reach out to the relevant consulate or embassy as soon as possible following the death — most maintain a 24-hour emergency line precisely for situations of this kind. You will need to supply the deceased’s passport details, the Italian death certificate (or confirmation that it is being processed), and the contact information of next of kin.

The consulate’s typical functions include: confirming the identity of the deceased; issuing a consular death certificate or registering the death in the home country’s vital records system; advising on the requirements for repatriation; liaising with Italian authorities in the event of a post-mortem or judicial investigation; and providing a list of local lawyers, funeral directors, and translators. In some instances, separate registration of the death with your home country’s authorities is unnecessary, as the Italian death certificate is generally sufficient for most legal purposes, including probate. Requirements do vary by nationality, however, and you should confirm the position with your specific consulate.

Consulates are not in a position to meet the costs of funeral arrangements, repatriation, or legal services. If the deceased held an insurance policy, contacting the insurer promptly is worthwhile, as many international health and travel insurance policies include repatriation assistance as a standard benefit.

How are funerals typically arranged in Italy, and what are the usual options for burial or cremation?

Funerals in Italy are arranged through a licensed impresa di pompe funebri (funeral director), who can be located through the local Comune, the hospital, or online directories. The funeral director manages transportation of the body, preparation (including embalming where required for repatriation), the coffin or urn, and coordination with the cemetery or crematorium.

The next of kin will generally need to decide between local burial, local cremation, or repatriation of the remains to the deceased’s home country. Burial remains the most prevalent choice in Italy, and municipal cemeteries are typically well maintained. Available burial options include family tombs (expensive, with a lease period for each family member), individual burial compartments (loculo) — layered marble niches leased for periods of between 10 and 50 years — and communal burial grounds (campo comune), which carry no charge but from which remains are exhumed after approximately ten years.

Cremation is also available, though it is worth noting that most Italian crematoriums do not have the facilities to host a funeral service; the service must take place elsewhere — either at a church or another venue in Italy prior to cremation, or at the destination following the repatriation of ashes. Crematoria are not numerous in Italy, so availability varies significantly between regions. If the deceased had not previously expressed a wish to be cremated, the family must submit a formal request through a notary to the registry office.

What are the approximate costs of a funeral in Italy, and are there any state or insurance-based funds that can help cover them?

Funeral costs in Italy vary widely depending on the type of service chosen, the region, and individual preferences. A basic funeral with a modest coffin and burial in a municipal cemetery typically starts at around €1,500–€2,500. A more complete funeral with a full church service, a quality coffin, and a leased individual burial plot (loculo) can readily amount to €5,000–€10,000 or more. Cremation, where available, is generally the less expensive option compared with burial. Repatriation of remains to another country adds substantially to the overall cost — see the dedicated section below.

The Italian state does not provide a universal funeral payment grant comparable to, for example, the Funeral Expenses Payment in the United Kingdom or equivalent bereavement support available in some other countries. Some municipal councils do, however, offer reduced-cost or free communal burial for individuals whose families cannot afford private arrangements. The communal burial ground (campo comune) is free of charge, though many families regard this as a last resort.

International travel and health insurance policies frequently include a repatriation benefit and sometimes a contribution towards local funeral costs; review your policy wording carefully and contact the insurer’s emergency line as early as possible. Some Italian employers and pension schemes also provide a death-in-service lump sum or funeral allowance. Funeral expenses can be deducted from the value of the estate prior to the calculation of inheritance tax, as deductible items include the debts of the deceased and medical and funeral costs.

What is the process for repatriating the remains of a foreign national from Italy to another country?

The repatriation of human remains from Italy is governed by both Italian law and international agreements, and requires careful coordination between the Italian authorities, the home country’s consulate, and a specialist funeral director. The process involves substantial paperwork and may take anywhere from several days to several weeks depending on the circumstances.

Under Italian law, 24 hours must elapse from the moment of death before the body can be prepared for repatriation. In certain circumstances, immediate repatriation may not be possible — for example, a post-mortem examination may be required to establish the cause of death, and where death has occurred in unusual or suspicious circumstances, authorisation from the Court will also be needed.

The time required to complete the repatriation of remains can vary considerably and is influenced by a number of factors, including the cause and location of death. When death results from natural causes, repatriation proceeds more swiftly than in cases involving suicide, accident, or criminal circumstances. For uncomplicated deaths from natural causes, the process typically takes between five and fourteen days from the date of death.

Key documents typically required for repatriation include: the Italian death certificate (atto di morte); a nulla osta (no-objection certificate) from the Italian authorities confirming that the body may be transported; consular authorisation from the receiving country; an embalming certificate (which is usually mandatory for international transport by air); and a sealed zinc-lined coffin meeting international transport standards. A specialist international funeral director will manage the majority of these requirements on the family’s behalf. Local undertakers will ordinarily arrange for certified copies of the death certificate to accompany the remains, but it is strongly advisable to request copies explicitly when discussing repatriation arrangements.

What happens to the estate of someone who dies in Italy — how does probate or estate administration work, and are there inheritance taxes?

Italy does not operate a formal “probate” court process in the manner of, for example, England and Wales or many US states. Instead, estate administration is centred on the filing of a Dichiarazione di Successione (Declaration of Succession) with the Italian Tax Agency (Agenzia delle Entrate). Regardless of whether a will exists, this declaration must be submitted within 12 months of the death.

A significant reform took effect in 2025. The Italian inheritance landscape was fundamentally reshaped by the enactment of Legislative Decree 139/2024. While the underlying principles of who is entitled to inherit remain unchanged, the manner in which an estate is administered and taxed has been transformed. The most consequential change is the abolition of the passive tax assessment model: under the previous system, heirs filed a declaration and waited for the Italian Revenue Agency to calculate and demand the tax owed; the responsibility now rests with the heir, who must personally calculate, declare, and pay the inheritance tax upfront.

Italy’s inheritance tax is widely regarded as comparatively favourable by European standards. With rates ranging from 4% to 8%, the Italian regime stands in marked contrast to higher-rate systems elsewhere; close relatives such as spouses and children benefit from a tax-free allowance of up to €1 million each, with the result that they often pay little or no tax (as of 2025). It is also important to be aware that Italy has entered into double taxation agreements with a number of countries. Always verify current rates and thresholds with the Agenzia delle Entrate or a qualified Italian inheritance lawyer, as these can change. Italian inheritance administration invariably involves complex bureaucratic procedures, and it is strongly recommended to seek guidance from an Italian lawyer with specialist expertise in inheritance and succession law.

If an expat dies without a will in Italy, what happens to their assets under local intestacy laws?

When a person dies intestate (without a valid will) in Italy, their estate is distributed in accordance with the rules of successione legittima (legitimate succession) set out in the Italian Civil Code. Where someone dies without leaving a valid will — or where a will is legally defective or deals only with part of the estate — the remaining assets are allocated according to the intestacy rules.

Those entitled to inherit under intestacy — referred to as successori legittimi — are: the spouse (and civil partner), descendants (children and adoptive children), and ascendants and siblings. Ascendants and siblings inherit only in the absence of surviving children. Notably, a divorced spouse or a cohabiting partner who is not in a registered civil union has no entitlement to inherit under Italian intestacy provisions. This is a crucial point for expats in long-term partnerships who are not legally married or in a registered civil union in Italy.

For expats, the question of which country’s law governs their estate can be particularly complex. EU Regulation 650/2012 (the European Succession Regulation) generally permits EU residents to elect for the law of their nationality to govern their succession — but only if this choice is explicitly stated in a valid will. Without such a declaration, Italian law will typically apply to assets situated in Italy. Complex rules of international private law govern the relationship between the estate and its beneficiaries, and bilateral treaties in force may also determine the relevant obligations of foreign beneficiaries of an Italian inheritance. Professional legal advice is indispensable in any cross-border situation.

Frequently asked questions

Will my international or foreign health insurance cover palliative care in Italy?

The answer depends on your individual policy. Some international health insurance plans cover palliative and hospice care as a standard benefit, while others exclude it or impose a financial cap. If you are registered with the SSN as a legal resident, palliative and hospice care are provided through the public system. If you are not enrolled in the SSN, review your policy documentation carefully and contact your insurer before a crisis arises to establish precisely what is covered in Italy and whether pre-authorisation is required.

Are advance directives or living wills written in another language legally valid in Italy?

A foreign advance directive does not carry the same automatic legal authority as an Italian DAT registered under Law 219/2017. While Italian physicians may take a foreign document into account as an expression of your wishes, there is no guarantee that it will be treated in the same way as a registered Italian DAT. If you live in Italy or spend substantial time there, completing an Italian DAT — ideally with the assistance of a bilingual notary — is strongly recommended alongside any document from your home country. The Italian DAT is held in a national database accessible to all treating physicians.

How long does the repatriation of remains from Italy typically take?

The duration varies considerably depending on the cause and location of death. When death results from natural causes, repatriation proceeds more quickly than in cases involving suicide, accident, or criminal circumstances. For straightforward deaths from natural causes, the process typically takes between five and fourteen days from the date of death, once all required documentation — including the Italian nulla osta, consular authorisation, and embalming certificate — has been secured.

What support is available to bereaved family members who are in Italy after a death?

Practical assistance can come from several quarters. The deceased’s consulate or embassy can supply a list of local lawyers, translators, and funeral directors. Many hospices and hospital palliative care units employ social workers and psychologists who offer bereavement support to families. Voluntary organisations affiliated with the Federazione Cure Palliative (FCP) also provide family support services. Where language presents a barrier, international funeral directors in major cities commonly have multilingual staff capable of coordinating across multiple institutions.

Does Italy recognise same-sex partnerships for the purposes of next-of-kin rights and inheritance?

Italy introduced registered civil unions (unioni civili) for same-sex couples in 2016 under Law 76/2016. A registered civil partner holds the same next-of-kin rights as a spouse for medical decisions and inheritance under Italian law. However, unmarried cohabiting partners — whether same-sex or opposite-sex — have no automatic next-of-kin rights under Italian law and are not entitled to inherit intestate. If you are in a cohabiting relationship, making a will is essential, and completing a DAT that names your partner as your fiduciario (healthcare representative) is equally important.

Can a death in Italy be registered in my home country without returning home?

In most cases, the Italian death certificate — once apostilled and translated — is accepted in other countries for legal purposes such as probate administration and pension claims. In some instances, separate registration of the death with your home country’s authorities is unnecessary, as the Italian certificate can generally be relied upon for most legal purposes including probate. Individual countries do have differing requirements, however; contact your consulate or embassy for guidance specific to your nationality and circumstances.

Is there a time limit for completing the Italian succession declaration after a death?

The Dichiarazione di Successione must be submitted to the Italian Tax Agency (Agenzia delle Entrate) within 12 months of the death. Missing this deadline can result in financial penalties. Given the complexity of Italian inheritance law — particularly for cross-border estates — it is advisable to engage an Italian notary or specialist inheritance lawyer as soon as possible after the death rather than leaving matters until close to the deadline.

Is palliative care quality consistent across all parts of Italy?

Although legislation has been enacted to ensure palliative care provision throughout the country, quality and availability remain uneven across different regions. Northern Italy generally offers more fully developed palliative services, with Lombardy, Emilia-Romagna, and Lazio having the highest concentrations of hospice beds. If you are living in a rural area or in southern Italy, it is worth raising the question of local service availability with your GP at an early stage, and considering private insurance to complement public provision if services in your area are limited.