Five years of Advance Treatment Directives

Five years to celebrate, but UAAR reports that something isn’t adding up: municipalities aren’t promptly sending updated data on living wills to the Ministry of Health.

February 1, 2025, marked an important anniversary. Five years ago, in 2020, the Database of Advance Treatment Directives, also known as living wills, was established. The Ministry of Health’s database, which should contain the advance treatment directives filed by Italian citizens, however, does not reflect the country’s true end-of-life situation.

The Union of Rationalist Atheists and Agnostics (UAAR) has reported this, having retrieved the data, analyzed it, and made it public, highlighting the compliant municipalities and those that are not. The numbers don’t add up, as approximately 45% of those who tried to search for their directives on the ministry portal were unable to find them.

What happened to our DAT (“Advance Treatment Directives”)? Massimo Maiurana, head of the Uaar “Free to Choose” campaign, asks: “Citizens who have submitted their Advance Treatment Directives are invited to check via SPID (the Italian “Public Digital Identity System”) whether they are present in the national database and, if not, to take action by writing to their mayor.”

The Regulation establishes that the transmission by the designated entities must occur, using a term borrowed from the Civil Code, “without delay,” therefore reasonably within a few days, using the Ministry’s form for the transmission of Advance Treatment Directives. Through Advance Treatment Directives, a person of legal age and capacity, anticipating a possible future inability to self-determination, can express their wishes regarding individual health treatments, as well as consent or refusal to diagnostic tests or therapeutic choices.

Advance treatment directives can be delivered to the registrars of the municipalities of residence, to Italian diplomatic or consular representations abroad, to the heads of the competent organizational units in the regions that have established electronic health records, and, finally, to notaries. The latter have also established a rule requiring uploading essential data as a professional ethical requirement.

Following a request for civic access sent to the Ministry of Health in August 2024 to determine the number of DATs transmitted to the database for each of Italy’s 7,896 municipalities, UAAR was able to compare the numbers with those requested directly from the municipalities by the Luca Coscioni association. The resulting picture is contrasting and at times bleak.

The Ministry stated that a total of 367,586 DATs were deposited in the database. The Coscioni association, for its part, received responses from only just over 6,100 municipalities. Nearly one in four municipalities (22.7% to be precise) did not respond to the civic access request, despite this being a specific legal requirement.

Based on the data from those who responded, these municipalities received a total of 231,219 DATs, but only transmitted 198,979 to the database: 32,240 orders are therefore missing. Most offices provided the second required figure, namely the number of DATs transmitted, but 244 did not. Many others only partially transmitted them.

Among the municipalities with no DATs recorded in the database, the most notable are Gela (CL) with 508 DATs, Caltanissetta with 291, and Avellino with 254, having declared they had not transmitted any. Pozzuoli (NA) with 340, Corato (BA) with 174, and Adrano (CT) with 126, did not provide the number of DATs transmitted. Vittoria (RG) with 243 and Caivano (NA) with 164 declared having transmitted all those received, although this is not listed on the ministry portal.

It’s impossible not to notice that the South dominates this sad ranking. Conversely, it’s in the North that we find the municipalities with the lowest ratios of DATs to inhabitants: topping the podium is Colle Santa Lucia (BL), which, with a population of just 353, is registered in the database with 32 DATs, or 90.65 DATs per thousand inhabitants. The first with more than 20,000 inhabitants is Cassano Magnago, with a ratio of 38.15. Above 100,000 inhabitants, Bolzano stands out with 16.83 DATs per thousand inhabitants.

At the provincial level, the top three places are all around Romagna: Pesaro-Urbino (15.41), Ravenna (12.4), and Forlì-Cesena (12.26). The leading region is Trentino-Alto Adige (10.16), followed by Emilia-Romagna (9.78), and Marche (9.39). Another interesting fact may partially explain the inconsistencies: 10,425 DATs are not associated with any municipality, meaning that the DAT transmission mechanism surprisingly does not include a check on the completion of a key field: that of the municipality.

The UAAR also provides an interactive map, updated to August 2024, which highlights not only the gap between North and South based on the DATs filed by province in relation to population, but also a very uneven picture across all regions:
https://public.flourish.studio/visualisation/20974783/

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