Autonomy, Dignity, and End-of-Life Decision-Making: Law No. 219/2017 Between Legal Norms, Psychosocial Processes, and Caring Communities

Italian Law No. 219/2017 represents a major normative turning point in the regulation of end-of-life (EOL) decision-making, grounding healthcare practices in the principles of autonomy, dignity, and informed consent. By introducing Advance Treatment Directives (DAT) and Shared Care Planning and Decision Making (SCPDM), the law promotes a shift from traditionally paternalistic models of care towards a more relational and dialogical approach to clinical decision-making. Despite its innovative potential, however, the law remains unevenly implemented and insufficiently understood among both citizens and healthcare professionals. This doctoral research explores how individuals understand, interpret, and engage with Law No. 219/2017 within a broader psychosocial and cultural context characterised by the social marginalisation of death. Drawing on the theoretical framework of caring and compassionate communities, as well as perspectives from community psychology, the study examines how social representations of death, relational contexts, and forms of community engagement shape end-of-life decision-making processes. An exploratory qualitative study was conducted with participants attending community-based Death Education initiatives organised in public libraries. Data were collected through questionnaires and semi-structured interviews. The findings highlight the importance of community-level educational and dialogical spaces in fostering awareness, reflection, and engagement with end-of-life issues. They suggest that the effective implementation of Law No. 219/2017 depends not only on legal provisions but also on broader cultural and relational transformations within society.