Palliative care was initiated in Italy towards the end of the 1970s, mainly through the efforts of Professor Ventafridda and his colleagues. This article describes some of the most important steps made in this country to gain widespread acceptance for the principles and practice of palliative care. After about 15 years the Italian situation is still confusing. While some Regions have made progress, others are far from reaching even minimal goals. The efforts of many charities and of the Italian Society for Palliative Care and the Italian School for Palliative Medicine, have been huge, but still not sufficient to promote widespread involvement of the National Health Authorities. In the absence of clear Regional and central laws, the recent changes in the Italian health system combined with increasing financial difficulties threaten the advances already made.