A legislative proposal originating in Madeira and now before Portugal’s Parliament seeks to turn territorial continuity into a concrete guarantee for island patients: priority shipment of medicines to the Autonomous Regions during shortages and, once emergency mechanisms are activated, a maximum 12-hour period for making those medicines available. The principle is powerful, but its legal formulation is already raising difficult questions of fairness when scarcity affects islands and the mainland simultaneously.
On an island, distance is sometimes measured in kilometers, sometimes in hours, and sometimes in anxiety. When the object crossing the sea is a book, a piece of machinery or an ordinary consumer product, delay is an inconvenience. When what has not arrived is insulin, an antibiotic, an oncology medicine or another essential pharmaceutical, geography acquires an entirely different moral weight. The Atlantic ceases to be scenery. It becomes part of the health-care system.
A legislative proposal now under consideration in Portugal seeks to address precisely that vulnerability by establishing priority in the supply of medicines to the Autonomous Regions of the Azores and Madeira, including preferential delivery to air carriers when medicines are unavailable or at risk of becoming unavailable.
Most significantly, the proposal would establish a concrete deadline: once the mechanisms for responding to a shortage are activated, the required medicines must be made available in the Autonomous Regions within 12 hours.
It is an attempt to transform one of the most frequently invoked principles of Portuguese insular policy—territorial continuity—from an aspiration into a clock.
From Madeira to the Portuguese Parliament
The initiative originated in the Legislative Assembly of the Autonomous Region of Madeira, which approved it in plenary session on June 17, 2026. It subsequently entered the Assembly of the Republic as Proposed Law No. 89/XVII/1st, seeking to amend Decree-Law No. 176/2006 of August 30, Portugal’s legal framework governing medicines for human use.
The legislative process formally reached the Azores at the beginning of September.
In a communication dated September 1, 2026, the Assembly of the Republic sent the initiative to both the President of the Legislative Assembly of the Azores and the President of the Regional Government, among other entities, requesting their opinions.
At the center of the proposed amendment is a deceptively simple sentence: to guarantee the principle of territorial continuity, “priority in supply to the Autonomous Regions must be ensured.”
Behind those few words lies a much larger question: should living on an island mean accepting greater vulnerability when the pharmaceutical supply chain breaks down? The proposal’s answer is no.
When the Medicine Must Fly
Under the proposed regime, whenever a medicine is unavailable—or there is a risk that it will become unavailable—a wholesale distributor or logistics operator would be required to prioritize delivery of the requested medicine to an air carrier when it is needed by a community pharmacy or hospital pharmaceutical service in an Autonomous Region.
The importance of aviation is obvious.
Unlike most of continental Portugal, the Azores cannot resolve an urgent pharmaceutical shortage by sending a truck several hundred kilometers overnight. Every emergency shipment encounters the sea. Maritime transportation may be appropriate for regular supply chains, but a serious shortage can transform time itself into a clinical consideration.
The proposal consequently envisages urgent logistical circuits, including air transport, capable of overcoming the structural disadvantage created by insularity.
The 12-hour requirement gives that principle an unusually tangible form. Territorial continuity would no longer mean merely acknowledging that citizens in the islands should enjoy comparable access to health care. In cases covered by the legislation, operators would face a defined obligation and a measurable period in which to respond. A right, in other words, would begin to acquire a timetable.
The Geography of Inequality
The Madeira parliament’s justification rests on the argument that structural inequalities in access to medicines persist in Portugal’s island regions despite existing measures regulating pharmaceutical availability.
The reasons are embedded in geography.
Both the Azores and Madeira are outermost European regions dependent upon air and maritime connections. Pharmaceutical distribution therefore operates within logistical conditions fundamentally different from those of continental territory. Interruptions in transportation, pressure on distribution chains or sudden shortages can become magnified when the destination lies hundreds or more than a thousand kilometers offshore.
For the Azores, the question adds another layer: the archipelago is divided among nine islands.
Getting medicine to the Region is not necessarily the same thing as getting it to the patient who needs it.
The proposal nevertheless represents an important conceptual shift. Rather than treating insularity as an unfortunate logistical circumstance to be managed when difficulties occur, it attempts to recognize that circumstance within the national legal architecture itself.
Equality, after all, does not always mean treating different geographies identically. Sometimes achieving comparable access requires compensating for the disadvantage that geography creates.
But What Happens When Everyone Needs the Same Medicine?
It is precisely here that the proposal enters more complicated legal territory.
The parliamentary analysis accompanying the process recognizes insularity as a constitutionally relevant justification for differentiated treatment. But it also raises concerns about how broadly the proposed priority could be interpreted.
Imagine that only a limited quantity of a critical medicine is available.
A hospital in an Autonomous Region urgently requires it. At the same moment, a hospital on the mainland faces an equally serious shortage.
Who receives it first?
If the legislation establishes an automatic preference for the islands solely because of geography, the legal analysis suggests, difficulties may arise. Differential treatment can be constitutionally justified when it compensates for concrete disadvantages associated with insularity; it becomes more problematic if geography operates as an absolute criterion regardless of the severity or urgency of competing needs elsewhere.
That distinction matters.
The purpose of territorial continuity is to prevent an Azorean or Madeiran patient from being disadvantaged because an ocean separates them from the principal distribution networks. It is not necessarily to establish that an island patient must always precede a mainland patient whose medical circumstances may be equally—or even more—urgent.
The parliamentary assessment also identifies a related weakness: the proposal does not yet appear to establish sufficiently precise criteria for deciding how scarce medicines should be distributed when simultaneous requests originate from the Autonomous Regions and continental Portugal.
A Law That May Need Refinement
Those reservations have not prevented the legislative proposal from proceeding.
The legal analysis concludes that there is no “manifest, direct and ostensible” unconstitutionality sufficient to prevent its admission. Instead, the concerns can potentially be addressed during the legislative process through more precise definitions of when regional priority applies, how competing shortages should be evaluated and what obligations should fall upon distributors and logistics operators.
The President of the Assembly of the Republic, José Pedro Aguiar-Branco, referred the initiative to the Health Committee, with connection to the Committee on Constitutional Affairs, Rights, Freedoms and Guarantees for possible consideration of the constitutional questions involved. The organs of government of the Autonomous Regions are also being heard as part of the process.
The final law, therefore, may differ from the proposal now under discussion. But the question it raises will remain.
Territorial Continuity Must Eventually Reach the Pharmacy
For decades, territorial continuity has been invoked in discussions about airfare, transportation, mobility, freight, public services and the economic disadvantages associated with Portuguese insularity. Yet health reveals the principle in perhaps its most elemental form.
A citizen does not become less Portuguese because an ocean lies between a prescription and the warehouse where the medicine is stored.
Nor can equality be understood solely as writing identical rules for fundamentally different geographic realities. If one citizen can receive an urgently needed medicine by road while another must wait for an aircraft, a connecting flight, favorable logistics and perhaps another journey between islands, formally equal treatment can produce materially unequal consequences.
That is the strongest idea behind this proposal.
Its final wording will need care. Medical urgency must matter. Scarcity must be governed by transparent criteria. The rights of mainland patients cannot simply disappear when supply is limited. And a 12-hour legal promise will only have meaning if airlines, distributors, pharmacies, hospitals and public authorities possess the logistical capacity to fulfill it.
But there is something significant in attempting to place time itself inside the guarantee of territorial continuity.
Because for an island patient waiting for medicine, the Atlantic is not an abstraction about autonomy, cohesion or constitutional law. It is the distance between illness and treatment.
A map may tell us that the Azores are far from continental Portugal. A democracy must decide whether that distance should also exist in the rights of its citizens. The purpose of territorial continuity, at its most humane, is not to pretend that the ocean is absent. It is to ensure that when health is at stake, the ocean is never allowed to have the final word.
From Diário dos Açores – Paulo Viveiros, director – Photos from DA.