There in 1982, he initiated the annual Christmas lunch (Pranzo di Natale) for the homeless and the poor, a project of the Community of Sant'Egidio held inside the church.

He successfully negotiated the re-opening of the seminary and the return of the cathedral, and he paved the way for relations between Albania and the Holy See.

[citation needed] On 4 March 2000, Pope John Paul II appointed him bishop of Terni-Narni-Amelia.

[4] In December 2010, the town of Narnia sold a castle to an Italian investment group whose head was also a financial officer of Paglia's diocese.

[10] On 26 June 2012, Pope Benedict XVI named him President of the Pontifical Council for the Family and raised him to the rank of archbishop.

[17] His appointment was part of Pope Francis' reform of the Roman Curia, timed to coincide with the erection of the Dicastery for the Laity, Family and Life.

He said how "Personally, I would not practice assisted suicide, but I understand that legal mediation can constitute the greatest common good concretely possible in the conditions in which we find ourselves.

[22] In 2024 under new guidelines that shifts toward a new openness with “aggressive treatment,” specifically the requirement to provide food and hydration to patients in a vegetative state.

In section 13 of the volume, which deals with this issue of food and hydration, a reference is made to the recently published declaration of human dignity from the Vatican’s Dicastery for the Doctrine of the Faith (DDF), Dignitas Infinita.