Spoilers: Ending
It ends with him having a fit, and then it focuses on his face. Does he die at the end?
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Yes. You can also verify this in the interview with the editor of the movie and with Lou Castel. Originally, he wasn't intended to die, but what Marco Bellocchio recorded of the way Lou Castel moved ("like a fish out of water") pointed directly to the death of Alessandro. It's hard to tell of what he died of - a stroke? An epileptic fit?
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My first thought was that he moved like a landed shark. It definitely didn't look like an epileptic fit or stroke. Seemed like it was something unique to him.
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