Until only a few decades ago health had mostly been regarded as a personal matter, implying a reciproca! relationship between patient and physician, as codified in the hippocratic oath. Today, however, health is considered a human right, with complex philosophical, ethical, social, economic, political and legal implications. Additionally, a child has his own fundamental rights, such that the problem of children's right to health becomes a concrete issue within humanitarian law.
{"title":"The right to health through international cooperation","authors":"William S. Gunn","doi":"10.4081/mem.1989.1302","DOIUrl":"https://doi.org/10.4081/mem.1989.1302","url":null,"abstract":"\u0000 \u0000 \u0000Until only a few decades ago health had mostly been regarded as a personal matter, implying a reciproca! relationship between patient and physician, as codified in the hippocratic oath. Today, however, health is considered a human right, with complex philosophical, ethical, social, economic, political and legal implications. Additionally, a child has his own fundamental rights, such that the problem of children's right to health becomes a concrete issue within humanitarian law. \u0000 \u0000 \u0000","PeriodicalId":36708,"journal":{"name":"Medicina e Morale","volume":"60 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The problem of the terminally ill in today's society","authors":"Paola Scarcella, Francesco Paolo Calamo-Specchia","doi":"10.4081/mem.1988.1316","DOIUrl":"https://doi.org/10.4081/mem.1988.1316","url":null,"abstract":"Not available.","PeriodicalId":36708,"journal":{"name":"Medicina e Morale","volume":"99 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Each of us has surely experienced in his or her dream experience the nightmare of being judged dead and thus being buried while still alive. Some famous writings (recall among them Edgar Allan Poe's “Premature burial‘’) have certainly contributed to fears and suspicions regarding the definition of the exact moment of death, so much so that some inventors have patented suitable systems for communicating ‘the untimely burial.’'
{"title":"Death and clinical parameters","authors":"Corrado Manni, Rodolfo Proietti","doi":"10.4081/mem.1988.1320","DOIUrl":"https://doi.org/10.4081/mem.1988.1320","url":null,"abstract":"Each of us has surely experienced in his or her dream experience the nightmare of being judged dead and thus being buried while still alive. Some famous writings (recall among them Edgar Allan Poe's “Premature burial‘’) have certainly contributed to fears and suspicions regarding the definition of the exact moment of death, so much so that some inventors have patented suitable systems for communicating ‘the untimely burial.’'","PeriodicalId":36708,"journal":{"name":"Medicina e Morale","volume":"21 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ethics, rationality and medicine","authors":"E. Sgreccia","doi":"10.4081/mem.1988.1318","DOIUrl":"https://doi.org/10.4081/mem.1988.1318","url":null,"abstract":"Not available.","PeriodicalId":36708,"journal":{"name":"Medicina e Morale","volume":"35 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"L’istituzionalizzazione dell’Health Technology Assessment (HTA) in Italia e in Europa","authors":"A. Spagnolo","doi":"10.4081/mem.2024.1293","DOIUrl":"https://doi.org/10.4081/mem.2024.1293","url":null,"abstract":"Non disponibile.","PeriodicalId":36708,"journal":{"name":"Medicina e Morale","volume":"28 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141815630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
La civiltà tecnologica si distingue per la compenetrazione del fare (techne) e del conoscere (episteme), che conferisce all’essere umano un inedito potere di manipolare la realtà. In questa cornice si collocano le Information and Communications Technologies (ICT), che indicano lo studio di sistemi che ricevono, elaborano e trasmettono dati e informazioni, e l’Artificial Intelligence (AI), che indica lo studio di sistemi informatici computazionali che replicano la condotta umana intelligente, che stanno innovando il tessuto socio-economico, riconfigurando le relazioni e plasmando l’esistenza. È quanto s’intende documentare, indagando il modo in cui la tecnologia condiziona l’esperienza umana e il modo in cui l’essere umano è chiamato ad abitare l’età tecnologica.
{"title":"La condizione umana all’epoca delle ICT e dell’AI","authors":"A. Frigerio","doi":"10.4081/mem.2024.1296","DOIUrl":"https://doi.org/10.4081/mem.2024.1296","url":null,"abstract":"La civiltà tecnologica si distingue per la compenetrazione del fare (techne) e del conoscere (episteme), che conferisce all’essere umano un inedito potere di manipolare la realtà. In questa cornice si collocano le Information and Communications Technologies (ICT), che indicano lo studio di sistemi che ricevono, elaborano e trasmettono dati e informazioni, e l’Artificial Intelligence (AI), che indica lo studio di sistemi informatici computazionali che replicano la condotta umana intelligente, che stanno innovando il tessuto socio-economico, riconfigurando le relazioni e plasmando l’esistenza. È quanto s’intende documentare, indagando il modo in cui la tecnologia condiziona l’esperienza umana e il modo in cui l’essere umano è chiamato ad abitare l’età tecnologica.","PeriodicalId":36708,"journal":{"name":"Medicina e Morale","volume":"30 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Italy has seen limited growth and institutionalization of clinical ethics activities in its territory. Only a few observational studies were conducted in Italy to assess the state of the art of clinical ethics services and activities. Aim: We sought to gain a broad and comprehensive understanding of the state of the art as perceived by Italian healthcare institutions and facilities. Methods: We prepared a questionnaire comprising of twelve close-ended and six open-ended questions. We sent it to all Local Healthcare Authorities (Aziende Sanitarie Locali, ASL), all private Scientific Institutes for Research, Hospitalization and Healthcare (Istituti di Ricovero e Cura a Carattere Scientifico, IRCCS), and all hospices throughout Italy. Out of 380 facilities, 90 of them (22.5%) responded to it. Results: All answers revealed interesting data. Among them, the ones that stood are: when asked who they turn to when an ethical dilemma arises, 27.7% of the respondents checked more than two answers, thus showing that there is not one clear and unequivocal body of reference. When asked if there are standard procedures, 55.4% of the respondents declared that there are no standard procedures. Only 4.4% of respondents declared the method of analysis being used. 53.3% responded that their hospital or healthcare facility does not regularly offer training activities and formation to deal with ethical dilemmas Conclusion: The three topics that stand out are a great fragmentation, the need to formalize and establish dedicated services to take care of ethical dilemmas and to offer training and formation to healthcare providers.
背景：意大利境内临床伦理活动的发展和制度化程度有限。在意大利，只有少数观察性研究对临床伦理服务和活动的现状进行了评估。目的：我们试图广泛而全面地了解意大利医疗机构和设施眼中的临床伦理现状。调查方法我们准备了一份调查问卷，其中包括 12 个封闭式问题和 6 个开放式问题。我们向意大利全国所有地方医疗机构（Aziende Sanitarie Locali，ASL）、所有私立科研、住院和医疗保健机构（Istituti di Ricovero e Cura a Carattereo Scientifico，IRCCS）以及所有临终关怀机构发送了问卷。在 380 家机构中，有 90 家（22.5%）做出了回应。结果：所有答复都揭示了有趣的数据。其中最突出的是：当被问及出现伦理困境时向谁求助时，27.7% 的受访者勾选了两个以上的答案，这表明并没有一个清晰明确的参考机构。当被问及是否有标准程序时，55.4% 的受访者表示没有标准程序。只有 4.4%的受访者说明了所使用的分析方法。53.3% 的受访者表示，他们所在的医院或医疗机构没有定期提供培训活动和处理伦理困境的培训：突出的三个问题是：存在严重的分散现象；有必要将处理伦理困境的专门服务正规化并建立起来；以及有必要为医疗服务提供者提供培训和培养。
{"title":"The current scenario of clinical ethics in Italy","authors":"Costanza Raimondi, P. Refolo, A. G. Spagnolo","doi":"10.4081/mem.2024.1295","DOIUrl":"https://doi.org/10.4081/mem.2024.1295","url":null,"abstract":"Background: Italy has seen limited growth and institutionalization of clinical ethics activities in its territory. Only a few observational studies were conducted in Italy to assess the state of the art of clinical ethics services and activities. Aim: We sought to gain a broad and comprehensive understanding of the state of the art as perceived by Italian healthcare institutions and facilities. Methods: We prepared a questionnaire comprising of twelve close-ended and six open-ended questions. We sent it to all Local Healthcare Authorities (Aziende Sanitarie Locali, ASL), all private Scientific Institutes for Research, Hospitalization and Healthcare (Istituti di Ricovero e Cura a Carattere Scientifico, IRCCS), and all hospices throughout Italy. Out of 380 facilities, 90 of them (22.5%) responded to it. Results: All answers revealed interesting data. Among them, the ones that stood are: when asked who they turn to when an ethical dilemma arises, 27.7% of the respondents checked more than two answers, thus showing that there is not one clear and unequivocal body of reference. When asked if there are standard procedures, 55.4% of the respondents declared that there are no standard procedures. Only 4.4% of respondents declared the method of analysis being used. 53.3% responded that their hospital or healthcare facility does not regularly offer training activities and formation to deal with ethical dilemmas Conclusion: The three topics that stand out are a great fragmentation, the need to formalize and establish dedicated services to take care of ethical dilemmas and to offer training and formation to healthcare providers.","PeriodicalId":36708,"journal":{"name":"Medicina e Morale","volume":"47 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141814861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salvatore Simone Masilla, B. Fionda, E. Placidi, M. Pagliara, Aniello Viscido, M. Blasi, Barbara Corsano, L. Tagliaferri, A. G. Spagnolo
Introduction: Uveal melanoma (UM) is the most prevalent primary intraocular tumor in adulthood, with an important risk of metastasis, notably to the liver, rendering standard chemotherapy ineffective. Cases of UM onset during pregnancy are rare but can exhibit accelerated tumor growth. For these cases the best conservative treatment is interventional radiotherapy (IRT) also known as brachytherapy (BT). It is a form of radiotherapy that demonstrates efficacy comparable to the more common enucleation, while mitigating any risks of intrauterine toxicity. Objective: We reported the case of M., a 39-year-old pregnant patient, diagnosed with UM and undergoing brachytherapy treatment. Our aim is to make pertinent ethical considerations about: a. The ethical and clinical approach favouring a treatment strategy that preserves the affected organ and its functionality, b. The advance care planning process conducted within a multidisciplinary team. Case discussion: With the objective of preserving the mother’s health and ensuring the protection of the foetus, the team unanimously agreed, through a collaborative decision-making process, to proceed with the viable brachytherapy intervention. This approach results in a lower burden and maximizes benefits for both the patient and the unborn child. Conclusions: Considering a holistic evaluation, especially considering the patient’s pregnancy, the multidisciplinary approach proves fundamental. Collaboration between bioethicists and health-care professionals facilitated the development of a shared document for healthcare ethics planning, expressing the team’s ethical-clinical considerations.
简介葡萄膜黑色素瘤（UM）是成年期最常见的原发性眼内肿瘤，有很大的转移风险，尤其是转移到肝脏，导致标准化疗无效。在怀孕期间发病的 UM 病例很少见，但会出现肿瘤加速生长的情况。对于这些病例，最好的保守治疗方法是介入放射治疗（IRT），也称为近距离放射治疗（BT）。这是一种放射治疗方式，其疗效可与更常见的去核疗法媲美，同时还能降低宫内毒性的风险。目的：我们报告了 M.的病例，她是一名 39 岁的孕妇，被诊断出患有子宫内膜癌并正在接受近距离放射治疗。我们的目的是就以下方面提出相关的伦理考虑：a. 支持保留受影响器官及其功能的治疗策略的伦理和临床方法；b. 在多学科团队内进行的预先护理计划过程。病例讨论：为了保护母亲的健康并确保胎儿得到保护，团队通过合作决策过程一致同意进行可行的近距离放射治疗干预。这种方法减轻了患者和胎儿的负担，并为他们带来了最大的益处。结论：考虑到整体评估，尤其是考虑到患者的怀孕情况，多学科方法证明是至关重要的。生命伦理学专家和医护人员之间的合作促进了医疗伦理规划共享文件的制定，表达了团队在伦理和临床方面的考虑。
{"title":"Shared Care Planning for a pregnant patient with uveal melanoma treated with interventional radiotherapy (brachytherapy)","authors":"Salvatore Simone Masilla, B. Fionda, E. Placidi, M. Pagliara, Aniello Viscido, M. Blasi, Barbara Corsano, L. Tagliaferri, A. G. Spagnolo","doi":"10.4081/mem.2024.1299","DOIUrl":"https://doi.org/10.4081/mem.2024.1299","url":null,"abstract":"Introduction: Uveal melanoma (UM) is the most prevalent primary intraocular tumor in adulthood, with an important risk of metastasis, notably to the liver, rendering standard chemotherapy ineffective. Cases of UM onset during pregnancy are rare but can exhibit accelerated tumor growth. For these cases the best conservative treatment is interventional radiotherapy (IRT) also known as brachytherapy (BT). It is a form of radiotherapy that demonstrates efficacy comparable to the more common enucleation, while mitigating any risks of intrauterine toxicity. Objective: We reported the case of M., a 39-year-old pregnant patient, diagnosed with UM and undergoing brachytherapy treatment. Our aim is to make pertinent ethical considerations about: a. The ethical and clinical approach favouring a treatment strategy that preserves the affected organ and its functionality, b. The advance care planning process conducted within a multidisciplinary team. Case discussion: With the objective of preserving the mother’s health and ensuring the protection of the foetus, the team unanimously agreed, through a collaborative decision-making process, to proceed with the viable brachytherapy intervention. This approach results in a lower burden and maximizes benefits for both the patient and the unborn child. Conclusions: Considering a holistic evaluation, especially considering the patient’s pregnancy, the multidisciplinary approach proves fundamental. Collaboration between bioethicists and health-care professionals facilitated the development of a shared document for healthcare ethics planning, expressing the team’s ethical-clinical considerations.","PeriodicalId":36708,"journal":{"name":"Medicina e Morale","volume":"10 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141816455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert Doričić, T. Buterin, Igor Eterović, Marianna Gensabella Furnari, Maria Laura Giacobello, Josip Guć, Eleni Kalokairinou, Željko Kaluđerović, I. Rinčić, Tijana Trako Poljak, Ivana Tutić Grokša, Miltiadis Vantsos, Ivana Zagorac, A. Muzur
Primarly as a reponse to mainstream bioethics – the one narrowed-down to issues related to medical ethics and research – various kinds of regional bioethics have emerged in an attempt to incoporate values other than those typical for the Anglo-Saxon culture. Among the most promising ones, the Mediterranean Bioethics, reflecting all the colorfulness of the Mediterranean microcosm and an expanded interest to the entire bios (faithful to the original ideas of Fritz Jahr and Van Renssealer Potter), has found its footholds particularly in Spain, Italy, Croatia, and Greece. Leaving aside those four countries with abundant literature and well-known contributions to the general history of bioethics, we wish to direct attention to other cultures and countries of the Mediterranean region, revealing a more complex struggle for identity.
{"title":"Mediterranean Bioethics in the bioethically lessknown Mediterranean: a struggle for identity","authors":"Robert Doričić, T. Buterin, Igor Eterović, Marianna Gensabella Furnari, Maria Laura Giacobello, Josip Guć, Eleni Kalokairinou, Željko Kaluđerović, I. Rinčić, Tijana Trako Poljak, Ivana Tutić Grokša, Miltiadis Vantsos, Ivana Zagorac, A. Muzur","doi":"10.4081/mem.2024.1297","DOIUrl":"https://doi.org/10.4081/mem.2024.1297","url":null,"abstract":"Primarly as a reponse to mainstream bioethics – the one narrowed-down to issues related to medical ethics and research – various kinds of regional bioethics have emerged in an attempt to incoporate values other than those typical for the Anglo-Saxon culture. Among the most promising ones, the Mediterranean Bioethics, reflecting all the colorfulness of the Mediterranean microcosm and an expanded interest to the entire bios (faithful to the original ideas of Fritz Jahr and Van Renssealer Potter), has found its footholds particularly in Spain, Italy, Croatia, and Greece. Leaving aside those four countries with abundant literature and well-known contributions to the general history of bioethics, we wish to direct attention to other cultures and countries of the Mediterranean region, revealing a more complex struggle for identity.","PeriodicalId":36708,"journal":{"name":"Medicina e Morale","volume":"5 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141816563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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