Medicina e Morale

La lezione di Indi Gregory

2024-01-29T15:23:53+00:00

Not available.

Improving equity in the kidney transplant continuum for non-European-born patients living in Italy: preliminary case-series findings of the contribution of pre-transplant ethical assessments

2024-01-29T15:23:50+00:00

The care of migrants pursuing kidney transplant (KT) is emergent in Europe. Studies emphasize the ethical duty to adopt a holistic approach to these patients to enable the identification of modifiable risk factors and provide tailored interventions to prevent inequities. The ethical challenge at the time of pre-transplant evaluations is to determine – and balance – the prospective benefit of KT for individual patients (beneficence/non-maleficence) and all candidates pursuing KT (justice), without disrespecting persons (autonomy). This case-series study aims to explore the contribution of ethical assessments – by means of clinical ethics consultation – to pre-transplant evaluations for the prevention of inequities in KT, and to determine the limitations of standardized tools for pre-transplant psychosocial evaluations in non-European- born populations living in Italy. A case-series of first-generation immigrant patients enrolled for KT was analyzed using the Four-Boxes Method to explore the ethical dimensions of individual cases, and the Stanford Integrated Psychosocial Assessment for Transplant for psychosocial analyses. Ethical assessments allow identification of the individual and contextual features with the potential for detrimental impacts on equity in KT. Standardized tools do not consider the conditions associated with immigrant status which may affect the score and ability to tailor interventions to the patients’ individual circumstances and disadvantage immigrant populations accordingly. This case-series study newly shows that ethical assessments may be a useful supplement to guide the examination of the ethical dimensions of individual clinical cases and to complement pre-transplant multidisciplinary evaluations, enabling a co-construction of the care process between individual patients and the transplant team. This approach shows potential to improve equity in KT care and to respect the principles of autonomy, beneficence/non-maleficence, and justice.

Enactive approach to communication of normativity in oncoradiology diagnostics

2024-01-29T15:23:48+00:00

This article examines the enactive approach to oncoradiology imaging and the diagnostic process involved. It investigates how diagnostically relevant knowledge is related to the radiologist’s (embodied) subjectivity and (professional) intersubjectivity. Besides identifying a number of correlations between the analysis of embodied cognition and image-based diagnostic praxis, the question of normativity in diagnostic praxis is thematized, which presupposes a social appropriation of biological processes and an urge to achieve optimality in the process of engaging with imaging technology and communication with professionally significant others. The theoretical claims of this research are supported and illustrated by the analysis of actual radiograms.

Gestation for others. Ethical arguments, psychological considerations, and legal notes

2024-01-29T15:23:46+00:00

This contribution investigates gestation for others (GPA), also known by the name of surrogate motherhood, around which a lively public debate is underway, which does not fail to interest political institutions, as it certifies in the Italian field the bill that intends to make this practice a universal crime. The article aims to examine the ethical and psychological aspects of the GPA in the dual form of paid surrogacy, known as commercial or rented womb, and free surrogacy, called altruistic, and to advance some political-juridical observations.

Humanizing medical practices. The ethical and cultural mission of palliative care

2024-01-29T15:23:43+00:00

This article aims to reread and rethink everyday medical practices in light of a borderline context: the palliative care. The starting point is an analysis of some of the crucial concepts of the pallium philosophy: attention to the phenomenology of the experiences of illness, the centrality of the patient in the care relationship, the concept of total pain as a synthesis of pain and suffering, and the theme of temporality in the therapeutic pathway and in the dynamics of accompaniment. The attempt is to show how these values, certainly valid in a context of exceptionality and incurability such as that of palliative care, also have a universal value and, as such, can act as a moral compass to guide medical action and restore its artistic and holistic face. It is a matter of unraveling certain ethical questions in order to rediscover the meaning of medical practices of care, which must not be limited to being technically efficient and in step with techno-scientific progress, but need the guidance of that humanitarian ethos that slows down the erosive processes of personality – triggered by an increasingly hyper-specialized but humanly poor technical medicine – in which the protagonists of the care relationship are involved: the doctor and the patient.

Rethinking the concept of “end-of-life decisions”: the bioethical contribution of the empirical studies ELDY and ELDY- CARE

2024-01-29T15:23:41+00:00

This paper aims to critically investigate the notion of “End-of-Life Decisions” (ELDs) in order to extend its current semantic range. In fact, this expression usually refers to those practices that imply the death of the patient or those acts that can potentially shorten the patient’s existence. Instead, we suggest including into the “end-of-life decisions” all the decisions made in the final phase of existence: killing (e.g., euthanasia and physician-assisted suicide), letting die (e.g., withholding or withdrawing treatments), keeping alive by any means, or keeping alive despite unfavorable prognosis (e.g., antibiotic therapy in an end-of-life subject with significant infection symptoms). Such an approach makes it possible to investigate ethical issues related to both practices that cause death or might affect the shortening of life and those aimed at procrastinating the fatal event. Following the conceptual analysis of the concept of ELDs, we discuss several empirical studies and the structure of questionnaires used in recent years to investigate end-of-life opinions and decisions among healthcare professionals, caregivers, and patients. In particular, we analyze the ELDY and ELDY-CARE studies, which are based on an extended concept of ELDs and thus focus not only on the anticipation of the death of the patient, but also on life-prolonging decisions.

Global Bioethics. A look from Evangelii Gaudium

2024-01-29T15:23:38+00:00

The birth of global bioethics is linked to the figure of U.S. biochemist and oncologist Van Rensselaer Potter, who first adopted the expression in the late 1980s, pointing to the need for a new morality capable of combining attention to human health with ecological science and the broader problems of humanity on a global scale. For a long time, however, this perspective was neglected, and a biomedical approach to bioethics prevailed, on which the traditional understanding of bioethics has been based. Thanks to Dutch physician and ethicist Henk Ten Have, whose volume “Global bioethics: an introduction” was recently translated into Italian, Potter’s vision has been recovered. The article aims to examine the framework of global bioethics, illustrating its specificity in light of four principles enunciated by Pope Francis in the apostolic exhortation Evangelii Gaudium, which will be used as interpretative criteria for the discipline under consideration. In addition, the centrality of the principle of vulnerability will be highlighted, with a concluding look at the pandemic event, which more than any other has shown the relevance and necessity of this approach.