A Second level Master in “Clinical Bioethics Consultation” has been organized in Italy to offer an opportunity to offer an adequate training to carry out an ethics consultation in different health fields. The master has been promoted and realized by different institutions: Catholic University of Sacred Hearth in Rome, Insubria University in Varese, “Federico II” University in Naples, Lanza Foundation in Padua and the Local Health and Social Care Unit n.7 in Veneto Region. The aim of the master is train (...) ethics consultants to offer help regarding a correct decision, which will take by others. The choice must be as much as possible shared between patient, family and health care team. Ethics consultation can be primarily request by the physicians, nurses and health care staff such as support about a choice that wants to be the most appropriate and to clarify a dilemma between different options. Secondly an ethics consultation can be demand by the patient and the family members to find a clarification about their dilemmas and future choices. Also the administrative staff could ask the consultation, when it need to better explain ad example about a specific clinical case or a question concerned the health policy. (shrink)

While much work has been done on improving undergraduate education in bioethics, particularly in medicine, less has been said about continuing education of health care workers, particularly non-medical and nursing personnel. Hospitals bring together a variety of professional and non-professional groups in the place where clinical dilemmas are daily events, and would seem ideal places to conduct an ongoing bioethics dialogue. Yet evidence that this is being achieved is sparse.The European Hospital (-Based) Bioethics Program (EHBP) brings together both current and (...) aspirant members of the EU as partners in a project that aims to assess the current situation with regard to bioethics education in hospitals, identify shortfalls, and address these. In order to achieve the first objective of the EHBP a survey of the current training activities (focused on activities in hospitals) in clinical bioethics in Europe was carried out. The results are presented in this paper, along with a discussion about the implications for the EHBP to address these issues. (shrink)

Due to the recent gains in biomedical sciences, the fetus1 is more exposed and subjected to increasing possibilities of intervention, becoming a full-fledged patient, and entering more often into a...

El uso de la Inteligencia Artificial (IA) y su desarrollo en los últimos años, así como el papel que jugó durante la pandemia en 2020 ha suscitado, por un lado, un gran interés en sus aplicaciones en favor de la vida y, por el otro, temores respecto a su apego a criterios éticos que promueven y defienden la dignidad humana, la justicia, el principio de sociabilidad y de subsidiaridad. Por ello surge la intención del papa Francisco y de monseñor Paglia, (...) desde la Academia Pontificia para la Vida, de lanzar el llamado a reflexionar sobre la incorporación de la ética en la IA; a la par, la fundación RenAIssance alberga el llamado para que, desde una perspectiva global y en todos los sectores, se incorporen principios éticos en las diferentes aplicaciones de la IA. (shrink)

The Italian debate about the role of clinical ethics and ethics consultation has brought about the need to create a working group of Healthcare Ethics Consultation. The group began to take shape an...

I grandi interrogativi sul significato della vita umana - sull'origine e la fine di ognuno - sull'origine e la fine dell'esistenza di ognuno - sono al cuore della riflessione filosofica e teologica, ma interpellano in maniera nuova anche le discipline scientifiche, psicologiche, sociali e giuridiche. Soprattutto toccano il nostro agire; è la sfera dell'etica ad essere coinvolta, come valori, principi e norme che guidano le decisioni da prendere. Le religioni e le tradizioni culturali hanno sempre accompagnato queste realtà, elaborando principi (...) e norme etiche, esperienze rituali e assistenziali. Al loro significato per la bioetica è dedicato il progetto di ricerca della Fondazione Lanza, che ha già trovato una prima espressione nel volume Bioetica e religioni. Un confronto dall'inizio della vita, a cura di Lorenzo Biagi e Renzo Pegoraro. In questo secondo testo, l'attenzione è sulle questioni legate alla fase terminale della vita umana, così profondamente toccata dai progressi della scienza e della medicina. Vi si trovano documentate le posizioni delle diverse confessioni cristiane (Cattolicesimo, Ortodossia, Protestantesimo, Anglicanesimo) e delle altre grandi fedi dell'umanità (Ebraismo, Islam, Buddismo, Induismo), illustrate da esponenti qualificati. Ad ampliare l'orizzonte, viene presentato l'approccio delle “nuove religioni” alla fine della vita, mentre un contributo esplora il rapporto tra religioni, etica e dialogo. (shrink)

Biobanks are an important resource for medical research. Genetic research on biological material from minors can yield valuable information that can improve our understanding of genetic–environmental interactions and the genesis and development of early onset genetic disorders. The major ethical concerns relating to biobanks concern consent, privacy, confidentiality, commercialisation, and the right to know or not to know. However, research on paediatric data raises specific governance and ethical questions with regard to consent and privacy. We have considered the Italian normative (...) context focusing on what is mentioned in each document on the ethical and legal requirements that guarantee the rights of minors. We found out that there is no systematic reflection on the ethical and policy issues arising from the participation of minors in biobank research. Moreover, we have focused on the same aspects for the new Italian Law on the National Forensic Biobank. (shrink)

Sometimes medical errors should not be disclosed. We report a case of semen samples exchange, during a homologous artificial insemination procedure, where a bioethics consultation was required. The bioethics consultation addressed ethical and legal elements in play, supporting non-disclosure to some of the subjects involved. Through a proper methodology, gathering factual and juridical elements, a consultant can show when a moral dilemma between values and rights—privacy versus fatherhood, in our case—is unsubstantial, in a given context, because of the groundlessness of (...) the value or the right itself. However, being the error elicited by organizational factors, a broader ethical pronouncement was needed. Under such circumstances, ethical evaluation should engage in a sort of ‘ethical-based root-cause analysis’, linking ethical principles to quality aims and showing the opportunity to integrate ethical methodology in healthcare management. From this perspective, errors may become an incentive to promote high-quality organizations, attending to the central value of person even through the organizational process. (shrink)

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (...) (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available. (shrink)

Clinical ethics has developed significantly in Europe over the past 15 years and remains an evolving process. While sharing our experiences in different European settings, we were surprised to discover marked differences in our practice, especially regarding the position and role of patients. In this paper, we describe these differences, such as patient access to and participation or representation in ethics consults. We propose reasons to explain these differences, hypothesizing that they relate to the historic and sociocultural context of implementation (...) of clinical ethics consultation services (Cecs), as well as the initial aims for which each structure was established. Then, we analyse those differences with common ethical arguments arising in patient involvement. We conclude that there is no unique model of best practice for patient involvement in clinical ethics, as far as Cecs reflect on how to deal with the challenging ethical issues raised by patient role and position. (shrink)

The tissue biobanking of specific biological residual materials, which constitutes a useful resource for medical/scientific research, has raised some ethical issues, such as the need to define which kind of consent is applicable for biological residual materials biobanks.

In 2001 the Italian Government defined Essential Assistance Levels (LEA), which can be considered as an important step forward in the health care system. The Italian health care system would provide payment of essential and uniform aid services in order to safeguard many values such as human dignity, personal health, equal assistance and good health practices. The Ministry of Health has worked to rationalize the National Formulary and to define evaluation methods for drugs in order to choose what to reimburse (...) without penalizing the rights of the individual and society.This paper describes how this job of rationalization was done and tries to illustrate the choices made in Italy by the use of two meaningful examples (statins and rivastigmine). (shrink)

This article focuses on three scenarios in which residual biological materials are turned into research collections during the procedure of procuring these materials for diagnostic, therapeutic or other non-research purposes. These three scenarios differ from each other primarily because they employ different models of consent: (a) precautionary consent, which may be secured during the collecting procedure; (b) the presumed consent model, which may be applied during the collection of materials; and (c) consent for research use of identifiable human biological materials, (...) which may be skipped entirely. These scenarios offer additional sources of biological samples for research purposes and at the same time seem to offer even more flexibility in terms of stringency of consent as compared with the more traditional models of broad consent in prospective research collections and the waiver of consent in retrospective research. Our discussion leads us to think that precautionary consent is preferable to presumed consent and no consent when handling issues of consent in the use of residual human biological materials for research. However, such precautionary consent should not be construed as blanket, unrestricted consent for any future use. (shrink)

This article provides a strategic history of the role assigned by modern historians to visual representation in early modern science, an aspect of historiography that is largely ignored in the scholarly literature. Despite the current undervaluation of images and visual reasoning, historians in the 1940s and 1950s who established the 20th century concept of the Scientific Revolution, also assigned a conspicuous role to images, claiming 15th century art as a chapter in the history of science and identifying the first modern (...) scientists in artists such as Brunelleschi and Leonardo. My analysis of the writings that shaped the discourse on visual representation---by giants such as George Sarton, Herbert Butterfield, and Alexandre Koyré---shows that the handful of concepts introduced in these early discussions formed the foundations of the subsequent scholarly approach to early modern scientific images. However, close scrutiny during the 1970s defined these concepts as interesting but not as key elements for the emergence of modern science proposed earlier. The wave of social studies of science in the 1980s further diminished the importance of images, to the point that recent surveys of early modern science neither consider the role of visual representation nor include figures in their narratives. Several recent publications with suggestive titles such as The Power of Images in Early Modern Science promise to recover a significant role for images in the Scientific Revolution. The present inquiry into the earlier discourse seeks to clarify the historiographic framework into which these new efforts fit. (shrink)

It has often been asserted that burnout is primarily linked to occupational-context factors, and only secondarily to individual-level and non-work factors. We evaluated the validity of this view by examining the links between burnout and an array of 22 work-situated, work-unrelated, dispositional, and intersecting variables. The study involved schoolteachers from three different countries: France, Spain, and Switzerland. Burnout was assessed with the Maslach Burnout Inventory for Educators. Most of our predictors were assessed based on widely used measures. In order to (...) assess sentimental accomplishment and familial accomplishment, we created two self-reported measures, namely, the Sentimental Accomplishment Inventory and the Familial Accomplishment Inventory. The SAI and the FAI both showed strong reliability and high factorial validity. Exploratory structural equation modeling bifactor analysis and Mokken scaling suggested that both instruments could be considered essentially unidimensional. The study results showed that neuroticism, job strain, skill development, security in daily life, and work–non-work conflict were consistently associated with burnout across the three samples. Sample-specific predictors of burnout included sex, age, unreasonable work tasks, weekly working hours, job autonomy, support in work life, sentimental accomplishment, leisure activities, support in personal life, and non-work–work conflict. Relative weight analysis indicated that neuroticism was the best predictor of burnout in each sample. Our findings suggest that burnout’s nomological network may not be primarily job-related. We conclude that the tendency to de-emphasize individual-level and non-work factors in burnout research is unwise. This tendency may constitute a roadblock in the development of effective interventional strategies. The implications of our findings for burnout’s conceptual status are discussed. The neuroticism-burnout link should be further examined in longitudinal studies. (shrink)

Sustainability reporting and assurance of sustainability reports have been used by organizations in an attempt to provide accountability to their stakeholders. A better understanding of current practices is important to provide a base for comparative and trend analyses. This paper aims to consolidate and provide information on sustainability reporting, assurance of sustainability reports and types of assurance providers. Another aim of this paper is to provide a descriptive analysis of these practices for a global sample, comparing results with previous studies, (...) and suggesting opportunities for future research. To accomplish these objectives, a literature review was performed, an analysis of the organizations included in the Fortune Global 500 2010 was completed, and results were presented and consolidated by country. These results demonstrate that all organizations analysed provided some type of information in relation to their social or environmental performance in their official website. The percentage of organizations issuing a sustainability report has been increasing in the last few years. However, the percentage of organizations assuring their sustainability report has stagnated. Types of assurance engagements include those performed by accountants and non-accountants, and new practices have emerged, namely the “mixed approach” and the “stakeholder or specialist review”. The analysis also shows that the practices of issuing sustainability reports and having them assured have become a world-wide phenomenon, occurring in developed, and emerging economies around the world. (shrink)

This study addresses the question of normative analysis of the value‐based aspects of nursing. In our perspective, values in science may be distinguished into (i) epistemic when related to the goals of truth and objectivity and (ii) non‐epistemic when related to social, cultural or political aspects. Furthermore, values can be called constitutive when necessary for a scientific enterprise, or contextual when contingently associated with science. Analysis of the roles of the various forms of values and models of knowledge translation provides (...) the ground to understand the specific role of values in nursing. A conceptual framework has been built to classify some of the classical perspectives on nursing knowledge and to examine the relationships between values and different forms of knowledge in nursing. It follows that adopting a normative perspective in the analysis of nursing knowledge provides key elements to identify its proper dimension. (shrink)

Diagnostic frameworks are essential to many scientific and technological activities and clinical practice. This study examines the main fundamental aspects of such frameworks. The three components required for all diagnoses are identified and examined, i.e. their normative dimension, temporal nature and structure, and teleological perspective.The normative dimension of a diagnosis is based on (1) epistemic values when associated with Hempel's inductive risk concerning the balance between false‐positive and false‐negative outcomes, leading to probabilistic judgements; and (2) non‐epistemic values when related to (...) ideas such as well‐being, normality, illness, etc, as idealized norms or ideal points of reference.It should be noted that medical diagnoses match the three necessary components, while some essential diagnostic frameworks – the taxonomies of Gordon and NANDA – in nursing lack some components. The main lack is normative as the most popular frameworks in nursing diagnosis seem to be descriptions of observed reality rather than normative and value‐based judgements in which both epistemic and non‐epistemic values may coexist. (shrink)

This study addresses the question of normative analysis of the value‐based aspects of nursing. In our perspective, values in science may be distinguished into (i) epistemic when related to the goals of truth and objectivity and (ii) non‐epistemic when related to social, cultural or political aspects. Furthermore, values can be called constitutive when necessary for a scientific enterprise, or contextual when contingently associated with science. Analysis of the roles of the various forms of values and models of knowledge translation provides (...) the ground to understand the specific role of values in nursing. A conceptual framework has been built to classify some of the classical perspectives on nursing knowledge and to examine the relationships between values and different forms of knowledge in nursing. It follows that adopting a normative perspective in the analysis of nursing knowledge provides key elements to identify its proper dimension. (shrink)

Nursing knowledge stems from a dynamic interplay between population‐based scientific knowledge (the general) and specific clinical cases (the particular). We compared the ‘cascade model of knowledge translation’, also known as ‘classical biomedical model’ in clinical practice (in which knowledge gained at population level may be applied directly to a specific clinical context), with an emergentist model of knowledge translation. The structure and dynamics of nursing knowledge are outlined, adopting the distinction between epistemic and non‐epistemic values. Then, a (moderately) emergentist approach (...) to nursing knowledge is proposed, based on the assumption of a two‐way flow from the general to the particular and vice versa. The case of the ‘placebo effect’ is analysed as an example of emergentist knowledge. The placebo effect is usually considered difficult to be explained within the classical biomedical model, and we underscore its importance in shaping nursing knowledge. In fact, nurses are primarily responsible for administering placebo in the clinical setting and have an essential role in promoting the placebo effect and reducing the nocebo effect. The beliefs responsible for the placebo effect are as follows: (1) interactive, because they depend on the relationship between patients and health care professionals; (2) situated, because they occur in a given clinical context related to certain rituals; and (3) grounded on higher order beliefs concerning what an individual thinks about the beliefs of others. It is essential to know the clinical context and to understand other people's beliefs to make sense of the placebo effect. The placebo effect only works when the (higher order) beliefs of doctors, nurses and patients interact in a given setting. Finally, we argue for a close relationship between placebo effect and nursing knowledge. (shrink)

The beliefs involved in the placebo effect are often assumed to be self-fulfilling, that is, the truth of these beliefs would merely require the patient to hold them. Such a view is commonly shared in epistemology. Many epistemologists focused, in fact, on the self-fulfilling nature of these beliefs, which have been investigated because they raise some important counterexamples to Nozick’s “tracking theory of knowledge.” We challenge the self-fulfilling nature of placebo-based beliefs in multi-agent contexts, analyzing their deep epistemological nature and (...) the role of higher-order beliefs involved in the placebo effect. (shrink)

La riflessione di Timothy Morton si muove all’interno di quel ripensamento del rapporto tra soggetto umano e ambiente – dunque anche dell’umano in generale - che la scienza ecologica è venuta imponendo con sempre maggiore urgenza. A partire da Hyperobjects, tuttavia, Morton si è inserito in quell’ampia ed eterogenea corrente, spesso definita «nuovo materialismo», che nel corso dell’ultimo decennio, sebbene in modi differenti, ha inteso tale ripensamento sempre più come una speculazione eminentemente ontologica: una rinnovata comprensione del modo d’essere dei (...) viventi e della loro interconnessione, in quest’ottica, appare come la via maestra per rimodellare «ecologicamente» la soggettività. In opposizione a questo approccio ontologico ed attingendo a quello critico-decostruttivo sviluppato nel precedente Ecology Without Nature, in questo articolo intendo sottolineare la necessità di riconoscere, anche nell’ambito del pensiero ecologico, il valore costitutivo delle mediazioni epistemiche, linguistiche e sociopolitiche distintive del soggetto umano, ma soprattutto della dimensione di storicità che di queste ultime è il denominatore comune. La frizione tra i due testi di Morton consente infatti di mettere a fuoco l’insufficienza di ogni eco-filosofia che pretenda di ripensare la costituzione del soggetto umano semplicemente tramite l’elaborazione di una differente ontologia dell’ambiente. (shrink)

En La Verdad de la Ficción, Mario Presas compila nueve artículos de su autoría que, aunque fueron escritos en distintos momentos de su carrera y sin una conexión sistemática, están estrechamente ligados entre sí por una misma problemática filosófica: la apertura, a través del arte, a un tipo de saber que es propio de la experiencia estética. La tesis central que atraviesa a todos los capítulos consiste en sostener que el arte habilita una vía de acceso a la realidad que (...) no puede subsumirse ni reducirse a otros tipos de saber, en particular, al conocimiento científico. El autor sostiene que el saber que brinda la experiencia estética es insustituible en relación a la ciencia, sin que por ello uno de los dos tenga primacía sobre el otro. (shrink)

In this article I criticize a theory of political obligation recently put forward by Christopher Wellman. Wellman's “samaritan theory” grounds both state legitimacy and political obligation in a natural duty to help people in need when this can be done at no unreasonable cost. I argue that this view is not able to account for some important features of the relation between state and citizens that Wellman himself seems to value. My conclusion is that the samaritan theory can only be (...) accepted if we are ready to give up either the traditional notion of political obligation as a prima facie duty valid for every citizen, or the current view of the relationships that should exist between states, citizens and foreigners (the view according to which states should have special concerns for their own citizens). (shrink)

Fierce debates surround the conceptualization and measurement of job-related distress in occupational health science. The use of burnout as an index of job-related distress, though commonplace, has increasingly been called into question. In this paper, we first highlight foundational problems that undermine the burnout construct and its legacy measure, the Maslach Burnout Inventory. Next, we report on advances in research on job-related distress that depart from the use of the burnout construct. Tracing the genesis of the burnout construct, we observe (...) that burnout’s definition was preestablished rather than derived from a rigorous research process and the MBI has little in the way of a theoretical or empirical foundation. Historical analysis suggests that the burnout construct was cobbled together from unchallenged personal impressions and anecdotal evidence before getting reified by the MBI. This state of affairs may account for many of the disconcerting problems encountered in burnout research. We close our paper by presenting the Occupational Depression Inventory, a recently developed instrument reflective of a renewed approach to job-related distress. The ODI has demonstrated robust psychometric and structural properties across countries, sexes, age groups, occupations, and languages. The instrument addresses job-related distress both dimensionally and categorically. A dimensional approach can be useful, for instance, in examining the dynamics of etiological processes and symptom development. A categorical approach can serve screening and diagnostic purposes and help clinicians and public health professionals in their decision-making. It is concluded that the ODI offers occupational health specialists a promising way forward. (shrink)

The paper deals with the relationship that can be assumed to hold between personality traits and creativity. What can be said to happen about personality preservation and change when personality traits evolve through an individual growth and ageing? And how will be that play among preservation and change brought to bear on creativity and art production? These issues are discussed with particular reference to Fellini’s artworks.