Dalla morale medica alla bioetica clinica

Antonio G. Spagnolo; Nunziata Comoretto; Dario Sacchini; Roberta Minacori

doi:10.4081/mem.2010.185

Dalla morale medica alla bioetica clinica

Medicina e Morale ◽

10.4081/mem.2010.185 ◽

2010 ◽

Vol 59 (6) ◽

Author(s):

Antonio G. Spagnolo ◽

Nunziata Comoretto ◽

Dario Sacchini ◽

Roberta Minacori

Keyword(s):

Twentieth Century ◽

Medical Ethics ◽

Preliminary Data ◽

Clinical Ethics ◽

Ethics Consultation ◽

Modern Medicine ◽

University Hospital ◽

Social Setting ◽

Clinical Bioethics ◽

Almost All

La riflessione bioetica clinica compare in senso proprio a partire dagli anni ’60, e pur affondando le sue radici nell’etica medica tradizionale, trae particolare impulso dalla nuova fisionomia che la medicina contemporanea assume, nonché da un nuovo setting sociale, religioso e culturale che a partire dalla seconda metà del XX secolo si è andato delineando pressoché in tutti i Paesi occidentali. La rivista Medicina e Morale si è rivelata particolarmente feconda nel preparare il terreno alla nascita della bioetica clinica nel nostro paese, a sostenerne lo sviluppo nelle fasi iniziali della sua attività e nell’offrire spunti ulteriori di crescita verso i quali la disciplina in un prossimo futuro dovrà muovere. Le diverse pubblicazioni sono in parte correlate con l’attività di consulenza di bioetica clinica svolta all’interno del Policlinico Universitario “A. Gemelli” di cui vengono presentati i dati preliminari di quasi vent’anni di consulenze. ---------- Clinical bioethics appears earlier in the ’60s. Although its roots in traditional medical ethics it draws particular boost from new look that takes on modern medicine, as well as a new social setting, religious and cultural in the second half of the Twentieth Century has emerged in almost all Western countries. The journal Medicina e Morale has been particularly fruitful in preparing the ground for the birth of clinical bioethics at our University and our country too, and to support development in the early stages of its activities, offering suggestions for further growth to which the discipline in the next future will have to move. Several publications cited in the article are in part related to the clinical ethics consultation held at our University Hospital “A. Gemelli” and preliminary data of nearly two decades of expertise are presented.

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Institute of Medical Ethics Guidelines for confirmation of appointment, promotion and recognition of UK bioethics and medical ethics researchers

Journal of Medical Ethics ◽

10.1136/medethics-2018-104816 ◽

2018 ◽

Vol 44 (5) ◽

pp. 289-291

Author(s):

Lucy Frith ◽

Carwyn Hooper ◽

Silvia Camporesi ◽

Thomas Douglas ◽

Anna Smajdor ◽

...

Keyword(s):

Medical Ethics ◽

Detailed Analysis ◽

Clinical Ethics ◽

Peer Assessment ◽

Ethics Consultation ◽

Clinical Ethics Consultation ◽

Policy Work ◽

Disciplinary Background ◽

Ethics Guidelines

This document is designed to give guidance on assessing researchers in bioethics/medical ethics. It is intended to assist members of selection, confirmation and promotion committees, who are required to assess those conducting bioethics research when they are not from a similar disciplinary background. It does not attempt to give guidance on the quality of bioethics research, as this is a matter for peer assessment. Rather it aims to give an indication of the type, scope and amount of research that is the expected in this field. It does not cover the assessment of other activities such as teaching, policy work, clinical ethics consultation and so on, but these will be mentioned for additional context. Although it mentions the UK’s Research Excellence Framework (REF), it is not intended to be a detailed analysis of the place of bioethics in the REF.

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Physicians’ and nurses’ expectations and objections toward a clinical ethics committee

Nursing Ethics ◽

10.1177/0969733013478308 ◽

2013 ◽

Vol 20 (7) ◽

pp. 771-783 ◽

Cited By ~ 9

Author(s):

Maximiliane Jansky ◽

Gabriella Marx ◽

Friedemann Nauck ◽

Bernd Alt-Epping

Keyword(s):

Clinical Ethics ◽

Ethical Issues ◽

Ethics Consultation ◽

Ethics Committees ◽

Ethics Committee ◽

University Hospital ◽

Sufficient Information ◽

Interprofessional Communication ◽

Clinical Ethics Committee ◽

Ethical Conflicts

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account.

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Paradigms for Clinical Ethics Consultation Practice

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180198703111 ◽

1998 ◽

Vol 7 (3) ◽

pp. 308-314 ◽

Cited By ~ 17

Author(s):

MARK D. FOX ◽

GLENN McGEE ◽

ARTHUR CAPLAN

Keyword(s):

Clinical Ethics ◽

Ethics Consultation ◽

Clinical Ethics Consultation ◽

University Hospitals ◽

Certification Exams ◽

Clinical Bioethics ◽

Clinical Consultation ◽

Malpractice Insurance ◽

Training Standards

Clinical bioethics is big business. There are now hundreds of people who “do” bioethics in community and university hospitals, nursing homes, rehabilitation and home care settings, and some (though quite a few less) who play the role of clinical ethics consultant to transplant teams, managed care companies, and genetic testing firms. Still, there is as much speculation about what clinically active bioethicists actually do as there was ten years ago. Various commentators have pondered the need for training standards, credentials, “certification” exams, and malpractice insurance for ethicists engaged in clinical consultation. Much of the discussion seems to accept an implicit presumption that all clinical ethics consultation practices look pretty much alike. But is this accurate? What do clinical ethicists do, how and where do they do it, and what kind of clinical ethics is useful in the hospital and in other settings?

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Authority in Ethics Consultation

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.1995.tb01363.x ◽

1995 ◽

Vol 23 (3) ◽

pp. 273-283 ◽

Cited By ~ 16

Author(s):

George J. Agich

Keyword(s):

Health Care ◽

Twentieth Century ◽

Medical Ethics ◽

Patient Autonomy ◽

Ethics Consultation ◽

Health Care Institution ◽

Individual Autonomy ◽

Broad Perspective ◽

Institutional Settings ◽

Legitimate Power

Authority is an uneasy, political notion. Heard with modern ears, it calls forth images of oppression and power. In institutional settings, authority is everywhere present, and its use poses problems for the exercise both of individual autonomy and of responsibility. In medical ethics, the exercise of authority (along with power) has been located on the side of the physician or the health care institution, and it has usually been opposed by appeal to patient autonomy and rights. So, it is not surprising, though still ironic, that ethics consultation, which develops from this patient rights-dominated ethic, should itself bring forth questions of authority. Nonetheless, it does. Insofar as authority has been discussed in ethics consultations, it has been understandably approached from the broad perspective of legitimation and power, which are common themes in social and political treatments of authority. These treatments have dominated twentieth-century discussions of authority, which primarily view authority as legitimate power.

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Development of Bioethics and Clinical Ethics in Bulgaria

Folia Medica ◽

10.1515/folmed-2017-0015 ◽

2017 ◽

Vol 59 (1) ◽

pp. 98-105 ◽

Cited By ~ 4

Author(s):

Silviya S. Aleksandrova-Yankulovska

Keyword(s):

Medical Ethics ◽

Clinical Ethics ◽

Ethics Education ◽

Ethics Consultation ◽

Clinical Ethics Consultation ◽

Medical Professionals ◽

Clinical Settings ◽

Choice Of Treatment ◽

The Subject ◽

Consultation Services

Abstract Background: Bioethics and clinical ethics emerged from the classical medical ethics in the 1970s of the 20th century. Both fields are new for the Bulgarian academic tradition. Aim: The aims of this paper were to demarcate the subject fields of medical ethics, bioethics, and clinical ethics, to present the developments in the field of medical ethics in Bulgaria, to delineate the obstacles to effective ethics education of medical professionals, and to present the results of the application of an adapted bottom-up methodology for clinical ethics consultation in several clinical units in Bulgaria. Materials and methods: Extended literature review and application of an adapted METAP methodology for clinical ethics consultation in six clinical units in the Northern Bulgaria between May 2013 and December 2014. Results: Teaching of medical ethics in Bulgaria was introduced in the 1990s and still stands mainly as theoretical expertise without sufficient dilemma training in clinical settings. Earlier studies revealed need of clinical ethics consultation services in our country. METAP methodology was applied in 69 ethics meetings. In 31.9% of them non-medical considerations affected the choice of treatment and 34.8% resulted in reaching consensus between the team and the patient. Participants’ opinion about the meetings was highly positive with 87.7% overall satisfaction. Conclusion: Development of bioethics in Bulgaria follows recent worldwide trends. Several ideas could be applied towards increasing the effectiveness of ethics education. Results of the ethics meetings lead to the conclusion that it is a successful and well accepted approach for clinical ethics consultation with a potential for wider introduction in our medical practice.

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Female Representation in Colombia

10.1093/oso/9780190851224.003.0013 ◽

2018 ◽

Author(s):

Mónica Pachón ◽

Santiago E. Lacouture

Keyword(s):

Twentieth Century ◽

Political Context ◽

The Political ◽

Political Rights ◽

Female Representation ◽

Political Arena ◽

Substantive Representation ◽

Representation Of Women ◽

Electoral Democracy ◽

Almost All

Mónica Pachón and Santiago E. Lacouture examine the case of Colombia and show that women’s representation has been low and remains low in most arenas of representation and across national and subnational levels of government. The authors identify institutions and the highly personalized Colombian political context as the primary reasons for this. Despite the fact that Colombia was an electoral democracy through almost all of the twentieth century, it was one of the last countries in the region to grant women political rights. Still, even given women’s small numbers, they do bring women’s issues to the political arena. Pachón and Lacoutre show that women are more likely to sponsor bills on women-focused topics, which may ultimately lead to greater substantive representation of women in Colombia.

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Testicular Involvement is a Hallmark of Apo A-I Leu75Pro Mutation Amyloidosis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa587 ◽

2020 ◽

Vol 105 (12) ◽

pp. e4758-e4766

Author(s):

Andrea Delbarba ◽

Paolo Facondo ◽

Simona Fisogni ◽

Claudia Izzi ◽

Filippo Maffezzoni ◽

...

Keyword(s):

Follicle Stimulating Hormone ◽

Organ Damage ◽

University Hospital ◽

Reproductive Hormone ◽

Testicular Dysfunction ◽

Amyloid Deposits ◽

Scrotal Ultrasound ◽

Almost All ◽

The University ◽

Male Subjects

Abstract Context Apo A-I Leu75Pro is a rare hereditary form of amyloidosis that mainly involves the kidney, the liver, and the testis. Objective To define the characteristics of organ damage and testis impairment in the largest cohort collected to date of men with Apo A-I Leu75Pro amyloidosis. Design, Setting, and Patients Retrospective study from a prospectively collected database of 129 male subjects >18 years with Apo A-I Leu75Pro amyloidosis from a reference center at the University Hospital of Brescia, Italy. Main outcome measures We evaluated liver and renal function, scrotal ultrasound, reproductive hormone levels, testis biopsy, hypogonadal symptoms, and fertility. Results Progressive involvement of testis, kidney, and liver was observed in 96/129 (74.4%) cases. Testis impairment was found in 88/129 patients (68.2%), liver in 59 (45.7%) and renal in 50 (38.8%). Testis damage was often the first manifestation of the disease and the only dysfunction in 30% of younger patients (<38 years). Testicular involvement was characterized mainly by primary (73/88 patients, 83.0%) and subclinical (8/88, 9.1%) hypogonadism. Almost all (85/88, 96.6%) also had high follicle-stimulating hormone, suggesting a primary global damage of endocrine and spermatogenic functions, and 30% of them did not conceive. Macroorchidism was found in 53/88 (60.2%) patients, especially in men <54 years (30/33, 90.9%). Apo A-I amyloid deposits were found in Sertoli cells, germinal epithelium, and vessel walls. Conclusion In men with Apo A-I Leu75Pro amyloidosis, testicular involvement is the hallmark of the disease, characterized by global primary testicular dysfunction and macroorchidism due to amyloid deposits.

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What Is Medical Ethics Consultation?

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2008.00241.x ◽

2008 ◽

Vol 36 (1) ◽

pp. 95-118 ◽

Cited By ~ 22

Author(s):

Giles R. Scofield

Keyword(s):

Health Care ◽

Decision Making ◽

Medical Ethics ◽

Medical Technology ◽

Clinical Decision Making ◽

Ethics Consultation ◽

Clinical Decision ◽

Law Students ◽

Medical Ethicist ◽

Care Decision

As everybody knows, advances in medicine and medical technology have brought enormous benefits to, and created vexing choices for, us all – choices that can, and occasionally do, test the very limits of thinking itself. As everyone also knows, we live in the age of consultants, i.e., of professional experts who are ready, willing, and able to give us advice on any and every conceivable question. One such consultant is the medical ethics consultant, or the medical ethicist who consults.Medical ethics consultants involve themselves in just about every aspect of health care decision making. They help legislators and judges determine law, hospitals formulate policies, medical schools develop curricula, etc. In addition to educating physicians, nurses, and lawyers, amongst others, including medical, nursing, and law students, they participate in clinical decision making at the bedside.

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