Goldberg notes that the relationship is a component of Conflicts of Interests. Networks of relationships and the simultaneous presence of several interests are not negative per se but become so when they generate a conflict that undermines impartiality. The solution to the problem of COIs, therefore, cannot be to abolish relationships and the interests that they necessarily express but rather to verify whether those relationships are such as to unduly affect an individual’s judgement. The evolution of an Italian legislation about (...) COIs is eloquent in this regard. (shrink)

After three proceedings in which neuroscience was a relevant factor for the final verdict in Italian courts, for the first time a recent case puts in question the legal relevance of neuroscientific evidence. This decision deserves international attention in its underlining that the uncertainty still affecting neuroscientific knowledge can have a significant impact on the law. It urges the consideration of such uncertainty and the development of a shared management of it.

Alzheimer’s disease is a very common, progressive and still incurable disease. Future possibilities for its cure lie in the promotion of research that will increase our knowledge of the disorder’s causes and lead to the discovery of effective remedies. Such research will necessarily involve individuals suffering from Alzheimer’s disease. This raises the controversial issue of whether patients with Alzheimer’s disease are competent to give their consent for research participation.

Public health emergencies such as pandemics can put health systems in a position where they need to ration medical equipment and interventions because the resources available are not sufficient to meet demand. In public health management, the fair allocation of resources is a permanent and cross-sector issue since resources, and especially economic resources, are not infinite. During the COVID-19 pandemic resources need to be allocated under conditions of extreme urgency and uncertainty. One very problematic aspect has concerned intensive care medicine (...) and age discrimination has been among the most hotly discussed issues, as age has been touted as a probable criterion for selection. In this paper we analyse some documents originating from scientific societies and medical associations, mainly related to EU sphere and available in English, French, Spanish and Italian, concerning the criteria for admission to the intensive care units. We highlights how, in most of these documents, it is explicitly stated that “age itself” is not a criterion for patient selection. Our conclusion is that these criteria should be defined in advance of a crisis situation and be grounded in clinical indicators. Establishing “cut-off” policies with regard to criteria such as age or chronic disability is definitely an unjustifiable form of discrimination even in the context of a public health emergency. (shrink)

PurposeThe aim of this paper is to assess the complex issue of responsibility in clinical practice. The paper focuses mainly on the relationship between personal- and medical-professional responsibility of practitioners and clinical guidelines.MethodsAfter a theoretical review of the different definitions of responsibility in selected bioethical and biojuridical literature, two recent juridical proceedings concerning medical responsibility from Italian Courts are discussed. Subsequently, a theoretical analysis of the definition of clinical practice guidelines is proposed in order to show their feasibility to assess (...) personal- and medical-professional responsibility.ResultsThe definitions of responsibility and the two Italian cases show the theoretical and practical difficulties of shared assessments of both personal-professional and medical-professional responsibility in clinical practice. Clinical practice guidelines cannot be assumed as an objective code of action stating exactly a rule of conduct in all situations, but as a tool suggesting how to decide what to do in different conditions.ConclusionsResponsibility in clinical practice is such a complex issue to deserve a special ethical assessment. The clinician’s personal-professional responsibility cannot be replaced or reduced by clinical practice guidelines, because medicine is as such a relationship focused on the expertize of practitioners. Nonetheless, a shared approach to different clinical conditions is needed in order to avoid a relativist outcome and protect patients’ and even clinicians’ rights. Formal guidelines (that describe not exactly what to do but how to decide what to do) are proposed as potential useful tool to achieve this aim. (shrink)

The American Journal of Bioethics, Volume 12, Issue 1, Page 37-38, January 2012.

According to Howick (2009a), the three main reasons for believing that placebo-controlled trials (PCTs) are methodologically superior to active-controlled trials (ACTs)—sensitivity, absolute effect...

Translational research is a main focus of current health policy (Albani and Prakken 2009; PLoS Medicine 2008). Translation of biomedical research knowledge to effective clinical treatment is essential to the public good (Lavis et al. 2003). Only 5% of basic science studies showing significant therapeutic promise are successfully translated into clinical application (Contopoulos-Ioannidis, Ntzani, and Ionannidis 2003; FDA 2004). As Hall (2001) observes, this is a problem: "When too many important discoveries lie dormant, the public good suffers" (p. G1127). Recent (...) health policy initiatives intended to foster the translation of basic science into clinical advances must consider the unique bioethical issues raised by .. (shrink)

Increases in international travel and migratory flows have enabled infectious diseases to emerge and spread more rapidly than ever before. Hence, it is increasingly easy for local infectious diseases to become global infectious diseases (GIDs). National governments must be able to react quickly and effectively to GIDs, whether naturally occurring or intentionally instigated by bioterrorism. According to the World Health Organisation, global partnerships are necessary to gather the most up-to-date information and to mobilize resources to tackle GIDs when necessary. Communicable (...) disease control also depends upon national public health laws and policies. The containment of an infectious disease typically involves detection, notification, quarantine and isolation of actual or suspected cases; the protection and monitoring of those not infected; and possibly even treatment. Some measures are clearly contentious and raise conflicts between individual and societal interests. In Europe national policies against infectious diseases are very heterogeneous. Some countries have a more communitarian approach to public health ethics, in which the interests of individual and society are more closely intertwined and interdependent, while others take a more liberal approach and give priority to individual freedoms in communicable disease control. This paper provides an overview of the different policies around communicable disease control that exist across a select number of countries across Europe. It then proposes ethical arguments to be considered in the making of public health laws, mostly concerning their effectiveness for public health protection. (shrink)

Clinical ethics refers to an emerging field in clinical medicine that focuses on the process of ethical decision-making in a clinicalsetting. It has developed as a result of a growing awareness that modern medicine – characterized by technological progress, culturaldiversity and social challenges – is posing a range of new “ethical dilemmas” that medical science alone cannot solve. For thisreason, clinical ethics is often linked to “ethics consultation,” which consists of services provided by an individual ethicist, ethicsteam or committee to (...) address the ethical issues involved in a specific clinical case. Although clinical ethics developed in the beginningmainly as a methodological analysis to arrive at a justification for clinical ethical decisions, it quickly has become clear thatthe difficulty in clinical decision-making is only one aspect of wider ethical problems pertaining to the doctor-patient relationshipas a whole and, most likely, to the core value of the medical profession. The principles method is usually presented as the mostpopular methodological approach to an analysis of clinical cases. However, strong criticism of this model has been voiced, and otheralternative approaches are referred to, such as the casuistry model. Recently, significant contributions have been made by narrativemedicine and virtue ethics. According to these methodologies, sound anthropology and a good relationship with the sick person arekey elements required of any person engaged in medical practice who aims to be genuinely appropriate from an ethical perspective. DOI: 10.5294/pebi.2016.20.1.3. (shrink)

The use of human biological materials involves a number of issues from both an ethical and a legal point of view. In recent decades, the purposes for which this material has been used have i...

Background On December 2017 the Italian Parliament approved law n. 219/2017 “Provisions for informed consent and advance directives” regarding challenging legal and bioethical issues related to healthcare decisions and end-of-life choices. The law does not contain an explicit reference to Ethics Committees (ECs), but they could still play a role in implementing the law. Methods A questionnaire-based survey was performed among the ECs of the Italian Institute for Research and Care belonging to the Network of neuroscience and neurorehabilitation, with the (...) aim of (1) knowing whether the ECs participated and, if so, how in the process of implementation of law n. 219/2017 in the referring institutes; (2) investigating the point of view of the ECs regarding their possible involvement in the process; (3) exploring the contribution ECs can provide to give effective implementation to the law principles and provisions. Results Seventeen ECs out of thirty took part in the survey; the characteristics of the responding and non-responding committees are similar, so the responding ECs can be regarded as representative of all ECs in the Network. Nine ECs did not discuss the law in anyway: the main reason for this is that the referring institutions (6) and the health care professionals (3) did not ask for an EC intervention. Nevertheless, the large majority of the ECs believe that their involvement in the implementation of the law as a whole is appropriate (8) or absolutely appropriate (6), while 3 of them are neutral. No EC believes that the involvement is inappropriate. The aspect of the law on which the 14 ECs converge in considering the EC involvement appropriate/absolutely appropriate is the one related to the health facilities obligation to guarantee the full and proper implementation of the principles of the law. Conclusions Our survey confirms that ECs believe they can play a role in the implementation of law n. 219/2017, although this does not entirely correspond to what the committees have actually done in reality. This role could be better exercised by ECs specifically established for clinical practice, which would have a composition, functioning and a mandate better suited to the purpose. This supports the call for a national regulation of ECs for clinical practice. (shrink)

Notwithstanding fundamental methodological advancements, scientific information about disorders of consciousness (DOCs)—e.g. Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) and Minimally Conscious State (MCS)—is incomplete. The possibility to discriminate between different levels of consciousness in DOC states entails treatment strategies and ethical concerns. Here we attempted to investigate Italian clinicians’ and basic scientists’ opinions regarding some issues emerging from the care and the research on patients with DOCs. From our survey emerged that Italian physicians working with patients with DOCs give a central role (...) to ethics. Current Italian regulation regarding basic research conducted in patients with DOCs apparently risks to be inadequate to support scientific advancement, and would deserve a different assessment compared to ordinary treatments. We think the results of our survey deserve attention from an international audience because they exemplify the difficulty to define a shared approach to the issues related to patients with DOCs and the necessity to better assess both the ordinary and experimental treatment of patients with DOCs at the ethical and legal level. (shrink)

The majority of literature on Slow Food focuses on the organization or actors involved in the movement. There is a dearth of material analyzing Carlo Petrini’s aspirations for Slow Food, particularly in light of his desire within Slow Food Nation (2007) and Terra Madre (2010) to make “freewill giving a part of economic discourse.” This essay corrects the literature gap through historicizing and critiquing Petrini’s alternative to global capitalism while rooting it in actually existing practices. First, (...) class='Hi'>Petrini’s problematic conceptualization of freewill giving will be compared to feminist theorizations and documentations of the gift economy. Second, Petrini’s avoidance of the toxic mimic of the gift, its subsumption to capitalism, will be amended by discussing how the gifting of food aid and emergency food networks actually reproduces inequality, poverty, and hunger. Third, Petrini’s example of gifting by a Trappist Monastery will be juxtaposed to the ongoing direct action strategies of Food Not Bombs, a much stronger example of an oppositional gift economy, one that is subsequently repressed by the state. In doing so, this essay seeks to expand discussion of the gift economy within the alternative food movement while amending many of the theoretical, historical, and political problems embedded within Petrini’s work, which performs a strong disservice to the politics of possibility embedded within gifting. (shrink)

Why do we remember the past and not the future? What does it mean for time to "flow"? Do we exist in time or does time exist in us? In lyric, accessible prose, Carlo Rovelli invites us to consider questions about the nature of time that continue to puzzle physicists and philosophers alike. For most readers this is unfamiliar terrain. We all experience time, but the more scientists learn about it, the more mysterious it remains. We think of it (...) as uniform and universal, moving steadily from past to future, measured by clocks. Rovelli tears down these assumptions one by one, revealing a strange universe where at the most fundamental level time disappears. He explains how the theory of quantum gravity attempts to understand and give meaning to the resulting extreme landscape of this timeless world. Weaving together ideas from philosophy, science and literature, he suggests that our perception of the flow of time depends on our perspective, better understood starting from the structure of our brain and emotions than from the physical universe. (shrink)

I am a theoretical physicist, and, following Aristotles' injunction (Aristotle, Physics III, 202b 34), I do consider it my responsibility to discuss the problem of the notion of infinity in the world--in particular, to "inquire whether there is such a thing or not." I will do so here by illustrating some aspects of the notion of infinity in the natural sciences.

All human civilizations have thought that the world was made of sky above and the Earth below. All except one. For the Greeks, the Earth was a rock floating in space, and under the earth there was no ground, no turtles, nor the gigantic columns of which the Bible speaks. How did the Greeks understand that the Earth is suspended in nothingness? Who understood this and how? It is this unique "scientific revolution" of Anaximander of which the author speaks, which (...) Karl Popper called "one of the most daring ideas, revolutionary and portentous in the entire history of human thought" The concern is with the conflict that was opened, still burning, with the nature of scientific thought, its critical and rebellious character, the force with which it subverts the order of things and our image of the world of scientific knowledge, and the highly effective "error" at the same time --as we teach physics in the twentieth century. Speaking of Anaximander, the author invites us to reflect on what his ideas mean to the scientific revolution opened by Einstein. (shrink)

Expressivists claim that normative judgments (NJ) are non-cognitive states. But what kind of states are they, exactly? Expressivists need to provide us with an adequate account of their nature. Here, I argue that there are structural features that render this task rather daunting. The worry takes the form of a looming dilemma: NJ are either conative states (i.e. states with a world-to-mind direction of fit) or they are not. If they are, then they are either attitudes de se (i.e. attitudes (...) about oneself) or they are not. If they are, then they’re unable to account for disagreement. If they are not, then they're unable to account for agent-relative NJ. So NJ cannot be conative states (they cannot have a world-to-mind direction of fit). On the other hand, however, if NJ are not conative states (if they are states without a direction of fit, like affective or other sui generis non-cognitive, non-conative attitudes) then it remains a mystery how they support relations of disagreement. (shrink)

The definitive account of Aristotle's life and school This definitive biography shows that Aristotle's philosophy is best understood on the basis of a firm knowledge of his life and of the school he founded. First published in Italian, and now translated, updated, and expanded for English readers, this concise chronological narrative is the most authoritative account of Aristotle's life and his Lyceum available in any language. Gathering, distilling, and analyzing all the evidence and previous scholarship, Carlo Natali, one of (...) the world's leading Aristotle scholars, provides a masterful synthesis that is accessible to students yet filled with evidence and original interpretations that specialists will find informative and provocative. Cutting through the controversy and confusion that have surrounded Aristotle's biography, Natali tells the story of Aristotle's eventful life and sheds new light on his role in the foundation of the Lyceum. Natali offers the most detailed and persuasive argument yet for the view that the school, an important institution of higher learning and scientific research, was designed to foster a new intellectual way of life among Aristotle's followers, helping them fulfill an aristocratic ideal of the best way to use the leisure they enjoyed. Drawing a wealth of connections between Aristotle's life and thinking, Natali demonstrates how the two are mutually illuminating. For this edition, ancient texts have been freshly translated on the basis of the most recent critical editions; indexes have been added, including a comprehensive index of sources and an index to previous scholarship; and scholarship that has appeared since the book's original publication has been incorporated. (shrink)

L'idee d'une multiplicite de causes, introduite dans la philosophie grecque a partir des dialogues de Platon, a trouve chez Aristote sa realisation grandiose et complexe.La discussion sur les causes a l'epoque hellenistique et imperiale confirme l'importance et l'extreme richesse de cette idee. Le titre du volume veut souligner les rapports dialectiques, parfois conflictuels et souvent polemiques, que les doctrines de la causalite de cette epoque presentent entre elles, aussi bien de maniere independante que et par rapport a la systematisation aristotelicienne. (...) Les principaux auteurs (Theophraste, Alexandre d'Aphrodise, Plotin) et les principales ecoles philosophiques (Peripatetique, Stoicienne, Epicurienne, Sceptique) de l'age hellenistique et imperial y ont ete abordes dans le but de produire un apercu le plus complet et le plus articule possible du probleme de la causalite a cette epoque. (shrink)

Introduction: Mexican Philosophy: What Is It and Why It Matters -- Relajo -- Nepantla -- Zozobra -- Corazonada -- Tik -- Figure of the World -- Mexistentialism.

As a result of the coronavirus (COVID‐19) pandemic, health professionals are faced with situations they have not previously encountered and are being forced to make difficult ethical decisions. As the first group to experience challenges of caring for patients with coronavirus, Chinese nurses endure heartbreak and face stressful moral dilemmas. In this opinion piece, we examine three related critical questions: Whether society has the right to require health professionals to risk their lives caring for patients; whether health professionals have the (...) right to refuse to care for patients during the coronavirus pandemic; and what obligations there are to protect health professionals? Value of care, community expectations, legal obligations, professional and codes of practice may compel health professionals to put themselves at risks in emergency situations. The bioethical principles of autonomy, justice, beneficence and non‐maleficence, as well as public health ethics, guide nurses to justify their decisions as to whether they are entitled to refuse to treat COVID‐19 patients during the pandemic. We hope that the open discussion would support the international society in addressing similar ethical challenges in their respective situations during this public health crisis. (shrink)