BackgroundUnder COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient’s care. MethodAccording to the argument-based review framework, we started our research from the following two questions: what are the ethical (...) principles adopted by the ethical guidelines produced at the beginning of the COVID-19 outbreak related to resource allocation? And what are the practical consequences in terms of 'priority' of access, access criteria, management of the decision-making process and patient care?ResultsTwenty-two ethical guidelines met our inclusion criteria and the results of our analysis are organized into 4 ethical concepts and related arguments: the equity principle and emerging ethical theories; triage criteria; respecting patient’s dignity, and decision making and quality of care.ConclusionFurther studies can investigate the practical consequences of the application of the guidelines described, in terms of quality of care and health care professionals’ moral distress. (shrink)

Following the traces of some references to pre-existing matter in the Septuagint, the article analyses the interpretation of Gen 1, 2a in Philo of Alexandria’s De opificio mundi with a focus on his omission of the ἀκατασκεύαστος character of the earth. Philo’s interpretation is closely linked to his conception of emptiness and to his pioneering defence of a creation ex nihilo. In his cosmology, which is articulated as a dual interpretation of the Genesis and Plato’s Timaeus, the matter plays an (...) essential role. Philo justifies its existence on Aristotelian-Stoic grounds, highlighting the process of gradual refinement whereby matter passes from being a rough ὕλη to being an elaborate type of οὐσία. (shrink)

This article proposes a retrospective analysis of a compassionate use, using a case study of request for Avelumab for a patient suffering from Merkel Cell Carcinoma. The study is the result of a discussion within a Provincial Ethics Committee following the finding of a high number of requests for CU program. The primary objective of the study is to illustrate the specific ethical and clinical profiles that emerge from the compassionate use program issue. The secondary goals are: a) to promote (...) a moral reflection among physicians who require approval for the CUP and b) provide the basis for recommendations on how to request CUP. The instruments for carrying out the analysis of the case study and the discussion are as follows: Analysis of the audio-recording of the EC meeting regarding the selected Case study. In-depth discussion of topics that emerged during the meeting by means of administration of 5 semi-structured interviews with 2 doctors involved in the case and with 3 components of the EC who played a major role in the EC internal discussion. In an exploration of emerging clinical and ethical issues, four primary themes arise: 1. efficacy, safety of the treatment and patient’s quality of life; 2. clear, realistic, adequate communication; 3. right to hope; 4. simultaneous Palliative Care approach. The results of ethical analysis carried out concern two areas: 1) ethical profiles relating to the use of CUP; 2) the role of the EC concerning the compassionate use of drugs and the need to provide recommendations on how to request CUP. With the aim of implementing these conclusions, the provincial EC of Reggio Emilia chose to steer the request for drugs for compassionate use through recommendations for good clinical and ethical practice based on the following assumptions: 1) the “simultaneous care” approach must be preferred. Secondly, 2) the EC’s assessment must be part of the decision-making process that the care team conducts before proposing compassionate use to the patient. (shrink)

Advance care planning (ACP) is considered a pivotal aid in the decision‐making process, especially for many people living with dementia, who inevitably will lose the capacity to make decisions at the end of life. In Italy, ACP has been recently regulated by law 219/2017, leading to the investigation of how physicians deal with ACP in dementia. In order to comprehend the perception of physicians who provide care for patients with dementia regarding ACP and to describe their difficulties and needs, this (...) study presents the results of a qualitative research study performed within a local health authority in northern Italy. Data were collected by semi‐structured interviews with 11 physicians dealing with patients with dementia and were analysed using interpretative phenomenological analysis. Four superordinate themes were identified, describing both the difficulties and challenges perceived by physicians in performing shared ACP in their daily activities. This study demonstrates that physicians experience troubles synchronizing the time of shared ACP with the more rapid development of dementia. Results also suggest that further training about communication on ACP is urgently required to ease the implementation of shared ACP. A broader involvement of institutions and other professionals is also important in spreading ACP among healthcare institutions. (shrink)

Research question and aimClinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020,...

BackgroundThis study aims to quantitatively and qualitatively evaluate the activities of a Bioethics Unit (BU) 5 years since its implementation (2016–2020). The BU is a research unit providing empirical research on ethical issues related to clinical practice, clinical ethics consultation, and ethical education for health care professionals (HPS).MethodsWe performed an explanatory, sequential, mixed-method, observational study, using the subsequent qualitative data to explain the initial quantitative findings. Quantitative data were collected from an internal database and analyzed by descriptive analysis. Qualitative evaluation (...) was performed by semi-structured interviews with 18 HPs who were differently involved in the BU’s activities and analyzed by framework analysis.ResultsQuantitative results showed an extensive increment of the number of BU research projects over the years and the number of work collaborations with other units and wards. Qualitative findings revealed four main themes, concerning: 1. the reasons for contacting the BU and the type of collaboration; 2. the role of the bioethicist; 3. the impact of BU activities on HPs, in terms of developing deeper and more mature thinking; 4. the need to extend ethics support to other settings. Overall, our results showed that performing both empirical bioethics research and more traditional clinical ethics activities at the same unit would produce an impetus to increase collaboration and spread an 'ethical culture' among local HPs.ConclusionsOur findings contribute to a growing body of literature on the models of clinical ethics support services and the role of empirical research in bioethics internationally. They also prepare the ground for the implementation of a multidisciplinary Clinical Ethics Committee (CEC) that aims to support the BU’s ethics consultation service within the local context. (shrink)

A creative attitude based on an “open mind approach” toward art, on a stylistic salience of images and on a continuative research of sense are the main features of Nespolo’s art. Many of his artworks are related to de Chirico’s artistic search. Many others are pervaded by a conceptualist approach to art. Nespolo’s formalist and visionary attitude becomes decisive in the 80s, the period in which he explores the effects of postmodernism in art. A topic in particular dominates his pictorial (...) production: that of museum, conceived as depository of forms. (shrink)

Was ist ein Einzelding? Gibt es ein erstes und letztes Prinzip, das erlaubt, etwas als Einzelnes und Eines anzusprechen? Lasst sich das Einzigartige und Einmalige mit den Mitteln des Denkens erfassen? Ist menschliche Individualitat ein Apriori oder eine empirische Konstruktion? Die Untersuchung erschliesst ontologische und ethische Grundzuge der Individuationsfrage im Gesprach mit drei ihrer Hauptstationen, die ihrerseits in einem dichten Geflecht von Verweisen, Anknupfungen und Anverwandlungen stehen. Sie kann als Beitrag zur Individuationstheorie wie auch als problemorientierte Einfuhrung in die behandelten (...) Positionen gelesen werden.Nietzsches Individuationsgedanke wird einerseits im Willen zur Macht als dem ontologischen principium individuationis der perspektivisch zerstreuten Realitat geortet, andererseits - anhand einer Neulekture zentraler Nachlass-Stellen - in dem abgrundlichsten Gedanken der ewigen Wiederkunft des Gleichen, der eine ethische (im Sinne Nietzsches: esoterische) Selbstpositionierung des Menschen vor dem Ganzen des Seienden erfordert.Als zweite Station erortert die Untersuchung Leibnizens monadologische Theorie einer absoluten Individualitat in ihren ontologischen Wesenszugen und im Hinblick auf das daraus erwachsende moralische Postulat einer universellen Harmonie, mit dem Leibniz die unter umgekehrten Vorzeichen auch Nietzsches Denken umtreibende Frage nach dem ontologisch-ethischen Verhaltnis von Perspektivitat und (moglicher oder negierter) Totalitat beantwortet.Mit der Thematisierung des aristotelischen Individuationsgedankens wird die Individuationsfrage in ihren massgeblich gewordenen Ursprung zuruckverfolgt. Besprochen werden u.a. die Frage nach der Bestimmbarkeit des Einzeldings als erster ousia, die entelechiale Wesensverfassung des Lebens, die Struktur des bestimmend-eingrenzenden logos sowie die Moglichkeit einer ethischen Selbstindividuation des Menschen im Spiel von Entgrenzung und Selbsthaltung. (shrink)

Volume 10, Issue 2, June 2019, Page 289-299.

Excerpt from Caroli Lachmanni in T. Lucretii Cari De Rerum Natura Libros Commentarius Iterum Editus Itaque recensendi mnnere ita functus sum nt quod Gumque bonum et verum esset'aut in utroque aut in alter utro codice id sine ullo dubitationis indicio exhiberem ver suum autem erdinem eum quo essent a veteribus librariis scripti, numeris appositis indicarem: emendafionem his re bus contineri arbitratus sum primum ut versus a. Librariis traiecti in suum locum reducerentur; quod ubi evenit nu meri sese naturali ordine excipere (...) non petuerunt: deinde nt ipsa versuum vocabula ubi vel perissent vel depravata es sent, quantum fieri posset, reciperarentur, ita tamen nt sin gula ad codicum fidemscripta cum singnlis commentariernm particulis praefigerentur, tum in imis paginis carminum enn merarentur. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works. (shrink)

Referring to entities is one of the key functions of language; learning to understand and use the relevant referential expressions is one of children’s major linguistic achievements. The 13 chapters of this volume bring together a wealth of information on the acquisition of referential processes in infants, pre-schoolers and school-age children drawing on data from more than 25 languages ranging from Italian to Inuktitut, and from Norwegian to Turkish. This book presents the state-of-the-art of corpus and experimental research on the (...) acquisition of reference. The breadth of aspects of referential acquisition will make the volume appealing to a wide audience of researchers, including linguists and psycholinguists working on phonological, morpho-syntactic, and discourse-pragmatic aspects of language development. The cross-linguistic perspective adopted by several of the contributors will be of particular interest to researchers investigating the relevance of typological differences. The state-of-the-art approach makes the research accessible to specialist and non-specialist researchers alike, and will provide an invaluable resource for graduate-level courses. (shrink)