In complex, pluralistic societies, different views concerning the moral duties of healthcare professionals inevitably exist: according to some accounts, doctors can and should cooperate in performing abortion or physician-assisted suicide, while according to others they should always defend human life and protect their patients’ health. It is argued that the very plurality of responses presently given to questions such as these provides a liberal argument in favour of conscientious objection, as an attempt to deal with moral diversity by protecting both (...) the professionals’ claim to moral integrity and the patients’ claim to receive lawful and safe medical treatments. A moderate view on CO is defended, according to which none of these claims can be credited with unconditional value. Claims to CO by healthcare professionals can be justified but must be subjected to a reasonableness standard. Both the incompatibility of CO with the medical profession and its unconditional sanctioning by conscience absolutism are therefore rejected. The paper contributes to the definition of the conditions of such reasonableness, particularly by stressing the role played by conceptions of good medicine in discriminating claims to CO; it is argued that respecting these conditions prevents from having the negative consequences dreaded by critics. The objection according to which accepting the physician’s duty to inform and refer is inconsistent with the professed value of moral integrity is also discussed. (shrink)

The Article focuses on the concept of social solidarity, as it is used in the Report of the International Bioethics Committee On Social Responsibility and Health. It is argued that solidarity plays a major role in supporting the whole framework of social responsibility, as presented by the IBC. Moreover, solidarity is not limited to members of particular groups, but potentially extended to all human beings on the basis of their inherent dignity; this sense of human solidarity is a necessary presupposition (...) for a genuinely universalistic morality of justice and human rights. (shrink)

It is often contended that certain enhancement technologies are acceptable, because they simply update traditional ways of pursuing the improvement of human capacities. This is not true with reference to moral bioenhancement, because of the radical difference between traditional and biotechnological ways of producing moral progress. These latter risk having serious negative effects on our moral agency, by causing a substantial loss of freedom and capacity of authentic moral behaviour, by affecting our moral identity and by imposing a standard conception (...) of moral personality. (shrink)

It is often contended that certain enhancement technologies are acceptable, because they simply update traditional ways of pursuing the improvement of human capacities. This is not true with reference to moral bioenhancement, because of the radical difference between traditional and biotechnological ways of producing moral progress. These latter risk having serious negative effects on our moral agency, by causing a substantial loss of freedom and capacity of authentic moral behaviour, by affecting our moral identity and by imposing a standard conception (...) of moral personality. (shrink)

In Italy, during the first wave of the Covid-19 pandemic, the Italian Society of Resuscitators and Pain Therapists (SIAARTI) and the Italian National Bioethics Committee (CNB) published ethical guidance on the allocation of scarce intensive care resources. In this paper, we outline and compare these documents in detail, highlighting differences and similarities. In particular, we argue that major differences exist with respect to the principles and values underpinning the documents and the normative allocation criteria proposed. Conversely, similarities can be traced (...) with respect to a functional rather than substantial endorsement of the age criterion, the importance of transparency, and the consideration over healthcare professionals’ responsibility regarding allocative decisions. In conclusion, we argue that Italy has lacked a comprehensive and publicly-accountable policy articulating principles and operational criteria geared to strengthen the “ethical preparedness” of the country in dealing with current and possible future public health emergencies. (shrink)

We explored the comprehension of the informed consent in 77 cancer patients previously enrolled in randomised phase II or phase III clinical trials, between March and July 2011, at the San Raffaele Scientific Institute in Milano. We asked participants to complete an ad hoc questionnaire and analysed their answers. Sixty-two per cent of the patients understood the purpose and nature of the trial they were participating in; 44% understood the study procedures and 40% correctly listed at least one of the (...) major risks or complications related to their participation in the trial. We identified three factors associated with comprehension of the informed consent: age, education and type of tumour/investigator team. We suggest several possible improvements of how to obtain informed consent that will increase patient awareness, as well as the validity and effectiveness of the clinical trials. (shrink)

Tännsjö’s book Setting Health-Care Priorities defends the view that there are three main normative theories in the domain of distributive justice, and that these theories are both highly plausible in themselves, and practically convergent in their normative conclusions. All three theories point to a somewhat radical departure from the present distribution of medical resources: in particular, they suggest redirecting resources from marginal life extension to the care of mentally ill patients. In this paper I wish to argue, firstly, that prioritarianism (...) should not be considered as an amendment to utilitarianism, as it is in Tännsjö’s view, but as a distinctive fourth option. This can best be appreciated if we focus on a reading of the theory that emphasizes its derivation from egalitarianism and its attempt to develop an intermediate approach between utilitarian and egalitarian intuitions. Secondly, in response to Tännsjö’s central objection to prioritarianism, I will argue that the theory does not apply in intrapersonal cases but is only relevant for decisions regarding the interpersonal distribution of benefits. Finally, I will suggest that a practical convergence of the four theories on specific issues such as artificial reproduction or mood enhancement is far less likely than Tännsjö seems to believe. (shrink)

Different definitions of bioethics in American and Italian literature are reported. It is argued that they refer to three different conceptions of the epistemological status of bioethics: the first conceives of it as an application of moral principles to biomedical problems, the second as a methodology for the working out of clinical judgement, the third as a broader and interdisciplinary public inquiry. It is suggested that each approach grasps a part of the truth, for each singles out one level of (...) the bioethical work. Bioethics is in fact a complex, three-level form of knowledge. The misunderstanding of this complexity has led to some confusion and to conflicts of attribution among those who are concerned with it. Keywords: applied ethics, bioethics, medical ethics, interdisciplinarrity CiteULike Connotea Del.icio.us What's this? (shrink)

Sidgwick considered Kant as one of his masters. However, he never devoted any systematic attention to Kant’s ethical theory; moreover, in The Methods of Ethics he concluded that Kantian ethics is inadequate to guide moral life. I review Sidgwick’s references to Kant in order to show that – along with basic differences − there are significant similarities in the main project of the two philosophers; and I suggest that, should Sidgwick have deepened his understanding of Kant, he might have realised (...) that Kantian ethics offered a somewhat different way to accomplish the philosophical project he was interested in, that is, the systematisation of the morality of common sense through the establishment of certain moral axioms. I also suggest that Sidgwick’s misunderstanding of the “formula of humanity” is at the heart of his final dismissal of Kant’s ethics and that deepening his understanding of Kant might have led Sidgwick to revise his views on the rationality of egoism, thereby opening the possibility to solve the dualism of practical reason. Finally, I offer some speculations on the reasons why Sidgwick never attempted a thorough confrontation with Kant, suggesting that both his distaste for Kant’s metaphysics and his Millian utilitarian bias deterred him from it. (shrink)

The discussion on the relationship between Hume and utilitarianism has been lively for many decades. To contribute to this discussion, I identify four main features of a utilitarian view: a) a consequentialist theory of the right, b) a hedonist theory of the good, c) some kind of impartiality in evaluating consequences, and d) an essentially prescriptive, rather than merely explicative, attitude. I then show that, first, although he borrowed the word ‘utility’ from Hume, Bentham did not consider Hume as a (...) utilitarian and, second, that Hume's ethics does not really endorse any of the four main tenets of utilitarianism, either in the Treatise or in the Enquiry. I thus conclude that, notwithstanding recent interpretations to the contrary, Hume was no utilitarian in any substantial sense. (shrink)

Nella seconda metà del Novecento la conoscenza dell'etica anglosassone in Italia è stata alquanto parziale. Si pensava che il mondo dell'etica di lingua inglese fosse stato dominato nel Novecento dallo scientismo neopositivista o pragmatista che non riusciva a concepire l'etica se non nella forma tecnicizzata dell'analisi del linguaggio o metaetica. In questo modo si è ignorata tutta una ripresa dell'etica normativa, in particolare di Kant e di Aristotele, o la ripresa del diritto naturale che ha tra i suoi principali riferimenti (...) storici il pensiero di Tommaso d'Aquino intorno alla legge. Questo volume presenta un quadro della filosofia pratica anglosassone degli ultimi cinquant'anni. (shrink)

It is often argued that scientific developments in the area of biomedicine call for new ethical paradigms. Given the inadequacies of the traditional “sanctity-of-life ethics” (SLE), many have argued for a quality-of-life ethics (QLE), based on a non-speciesistic theory ofthe value of life. In this paper, I claim that QLE cannot account for the normativity of moral judgments, which can be explained only within the context of a theory of practical rationality: the peculiarity of moral normativity calls for an ethics (...) based on respect for rational creatures. I then go on to argue that the ethics of respect for persons (ERP) is not equivalent to SLE; that it can ground the moral protection of human “marginal cases”; that it does not rely on a scientifically implausible notion of human nature; and that it is not vulnerable to the charge of speciesism. Lastly, I suggest that ERP is a strictly philosophical interpretation of the Judeo-Christian moral tradition, and that is a better interpretation than SLE. If these assertions are correct, then the necessity of a new moral paradigm is seriously undermined. (shrink)

The U.S. Supreme Court’s Dobbs ruling triggered a global debate about access to abortion and the legislative models governing it. In the United States, there was a sudden reversal of federal guidance about pregnancy termination that is unprecedented in Western and high-income countries. The strong polarization on the issue of abortion and the difficulty of finding a point of compromise lead one to consider the experiences of countries that have had different paths. Italy stands as a candidate for being a (...) partially alternative model because it allows abortion up to 12 weeks, but without considering it a subjective right. The legislation in place since 1978 aims to balance the interests of the fetus and those of the woman. An issue often raised concerning Italian law is that of conscientious objection granted to doctors. Many gynecologists declare themselves objectors, and this makes access to abortion more difficult in some regions of Italy. After discussing this issue and envisaging different ways to deal with it, the article concludes by highlighting new dilemmas about a possible divorce between the law and medical ethics in different directions and offers some avenues to begin setting up a response. (shrink)

In questo testo viene discussa la tesi secondo cui sarebbe possibile una comprensione esaustiva del fenomeno amoroso sulla base dei meccanismi della chimica cerebrale. Si distinguono diversi aspetti dell'amore e si portano ragioni per le quali le chimica cerebrale può svolgere un ruolo più o meno ampio in ciascuno di essi nel fornire una spiegazione del fenomeno amoroso.

The article briefly analyzes the concept of a person, arguing that personhood does not coincide with the actual enjoyment of certain intellectual capacities, but is coextensive with the embodiment of a human individual. Since in PVS patients we can observe a human individual functioning as a whole, we must conclude that these patients are still human persons, even if in a condition of extreme impairment. It is then argued that some forms of minimal treatment may not be futile for these (...) patients; they may constitute a form of respect for their human dignity and benefit these patients, even if they are not aware of that. Moreover, it is important to consider the symbolic significance of care: while many believe that PVS is a kind of imprisonment, for others providing food and fluids is the only way to testify our proximity to these persons. The best policy would be to provide, as a general rule, artificial nutrition and hydration to PVS patients: this treatment could be withdrawn, after a period of observation and reflection by the family and proxies, on the basis of the proxies' objection to the continuation or of the patient's advance directives specifically referring to this situation. (shrink)

The article briefly analyzes the concept of a person, arguing that personhood does not coincide with the actual enjoyment of certain intellectual capacities, but is coextensive with the embodiment of a human individual. Since in PVS patients we can observe a human individual functioning as a whole, we must conclude that these patients are still human persons, even if in a condition of extreme impairment. It is then argued that some forms of minimal treatment may not be futile for these (...) patients; they may constitute a form of respect for their human dignity and benefit these patients, even if they are not aware of that. Moreover, it is important to consider the symbolic significance of care: while many believe that PVS is a kind of imprisonment, for others providing food and fluids is the only way to testify our proximity to these persons. The best policy would be to provide, as a general rule, artificial nutrition and hydration to PVS patients: this treatment could be withdrawn, after a period of observation and reflection by the family and proxies, on the basis of the proxies' objection to the continuation or of the patient's advance directives specifically referring to this situation. (shrink)