BACKGROUND: The current lack of scientific validation of non-conventional treatments in medicine, whose epistemological foundations lie in scientific evidence and experimentation, raises a significant questions regarding the costs and benefits of alternative-treatment forms. Nonetheless, in the last few decades non-conventional treatments have been increasingly recognised by the Italian medical profession, with one regional healthcare administration adopting some non-conventional practices as part of its conventional healthcare services. AIMS: The Authors aim to analyse non-conventional treatments in medicine from an epistemological, cultural, ethical, political and economic point of view, in order to highlight criticalities and incongruities, especially when these treatments are approved by a public healthcare system, which should be grounded on the "evidence-based medicine" principle. CONCLUSIONS: Non-conventional treatments in medicine are constituted by meta-theories, i.e. philosophical, religious and ideological concepts that conflict with contemporary rational, empirical medicine. In the interest of patients and society, the paper stresses the incongruity of a healthcare system which, despite being grounded on the "evidence-based medicine" principle, allows the development of non conventional treatments. Having said that, medical science should address not only the biological domain of illness but also its existential implications. Awareness and respect for the individual experience can undoubtedly lead to a new medical model that allows for a more effective therapeutic intervention. (www.actabiomedica.it)
•We analyse the current European legislation in order to provide guidance for regenerative medicine professionals.•Collagenase digestion, as well as cell culturing, is considered to be a substantial manipulation.•Only transplantation of a non-manipulated tissue to the same histological environment is considered to be homologous.•ASCs should be not-cultured, isolated mechanically and used only in the subcutaneous tissue.
Over the last decades the expansion of ethical needs has stimulated legislators' attention to consider people and their fundamental legal rights altogether, free from all merely patrimonial requests, in order to mainly address to personal values. According to this view, the refundable profile also shows itself in favour of a wider and more integral defence of a person as a whole,also aimed at including all the damages that, at least potentially, can affect his/her individual capability of realizing his/her potentialities, in any possible manifestations and expressions (art.2 It. Const.). By facing this task, forensic medicine, and in particular forensic psychopathology, urge a new interdisciplinary synergy among several different sciences, with the contributions of medicine, anthropology, sociology, psychology and philosophy. The appearance of new values, worthy to be defended, leads the Authors, beyond all different nomenclatures and labels linked to the various voices of damage, to verify the validity, and even actuality of an evaluation system that seems to curb forensic psychopathology activities within the narrow toils of a stiff and antiseptic tabular mechanism. As a matter of fact, the real crucial pointoccurs from the awareness that, apart from taking a definite position regarding the different points of view on the evaluation of psychical and/or existential damages, the reassuring and traditionally solid tabular mechanism does not always seem to be fit to properly evaluate this kind of harm. Therefore, according to the Authors the knotting problem to solve is not to establish whether an alteration to psychic integrity is to be referable to a determinate box of pathology-normalcy, but to pick up and analyze, as already before the existential damages, as much information as possible about the negative alterations of the harmful event, able to illustrate its gravity and compatibility with the lesions occurred. The methodological exactness of forensic medicine and, in particular, of forensic psychopathology, must contribute to pay the damage people have unjustly suffered to their psychic integrity, avoiding any disproportions or duplications. ; Negli ultimi decenni l'espandersi delle istanze etiche ha stimolato l'attenzione del legislatore ad una considerazione più globale della persona e dei suoi fondamentali diritti, capace di affrancarsi dalle sollecitazioni meramente patrimonialistiche per rivolgersi principalmente e primariamente ai valori personali. In questo scenario anche il profilo risarcitorio si mostra favorevole ad una più ampia e integrale tutela della persona nella sua interezza volta a ricomprendere anche tutti quei danni che, almeno potenzialmente, ostacolano le attività realizzatrici dell'individuo,in tutte le sue possibili manifestazioni ed espressioni (art.2 Cost.).Nel misurarsi con questo impegno la medicina legale e, in particolare la psicopatologia forense, sollecitano una nuova sinergia interdisciplinare tra le diverse scienze, con i contributi della medicina, con l'antropologia, la sociologia, la psicologia e la filosofia. L'emergere di nuovi valori degni di tutela inducono gli Autori, al di là delle diverse nomenclature ed etichette alle varie voci di danno, ad interrogarsi sulla validità e, anche, sulla attualità di un sistema valutativo che sembra imbrigliare le attività della psicopatologia forense, entro le strette maglie di un rigido quanto asettico meccanismo tabellare. Il vero punctum dolens nasce infatti dalla consapevolezza che, indipendentemente da una precisa presa di posizione da un lato o dall'altro degli schieramenti di pensiero in ordine alla valutazione del danno psichico e/o esistenziale, il rassicurante e tradizionalmente solido meccanismo tabellare non pare sempre adeguato alla valutazione concreta di questo tipo di lesioni. Secondo gli Autori, il vero nodo da sciogliere non è, quindi, quello di stabilire se un'alterazione dell'integrità psichica sia o meno riconducibile ad una determinata casella di patologia-normalità, bensì quello di raccogliere e analizzare, come già prima del danno esistenziale, più informazioni possibili circa le alterazioni negative dell'evento dannoso, illustrandone la gravità e la compatibilità con le lesioni riportate. Il rigore metodologico proprio della medicina legale e, nello specifico, della psicopatologia forense, dovrà contribuire alla riparazione del danno all'integrità psichica ingiustamente subito dalla persona, evitando sperequazioni o duplicazioni.
In Italy, the National Vaccinal Prevention Plan has renewed the commitment of the Italian government to promote a culture of vaccination practices in the general population and especially among healthcare professionals, considering it as a strategic goal. The search for useful tools and techniques to promote a layered and widespread information network capable of restoring a climate of trust and confidence towards vaccination, leads us to reflect on the possibility, already adopted in numerous countries, of enlisting community pharmacies in immunization campaigns also in Italy, positively implementing the professional role of the community pharmacist in immunization. The pharmacist is often the first point of contact with both the patients and the public, both for the relationship of trust and confidence that binds him to the citizens, and for the ease of access in relation to the widespread distribution of community pharmacies in the territory, the availability of prolonged operating hours, the absence of need for appointments and positions near/outside of healthcare facilities. Currently, in Italy the role of the community pharmacist is limited to counseling and providing advice and information regarding the benefits and/or any risks of vaccination practices, but does not imply a direct engagement in immunization programs, rather a collaboration to avoid straining and overwhelming the vaccination centers. Some recent questionnaire-based studies have shown that Italian community pharmacists have attitudes that are favorable to vaccinations, even though their knowledge is rather limited. Together with expanding the engagement of community pharmacists in immunization programs, their educational gap should be addressed in order to significantly improve and enhance the protection of the public health.
Background and aim: Medical deontology is increasingly important, owing to the interests and rights which the medical profession involves. This paper focuses on the relationships of the Italian Code of Medical Deontology (CMD) with both the ethical and legal dimensions, in order to clarify the role of medical ethics within the medical profession, society and the overall system of the sources of law. Methods: The authors analyze the CMD from an ethical perspective and through the new doctrinal guidelines and current trends in the Italian law courts. Results: From an ethical point of view, moral philosophical analysis scarcely seems to address professional medical ethics. Nonetheless, the CMD needs to undergo careful ethical analysis. From a legal perspective, the Italian CMD contains provisions which do not have an official legal nature. However, they are directly binding for medical practitioners, and therefore could be understood as a supplement to the general rules of the legal system. Conclusions: At an ethical level, rigorous debate on the CMD is indispensable, in order to update its specific principles and to make it a real moral normative document. At a legislative level, there is a possible contradiction between a legal system that does not take into account the CMD, but which then attributes significant importance to the violation of its rules. (www.actabiomedica.it)
Background and aim: The social role of the minor, as indeed that of the physician, has changed markedly. This transformation has given rise to new patterns and responsibilities in the management of healthcare procedures that involve minors. Discussion: According to international legislation, in the clinical setting, as in other areas of social life, minors have the right to be heard and to have their opinions taken into consideration as an increasingly determining factor, in accordance with their age and degree of maturity and discernment. The authors describe the right to information and the decision-making process when the patient is a minor and underline the role of the parties involved (physicians, parents, under-age patient, judge) in various circumstances. Specifically, the paper analyzes the ethical and legal issues relating to the entitlement to decisions concerning the medical treatment of children and assesses the importance that Italian law attaches to the will of minors in the healthcare choices that affect them. Conclusions: Healthcare workers are called upon to face new challenges in order to ensure that healthcare services are able to safeguard the interests of minors while, at the same time, respecting their will. How to evaluate children's competence to consent and how to balance the autonomy of parents and minors are crucial questions which the law courts in the various countries are increasingly being asked to address. These issues require close collaboration among various figures (parents, doctors, psychologists, judges) and imply the ethical need to undergo continuous training. (www.actabiomedica.it)
The COVID-19 pandemic has evidenced the chronic inequality that exists between populations and communities as regards global healthcare. Vaccination, an appropriate tool for the prevention of infection, should be guaranteed by means of proportionate interventions to defeat such inequality in populations and communities affected by a higher risk of infection. Equitable criteria of justice should be identified and applied with respect to access to vaccination and to the order in which it should be administered. This article analyzes, as regards the worldwide distribution of anti-COVID-19 vaccines, the various ways the principle of equity has been construed and applied or even overlooked. The main obstacle to equal access to vaccines is vaccine nationalism. The perception of equity varies with the differing reference values adopted. Adequate response to needs appears to be the principal rule for achieving the criterion of equity in line with distributive justice. Priorities must be set equitably based on rational parameters in accordance with current needs. The entire process must be governed by transparency, from parameter identification to implementation. The issue of equal access to vaccination affects the entire world population, necessitating specific protective interventions. In light of this, the World Health Organization (WHO) has devised the COVAX plan to ensure that even the poorest nations of the world receive the vaccine; certain initiatives are also supported by the European Union (EU). This pandemic has brought to the fore the need to build a culture of equitable relationships both in each country's own domain and with the rest of the world.
The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.
