Suchergebnisse

Introduction: The responsibility of the Department for Prevention and Safety at the workplace of the Palermo Health Authority (ASP) is to monitor and coordinate the activity of occupational physicians operating in Palermo and its province. One of its obligations is to examine appeals "against the judgment of occupational physicians", ".and, after carrying out further investigation, confirm, modify or reverse the ruling itself " (art. 41, par. 6, legislative Decree 81/08). Objectives: The purpose of this study was to analyze the appeals lodged against a "judgment of fitness for work" submitted to the "Health Prevention and Occupational Epidemiology Operative Unit" of the Department of Prevention and Safety at the Workplace of the ASP Palermo, from 2008 to 2010. Methods: The total number of appeals lodged during the three-year period was 211, 174 of which were finalized. Results: The most frequent job category among the appellants was that of blue-collar workers, in various sectors, covering 44.5% of the subjects under study (93 cases). In 64.2% of the processed appeals (131 cases), the judgment of the physician was modified, while in the remaining 36.8% (73 cases) it was confirmed.The work fitness judgment with restrictions was the category against which most appeals were lodged, and the diseases in question mostly concerned the osteoarticular and cardiovascular systems. Conclusion: In a context of continuous change in the labour field and the related risks to the health and safety of workers, the occupational physician must approach the worker in a comprehensive manner,through an assessment of the possible health problems and the working environment in which he/she operates.

Magister Grazia Orlandi medicinalis scientie professor is documented in Cagliari since the early years of the fourteenth century, in connection with other physicians and apothecaries. He was the doctor of many families and rich merchants, such as Neri da Riglione who died in Cagliari at the end of 1316. Among its most illustrious patients remember the infant Alfonso of Aragon, which lent support in 1324, when the military campaign in Sardinia and the judge Hugh II of Arborea, for which he also held the post of ambassador in Catalonia, to important posts, including the marriage of her children, Marian and John, and the purchase of the barony of Cervello.

[Appeal against the judgment of the physician in charge: a case report]Health surveillance is only one of the roles of the competent physician: his duties and responsibilities are governed by Legislative Decree 81/08. The case report is described to reflect on the roles of the various components (employee, employer and physician) in compliance with the Constitution (articles 35-40) and the Workers' Statute (Law 300, 20 May 1970).

[Appeal against the judgment of the physician in charge: a case report]Health surveillance is only one of the roles of the competent physician: his duties and responsibilities are governed by Legislative Decree 81/08. The case report is described to reflect on the roles of the various components (employee, employer and physician) in compliance with the Constitution (articles 35-40) and the Workers' Statute (Law 300, 20 May 1970).

Lo scritto sottolinea l'importanza della distinzione fra il rifiuto dei trattamenti, che per il medico implica un accompagnamento di tipo palliativo, e l'intenzione di uccidersi e di aiutare a tal fine, che non è un atto terapeutico, secondo i codici deontologici di tutto il mondo e le società mediche scientifiche internazionali, inclusa la World Medical Association (Declaration on euthanasia). L'ordinanza 207/2018 della Corte costituzionale trascura però questa distinzione, allorché ritiene che in entrambi i casi il soggetto sarebbe intenzionato a «porre fine alla propria esistenza». Se il discrimen è nell'intenzione di uccidere, ne discende che l'art. 580 c.p. può interpretarsi nel senso che è incriminabile colui che, con il proprio comportamento, intenzionalmente contribuisce a determinare o a rafforzare il proposito o ad agevolare in qualunque modo l'esecuzione del suicidio altrui. Ragionevole è dunque l'ipotesi di una sentenza interpretativa di rigetto, quale epilogo della questione di costituzionalità concernente l'art. 580 c.p. Desta preoccupazione, poi, che una Corte possa privare un Parlamento dell'ampio margine di apprezzamento di cui godono, in riferimento all'art. 2 CEDU e al fine vita, tutti gli Stati aderenti, nel valutare se e come introdurre una disciplina sul suicidio medicalmente assistito. Radicalmente in contrasto con i fondamenti costituzionali appaiono poi il presunto dovere di uccidere (posto il carattere pretensivo del diritto di morire), il concetto di dignità umana intesa in senso individualistico, e le derive cui invariabilmente conduce la legalizzazione, come mostra l'esperienza del Benelux, dove l'eutanasia, in principio ammessa in casi estremi, è divenuta routine e, sganciata dallo stesso principio di autodeterminazione, è praticata a bambini, neonati e malatici psichici. ; The paper underlines the importance of the distinction between the right to refuse treatment, which for the doctor implies palliative care (and not help to kill), and the intention to commit suicide and to receive assistance in suicide, which is not a medical act, according to the medical codes of practice all over the world and international scientific medical societies, including the World Medical Association (Declaration on euthanasia). However, the Order 207/2018 of the Constitutional Court neglects this distinction, when it believes that both practices involve the intention to "put an end to the existence". If the focus is on the intent to kill, it follows that art. 580 Italian Penal Code can be interpreted in the sense that it is guilty (only) the person who, with his or her own behavior, intentionally contributes to advise or to reinforce the purpose or to aid in any way another to commit suicide. Reasonable is therefore the hypothesis of an interpretative judgment of dismissal, as an epilogue of the question of unconstitutionality concerning art. 580 c.p. It is also problematic that a Court may deprive a Parliament of the wide margin of appreciation that, with reference to Article 2 of the ECHR and end of life issues, Contracting Parties enjoy, in assessing whether and how to introduce physician-assisted suicide. Radically in contrast with the constitutional principles appear the individualistic concept of human dignity, the presumed duty to kill (given the pretensive nature of the right to die) and the tendencies invariably led by legalization, as shown by the experience of the Benelux, where euthanasia, initially admitted in extreme cases, has become routine and, detached from the same principle of self-determination, is practiced to children, newborns and mental ills.

[Mediation in health care. Inappropriate use of ionizing tests, informed consent and opportunity of Legislative Decree n. 28/2010]Inappropriate use of ionizing tests in medicine represents an increasing trend, which causes noteworthy damages to health, as well as a huge increment of health expenditures, waiting lists, organizational conflicts, judicial disputes, and insurance compensations. This phenomenon is strictly related to the key bioethical and legal issue of patient's autonomy, which is protectable by means of a correct implementation of informed consent. The current practice of the passive signature on incomplete and unreadable informed consent templates belongs to the so-called "event-based" approach. This practice mortifies the patient's right to decide freely and deliberately, being him unaware of the biological consequences of diagnostic-therapeutic interventions on himself and on his progeny's health. On the other hand, physicians themselves are not protected, since they can generate arbitrary clinical acts more frequently, with heavy deontological and legal consequences. Conversely, a "process-based" approach is necessary, which conveys informed consent in a series of other clinical and organisational processes towards a full therapeutic alliance among physician and patient. Actually, in both the presence and absence of the inauspicious event recurring also in the area of imaging as well as in other specialist areas, an arbitrary informed consent is the cause of deep conflicts, especially at relational level, between physician and patient. The authors suggest – in both juridical and communication perspectives – that these conflicts deserve to be properly analyzed and brought to the surface by the parties through the tool of mediation in healthcare, provided by Legislative Decree n. 28/2010. This tool is oriented not so much towards a technical solution at all costs, as towards a reconstruction of the care relationship, which unfortunately is lacking in the current way of conceiving and managing informed consent.

[Mediation in health care. Inappropriate use of ionizing tests, informed consent and opportunity of Legislative Decree n. 28/2010]Inappropriate use of ionizing tests in medicine represents an increasing trend, which causes noteworthy damages to health, as well as a huge increment of health expenditures, waiting lists, organizational conflicts, judicial disputes, and insurance compensations. This phenomenon is strictly related to the key bioethical and legal issue of patient's autonomy, which is protectable by means of a correct implementation of informed consent. The current practice of the passive signature on incomplete and unreadable informed consent templates belongs to the so-called "event-based" approach. This practice mortifies the patient's right to decide freely and deliberately, being him unaware of the biological consequences of diagnostic-therapeutic interventions on himself and on his progeny's health. On the other hand, physicians themselves are not protected, since they can generate arbitrary clinical acts more frequently, with heavy deontological and legal consequences. Conversely, a "process-based" approach is necessary, which conveys informed consent in a series of other clinical and organisational processes towards a full therapeutic alliance among physician and patient. Actually, in both the presence and absence of the inauspicious event recurring also in the area of imaging as well as in other specialist areas, an arbitrary informed consent is the cause of deep conflicts, especially at relational level, between physician and patient. The authors suggest – in both juridical and communication perspectives – that these conflicts deserve to be properly analyzed and brought to the surface by the parties through the tool of mediation in healthcare, provided by Legislative Decree n. 28/2010. This tool is oriented not so much towards a technical solution at all costs, as towards a reconstruction of the care relationship, which unfortunately is lacking in the current way of conceiving and managing informed consent.

L'autrice analizza le disposizioni del decreto legislativo 9 aprile 2008, n. 81, e successive modificazioni,riguardanti l'organizzazione del sistema aziendale di prevenzione, con particolare riferimento alla disciplina in tema di servizio di prevenzione e protezione dai rischi, gestione delle emergenze, medico competente e sorveglianza sanitaria, così da evidenziare gli elementi di continuità e di discontinuità rispetto alla normativa pregressa, nonché le criticità presenti nella legislazione vigente, in relazione alle quali sono proposte possibili soluzioni interpretative.The author analyzes the provisions of the Legislative Decree no. 9 April 2008, n. 81, as amended, concerning the organization of the system of prevention, with particular attention to the discipline of the risks prevention and protection service, the emergency management, the occupational health physician, and the workplace health surveillance, in order to highlight the elements of continuity and discontinuity with respect to the previous legislation, and also the critical issues in the current legislation, in relation to which possible interpretative solutions are given.Parole chiave: salute e sicurezza sul lavoro, servizio di prevenzione e protezione dai rischi, medico competente, sorveglianza sanitaria, emergenzeKeywords: health and safety at work, risks prevention and protection service, occupational health physician, workplace health surveillance, emergencies