Valentina Di Bernardo
rMH 1, 2007, 13-14
A subversive choice in defence of the vulnerability of the sick
Reaching the heart of Medical Humanities implies going beyond the conventional meaning of the concept of «treating», and asks for the human sciences’ involvement in curing the sick. This itinerary, at the same time an adventure to tell, starts from the bed of the sick, examines the possibilities in techniques; transcends, thanks to an interdisciplinary approach, the illness and the body of the sick, to observe it with different eyes, sensitivity and new treatment. Thus it is possible to establish a relationship that allows one to take care of the other with the right tenderness to face the vulnerability of being alive. The principle of vulnerability, Medical Humanities should endorse, underlines the state of interdependence that links all human beings, it involves the responsibility in taking care of one another and represents the underlying principle of the notions of treatment, responsibility, empathy and reciprocity.
rMH 1, 2007, 17-20
The critical humanism of Medical Humanities
This article looks at the question of the role of Medical Humanities with a respect for a clinical approach on the basis of two metaphorically-used concepts: that of anaesthesia and that of synaesthesia. It also focuses on the reductionist perspective, which eliminates from the observation field all resistance to the formalisation protocols. Medical Humanities intend to enlarge the visibility horizon, within which the patient is situated. The question is therefore how to integrate the patient’s experience into the clinical practice.
rMH 1, 2007, 25-30
A style to think «in another light»
What are we talking about when discussing Medical Humanities? MH do not belong to the terra firma, where disciplines defend their epistemological and methodological paradigms, but are sailing with no fixed abode between the islands of an archipelago which force them to speak several dialects and to experiment in several complicated practices. MH are inhabited and crossed by human science, from philosophical reflection, anthropology, psychology and sociology, to bioethics and medical ethics, without being exhaustive. Thus, MH are not a mere decoration of health care, a way to make the caregiver-patient relation a more human or good mannered practice, but a practical and theoretical cross of disciplinary knowledge, to make a real «epistemological breakdown» within medicine itself, to «think in a different light», where the empiric-technical-rational thought is conjugated, as Edgar Morin suggests in his work about the «dual thought», with the symbolic-mythological-magic thought.
rMH 1, 2007, 31-34
Cultural sciences of medicine
Illness is an event always too big both for the individual alone to deal with, and for medical science to take care of: therefore other answers, of a cultural kind, are required. Throughout history, there has been a succession of imposing structures of collective meaning (such as religion, history, politic ideologies, etc.), which aimed to offer imaginary settings in order to understand and share the meaning of single events. Nowadays these «great narrations» seem to have disappeared, and it is medicine itself that has to answer to the void they left behind. Medical Humanities can perhaps help medical science in its task of «representation’s care»: avoiding all «great narration», but recognising the power of «small tales» instead – narrations provided above all by literature – and the important role they can play reconnecting the individual’s experience with a broader human and cultural horizon.
Valentina Di Bernardo
rMH 1, 2007, 75-79
Autonomy, self determination, empathy and treatment relationship
The advance guidelines are the means, created by the law, to guarantee the expression of individual liberty in case of the loss of capacity for judgment. There are certainly remarkable advantages, however, besides them, difficulties still exist that feed the discussion on this subject. The main concepts of autonomy and self-determination are, at first, analysed by an ethical, clinical and legal point of view to be later traced back to the field of treatment. Furthermore other concepts strictly linked to the topic are evaluated: the judging capacity, the therapeutic representative, the role of relatives and the more legal issues such as the absolute right to live and exist. The role of the therapeutic representative is given particular relevance. It should be a person able to describe the reality of the cure in order to define not only the interventions and their acceptability, but also their duration. Having once evaluated the legal aspect of the subject, the reflection weighs on the concept of mimetic wish and the principle of reciprocity as factors that can influence the presumed liberty of one’s wishes.
rMH 1, 2007, 87-91
Advantages and disadvantages of directives imperfectly disclosed
To think of advance directives that agree – and fulfil – the various situations in which the patients could find themselves, could, due to psychological reasons which concern our own finitude and for various medical notions required in writing them, turns out to be a difficult task. It is important however that advance directives are written so that the patients wills are clearly stated in preparation for critical situations when it is no longer possible to formulate one’s own thoughts. In consideration of the patient’s will, informing the family and wider circle about the existence and content of a living will, would ease the task of the medical team taking care of the patient. It would also avoid possible disagreements – or conflicts – among the family or between the family and the medical team, over the different therapeutic options. To ask a patient about his own wish in a given situation means respecting his dignity. However, to take time with the patient to discuss and explain certain procedures and their issues (for example the potential rate of failures in the case of resuscitation), requires time with the physicians, therefore at first sight additional costs. Writing advance directives would help the medical teams to be more efficient as it would no longer be necessary to systematically try to restore the patient’s wish through several team meetings.
rMH 1, 2007, 92-94
In dialoguing is the secret of a right decision
The motivations to compile personal advance directives are various: patients don’t want to become dependent, they don’t want to be kept alive under any circumstances or they simply want to talk about their wishes for end of life therapy with their relatives. The results of a representative study in Germany (Schröder et al. 2002) indicate that only three percent of people have such a document. However, twelve percent have communicated their wishes verbally and the same number have considered it. On the other hand, the occurrence of personal advance directives is elevated amongst hospitalised patients (Federspiel 2004, Oorschot 2004). Ultimately though, almost three quarters of the population is not interested in compiling advance directives. A 20 year long experience with advance directives in the United States has produced different studies about the impact of advance directives with controversial results. While some show the benefits of this technique in communication, others doubt that this instrument can be helpful. In turn, they suggest a better concentration on the involvement of health care proxies. The document edited by Caritas also allows to refer a proxy. But the primary goal is to open up a timely discussion between the patient and their family about death and dying. In this way advance directives can be a valid tool for decision-making at the end of life.
Marzio Della Santa
rMH 1, 2007, 95-97
An innovative solution: the e-health card
Apparently, dealing with two topics with such big differences such as e-health and living appears contradictory. One’s living will can be read as a response to therapeutic perseverance, which is a consequence of a longer life-span expectation, due to health care technologies. This result can appear sometimes opposed to the patient’s living will. To tackle these subjects together seems, in contemporary society, a necessary task. The introduction of information and communication technologies in many health care sectors has changed or is currently changing our behaviour and approach to health: we consider it more advantageous to know beforehand the costs and benefits of information and communication technologies, to then allow the communities to reap the greatest possible benefits. Two main aspects should be evaluated: the first is related to the impact of e-health instruments in the management of the process of living will, the second is attached to patients rights, for whom living will is an expression of their wishes.
rMH 1, 2007, 49-55
Comec Case. A problem of trust
The description of the attitude of the members of an ethical commission to deliver a shared view on a complex case. A consideration relating to the principles of bioethics, at the same time aiming to be absorbed by the reality of the treatment, in order to be of help to the clinical team who asked for a judgement on the basis of a possible problem concerning the withdrawal of therapies and distributive justice. In the case described, the patient’s family nourished expectations and hope in conflict with the values and the convictions of the medical team. The situation was aggravated by the patient belonging to a culture and religion that provided principles and rules of behaviour his/her family could not disregard.
Valentina Di Bernardo
rMH 1, 2007, 56-63
An impossibile comprehension
In the case of Mr Francesco, a patient with compulsive bulimia who arrives in intensive care after a trauma, the categories of pain, suffering and evil seem to manifest themselves in various forms, at the same time affecting all those involved. The analysis tries to enlighten some aspects taken on by the suffering in the specific situation, with reference to some philosophical terms. One of the fundamental questions of this refection is: what are the consequences of pain, of suffering and of evil that effect most importantly the individual and the community – e.g. evil as injustice, guilt, exclusion and loss of control? And, consequently, which aspects do we risk to neglect? We are going to focus mainly on two dimensions: evil as a impossibility of understanding, as radical incapacity to give sense, communicate and share meaning; and the evil as a loss of control.
rMH 1, 2007, 101-104
International Master in Medical Humanities
During 2001, a few teachers from the Department of Medicine and public health of the Insubria University, Varese (Italy) together with some members of the Foundation Sasso Corbaro of Bellinzona (Switzerland), began to talk about a potential co-operation. On September 26th, 2002, the Master in Medical Humanities was born. The first edition was attended by 19 students coming from Italy, Switzerland, Malta, Spain, Cuba, Brazil and visiting professors such as Warren Reich from GeorgetownUniversity of Washington (USA) and Anne Hudson Jones from the Institute for Medical Humanities of Galvestone, Texas (USA). The two-year Master was divided into 16 sessions, from Thursday afternoon through to Saturday morning. Sessions were held in Italy, Switzerland, Spain and France. Medical Humanities study the interaction among science, medicine, philosophy, history, public health, social sciences, literature and arts in order to find answers to the questions arising in the field of health and medicine. The board’s task was to find a main criteria to direct the contents and methods of the program. Narration was elected as the core issue of the Master: telling our own story and our relationship with other people, environment and cultural traditions. These discussions became the main instrument in improving capacity for judgement and finding solutions to particular situations. Thanks to the positive experience, a second edition of the Master began on March 16th, 2006, for 20 sessions. This 2nd edition will finish in December 2007.