Rivista per le Medical Humanities

Silvia Zaina
rMH 6, 2008, 13-17

The gift in hospital

In the departments of hospitals, futuristic temples of science and medical techniques, now like in the past, dwells the gift: from books, flowers, home-made puddings, brought by relatives to their hospitalized loved ones, up to the signs of gratitude shown by the patients to their carers. Everybody knows it exists, everybody experiences it, but nobody gives it value. Hence the interest in putting the gift at the centre of an ethnographic research carried on in the hospitals of Canton Ticino. From this research emerges that in reality the gift has a fundamental importance, not only in constructing relations, but allowing patients, family and carers to be social actors, i.e. to be human beings. The gift presents itself as well as a form of resistance against the standardization of the behaviours and of the identity imposed upon by the institution, as a method to carve out a space for personal expression and to affirm oneself as subjects who are unshakeably free.  

Pietro Grassi
rMH 6, 2008, 18-24

What does giving mean?

To give, a complex and manifold phenomenon, gesture highly diffused in our every day lives, has characterized throughout the ages the human existence, changing from a nearly regal concept to the banal degeneration of our times. The history of gift speaks of something continually fluctuating, always on the verge of modifying itself into economic exchange. Man himself has to be considered responsible for these oscillations, giving peculiarity to the gift and apparently privileging exclusively the utilitarian aspect. In the concept of giving it is possible to glimpse a reflection that, since ever, talks of it above all as a symbol. Giving is characterized by its gratuity, not quite because it does not ask for return, but rather because its circulation seems to break the rules of commercial exchange. Gratuity asks for a sentimental inclination, the light asymmetry of the relationship between giver and receiver, of those who give without waiting for a return, the expression of that greater of love that does not put into play one’s own serenity and existential certainty. But perhaps the authentic giving really belongs to God: man can only give back.  

Graziano Martignoni
rMH 6, 2008, 25-30

Care as gift

This text looks at covering the dimension and enigma of care, that, beyond its visible manifestations, is fundamentally exposure and relationship to that illness of existence that belongs to us as mortal men. Care, therefore, as a practice of giving related to the condition of exile in which man finds himself, and whose witnesses are the suffering of his body, of his mind and his world. It is as if the gift, giving oneself, and forgiving were then the alphabet of a voyage that man carries out inside his fragility. Without that giving, that is always risk and personal exposure, every gesture of therapy, every word, even if effective, risks to fail. The relationship between gift and care is therefore an exploration inside the most intimate and at the same time most public of man’s homes, the most generous and egocentric of his actions. It is to pass through the lights and shadows of that relationship of otherness of which man is both actor and spectator. Something that belongs to the intimacy of every man and which calls from the depths of that intimate, a voice addressing the You. Gift and vocation walk together then in the disposition to Care. It is the meeting of the Face of the other man that puts us in front of the mystery and the gift of hospitality. But what to host of man in that hyper human “looking at one in the face” of which our every day life should feed on?

Mario Picozzi
rMH 6, 2008, 31-35

Gift and freedom

A society is constituted by social bounds and a circulation of objects along with services. In any society, there is an interaction among the concepts of gift, market and state. Considering the increasing need of transplant organs, these different concepts and their links are analyzed to offer evaluation criteria.  

Bernard Baertschi
rMH 6, 2008, 36-43

Giving one's blood, is it reasonable?  

Giving blood is a very particular gift: at times defined as transplant, at times as medicine, always as “act of benevolent solidarity”. Not always, however, a practice which is free, voluntary and risky for the giver, is capable of satisfying that which is recognized as a right to treatment: indeed, the shortage of blood puts us in front of a practical and ethical problem. This article values in an analytical way the various solutions theoretically imaginable to face this difficulty, considering the advantages, the obstacles and the undesirable consequences: to encourage the moral conscience of the individuals in order they may become givers, paying the givers, making giving obligatory. The solution that the analysis arrives at is one which puts forward a principle of justice based on reciprocity: favouring in the distribution of blood those who choose in their turn to be donors.  

Alain F. Junod
rMH 6, 2008, 79-86

Should the Oregon Health Plan be applied in Switzerland?

The Oregon Health Plan was developed to try to correct the inadequacy of the health insurance coverage in this State. It proposed to limit the number of treatable conditions as a function of priorities rather than to decrease the number of people having access to insurance. This project, which is a form of explicit rationing, was the fruit of an intense preparation on the values of the cost/benefit ratio of hundreds of treatments and involved heavily citizens of the State. Although the health insurance systems differ between the United States and Switzerland, the implementation of this program of explicit rationing through an important information campaign and the involvement of the population deserves due consideration. Especially in view of the fact that, in Switzerland as well as elsewhere, a phenomenon of insidious implicit rationing appears to develop...

Jean-Daniel Rainhorn
rMH 6, 2008, 87-95

Ethics, poverty and health

This article looks at the relationship between poverty and health, starting from the perspective of those who have no access to a quality sanitary structure. Observed from this point of view – which is the one of a broad part of world’s population –, ethical questions take a particular form and gravity. Fundamental values, like freedom, equality and justice, should be re-questioned. The health of the poor presents itself as an ethical question, being one of fundamental human rights. In particular, the author looks at some problems that focus on the conditions of populations in poverty: the paradox of the “paying poor”, that is the poor forced (without having the chance) to pay for sanitary care out of their own pockets; the traffic of organs, which has a different meaning for the rich and for those that have only their bodies to sell; the clinical test for HIV/Aids vaccinations; brain drain’s effects.  

Maria Schubert
rMH 6, 2008, 96-98

Effects of Rationing of Nursing Care in Switzerland

The Rationing of Nursing in Switzerland Study was initiated in response to reports from nurses regarding implicit rationing of nursing care in Swiss hospitals. The aims of this study were to describe the levels of implicit rationing of nursing care in Swiss acute care hospitals and to explore its association with selected patient and nurse outcomes, adjusting for major organizational variables. A convenience sample of 1338 nurses and 779 patients of eight acute care hospitals were included. Ninety-three percent of participating nurses reported having had to ration their care in the previous seven working days. Due to scarce nursing resources, the most frequently omitted nursing measures involved documentation or caring. Although average rationing levels were low (slightly below rarely), implicit rationing of nursing care was the only factor significantly related with all six patient and both nurse outcomes studied. Regarding patient safety, quality of nursing care and patient protection from harm, then, even very slight rationing is cause for concern. Since rationing of nursing care cannot be completely avoided, it is important to acquire more knowledge of these processes, and to define a clinically meaningful rationing threshold.