Rivista per le Medical Humanities

Franco Zambelloni
rMH 25, 2013, 11-33

The shadow of Evil

Already the oldest mythologies conceived good and evil as absolute opposites, die-hard opponents. Even common sense would make us believe that life and death, pleasure and pain are incompatible with each other. But if one looks at mythological and religious attempts to understand evil in its natural and human manifestations, one begins to doubt of a net separation: good and evil seem rather to emerge from a single root and to represent the two faces of a single identity. Moving from this analysis, this report considers the ability of good and evil that is in every person and also finds in human nature the same ambiguous presence. Recent scientific knowledge – from biology to ethology and neuroscience – confirm that life and death, pleasure and pain, altruism and aggression constitute a constant interweaving, inseparable in the path of life. In nature, what we assess as positive and negative are related: as light and shadow, good and evil are always present. But man establishes values, under which he rewards or condemns what in nature is totally valueless. Culture, emerging from nature and moving away from it, produces, together with values, the categories of good and evil: fight for the one and against the other is precisely what characterizes us as cultural animals.

Enrichetta Buchli
rMH 25, 2013, 57-61

No country for old men

The old man has traditionally enjoyed a special privilege as depositary of knowledge. In postmodern society, on the other hand, there is no place for the elderly. And perhaps this is the origin of the various difficulties that seniors face: loneliness, abandonment, depression, perception of total uselessness, physical discomfort and disabilities. Our postmodern, liquidconsumerist civilization is marked, if we believe Zygmunt Bauman, by a serious anthropological mutation of temporality, characterized by the tyranny of the present that slices the timestream by forcing a rootless man to live in an eternal present like animals. Then, what can make seniors feel still alive, recognizable, and guarantee in old age a quality human life? That question should be afforded by doctors and by those interacting with old persons. If the conceptual and symbolic idea of old age is the great absent from the postmodern society, we should take a small step back and rethink an “old age culture”, ancient and new at the same time. 

Graziano Ruggieri
rMH 25, 2013, 62-68

The risk of diagnostical therapeutic obstinacy in old age patient

Aging has been constructed as a problem that pose a great threat to our healthcare and social service systems. This threat is reflected in healthcare regimes, scientific research, and market innovations that treat elderly bodies as beset by decline, deterioration, and age-related diseases that require intervention. The recent surge of gerontological research must be contextualized within this apocalyptic discourse. Developments in the realms of medical innovation and geriatric clinical intervention impact our understanding of the nature of late life, the possibilities for health in advanced age and the medical decision making model in ways that could not have been predicted 20 years ago. The purpose of this paper is to analyze the impact of the “biomedicalization of old age” through a discussion of some aspects in this emergent clinical and ethical field of medicine. Foucault’s theoretical work can be used to understand the construction of old age and as critical analysis of this postmodern gaze on aging. Under this biomedical gaze, aging is only treated as pathological phenomenon and is managed through clinical treatments established by medical professionals. This codification is a reflection of the larger cultural process that Ivan Illich called “the medicalization of everyday life”. We believe that this focus on the biomedicalization of aging is dangerous and seriously limits the ability of people, researchers, and doctors to focus on any other aspects of aging such as the psychological, emotional, and social aspects. In order for this to happen, society’s “medicalized” view toward life and aging needs to be dispelled and a new, more comprehensive, positive outlook on life and aging needs to be developed. Unfortunately, given the dominance of the biomedical focus on life, it doesn’t seem that the needed changes will occur any time soon.

rMH 25, 2013, 70-75

Maltreatment of older persons

The care and support of elderly, especially if dependent, is a field of growing importance in view of the demographic aging of our populations, with marked political consequences. It leads to additional demands for resources. A changing society has to develop a related new culture, in a perspective of conviviality and public health. This paper discusses the issues posed by maltreatment of various types, which may be observed in the care of old dependent persons: voluntary or involuntary, active or passive. The reality of violence in care has long been underestimated or hidden (in regard to both old persons and children). Yet it exists and it should be discussed. Its possible causes have to be studied and corrective and preventive programmes should be devised: on one hand for the training and support of professionals and other helpers, as well as health institutions, and as control measures; on the other hand, for the old persons themselves, aiming to the empowerment. When the severity of the cases makes it necessary, disciplinary or penal procedures must be undertaken. This problem is a real challenge, from a public health as well as community life point of view.

Pietro Tiraboschi
rMH 25, 2013, 76-82

Communicating the diagnosis to a patient affected by dementia

Several ethical problems need to be faced by physicians in their dealings with persons with dementia in the different stages of the disease. Both chronologically and in terms of relevance, the first issue is whether or not to disclose the diagnosis to the patient. How this is faced by physicians has a deep effect on medical and non-medical decisions, which would be taken with or without the direct consent and active participation of the patient. Huge differences in dealing with this topic have been shown in the past between US and Italian physicians. 

Claudia Gamondi
rMH 25, 2013, 83-84

End of life care and dementia

Dementia is a progressive and irreversible disease. At present there are no treatments allowing specific etiological healing. In Switzerland, more than 110,000 people are currently living with dementia. These numbers are expected to rise: in 2050 it is estimated that about 266,000 people will be suffering from dementia. The average survival of patients with dementia is about 8 years. Many tools can help clinicians to identify patients’ prognosis and to adapt therapeutic choices accordingly. It represents good clinical practice to use these tools in order to prioritize care goals, inform the relatives and implement advance directives. It is known that the simple question, “would you be surprised if this patient will be dead within the next three to six months?” is a valuable and simple tool to identify terminal ill patients. Dementia patients do not receive adequate palliative care neither in the early stages of the disease nor at the final stages. The burden of not recognized and undertreated symptoms is high, causing an unnecessary and largely avoidable suffering.

Antonello Ambrosio
rMH 25, 2013, 85-89

Advance directives between limitations and opportunities

If the new federal rules have had the merit to clarify legally the issue of advance directives much still remains to be done in terms of ethics. The drafting thereof may lead to critical points, not immediately appareant: fragility (who writes advance directives must necessarily face, at least in hypothetical terms, the idea of its death), projection (to imagine a condition for which we do not want any more therapeutic support, which is always a loss-making operation) and the difficulty of coming to a shared understanding of potential future conditions between therapist and patient. The forms (designed by some associations) for advance directives can help people in their efforts to express themselves, although the risk remains of simplifying and reducing the man in its imagination about his own death and how he envisages being taken over by the institution.