rMH 18, 2011, 11-18
For an ethics of hope
The prediction of the course of an illness (prognosis) makes us think about the management of future in care. Today, uncertainty, truth based on probability and the subjectivity of health seem to complicate the communication between doctor and patient, destabilizing the relationship of trust. From a psychological point of view, hope can be considered as a positive emotion, which can usefully manage the expectations towards a possible or probable future. However, hope can lead us to hide or disregard reality and to pursue unrealistic objectives, bound to disenchantment. The present article analyses this problem applying the principles of bioethics: in emphasizing the therapeutic intent and its privileges, the controversial relationship between autonomy and beneficence results to be more balanced.
rMH 18, 2011, 19-21
The shared truth
This is a text on hope, dashed off in haste, inspired by the thousands of interviews with the families of our patients in intensive care, which included the duty of communicating them «bad news». It shows how hope is, unintentionally, adapted to truth, uncertainty and trust.
rMH 18, 2011, 22-27
The time of expectations in antiquity
Hope is a typical capacity of the human mind of projecting itself in the future and, in so doing, of feeling and emotion about it. It has represented a complex notion ever since the Greeks. A factor of dynamism in taking action and sustaining the mood of the troops in the Iliad, it often transcends the possibilities of success and leads to failure. In the Greek tragedy of the classical period, trust and blindness were the two sides of hope. At the opposite, for the Hippocratic medicine, which is focused on the development of the illness and on its possible result, hope appears as a rational prevision of its progress and not as a patient’s feeling. This hope-expectation leads to the happy or sad prognosis. The doctor’s personal sensitivity is involved only at a later time and for the most serious cases, for which the death is expected. According to the historian Thucydides, the issue of the issue of hope, preserved by human beings on the face of adverse conditions, is deceiving and calls for a political interpretation.
rMH 18, 2011, 28-35
To abandon every hope?
It is said that, when everything is lost, hope remains. What is not said is that this can be more a refined torture than a sweet consolation. Anyway, as shown in the myth of Pandora, the Greeks distrusted hope and would have been surprised to see it elevated at the rank of divine virtue. In fact, hope presumes to put oneself in the hands of God and to wait for the accomplishment of the whole with fear and tremor. Despite gesturing at the “Galileans” only between the lines, he condemns from the outset this servile attitude which exempts us from facing one’s responsibilities and from accepting reality. Without a doubt, the dream of a better world is a powerful motor of action, which prevents us from adhering to this world and from investing in it. In the same way, Montaigne considers hope an illusory character because it prevents us from «living with purpose». The practice of diversion can’t be blamed. The restless wait removes every frivolousness from it and makes it sadly systematic. Whatever one might say, hope goes with fear and uncertainty. Pascal understood it, when made it a matter for a doubtful bet on eternal life. However, this promise of salvation reduces our present life to a simple parenthesis without importance: it is only enough to wait the necessary time in order to spend it. On the contrary, as Dante asserts, we must abandon every hope to the purpose of living fully: not in order to go beyond the hell’s doors but because the accomplishment is already here, at hand. In this way, we will be able to wait for it with trust and without fear.
rMH 18, 2011, 36-39
«Grasp eternity in the instant»
Hope lives in the heart of care act as a kind of temporal «passeur
», both emotional and projectual. Even in the most serious cases, it keeps the future alive until its time, until the last act of Atropos
. A cure without the company of hope is blind. Despite being a constant need of the patient, however, it is of ever less importance in the techno-scientific domains of contemporary medicine. It seems to be excluded from the medicine in order to be entrusted to other “specialists”, those of the “passions of the soul”, or reduced to an index of “good communication” in the patient-caregiver relationship. Hope, instead, «builds the future». The future of a patient lies not just in the diagnosis, or even in the prognosis, rather in the reception of their still hidden possibles. Hope takes charge of this unlimited openness toward the possibilities of life. It takes charge of a co-construction of the future between the care provider and the patient, the who waits for the future and the one who trusts the generative and regenerative force of the «presence».
rMH 18, 2011, 40-42
The dawn of a promise
Hope is constituted in the simplicity of sharing, by sharing all our fragilities towards the disease; together, open to possibles, whose limits and utopias we accept, we challenge the intransigence of a sentence that abolishes our freedom. This is how I interpret the passionate character of a relationship in care that, without renouncing to knowledge and skill, grounds its dignity in the invulnerable consciousness of a deed to hope; need for a freedom that elates us beyond any threaten to our fidelity to a life so spoiled by illness.
Paola Di Giulio
rMH 18, 2011, 65-68
Are we all at risk?
The decision of what constitutes a risk and what is normal have been the preserve of the medical profession but the closeness to those who profit from developing drugs for new diseases may make the profession no longer fit to take such decisions. The recent example of the recommendations for treating with drugs patients with a blood pressure ranging from 130-139 and 80-89mmHg, previously considered within normal ranges, and the creation of a the new entity of the “pre-hypertension” as a risk factor for developing hypertension or cardiovascular problems is an example of contamination between profession, industry and market. Pre-hypertension, together with other conditions such as pre diabetes, pre-osteoporosis and other preillnesses, has the potential to transform most of the world’s adult population into patients. Another example is the obesity, which is strongly related to diet and lack of exercise: an intervention on promoting exercise without affecting the strong power of food industry (that strongly condition the market and what we eat) very powerful food market will inevitably transform obesity in a condition that requires exams and drugs. The definition of the boundaries between health and illness cannot be left only to the medical profession, and the choice is between interventions on economical and social determinants of illness or the medicalization of society.
rMH 18, 2011, 69-75
Patient safety and the caregiver's professional responsibility
The task of guaranteeing the safety of the patient holds a central place in all theories of nursing, in all directives and deontological codes of caring professions, as shown by a quick survey of the texts. In everyday practice, the patient’s safety can only derive from the concerted and integrated action of many professionals, who deal with the care of the person and are called to grant it in different and complementary ways and to different extents. This article focuses on the different and complementary responsibilities of the various actors towards the patient’s safety.
rMH 18, 2011, 89-94
Basic care for non regular immigrants in the national health care system
In 2007 the San Paolo Hospital (Milan) has activated an outpatients department for irregular immigrants. We conducted a retrospective study of all the first examinations between October 2008 and August 2010 on 644 patients (417 males and 224 females) of an average age of 35.8 year-old (males: 34.9, females: 41.7). The average time of residency in Italy is 3.8 years. 27% of the total were employed with caretaking mansions, another 27% were workers, 14% had occasional or varying jobs, 8% were retailers, 2% students and 22% unemployed The main pathologies diagnosed were the orthopaedic and gastroenteric ones, infection of the higher respiratory system, symptoms of influenza and diabetes mellitus. It is therefore deemed necessary to activate outpatients clinics open to irregular migrants in the other main hospitals of Milan and in the rest of the region, in order to guarantee the best possible basic medical care to a population present and rooted into our territory for many years, but often paradoxically excluded from the sphere of social and medical care.