Rivista per le Medical Humanities

Simone Romagnoli
rMH 47, 2020, 11-14

Presumed consent in the context of organ donation

The text presents in an introductory form the models of authorisation for post-mortem organ removal and the context of the debate currently taking place in Switzerland, a country that deals with a persistent lack of organs, given that the demand for organs for transplantation dramatically exceeds the offer. As the current situation is not satisfactory, it is necessary to reflect on new measures, while respecting fundamental rights, in particular personal freedom. With regard to the ongoing discussion, at an ethical, political and legal level, particular importance is given to the opinions expressed by the National Advisory Commission on Biomedical Ethics (NEK-CNE), respectively in 2012 and 2019, the latter being reproduced in full in the rest of the volume. The goal is to provide the reader with some general information that will allow him to grasp the issues linked to the subject matter of the dossier and discussed in the various articles.

Guenda Bernegger
rMH 47, 2020, 17-37

Organ donation and consent models. An invitation to express oneself

What do people really think on the issue of consent to organ donation? And in particular, what is their approach with respect to the different models of authorisation for removal, which various ethical and political instances have recently been carrying out and offering for discussion? In this respect, the editorial staff of rMH decided to make its contribution by inviting some colleagues to express themselves on a pregnant topic full of implications not only of a clinical, legal and political nature, but at the emotional and symbolic level as well. The purpose is to help the reader, who is perhaps likewise at the mercy of conflicting thoughts and feelings, to reach a clearer and more precise understanding of the issue and to lead him to make a free choice and achieve a well-founded awareness. The call was welcome by Raffaella Ada Colombo, Paolo Ferrari, Paolo Cattorini, Marco Previsdomini, Mario Picozzi, Mario Lazzaro, Ernesto Borghi, Fabio Pusterla, Andreina Bocchi.

Commissione Nazional CNE
rMH 47, 2020, 38-61

Organ donation. Ethical considerations on the authorisation models for organ removal

In the light of the fact that there is a shortage of organs for trans- plant, the National Advisory Commission on Biomedical Ethics (NEK-CNE) suggests to implement the «declaration model» as a practice that can further encourage donation, thus sparing the families of the deceased an often difficult and painful choice, poised as they are between essential values: respect for the will – often not explicit – of the dead person and the altruistic and supportive gesture of the donation. The press release that is republished here was issued by the NEK-CNE on 9th September 2019, announcing the stance «Organ donation. Ethical considerations on the models of authorisation for organ removal»: this is the Opinion N. 31/2019 expressed by the National Advisory Commission on Biomedical Ethics (NEK-CNE), unanimously approved by the latter on June 27th, 2019. This document, made available in the Italian version (while the original version is the French one), is presented in the volume in its entirety, which faithfully reflects that published on the website: www.nek-cne.admin.ch.

Michael Llamas
Marco Conti
rMH 47, 2020, 67-75

Intubation, tracheotomy and artificial ventilation: specificity of covid-19 pneumonia

COVID-19 pneumonia has dramatically overwhelmed the healthcare system, putting a strain on doctors, nurses and hospitals altogether. The situation is told from the side of those who, standing on the front line and holding a position of responsibility in the field of intensive care – as is the case for the authors – found themselves in the condition of not being able to cope with the events, torn between deductions and clinical intuitions. The narration portrays and provides an insight into the typical profile of a patient suffering from COVID-19, allowing the reader to follow the possible evolution of his disease and its management, as well as to become acquainted with all the various therapeutic aids available. The article provides a valuable and precise testimony on how we can act in the emergency and in the awareness of starting almost from scratch, to fight a disease that still remains largely unknown.

Mattia Lepori
Paolo Merlani
rMH 47, 2020, 76-83

Triage: age as a criterion of choice?

In the emergency of the pandemic, medical and therapeutic resources are exposed to the risk of being in short supply, due to the large number of cases: the issue of triage – through which we try to convey the available resources to the most appropriate place – thus plays a key role, bringing clinical ethics and the right to treatment into play. A profound reflection on triage has become more than ever necessary, as specific decision-making tools for the emerging situation were not available at the begin- ning of the pandemic. The authors who, as early as between the end of February and the beginning of March 2020, contrib- uted to the creation of the guidelines of the Swiss Society of In- tensive Care Medicine (ssicm-sgi-ssmi) – which, when adapted, became the decision-making support then adopted through- out Switzerland – account for this trailblazing path. The resource allocation procedure must be based on the principle of equity and should be especially concentrated where such resources might be more useful.

Giorgio Merlani
rMH 47, 2020, 84-92

Total isolation versus

An analysis of the pandemic situation in Switzerland – especially in Ticino –, among the known data and what is still unknown, allows to clarify some of the concepts and words relating to the pandemic – e.g. “herd immunity”, “innate immunity”, “replication rates”, “serological tests”, “disease containment measures” – which even ordinary citizens have now introduced into their daily vocabulary, although these are not always accompanied by a clear and precise definition. On the contrary, all these concepts have long been well-known to the two speakers who took part in the lecture on September 23th, 2020, as cantonal doctor and infectious disease specialist, respectively. The interpretation of international data and the comparison with the strategies implemented by the various countries offer further elements, which favour a more objective insight into the cur- rent situation.

Alessandro Ceschi
Antonio Lanzavecchia
rMH 47, 2020, 93-98

Currently available medications and future vaccine: what are the prognostic possibilities?

What has been possible to do so far, at a pharmacological level, while waiting for the development of an anti-covid-19 vaccine? The medical and scientific director of the Institute of Pharma- cological Sciences of Southern Switzerland (isfsi), as well as director of the Clinical Trial Unit and chairman of the Drug and Therapeutics Committee at eoc, and the founder and for twenty years director of the Institute for Research in Biomedi- cine (irb) in Bellinzona, explain which medicaments are cur- rently valid for the different stages of the disease, and how the currently most effective therapies work. They also wonder to what extent it would have been possible to predict, or even pre- vent, the pandemic situation that has been affecting the whole world: a necessary reflection to acquire the ability to protect ourselves in the future.