rMH 5, 2008, 13-18
This essay deals with the problem of knowledge concerning singularity and subjectivity, through the analysis of the epistemological significance of the singular case study. This paper is made up of two main parts. The first analyses the function that the singular case study can assume in clinical literature, especially in pathologies concerning human higher functions. It especially emphasises the role that the «clinical case format» can have in order to highlight pathological phenomena that seem at the present not to have been adequately understood or treated. At the same time, within a research context the interpretation of a clinical case also seems to provide a context within which the proposal for a new tradition of research/a new style of explanation can be situated. The fact that each «singular» case also has a «general» reference framework and a «general» conceptual significance, this does not imply, however, that it is therefore also destined to dissolve within a new, general theory, leaving no room for an individual-based approach. The second part of the essay is then devoted to the analysis of the reasons why «cases won’t go away», that is the reason why clinical disciplines (and especially certain ones) seem to be constitutionally bound to an individualising approach and to a personal level of analysis also based on singular cases.
rMH 5, 2008, 19-22
Auguste D. and the Alzheimer's disease
The theme discussed is the clinical case considered as a method of scientific communication. Through an analysis of the narrative structure of a historic case – that of Auguste D. presented by Alois Alzheimer in 1906 – it is shown how the scientific documentation in a clinical case can determine a new knowledge in the panorama of medicine, in a precise historic period. The first case of what was going to be indicated as the Alzheimer’s disease constitutes a prototype for further studies, which are still at the centre of complex issues. For an ulterior epistemological examination, a synopsis between the case of Auguste D. and a contemporary one is suggested. The comparison between the two allows an acknowledgement of the continuity of perspectives in neuroscientific research from Alzheimer’s time up to now. However, even if one shows the diversity of investigative methods, researching the correlation between various cognitive disturbances and the anatomic and functional structure of the brain turns out to be central.
rMH 5, 2008, 23-26
The clinical lives of illustrious men
In the last hundred and fifty years, the relationship between genius and madness has been one of the most debated themes in psychiatric knowledge. This debate has produced a series of works that are now considered amongst the classics of psychiatric literature and have not only had clinical importance, but also a social one. This work analyses some ways in which psychiatry has put into debate the privileged position that genius has gained in modernity, making it a clinical case, and some being among the most relevant answers that the western culture has produced in response to this menace.
Marc J. Ratcliff
rMH 5, 2008, 27-33
Of the proper use of the case
This article proposes to study the psychologist’s relationship with the test and with the case, analysing how he deals with the instruments at his disposal or that he creates for clinical diagnostics. We analyse this relationship at the «laboratory of psychology» of the Cantonal Hospital of Geneva, directed since 1940 by the Swiss psychologist André Rey (1906-1965). This laboratory is one of the first services in psychological consultation established in Switzerland in a medical environment, by Édouard Claparède (1873-1940).
rMH 5, 2008, 73-78
Practical Wisdom or Economic Rationality?
This article explores the relationship between ethics and economics in the area of health care. Justice, it is argued, needs to be the superior measure in health care, not economic rationality, because health and life are fundamental capabilities (in the sense of Martha Nussbaum’s «capabilities approach»). But opposite to economic rationality is also practical wisdom, a term that refers to Aristotle’s concept of phronesis. Three practical examples are discussed in this light: research with human embryos, assistance to suicide provided by right-to-die organizations, and living donor organ transplantation. A proper ethical discussion of these examples needs them to be inscribed into a perspective of «good life». This implies a critical reflection on what it means to be a human being, without falling into the trap of ideological naturalism. Practical wisdom can be a guiding idea for economic rationality that directs the actors to real needs (not just the needs of the market), and to what is really useful to human life.
rMH 5, 2008, 79-85
The right to be cured. Why is it disturbing?
The recognition of a justifiable right to be cured (that is a right that can be appealed in justice) implies the reinforcement of the position of the person who made the appeal in comparison with the those burdened with the task of allocating resources; it is in this way that one can even involve and modification in the politics of health. It is in this way that it can be disturbing. Two examples illustrate this issue: the first looks at the problem of geographical access to cure; the second concentrates on the criteria of allocation of the organs in view of transplants. The author studies these two examples, after having examined the specifics of rights to be cured in Switzerland, considering that the issues presented here are not dissimilar to those posed in other countries. It is therefore a problematic that has certain universality.
rMH 5, 2008, 91-94
The error in the sanitary field: lessons from the SAVE research
Errors in medicine have been defined as the failure of a planned action to be completed as intended (execution error), or the use of a wrong plan to achieve an aim (planning error). The primary purpose of reporting errors is to learn from experience, thus monitoring continuously our progress in prevention. A non-punitive, independent and confidential reporting system has been considered one of the most effective practices of reporting, aiming to achieve a «safe practice program» of risk management for a given hospital. We therefore developed a similar incident reporting system (IRS) in our multi-site hospital ICUs (33 beds) of the Ente Ospedaliero Cantonale of Canton Ticino, mainly aiming to analyze factors from reports that contribute to incidents and use this knowledge to improve patient safety. The IRS was accomplished in 2006, with the nurses completing most of the reports in spite of intermittent motivation barriers. Common types of errors were slips and lapses, guidelines not being followed and a high incidence of communication and medication errors. Future directions should focus on understanding barriers in reporting, developing, implementing and disseminating datamanaging systems and evidence-based initiatives to improve patient safety.
rMH 5, 2008, 95-101
Medical error between prevention, fault and errancy
The authors concentrate on the theme of medical error to underline the need to develop a culture capable of speaking about such events, to imagine their possible occurrences and to integrate the phenomenon of error as a constitutive element of the art of medicine. This, not only with the aim of favouring a more efficient prevention of errors and a better management of their consequences, but also of rethinking – through the mirror of errors – the epistemological assumptions and the values grounding our western medicine.
Fabio Mario Conti
rMH 5, 2008, 102-105
Treating and taking on patients with severe and lasting cerebral injuries
The author brings up and comments upon the main points of the Medical-ethical Guidelines of the Swiss Academy of Medical Sciences
dedicated to treatments and the taking on of patients that suffer from severe and lasting cerebral pathology, insisting on how the responsibility of the decisions on their behalf is made heavy by the multiplicity of the parameters that are difficult to handle. He adds considerations taken from his own clinical experience.
rMH 5, 2008, 106-111
Sissel Tolaas and the art of olfaction
Every day we breathe about 12.5 m3 of air and repeat the same action over 23 040 times, breathing in pairs – in and out – with two exceptions: at the beginning and the end of our life. But respiration not only fulfils a vital function, it also channels molecules of odour to the nervous system, which in turn convey important information about our surroundings. Smell is the oldest phylogenetic sense, yet it is also the most neglected. The artist Sissel Tolaas uses her background in chemistry to work with smells, investigating the physical world through the nose. By analysing the effects smells have on people’s bodies and psychology, she is able to intervene on hospital environments modifying their perception as sites of sorrow. Fear is communicated through smell, yet smells can also relax muscles and induce concentration. For a maternity ward in the UK she has designed sofas upholstered with microcapsulated fabric, which release a scent of vanilla when seated on. New mothers stilling their babies will be able to dissociate the experience from the hospitalized environment. A further step, currently under research, is to formulate an «odour therapy» for the rehabilitation of brain damaged patients.
rMH 5, 2008, 115-125
Reflections on monitoring in intensive care
Monitoring in the intensive care department has substantial advantages on one hand but also it creates a series of side effects. The purpose of these reflections is to face the delicate issue of the monitoring, beyond the typical technical aspects or the known syndromes related to the sensorial deprivation/over-stimulation that characterize some aspects of hospitalisation in the intensive care room. Therefore the theme was approached with an ethical, philosophical and psychological prospective that distinguishes the Medical Humanities disciplines. Issues such as monitoring/time relationship, space, body, perception of death, need for control, fate, telling, concrete and symbolic have been discussed. Various theoretical inputs and medical staff testimonials led to the conclusion that it is possible to counter the monitoring act and therefore the technologization of the individual’s existence, with the need of demonitoring that occurs still in the intensive care room and that brings back to the patient and to the care team the inseparable and ineluctable dimensions of the human being.