Sezione Medicina

from Leadership Medica n. 2/2000

It's going on the debate about bioethics and the comparison this time focalizes ethical behaviors.
Interviewed first professor Enzo Pretolani, President of the Ethic Committee of the Hospital "Bufalini" of Cesena; then Professor Novarini of the University of Parma.

Interview to Prof. Enzo Pretolani, head of ethical committee of Bufalini Hospital, Cesena

L. M. - Do you think that behavior, based on ethical outlook, so much debated at the moment, may be originated in the formal education and upbringing each individual receives in their family and social environment?

P. - Ethics, which orders behavior, is certainly influenced by family education first of all, and secondly by school's. As far as medical bioethics is concerned its teaching should be compulsory and provided in medical school.

L. M. - As regards ethics, what are the "viruses" contributing to human degeneration today?

P. - The "viruses" which from an ethical perspective would contribute to a progressive moral decay of humanity are many, buth the main ones are four, namely ignorance, dogmatic fanaticism, reearchers' feeling of all-powerfulness, and greed for money.

L. M. - In the field of research, what may and should be the boundaries in carrying out experiments?

P. - Within the framework of experimental and clinical research, the foremost boundary must be the respect for human beings, living species and the environment. As regards human beings, the principle of freedom and self-determination principles are fundamental, whose core is representd by the informed consent. Another foremost boundary consists in not depriving the person involved in the research of an already establisehd tratment; this boundary could sometimes conflict with the placebo administration as envisaged in some research protocols

L. M. - Should biotechnologies have limits and boundaries, and, if yes, at what level should they be stopped?

P. - Biotechnologies, which are the basis of genetic engineering, comprise manipulation techniques of living entities, thus enabling to modify the genetic features of organism, by trasferring then from one being to another. A fundamental boundary - never to be bypassed even in the future - consists in totally prohibiting the manipulation of human beings via the possible complete transfer of genetic make-up. Strict laws are required for technologies aiming at creating transgenic animals an plants and their subsequent food products.

L. M. - The Hippocratic oath seems today be obsolete, considering that the regional medical boards provide autonomously for the drafting of an ethical code. What is your opinion? Should a thorough code be drafted which doctors ought to adhere to?

P. - The Hippocratic oath is still valid today from a conceptual and moral perspective, with the addition of the fundamental guidelines established by the Helsinki declaration, of Medical Bioethics, and the revised national Code of Medical Deontology.

L. M. - Doctors should be influenced in their activity by a merely economic reasoning? Would not it hamper both the doctor's and the patient 'freedom?

P. - Doctors should not be conditioned both in the public and private spheres by exclusively or mainly economic aspects, because a balanced and not biased position should be required between the search for profit and a totally voluntary, charity based approach. The centrality of the doctor-patient relatinship should be stressed again, based on mutual trust and co-operation in order to overcome the incresed conflict now permeating this age-old profession.

L. M. - Professor, in your book you have discussed some essential topic: the doctor-patient relationship, ethical dilemmas involving the holistic medicine. In your opinion what are the core issue to face?

P. - The doctor-patient relationship, as previously stated, should become the fundamental element of holistic medicine, as a way of carrying out and living the medical professions, where the patient is evaluated in his/her entirety, namely in his/her psycho-physical wholeness, thus bypassing today's fragmentary approach derived from hyper-specialization, generally considering the involved organ quite separated from the general context of the disease, of which the patient should be considered the subject and not an object.

Interview to professor Almerico Novarini, Medical  Semeiotic Institute of the University of Parma

L. M. - Which are, according to you, the sectors where professional ethics is less sensed by the medical class?

N. - That of ethics is a strong problem coming out ever more for the dilemma planted nowadays by the medical profession. As a clinic I notice troubles mainly in the physician-patient relationship, concerning the possibility that decisions are taken by the means of a free informed consent and over the active participation of the physician who proposes diagnostic-therapeutic free alternatives.

L. M. - Does it lack training?

N. - Sure. The medical training lacks in many fields as it emerges, for example in the health economy and ethics. 
The outburst of the scientific acknowledgment, the diagnostic and therapeutic possibilities and the increasing emergency about rights setting the physician-patient relationship not anymore on a paternalist level but on an almost equal level, requires suitable proposals and training is not gave nowadays in adequate and complete terms.

L. M. - Problems set by bioethics make physicians face choices of natural, religious kind and others...

N. - I think the lying problem is that of clearing which are the attitudes to have in front of the defense of life and as regard to the dignity of individuals. It concerns two untouchable goods that a physician must remember.

L. M. - Is there the risk to create a break between the Catholic physicians, maybe more sensitive to this kind of problem, and others supporting laic positions?

N. - I think there's no break provided it is clearly told which role must the physician act in front of the defense of life and human dignity.
For example it cannot be asserted that under certain conditions there's no life anymore; life is one of the untouchable goods also according to the Italian constitution.
If we put ourselves in front of the great dignity and beauty of our profession, then we must understand that the physician must defend life and respect it. Choices must not be imposed but discussed.
Following I'm in favor of a basic aspect of the professional ethics: that of the reciprocal freedom, the patient's freedom and that of the physician that must behaviors according to one's conscience.

L. M. - And in the case the patient bears that there's no live anymore?

N. - I do not intervene. It's not this way for me. I mean that the physician must respect the will of the patient, but he must not accept it if in contrast with his conscience. And that for any kind of choice. I tell my opinion to the patient, I tell him what science tells me to do if the therapy or the intervention matches my morals and my convictions, and otherwise I reject intervening. I'm enthusiastic for the concept of freedom and responsibility by the physician and the patient when he is correctly informed.

L. M. - Does not it seem to you that due to the scientific advances physicians have become arrogant?

N. - There has always been arrogance. On the other side the physician is in a position of advantage since he is who cures. 
But it must be remembered a basic principle: man is never a mean but an aim.
Man cannot be deemed a mean to carry out researches or to exploit his personal image.