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UNESCO Chair in Bioethics 9th World Conference

Bioethics, Medical
Ethics and Health Law
Programme and
Book of Abstracts
Royal Continental Congress Centre
Naples, Italy
November 19-21, 2013

Secretariat: ISAS International Seminars, POB 574, Jerusalem 91004, Israel, Tel: +972-2-6520574, seminars@isas.co.il

Table of Contents

Programme at a Glance

2-3

Social Programme

Message from the Conference Presidents

UNESCO Chair in Bioethics, Unit Heads, Departments and Sponsors

UNESCO Chair Document Center Network

Local Ethics Committee Members

Call for Establishment of New Bioethics Units

General Information

10

Scientific Programme - Oral Presentations

11

Tuesday, November 19

13

Wednesday, November 20

20

Thursday, November 21

31

Poster Presentations

35

Abstracts
Oral Presentations (alphabetical order by author)
Poster Presentations (by day and by presenter)

37
167

Tuesday, November 19

169

Wednesday, November 20

177

Index of Chairmen, Speakers and Authors


Map of Conference Venues and Location of Halls

Social Programme
Tuesday, November 19 - 19:00 in Hotel Restaurant
Welcome Gala Get-together Dinner with Musical Accompaniment
Wednesday November 20
19:30 Musical Performance in Hall A - Amelia and Francesca
Rondinella preceded with wine and socializing
21:00 Farewell Dinner in Hotel Restaurant
Optional Tours: See conference registration desk

185
inside back cover

Message from the Conference Presidents

President Carmis Message


For the first fifty years of bioethics we discussed the construction and development of its concept. The original idea slowly
gained its directions and followers, and constitutes a comprehensive perception concerning many issues that are critical
for our human society. We are now facing a second stage, a new task, that seems to be even more important, complex
and difficult, namely the delivering of our message to society, by planting the ethical values into the soul of the people
and into their daily life and behavior.
Our task may be and should be realized in two ways, by two different tools: An educational tool and a legal tool. The
educational tool will consist of the use of novel methods that will enable us access to the minds of potential consumers
- the students, the caretakers, the patients and the public at large. The theory and language of bioethics should be
translated and adopted by the legislator and the judiciary, and constitute the legal tool.
A concrete example can be found in the Universal Declaration of Bioethics and Human Rights of UNESCO, and its
application by the UNESCO Chair in Bioethics. The UNESCO Declaration includes 15 ethical principles that have been
approved and accepted by all the states worldwide. Our UNESO Chair in Bioethics was authorized to deliver the message
of the Declaration to the students all over the world. The first step has been made. We have published ten guidance
books for teachers and have established not less than 32 Units in 32 academic institutes on five continents. Each Unit is
committed to the advancement of ethics education in its university and around its country.
The experts that attend our conference in Napoli are expected to undertake this mission, to start the second step and
to establish additional units in their own institutes. You have the knowledge and the close contact to the field of bioethics,
you understand its relevance and importance, you have the tools, the wisdom and the courage to motivate this process.
Let the Conference in Napoli function and serve as the bioethical lighthouse for the next generation.

Prof. Amnon Carmi


Zefat Academic College

President Buccellis Message


More than 40 years have passed from the brilliant intuition by Potter who proposed ethical thought as the science of
survival and a bridge towards the future of human existence threatened by the dramatic progress and massive use of
biotechnologies and detached from the necessary focus on moral values and principles. It seems now convenient to review
the events that have taken place along that bridge connecting biological knowledge with human values. This must be
done in view of a more aware and constant development aiming at a salvational equilibrium between science and society.
In this framework, ethical committees, established to meet the need for a balanced cultural and moral mediation at the
highest levels, in the confrontation between scientific progress and human rights in a pluralistic and inter -as well asmultidisciplinary framework, are fitly taking part in the spread and progress of bioethics towards creating a correct
relationship between anthropology, ethics and scientific research.
For such a reason, the Ethical Committee for Biomedical Activities Carlo Romano of the Universit degli Studi di Napoli,
has been engaged for a long time in the promotion and defense of bioethical and medical deontological principles as
well as in the ethical training of medical and non-medical staff at international level too, and is now proud to collaborate
with great enthusiasm to the organization of the 9th World Conference of the UNESCO Chair in Bioethics concerning
the future prospects of Bioethics in the 21st Century. The fruitful collaboration with the UNESCO Chair in Bioethics and
their mission as well as with the European Centre of Bioethics and Quality of Life - UNESCO Chair in Bioethics Italian Unit
and the great appreciation for Prof. Carmis and Dr. Vasinovas unrelenting activity have contributed to establishing an
increasingly closer relationship between the Committee and the above Institutions.
Therefore, the present World Conference represents the fair reward for the efforts made by the Committees members
and Secretariat for their indefatigable activity in favor of a clinical and experimental medicine that respects people and
their personal autonomy while being necessarily aware of the need for a balanced scientific progress.
I am convinced that this large pool of energies, competences and enthusiasm by the Congress participants will be
tantamount to the progress and success of bioethics in the years to come, also thanks to the contribution of Italian experts
and scholars among whom we may count many students.
I therefore wish everybody fruitful discussions in the beautiful city of Naples rich in history, sensitivity and cultural traditions.

Prof. Claudio Buccelli


University of Naples Federico II Ethics Committee Director & International Office for Bioethics Research Head & UNESCO
Chair in Bioethics International Network Scientific Coordinator

The UNESCO Chair in Bioethics

Presidents of the Conference


Prof. Amnon Carmi Prof. Claudio Buccelli
Vice President
Dr. Miroslava Vasinova
International Scientific Committee
Dr. Yoram Blachar (Coordinator)
Prof. Shai Ashkenazi, Dr. Oren Asman, Dr. Jeff Blackmer, Prof. Russell DSouza,
Dr. Leonid Eidelman, Dr. Dafna Feinholz, Adv. Annabel Seebohm,
Adv. Leah Wapner, Dr. Cecil B. Wilson, Prof. Chonqi Wu
Heads of Units
Albania: Dr. Altin Stafa
Argentina: Prof. Moty Benyakar
Armenia: Dr. Susanna Davtyan
Australia: Dr. Irina Pollard
Austria: Dr. Gabriele Werner-Felmayer
Azerbaijan: Prof. Vugar Mammadov
Brazil: Prof. Jose Thome
Bulgaria: Prof. Sashka Popova
Canada: Prof. Joel Lamoure
China: Prof. Li Zhen
Croatia: Prof. Sun ana Roksandi Vidli ka
Czech Republic: Prof. Tomas Dolezal
Fiji: Ms. Sharon Biribo
Germany: Prof. Dr. Nils Hoppe
India Nodal Center: Prof. Dr. P. Thangaraju,
Prof. Dr. D. Balakrishnan
North India: Prof. Mushtaq Margoob, Prof.
Rafiq Pampori
South India: Dr. Princy Louis Palaty
Kerala: Prof. Dinesan Narayanan
West India: Prof. Anu Kant Mittal
Indonesia: Prof. Sajid Darmadipura
Israel: Prof. Shai Linn
Italy: Dr. Miroslava Vasinova
Japan: Prof. Mitsuyashu Kurosu
Macedonia: Prof. Mentor Hamiti
Malaysia: Prof. Dato Mohd Zin bin Bidin
Nigeria: Prof. Yohanna Dangata
Pakistan: Prof. Rizwan Taj
Poland: Prof. Joanna Rozynska
Russian Federation - St. Petersburg:
Dr. Galina Mikirtichan
Russian Federation - Volgograd: Prof. Natalia Sedova
Serbia: Prof Vojin Rakic
Sri Lanka: Dr. Harischandra Gambheera
Taiwan: Prof. Daniel Fu-Chang Tsai
Ukraine: Dr. Radmila Hrevtsova
USA: Dr. Harold J. Bursztajn, Dr. Terry Bard
Vietnam: Prof. Nguyen Duc Hinh;
Dr. Tran Thi Thanh Huong
Asia Pacific Bioethics Network:
Prof. Russell DSouza

Education Department
Argentina: Moty Benyakar
Australia: Irina Pollard, Russell DSouza, Giuliana Fuscaldo
Azerbaijan: Vugar Mammadov
Bulgaria: Sashka Popova
Canada: Joel Lamoure
Israel: Guy Enosh
Italy: Fulvia DeMatteis, Anna Maria Traversa,
Miroslava Vasinova
Nigeria: Yohanna Dangata
Serbia: Zoran Todorovic
USA: Miriam Cotler

Organized in collaboration with:


Ethics Committee for Biomedical Activities Carlo
Romano and the International Office for Bioethics
Research of the Naples Federico II University
The European Centre for Bioethics and Quality of
Life - UNESCO Chair in Bioethics Unit
LifeLong Learning Center of the Naples lOrientale
University

The conference is under the auspices of:


United Nations Educational, Scientific and Cultural
Organization (UNESCO)
World Medical Association (WMA)
Israel Medical Association (IMA)
Fourth International Conference, Zefat Bioethics
Forum, Zefat Academic College
International Center for Health, Law and Ethics,
Haifa University
China Health Law Society
World Association of Medical Law (WAML)
World Psychiatric Association (WPA)

Research Department
Albania: Altin Stafa
Argentina: Juan Jorge Michel Farina
Armenia: Susanna Davtyan
Australia: Michael Lupton, Russell DSouza, Giuliana
Fuscaldo, Mirko Garasic
Austria: Gabriele Werner-Felmayer
Belgium: Laurent Ravez
Brazil: Jose Thome
Bulgaria: Sashka Popova
Canada: Joel Lamoure
Czech Republic: Renata Veselska
Georgia: Irma Manjavidze, Eka Sanikidze
Israel: Guy Enosh, Yoram Blachar, Haim Knobler
Italy: Miroslava Vasinova, Paolo Benanti, Nunzia
Cannovo, Rosa Maria, Gaudio, Pasquale Giustiniani,
Alessandra Pentone, Anna Maria Traversa
Japan: Mitsuyasu Kurosu
Macedonia: Mentor Hamiti
Mexico: Ma de Luz Casas-Martinez
Nigeria: Yohanna Dangata
Serbia: Jovan Babic, Dragoslav Marinkovic, Vojin Rakic
South India: Princy Louis Palaty
Switzerland: Lazare Benaroyo
Taiwan: Daniel Fu-Chang Tsai
UK: Rhys Carwyn-Hooper
USA: Terry Bard, Miriam Cotler, Kenneth Goodman

Documents Center of the International Network of UNESCO Chair in Bioethics

The new framework

The UNESCO Chair in Bioethics

The Bioethics Documents Center of the International


Network of UNESCO Chair in Bioethics
I. Purposes: For establishing a comprehensive
documents center for collecting and providing
bioethics references, teaching materials and related
publications, the International Network of the
UNESCO Chair in Bioethics, as commissioned by
Director Professor Carmi, is planning to set up a
Bioethics Documents Center under the Network
Website.
II. Contents: For providing more comprehensive
function and presentation, we will use Bioethics
Documents center to substitute the original
category Publication. The Bioethics Documents
Center will contain five sub-categories including:
Case book series, Other UNESCO bioethics
books, Unit Country publications, Bioethics
multi-media and Other types of publications.
1. Case book series: keep the case book series
which already exist.

2. Other UNESCO bioethics books: other related


bioethics books published by UNESCO.
3. Unit country publications: bioethics books, papers,
and other publications published and provided
by all unit countries.
4. Bioethics multi-media: bioethics films, dramas,
other multi-media publications and links.
5. Other publications: relevant publications but not
from our unit countries.
III. Framework of the Bioethics Documents Center
Website
The new Bioethics Documents Center will be arranged
according to following framework with sub-categories.
IV. Working Plan
Once approved by Director Prof. Carmi, the UNESCO
Chair in Bioethics secretariat and website maintaining
unit will start to contact and collect bioethics
documents from contact persons and Unit countries
and do the website revision.

Local Ethics Committee


NAPLES FEDERICO II ETHICS COMMITTEE
President
Prof. Buccelli Claudio
Vice President
Prof. De Placido Sabino
Secretary
Prof. Mastronardi Pasquale
Members
Dr. Amirante Igino
Prof. Annunziato Lucio
Dr. ssa Bryce Jane
Dr. DOnofrio Gaetano
Dr. Cacciapuoti Giuseppe
Dr. ssa Cannovo Nunzia
Dr. Cimino Filiberto
Prof. Consiglio Eduardo
Avv. Cortese Silvana
Prof. De Divitiis Oreste
Prof. Del Forno Domenico

Prof. De Michele Giuseppe


Prof. Di Renzo Gianfranco Maria Luigi
Prof. Donisi Carmine
Dr. ssa Gasparini Nicoletta
Prof.ssa Izzo Paola
Prof. Lobello Roberto
Prof. Lombardi Gaetano
Prof. Rossi Guido
Prof. Rubba Paolo
Prof. Sacc Luigi
Dr. ssa Vozza Antonietta

EUROPEAN CENTRE FOR BIOETHICS AND QUALITY OF LIFE


UNESCO Chair in Bioethics Italian Unit
President: Dr. Miroslava Vasinova
Vice President: Avv. Agata Bonaudo
Secretary General: Dr. Patrizia Scaglia
Treasurer: Prof. Anna Maria Traversa
Scientific Director: Prof. Carlo Pasetti
Scientific Committee Members: Dr. Antonio Belloni,
Avv. Stefano Bonaudo, Dr. Antonio Colotto,
Dr. Fulvia Dematteis, Dr. Tiziana Devoti,

Dr. Stefano Ghidoni, Dr. Antonella Migliore,


Anna Maria Traversa
Honorary Members: Mons. Piero Monni,
Prof. Antonio Piga Rivero, Dr. Giacomo Sado
Founder Members: Dr. Maurizio Castellli,
Dr. Antonio Cerruti, Dr. Andrea Leonardi

The UNESCO Chair in Bioethics promotes

A Call for the Establishment


of New Bioethics Units
You are invited to establish a new UNIT at your Institute!
The United Nations Educational Scientific and Cultural
Organization (UNESCO) established (2001) the
UNESCO Chair in Bioethics
The purpose of the CHAIR is to build, activate, co-ordinate
and stimulate an International Network of Units in Academic
institutes for ethics education.
The Chair has established until now 33 Units in 33 countries
in the five Continents.
If you wish to establish a new UNESCO Unit in your own
institute you may forward your application to:
amnoncarmi@gmail.com
For more details, guidelines and list of other Units,
see: www.unesco-chair-bioethics.org

10

General Information

Conference Venue:
Halls A-H
Royal Continental Congress Center
Via Partenope 38-44
Naples, Italy
Tel. 081.7644621
Halls I-K
LOrientale University
Palazzo Du Mesnil
Via Partenope 10/A - 80121
Naples
Tel. 081.6909121
(5 minutes walk from venue - see map on inside back cover)

Language & Simultaneous Translation:


The World Conference will be held in English.
Simultaneous translation Italian/English & English/Italian
will be provided in Halls A, B, and I, and consecutive
translation in halls J and K
Conference Secretariat:
ISAS International Seminars
POB 574, Jerusalem 91004, Israel
Tel: +972-2-6520574
Fax: +972-2-6520558
seminars@isas.co.il
www.isas.co.il/bioethics2013
Local PCO:
Defla Organizzazione Eventi
Via del Parco Margherita, 49/3
80121, Naples, Italy
Tel: +39 081402093, Fax: +39 0810606133
bioethicsitaly2013@defla.it
In case of emergency: +39 334 7618996
Press Office Adviser: Dr. Giacomo SADO
com - mobil 0039 335 57 89671
The conference secretariat appreciates the generous
work of Giacomo Sado and the heads of the Naples
Municipality and Campania Regional administration
Press Offices
Conference secretariat and Press Office are located
in the Borbonica meeting room near the Auditorium Hall A

Name badges: Your personal name badge serves as


your passport to the scientific sessions. Participants
are expected to wear their badges visibly at all times.
No badge = no entry. Badge replacement costs 25.
Poster presentations should be put up in the lobby
area from 08:00-09:00 on the morning of presentation.
A hostess will be available to help attach the posters
each morning until 10:00. Posters must be removed
at the end of the day. The Organizers will not be
responsible for posters that have not been collected.
Business Centre:
Printing, copying and other office requirements can
be purchased at the Business Centre located in the
Royal Continental Hotel.
Accompanying Persons:
Accompanying persons do not have entry to lecture
halls. The registration fee includes the gala get-together
dinner, farewell dinner and folklore evening and a half
day tour of Naples - Walk with the Kings, Thursday,
November 21. Tour will depart Royal Continental at
13:00
Note:
ISAS International Seminars, Defla Organizzazione
Eventi and all sponsors shall not be responsible for
and shall be exempt from any liability in respect of
any loss, damage, injury, accident, delay or
inconvenience to any person, or luggage or any other
property for any reason whatsoever, for any tourist
services provided. Personal travel and health insurance
is recommended.
Gala Get-Together Dinner:
Tuesday, November 19 at 19:00 Hotel Restaurant
(Dress - informal)
Price: 60
Folklore Evening and Farewell Dinner:
Wednesday, November 20 at 19:30
Musical performance Hall A
Dinner Hotel Restaurant at 21:00 (Dress-informal)
Price: 70
Tickets must be purchased in advance

Hospitality desk:
November 19 and November 20: 09:00-18:30
November 21:
09:00-14:00

Tours:
For further information and questions about
tours, please contact the hospitality desk.

Certificate of Participation: A certificate of


participation will be supplied upon request.

Dine Around:
A list of nearby recommended restaurants will be
provided at the conference.

Access to lecture rooms: Your registration fee includes


entry to sessions, conference programme and book
of abstract, and coffee breaks. Seating is on a firstcome, first-served basis. We recommend you go to
the lecture room well before the session starts. Safety
regulations require us to limit access to the session if
the room is filled to capacity.
A sweater or jacket is recommended, as the conference
rooms may be cool.

UNESCO Chair in Bioethics 9th World Conference

Bioethics, Medical
Ethics and Health Law

Scientific Programme
Oral Presentations
Poster Presentations

Tuesday, November 19, 2013


08:00-09:00
Welcome coffee

13

Your own personal genome: ethical issues in directto-consumer (DTC) genomics services
Amy Michelle DeBaets, USA

09:00-10:30
CONSULTA WORKSHOP (1)
Hall B
ETHICS AND MEDICINE: ISSUES AND PROBLEMS IN
SOME AWARD AREAS I
Co-Chairs: Paolo Procaccianti, Filiberto Cimino
Current legislation in the field of preimplantation
genetic diagnosis in European Union members
Francesco Paolo Busard, Italy
Which consent in biobank-based research
Gianluca Montanari Vergallo, Italy
The donation of a persons body after death: a question
of ethics and science
Alessandro Bonsignore, Italy
Clinical experimentation on vulnerable subjects: issues
on the evaluation of a study on patients of the Italian
secure hospitals (OPG)
Valeria Marino, Italy
Immigrants! How Italian emergency health workers
perceive the other patients
Paola Antonella Fiore, Italy
Treatment prospects in sex offenders with paraphilic
disorders: pharmacological androgen deprivation
between the need for social defense and the right to
health
Roberta Carrossino, Italy

The ethics of preimplantational diagnosis in savior


embryos
Iuri Cosme Dutra da Silva, Brazil
Enhancing human persons: does it violate human
Nature?
Jason T. Eberl, USA
Genetic data protection and reuse: ethical implications
and legal issues
Mara Magnolia Pardo-Lpez, Spain
WPA SECTION ON PSYCHIATRY,
LAW AND ETHICS (1)
Co-Chairs: Oren Asman, Harold J. Bursztajn

Hall E

Ethical considerations in legal representation of older


clients with diminished capacity or impaired
competence
Meytal Segal-Reich, Israel
The study of massive psychic trauma and resilience is
fundamental for ethically informed psychiatric
diagnosis, treatment and forensic evaluation
Harold J. Bursztajn, USA
Informed consent in clinical studies on cognitively
impaired persons: an ethical dilemma in research
Gary Sinoff, Israel
Experiencing seclusion: a phenomenological study
Dave Holmes, Canada

From Bonifacios serum to stamina method:


the overpromising of alternative therapies
Giacomo Tassi, Italy

Long acting injections antipsychotics: ethical issues


Irket Kadilli, Italy

The Stamina case: bioethical issues


Filomena Casella, Italy

BIOETHICS GENERAL (1)


Co-Chairs: Vojin Raki , Ariela Lowenstein

SIOF NATIONAL CONGRESS ON


Hall C
FORENSIC DENTISTRY WORKSHOP (1)
THE COMMUNICATION OF THE MISTAKE BETWEEN
ETHICS AND PROFESSIONAL ETHICS
Co-Chairs: P. di Michele, P. Frati, A. Polimeni

Bio-enhancement or ultimate harm


Vojin Raki , Serbia

The physicians duty to inform in patients decision


making process
Francesco De Stefano, Italy

Ageing at the beginning of the 21st century: longevity,


ageism, stem cells research and active ageing
Ariela Lowenstein, Israel

What went wrong? The full disclosure policy to the


patient
Vittorio Fineschi, Italy

Collective consequences of a very long life: the right


to life extension could / should be considered a human
right
Didier Coeurnelle, France

The full disclosure policy: a difficult balancing between


information to the patient and communication to the
odontologists
Alberto Laino, Italy
Dentistry and disability
Gabriela Piana, Italy
GENETICS (1)
Hall D
Co-Chairs: Jason T. Eberl, Mara Magnolia Pardo-Lpez

Hall F

Personal identity and extended life: bioethical concerns


Rosa Rantanen, Finland

The triangle of dependence in stem cell science: the


impact of law, ethics and science on stem cell research
and the phenomenon of stem cell tourism
Bianca Buechner, Germany
ETHICS GENERAL (1)
Co-Chairs: Bert Vanderhaegen, Sophy Dombe

Hall G

Human rights and Nigerian prisoners: are prisoners


not humans?
Istifanus Joshua, Nigeria

14

Tuesday, November 19, 2013

Consciousness: cognitive neurosciences and the problem


brain/mind
Massimo Gandolfini, Italy

Integration of medical law and ethics into medical


training and practice: lessons from the Nigerian story
Yohanna Dangata, Nigeria

Empirical ethics and its eternal problem


Bert Vanderhaegen, Belgium

HEALTH CARE SYSTEMS ETHICS (1)


Co-Chairs: John P. Conomy, Carina Fourie

Bio-ethics issues in literature and the arts: Ecology of


the Soul mini-essays
Marija Emilija Kukubajska, Macedonia

Is there an ethical dimension to contemporary health


care reform in the United States of America?
John P. Conomy, USA

Together rather than separately - conducting a


discussion about ethical dilemmas in a regional
multidisciplinary multi-professional forum
Sophy Dombe, Israel

Vertical health programmes: ethics and effects on


integrated health care delivery systems in Africa
Bege Dauda, Belgium

MEDICAL ETHICS (1)


Hall H
Co-Chairs: Abdul Halim Sawas, Luz Maria Pichardo Garcia
Internet, bioethics, and trends of conduct
Luz Maria Pichardo Garcia, Mxico
Bioethical demand for clinical pharmacokinetic
Abdul Halim Sawas, Saudi Arabia
Over reliance upon diagnostic aids and its implications
upon our practice as physicians
Uri Netz, Israel

Hall K

Public accountability and the ethics of health care


reform decision-making in Switzerland
Carina Fourie, Switzerland
Ethical and psychological aspects of trust in the health
care system in South Bulgaria
Mariana Liotchkova, Bulgaria
Towards an ethical analysis of public health reform:
why it matters among the indigenous communities in
the Philippines
Klein R. Fernandez, Australia
11:00-12:30

ETHICS EDUCATION
Hall I
Co-Chairs: Assya Pascalev, Washirasorn Saengsuwan
Developing ethical understanding and designing a
rubric to measure progress
Marie Catherine Letendre, Italy
The interdisciplinary ethics course at Howard University
Health Sciences Center: a model of ethics education
for in the 21st Century
Assya Pascalev, USA
Training the moral muscle: a competencies based
approach to the teaching and evaluation of
professional ethics
Johannes Renders, The Netherlands
Ethical behavior in temporal perspective: ethical mirage
phenomenon in applied ethics
Daniela Sotirova, Bulgaria
Thai teachers opinions and reflective thinking on
ethics in science from participating in an academic
service project for science teacher development
Washirasorn Saengsuwan, Thailand

OPENING SESSION

Hall A

Claudio Buccelli, Conference President, Naples University


Federico II Ethics Committee Director & International Office
for Bioethics Research of the European Centre for Bioethics
and Quality of Life Head & UNESCO Chair in Bioethics
International Network Scientific Coordinator
Amnon Carmi, Conference President, UNESCO Chair in
Bioethics Holder, Zefat Academic College
Otmar Kloiber, Secretary General, World Medical
Association
Georges Kutukdjian, Member of the Scientific Committee
of the International Bioethics Society (SIBI)
Massimo Marelli, Chancellor of the Naples Federico II
University
Stefano Caldoro, President of Campania Region
Sen. Raffaele Calabr, Advisor for Health of Campania
Region
Guido Trombetti, Universities Regional Counselor for
Scientific Research, Statistics, Information Technology and
Informatics

BIOETHICS EDUCATION (1)


Hall J
Co-Chairs: Kevin Gary Behrens, Yohanna Dangata

Luigi De Magistris, Mayor of Naples

Mainstreaming African ethics into the bioethics


curriculum
Kevin Gary Behrens, South Africa

Lida Viganoni, LOrientale University of Naples Chief Rector

Theory and practice of hospital training for medical


ethics - consensus building method with spatiotemporal perspective
Kumiko Yoshitake, Japan
Bioethics education in a formative and wide model
Valeria Trigueiro Santos Adinolfi, Brazil

Giovanni Persico, AOU Federico II General Manager


Miroslava Vasinova, Conference Vice-President, President
of the European Centre for Bioethics and Quality of Life UNESCO Chair in Bioethics Italian Unit
Last minute administrative announcements
And now let the conference begin

Tuesday, November 19, 2013

15
9

12:30-13:30
Optional lunch break and poster session

GENETICS (2)
Co-Chairs: Froldi Rino, Catanesi Roberto

13:30-15:00

The moral challenges of predictive genetic information


Gsta Gantner, Germany

WORLD MEDICAL ASSOCIATION WORKSHOP Hall A


DECLARATION OF HELSINKI
Co-Chairs: Yoram Blachar, Otmar Kloiber
Discussion and ethics-based review of the revisions in
either scenario and suggested changes if the policy is
not yet approved; if the policy is approved, it will also
include a discussion of the potential practical impact
of the changes from an ethics perspective
Jeff Blackmer, Canada
Discussion and legal-based review of the revisions in
either scenario and suggested changes if the policy is
not yet approved; if the policy is approved, it will also
include a discussion of the potential practical impact
of the changes from a legal and regulatory perspective
Annabel Seebohm, Germany
Summary and next steps
Otmar Kloiber, WMA
Questions and discussion
CONSULTA WORKSHOP (2)
Hall B
ETHICS AND LAW IN FORENSIC MEDICINE II
Co-Chairs: Mariano Cingolani, Pierantonio Ricci
The evaluation of malpractice is always carried out
pursuant to the code of ethics?
Sara Campilongo, Italy
The reliability of the childs testimony: forensicpsychiatric issues and ethical-deontological implications
Gaspare Ronchi, Italy
The right to be born healthy in the light of the Supreme
Courts judgment N. 16754 of the 02.10.2012
Marianna Longo, Italy
Medico-legal aspects of sexual violence in the penal
codes of the historic states of Italy during the first half
of the XIX Century
Alessandro Feola, Italy

Hall D

The challenge of medical progress for international


soft law - the example of next-generation-sequencing
Fruzsina Molnr-Gbor, Germany
Science and law in the age of genetics
Silvia Salardi, Italy
Acceptable applications of Preimplantation Genetic
Diagnosis (PGD) among Israeli PGD users
Shachar Zuckerman, Israel
WPA SECTION ON PSYCHIATRY,
Hall E
LAW AND ETHICS (2)
Co-Chairs: Tal Weizman, Maria Joana de S Ferreira
Compulsory psychiatric hospitalization of minors - the
impossible boundaries of autonomy?
Dorit Porat, Israel
Ethical dilemmas relating to the diagnosis and
treatment of people with autistic spectrum disorder
- the psychiatric perspective
Nachum Katz, Israel
Ethical dilemmas stemming from compulsory
hospitalization in a mental health facility: the
complexities of the multiple loyalties of the psychiatrist
Janna Yakirevitz, Israel
Ethical dilemmas regarding the place of mental health
within prison system
Tal Weizman, Israel
Psychiatric compulsory admissions at Beatriz ngelo
Hospital: a report from one year experience
Maria Joana de S Ferreira, Portugal
BIOETHICS GENERAL (2)
Hall F
Co-Chairs: Brunetto Chiarelli, Johanna Kostenzer
Global bioethics: historical and present perspectives
Brunetto Chiarelli, Italy

Medication abortion and conscientious objection


Marta Giammaria, Italy

Bioethic(s): bridge to the future (of sport)


Franco Bruno Castaldo, Italy

Communicating errors and learning from own errors:


the mediation as educational instrument
Matteo Gulino, Italy

Gender-biased prenatal sex selection - international


organizations and the ethical reasons behind dealing
with the issue
Johanna Kostenzer, Austria

Bioethics and human rights protection: the role of


forensic evidence
Rossana Cecchi, Italy
SIOF NATIONAL CONGRESS ON FORENSIC
DENTISTRY WORKSHOP (2)
THE ROLE OF GUIDELINE IN DENTISTRY
Co-Chairs: P. di Michele, P. Frati, A. Polimeni

Hall C

Implementing dentistry guidelines in children: pediatric


dentistry
Antonella Polimeni, Italy
Discussion

Through the spectacles of tomorrow: toward a casuistic


model for guiding choice in human enhancement
issues
Anders Herlitz, Sweden
ETHICS GENERAL (2)
Co-Chairs: Corinna Jung, Jiri Simek

Hall G

Ethics committees in politics - the meaning of ethical


deliberation for political decision-making
Corinna Jung, Switzerland

16

Tuesday,
November
19, 2013
Scientific
Programme

Volunteerism in the context of pro-social behavior and


a possibility of its education
Jiri Simek, Czech Republic
To free ourselves we need to be slaves of the rules
Alessandra Pentone, Italy
MEDICAL ETHICS (2)
Hall H
Co-Chairs: Miriam I. Siebzehner, Pieter Carstens
Big things cost more
Miriam I. Siebzehner, Israel
Revisiting the infamous Pernkopf Anatomy Atlas:
historical lessons for medical law and medical ethics
Pieter Carstens, South Africa
Primum non nocere v. caveat emptor
Ross W. Halpin, Australia
Medical futility (MF) - doctors point of view: medical
futility in Israel health care system 2013
Avi Levin, Israel

HEALTH CARE SYSTEMS ETHICS (2)


Hall K
Co-Chairs: Mustafa Volkan Kavas, Jochen Vollmann
Pay For Performance (P4P) and estrangement: moral
transformation of residents under a new payment
policy
Mustafa Volkan Kavas, Turkey
Does the health brain drain pose ethical concerns?
If so what can and should be done about it?
Theodore Pang, UK
Reducing medical education cost with cross subsidy
Djoko Santoso, Indonesia
Personalised medicine: priority setting and
opportunity costs at an international scale
Jochen Vollmann, Germany
Ethical issues of insurance medicine
Ekaterine Sanikidze, Georgia
15:00-16:30

The creation of an ethical code on the limits of intimacy


and touch in complementary medicine
Maya Peled-Raz, Israel

WORLD MEDICAL ASSOCIATION WORKSHOP Hall A


HUNGER STRIKES
Co-Chairs: Yoram Blachar, Otmar Kloiber

INTERCULTURAL BIOETHICS & LIFELONG


Hall I
LEARNING WORKSHOP (1)
BIOETHICS, LIFELONG LEARNING & SOCIAL INCLUSION I
Co-Chairs: Luigia Melillo, Anna Maria Traversa

Introduction to the session by a moderator and


background information

A network to enhance lifelong learning


Aureliana Alberici, Italy
Universality of human rights and cultural diversity:
some thoughts from the perspective of migrations
Giuseppe Cataldi, Italy

Hunger strikes and other forms of protest fasting:


medical dilemmas, manipulation and medicalization
Hernan Reyes, Chile
Ethical aspects of hunger strikes; dilemmas for health
professionals
Vivienne Nathanson, UK

Migrating modernitys
Ian Chambers, Italy

The legal obligations of health professionals hunger


strikes and the law
Malke Borow, Israel

Immigration policies for the schools


Luciano Chiappetta, Italy

Hunger strikers in detention - the Israeli experience


Tami Karni, Israel

BIOETHICS EDUCATION (2)


Hall J
Co-Chairs: Mitsuyasu Kurosu, Robyn Fellingham

Questions and discussion

Bioethics education in clinical research with model


tool
Arja Halkoaho, Finland

CIRB (INTER-UNIVERSITIES CENTER


Hall B
FOR RESEARCH ON BOETHICS) WORKSHOP (1)
PLURALITY OF IDENTITIES
Co-Chairs: Paolo Valerio, Anna Maria Colau

Teaching bioethics via the production of studentgenerated videos


Chris Willmott, UK

Bioethics and occupational safety in genders studies


Isotta Burlin, Italy

Movies and drama related to bioethics in Japan


Mitsuyasu Kurosu, Japan

Puberty blocking during developmental years: issues


and dilemmas for gender variant adolescents
Paolo Valerio, Italy

Humanising medical ethics: reflections on a bioethics


OSCE in a South African medical school
Robyn Fellingham, South Africa

Disorders of sex development: the frontiers in a


scientific, bioethical and social debate
Francesca Dic, Italy

Attitudes of Lithuanian teachers give notice about a


ban of abortions
Grita Skujiene, Lithuania

Homophobia and criminal law


Gianluca Gentile, Italy
Heteronormativity, homophobia and transphobia in sport
Cristiano Scandurra, Italy

Tuesday, November 19, 2013


Marriage in Italy between persons of the same sex
Alessia Schisano, Italy
Pluralities of identities, gender issues and sexual
orientation: between bioethics and bio-law - an
interdisciplinary reflection
Alberto Postigliola, Italy
SIOF NATIONAL CONGRESS ON FORENSIC
Hall C
DENTISTRY WORKSHOP (3)
THE ROLE OF GUIDELINE IN DENTISTRY AND CHILD
ABUSE
Co-Chairs: C. Buccelli, G. Cerretti, M. Niola
Guidelines between the protection of the patients
health and economic constraints
Alessandro DellErba, Italy
The value of the guidelines and juridical interpretation
to protect the patient
Paola Frati, Italy
Child abuse: evaluation and general aspects
Francesco Introna & Valeria Santoro, Italy

17
9

The psychiatrists role in the dilemmas arising from


the relationship between euthanasia and depression
particularly in Holocaust survivors
Marnina Swartz-Vanetik, Israel
Developing new/reformed psychiatric services - what
should be the primary target?
Muli Linder, Israel
Methylphenidate for cognitive enhancement; myths
and facts
Nurit Shlafman, Israel
BIOETHICS GENERAL (3)
Co-Chairs: Jan Hartman, Carmen Pennacchio

Hall F

Communicating bioethics within family context


Pasquale Giustiniani, Italy
Tobacco control policy in the EU: protecting public
health in the free market
Iris Goldner Lang, Croatia
Medicus amicus: professional ethics in the ancient world
Carmen Pennacchio, Italy

Dental caries in children: sign of abuse by neglect?


Aniello Ingenito & Pierpaolo Di Lorenzo, Italy
Role of guidelines in dentistry and treatment of child:
The traumatology of the child - from the event to
follow up
Enrico Spinas, Italy
GENETICS (3)
Hall D
Co-Chairs: Gabriele Werner-Felmayer, Caroline Guibet Lafaye
Visualizing bioethical issues of personal genomics
through arts
Gabriele Werner-Felmayer, Austria
Information on risk genes for breast cancer in a
population, to inform or not to inform individuals at risk
Jon Snaedal, Iceland
Ethical approach and professional responsibility in
workplace drug testing
Renata Borriello, Italy
Ethical and social issues raised by recent research in
epigenetics
Caroline Guibet Lafaye, France

Bioethics and its claims for competency


Jan Hartman, Poland
ETHICS GENERAL (3)
Co-Chairs: Jos Kole, Liljana Siljanovska

Hall G

Youth work and ethical reflection: stimulating


interprofessional ethical reflection
Jos Kole, The Netherlands
Ethics and evolution
Peter Lachmann, UK
Media ethics - principles and practices in Macedonian
journalism
Liljana Siljanovska, Macedonia
MEDICAL ETHICS (3)
Co-Chairs: Jaroslav Blahos, Svetlana Dimitrova

Hall H

Patients expectations of the medical profession - new


challenges
Iveta Barchovska, Bulgaria
Evidence, experience and ethics-based medicine
Jaroslav Blahos, Czech Republic

Why justice is good for African health care: first steps


towards an African theory of health care justice
Samuel J. Ujewe, UK

The Balint method practising in Bulgaria


Svetlana Dimitrova, Bulgaria

WPA SECTION ON PSYCHIATRY,


LAW AND ETHICS (3)
Co-Chairs: Tal Bergman-Levy, Rael Strous

Medical ethics: a guarantee of impartiality versus


conflict of interest
Cristoforo Ricci, Italy

Hall E

Specific ethical codes for mental health care


professionals - do we need to annotate?
Tal Bergman-Levy, Israel

Attitude, practice of clinical physicians in Vietnam on


medical professionalism
Tran Thi Thanh Huong, Vietnam

Patient rights in mental-health care facilities: an


empirical study of the phenomenon
Rael Strous, Israel

INTERCULTURAL BIOETHICS & LIFELONG


Hall I
LEARNING WORKSHOP (2)
BIOETHICS, LIFELONG LEARNING & SOCIAL
INCLUSION II
Co-Chairs: Luigia Melillo, Anna Maria Traversa

18

Tuesday, November 19, 2013

Respect for cultural diversity and pluralism


Joel Farcoz, Italy
Lifelong learning as an emerging right
Laris Gaiser, Italy
Policies of Naples municipality for the Lifelong Learning
and the migrants
Annamaria Palmieri, Italy

CIRB (INTER-UNIVERSITIES CENTER FOR


RESEARCH ON BOETHICS) WORKSHOP (2)
BEGINNING OF LIFE
Co-Chairs: Fabio Buzzi, Maria Luisa Di Pietro

9
Hall B

The intersection of the logics of filiation in the context


of beginning of life: a psychoanalytic approach
Maria Clelia Zurlo, Italy

BIOETHICS EDUCATION (3)


Hall J
Co-Chairs: Vina Vaswani, Maria de la Luz Casas

The human embryo between res and person inspired


from the legal debate of the ancient world
Osvaldo Sacchi, Italy

Positive attitude changes in bioethics students before


and after survey application
Maria de la Luz Casas, Mxico

Bioethical issues at the beginning of life and female


citizenship
Emilia Taglialatela, Italy

The implications of bioethics education for developing


nations
S. Iniobong Udoidem, Nigeria

Political appreciation and judicial control in Italian law


on assisted reproduction technologies
Andrea Patroni Griffi, Italy

Introducing bioethics course in a medical university in


India for the first time - the challenges
Vina Vaswani, India

Parental responsibility and responsible parenthood:


some reflections about the instruments for the defense
of children reference to medically assisted procreation
in Italian law
Laura Tricomi, Italy

ETHICS KNOWLEDGE OF
Hall K
HEALTH CARE WORKERS
Co-Chairs: Dilara Mamedaliyeva, Maurizio Carnassale
Current level of knowledge, perception and practice
of medical law and ethics among Nigerian medical
practitioners: deficiencies and remedies - the Nigerian
model
Awawu Grace Nmadu, Nigeria
About nurses knowledge of medical deontology
Dilara Mamedaliyeva, Azerbaijan
The international code of ethics for occupational health
professionals: a guide for the physicians who work for
Italian Workers Compensation Authority
Maurizio Carnassale, Italy
16:30-17:00
Coffee break and poster session
17:00-18:30
Hall A
EUROPEAN SOCIETY FOR
CARDIOVASCULAR SURGERY WORKSHOP
BIOETHICAL ISUES IN CARDIOVASCULAR SURGERY:
NEW TECHNOLOGIES, NEW FRONTIERS, NEW RULES?
Co-Chairs: Domenico Palombo, Oto Oztekin
The need of ethical training for cardiovascular surgeons
Domenico Palombo, Italy
ECMO: limits and indications, a bioethical discussion
Oto Oztekin, Turkey
EVAR for abdominal aortic aneurysm in elderly patients:
bioethical issues
Lazar Davidovic, Serbia
Peripheral arteriopaty and diabetic patients in
endovascular era: is it bioethically worthwhile?
Giancarlo Bracale, Italy

SIOF NATIONAL CONGRESS ON


FORENSIC DENTISTRY WORKSHOP (4)

Hall C

 Discussion
 Election of SIOF President and Assembly
ABORTION
Co-Chairs: Laura Andrissi, Sara Dejevsarov

Hall D

Cultural differences and the intention to undergo an


elective abortion in case of a fetal abnormality
Sara Dejevsarov, Israel
Immigrant women from sub-Saharan Africa in Italy: a
survey on the phenomenon of induced early abortion
during their irregular staying: epidemiological,
anthropological and ethical aspects
Laura Andrissi, Italy
The human embryo
David ern , Czech Republic
Womans right to abort a viable fetus
Pnina Lifshitz-Aviram, Israel
WPA SECTION ON PSYCHIATRY,
Hall E
LAW AND ETHICS (4)
Co-Chairs: Asima Mehboob Khan, Gisela Badura-Lotter
Mental disorder and incapacity to make healthcare
decisions
Claire Rommelaere & Albert Fox, Belgium
Assessment of parenting competence in individuals
with mental illness and the role of a new kind of legal
guardianship in Italy
Linda Alfano, Italy
The professional discourse on desire for children and
parenthood in mental health service users in Germany
- reflections of the past on actual ethical challenges
Gisela Badura-Lotter, Germany

Tuesday, November 19, 2013


Mind and health - an awareness program for media
Asima Mehboob Khan, Pakistan
BIOETHICS GENERAL (4)
Co-Chairs: lose Gennet, Samual A. Garner

Defining an interdisciplinary research methodology


linking legal, normative and empirical ethics
lose Gennet, Switzerland
An introduction to animal research ethics
Samual A. Garner, USA
Conscience and bioethics: what if everybody were
objectors?
Michele Saporiti, Italy

Parental conflict separation as an early traumatic event


for child
Maria Giuseppina Mantione & Alessandra Muscetta, Italy
Pathology in the parental relationship: the good praxis
for evaluation of parental capabilities
Elisa Spizzichino, Italy
To preserve the children from parental conflict and
divorce by application of juridical and clinical
instruments
Adriana Mazzucchelli, Italy
Conditions and limits of protective measures involving
childs removal from primary attachment figures:
psychological and ethical aspects
Tiziana Frau & Sabina Gorcelli, Italy

Hall G
BIOETHICS EDUCATION (4)
Co-Chairs: Sashka Popova, Siti Pariani

Giving them their voices back: a media project offers


a floor for the vulnerable
Ralf Stutzki, Switzerland
Dictatorships reflect societal faultlines
Digvijay Singh Goel, New Zealand
Law students as agents of social change - moral values
and attitudes in Zefat College School of Law
Yael Efron, Israel
Bioethics and autism: securing the moral compass of
children with autism in developing countries
Mona Indargiri, USA
The assessment of medical professionalism among new
paramedical staff under post-graduate training
program
Chiung-hsuan Chiu, Taiwan
MEDICAL ETHICS (4)
Co-Chairs: Zafrira Hillel-Diamant, Josef Ku

The childhood trauma in the breakdown of family


relationship: clinical and bioethical aspects
Angelo Maria Inverso, Italy

Hall F

Bioethics and compulsory hospitalization: the evolution


of crack in So Paulo, Brazil
Ruy de Mathis, Brazil

ETHICS GENERAL (4)


Co-Chairs: Ralf Stutzki, Yael Efron

19
9

Hall H

Hall J

Bioethics education in a South African university of


technology - a multidimensional best practice approach
Willem A. Hoffmann, South Africa
How to learn bioethic in school of medicine (bioethic
education)
Siti Pariani, Indonesia
Working towards a culture of collaboration in medical
schools
Sashka Popova, Bulgaria
BIOETHICS AND RELIGION
Co-Chairs: Annie Reiss, Diana Aurenque

Hall K

Bioethics between science and religion


Flora Strozenberg & Edna Raquel Hogeman, Brazil
Jewish perspectives on distributive justice and economic
considerations in medical care
Annie Reiss, Israel

Does a child on chronic ventilation have the right to


demand home care?
Zafrira Hillel-Diamant, Israel

The new law on religious circumcision in Germany and


its legal, ethical and political debate
Diana Aurenque, Germany

Understanding of euthanasia by medical students


Josef Ku , Czech Republic

Christian anthropology vs. the new anthropology and


the quest for human perfection
Tomasz Kraj, Poland

Pictorial art as alternative way of communication: a


case report in a patient with Alzheimer Disease
Marina Tullii, Italy
Scientometrical studies on hot topics and research
structures of Chinese medical ethics in recent 20 years
Yanhua Lv, China
CHILD PSYCHIATRY WORKSHOP
Hall I
THE CHILDHOOD TRAUMA IN THE BREAKDOWN OF
FAMILY RELATIONSHIP: CLINICAL AND BIOETHICAL
ASPECTS
Co-Chairs: Angelo Maria Inverso, Fabio Canziani

Coping with religious pluralism in public bioethics


discourse
Chris Durante, USA

20

Wednesday, November 20, 2013

09:00-10:30
Hall A
AOGOI WORKSHOP (1)
ETHICAL DIMENSIONS OF OBSTETRICS & GYNECOLOGY I
Co-Chairs: Vito Trojano, Antonio G. Spagnolo

Is there autonomy of the will for mentally ill patients?


What are the roles for patients, family, physicians and
legal authorities? Brazilian solutions and perspectives
Washington Fonseca, Brazil
A challenging future for ethical decision-making in
psychiatry
Magdaleen Swanepoel, South Africa

When does human life begin endless


controversies?
Asim Kurjak, Croatia

BIOETHICS GENERAL (5)


Hall F
Co-Chairs: Morten Ebbe Juul Nielsen, Nenad Ceki

Is preimplantation genetic diagnosis ethical?


Giovanni Monni, Italy
Ethics an essential dimension of prenatal diagnosis
Domenico Arduini, Italy

Bioethics in the pharmaceutical industry? Concerns,


standards and a strategy for trustworthy reform
Jennifer E. Miller, USA

Planned home birth: an ethical challenge for the


developed world
Frank Chervenak, USA

A survey on the degree of knowledge of bioethics and


its application in health management
Annunziata Mazzitelli, Italy

BIOETHICS AND FILM: AUDIOVISUAL


Hall C
RESOURCES FOR TEACHING AND RESEARCH
Co-Chairs: Moty Benyakar, Juan Jorge Michel Faria

Obesity and personal responsibility


Morten Ebbe Juul Nielsen, Denmark
Bioethical implications of globalisation and societies
in transition
Russell DSouza, Australia

Cinema and television: developing subjective


dimensions to deal with bioethics
Moty Benyakar, Argentina
Bioethics in contemporary cinematic narratives
Andrea Hellemeyer, Colombia
The ethical condition of man: a music-oral reading of
the second chorus of Sophocles Antigone
Juan Jorge Michel Faria, Argentina
INFORMED CONSENT (1)
Co-Chairs: Nicole Gallus, Tracey Elliott

Hall D

Free and informed consent to medical treatment and


vulnerable persons
Nicole Gallus, Belgium
From consent to choice: the ethical implications of
empowerment-centred healthcare
Luca Chiapperino, Italy
Incompetent patient and therapeutic destiny
Alessandra De Gasperis, Italy
Factors influencing informed consent implementation
in health care service in Indonesia
Ivan Rahmatullah, Indonesia
Sacrificing proper practice on the altar of the beauty
business? Informed consent in the field of cosmetic dentistry
Tracey Elliott, UK
WPA SECTION ON PSYCHIATRY,
Hall E
LAW AND ETHICS (5)
Co-Chairs: Samuel Wolfman, Washington Fonseca
Non-consented ECT treatment for involuntary
hospitalized mentally ill patients
Samuel Wolfman, Israel
Psychiatric treatment consent and the support trustee:
from a new form of guardianship to the cura
personae
Diana Galletta, Italy

Metaethics and bioethics: psychopath case


Nenad Ceki , Serbia
RESEARCH ETHICS (1)
Co-Chairs: Hedva Eyal, Josep Corbella i Duch

Hall G

Regulation of medical experiments on human subjects:


the case of anthrax experiments in IDF
Hedva Eyal, Israel
Understanding why people refuse to participate in
research may strengthen mutual trust and ethical
standard in biomedical research...experiences from
following up refusals in Kilifi Health and Demographic
Surveillance System, Kenya
Francis Kombe, Kenya
Some ethical aspects in medical and clinical research
Rodica Feraru, Israel
Clinical ethics committees in Spain
Josep Corbella i Duch, Spain
The usage of bio-markers in clinical settings: ethical
reflections (observations?)
Antonio Leo, Italy
MEDICAL ETHICS (5)
Hall H
Co-Chairs: Rachel Nissanholtz-Gannot, Raffaella Rinaldi
The truth and the physician
Rachel Nissanholtz-Gannot, Israel
Ethical and clinical implications of interrupting
acetylcholinesterase inhibitor treatment in severe
Alzheimers
Raffaella Rinaldi, Italy
The biology of empathy and its role in good ethical
practice in healthcare delivery
Esther B. Patrick, Nigeria

Wednesday, November 20, 2013


Healthy lifestyle requirements; laudable or paternalistic
meddling
Lizette Schoeman, South Africa

21
9

10:30-11:00
Coffee break and poster session
11:00-12:30

Social media and medicine: legal and ethical


implications
Konstantinos Roditis, Greece
INTERCULTURAL BIOETHICS & LIFELONG
Hall I
LEARNING WORKSHOP (3)
BIOETHICS, MINORS & ADOLESCENTS: TEACHING
BIOETHICS AND METHODOLOGICAL PROPOSALS I
Co-Chairs: Luciano Chiappetta, Miroslava Vasinova
Bioethics education in a multicultural society: Aosta
Valley Autonomous Region examples and suggestions
Anna Maria Traversa, Italy
The project A healthy week!
Claudio Todesco, Italy
Ethics problems and values transmission to prevent
premature childhood
Antonella Migliore, Italy

Principles of the education in bioethics and ecobioethics in medical schools and to the healths
professionals in hospitals in So Paulo
Jose T. Thom, Brazil
Bioethics education on vulnerable subjects and groups
Zoran Todorovi , Serbia
Emotional intelligence as methodology and didactic
tool in teaching bio-ethics at nursing schools: practical
steps
Daniella Keidar, Israel
A disability bioethics curriculum that encourages
reflection and open discussion among students and
community members
Julie Rogers, USA
Hall K

Judicial intervention in private health care policies in


Brazil
Daniela Ito, Brazil
Legal and ethical challenges in medical rescue
Xueqian Zheng, China
Legal protection of patients rights in China
Hong Le, China
Health protection between ethics and law
Michele Capasso, Italy

What is the role of fetal therapy?


Giuseppe Noia, Italy
Evolving ethical challenges of HIV in obstetrics &
gynecology
Pasquale Martinelli, Italy
Women and children first: an ethical challenge for the
developing world
Laurence McCullough, USA
Hall B

Hall J

Bioscience ethics education: challenging learning across


the generations with particular reference to human
reproductive biology
Irina Pollard, Australia

MEDICAL LAW (1)


Co-Chairs: Daniela Ito, Michele Capasso

Hall A

Cord blood banking public or private?


Antonio Chintera, Italy

NAPLES FEDERICO II UNIVERSITY ETHICS


COMMITTEE & CIRB WORKSHOP (1)
END OF LIFE I
Co-Chairs: Lorenzo Chieffi, Giuseppe Lissa

Best practices of Campania URS


Ugo Bouch, Italy
BIOETHICS EDUCATION (5)
Co-Chairs: Irina Pollard, Jose T. Thom

AOGOI WORKSHOP (2)


ETHICAL DIMENSIONS OF OBSTETRICS &
GYNECOLOGY II
Co-Chairs: Giovanni Scambia, Carmine Nappi

At the edge of consciousness: does neuroscience


revolutionize law at the end of life?
Valeria Marzocco, Italy
Technological delay of death
Rosalba Tufano, Italy
Disorders of consciousness and brain death: medical
and ethical considerations
Anna Estraneo, Italy
From cardiac death to brain death: how death is ascertained
Giuseppe Mastroroberto, Italy
The right to self-determination of terminally ill patients
through the interpretation of constitutional principles
Lorenzo Chieffi, Italy
Profiles of legal significance of advance directives for
medical treatment: experiences to comparison
Roberta Catalano, Italy
NAPLES FEDERICO II UNIVERSITY ETHICS
Hall C
COMMITTEE WORKSHOP (1)
CLINICAL TRIALS, DILEMMAS THERAPEUTIC, ETHICS
COMMITTEES
Co-Chairs: Carmine Donisi, Dario Sacchini
Contributions from the discussions held by the national
bioethics committee on scientific research and the role
of ethics committees in Italy
Pasquale Severino, Italy
Ethical committees in Europe
Emanuele Capasso, Italy
Insurance coverage in clinical trials in the experience
of the ethics committee for biomedical activities Carlo
Romano
Igino Amirante, Italy

22

Wednesday, November 20, 2013

The use of placebo in clinical trials: a matter still in


progress
Danila Faillace, Italy

The legitimacy of race as variable in the deliberations


of Institutional Review Boards (IRBs)
Anton A. van Niekerk, South Africa

Light and shadow in the new Italian regulation on


ethics committees
Paola Buccelli, Italy

Clinical study with medical device in the Lecce ASL


Rossella Ileana Romano, Italy

INFORMED CONSENT (2)


Co-Chairs: Adam Dolezal, Rima Nakkash

Hall D

Protection of human subjects: introducing the Research


Participant and Family Advocate (RPFA)
Tomas J. Silber, USA

Informed consent in Czech Republic and Slovak Republic


- ethical and legal issues
Adam Dolezal, Czech Republic

Is it ethically justifiable to involve children in nontherapeutic research?


Domnita Oana B d r u, Switzerland

Informed consent, autonomy and compensation in


the twenty-first century - a call for a new approach
Nili Karako-Eyal, Israel

MEDICAL ETHICS (6)


Co-Chairs: Altin Stafa, Juan Bar el

Practices of obtaining informed consent in Lebanon


and Qatar: a disconnect between standards and practice
Rima Nakkash, Lebanon
Is consent truly informed? The readability scores of
information and consent forms for cancer clinical trials
and research in Italy
Laura McMahon, Italy

Hall H

Physician-patient communication during the


endovascular and percutaneous therapeutic procedures:
some personal considerations based on a personal
experience in an interventional radiologyneuroradiology clinical context
Altin Stafa, Italy
Ethical aspects of the treatment of people belonging
to mythical cults
Juan Bar el, Israel

BIOETHICS TRAINING IN INDIAN MEDICAL


Hall E
EDUCATION
Co-Chairs: Mushtaq Margoob, Russell DSouza, Rizwan Taj

Nothing is what it seems - prenatal diagnosis in Poland


Weronika Chanska, Poland

Bioethics applied from the Islamic religion


Rizwan Taj, Pakistan

When can a family physician refuse to treat a patient?


Yisrael Katz, Israel

Bioethics training in medical education in India current


requirements
Mary Mathew, India

Assessment of ethics courses in professional ethics


education
Mariette van den Hoven, The Netherlands

Developing bioethics curriculum in medical education


in India - current practice
Princy Palaty, India

INTERCULTURAL BIOETHICS & LIFELONG


Hall I
LEARNING WORKSHOP (4)
BIOETHICS, MINORS & ADOLESCENTS: TEACHING
BIOETHICS AND METHODOLOGICAL PROPOSALS II
Co-Chairs: Luciano Chiappetta, Miroslava Vasinova

Globalisation and bioethics education and training in


India
Dinesh Narayanan, India
BIOETHICS GENERAL (6)
Hall F
Co-Chairs: Tatyana A. Sidorova, Susanna H. Davtyan
Aspects of normativity in bioethics
Tatyana A. Sidorova, Russia

CIRED actions: study cases


Giuseppina Iommelli, Italy
Understanding the social fragility
Antonio Esposito, Italy
The development of bioethics thinking skills
Luigia Melillo, Italy

Principles of responsibility and precautionary in the


use of antibiotics and anabolic in cattle: a Colombian
experience
Gina Lorena Garca, Colombia

Legal aspects in educational processes: de iure condito


and de iure condendo
Agata Bonaudo, Italy

The fifteen year experience of the bioethical committee


for veterinary medicine
Pasqualino Santori, Italy

BIOETHICS EDUCATION (6)


Hall J
Co-Chairs: Mohammad Baharuddin, Silviya AleksandrovaYankulovska

Bioethics, word curing and music therapy


Susanna H. Davtyan, Armenia

Overview learning implementation of bioethics of


midwifery education in Indonesia
Mohammad Baharuddin, Indonesia

RESEARCH ETHICS (2)


Hall G
Co-Chairs: Anton A. van Niekerk, Tomas J. Silber

Knowledge, attitudes and practices of nursing ethics


medical students in Mali
Samba Diop, Mali

Wednesday, November 20, 2013

23
9

Current situation and issues of continuing ethics


education in nursing
Yuko Hamajima, Japan

The right to self-determination and end-of-life


decisions: the role of the fiduciary
Barbara Salvatore, Italy

Obstacles to effective ethics education of medical


professionals in Bulgaria
Silviya Aleksandrova-Yankulovska, Bulgaria

Living will: problematic profiles


Carlo Venditti, Italy

Mutual learning to overcome the risk of self-referencing


in health professions
Antonio Del Puente, Italy
MEDICAL LAW (2)
Co-Chairs: Kim Hwee Koh, Lucy A. Knouse

Living will according to the Italian Acts


Rosa Guarino, Italy
Right not to suffer and the analgesic therapies
Daniela Minutelli, Italy

Hall K
The spiritual assistance
Adolfo Russo, Italy

Ethics and regulation of aesthetic medicine - a


Singapore experience
Kim Hwee Koh, Singapore
Right for health protection in CIS countries constitutions
Fatima Aliyeva, Azerbaijan

NAPLES FEDERICO II UNIVERSITY ETHICS


Hall C
COMMITTEE WORKSHOP (2)
CLINICAL TRIALS, DILEMMAS THERAPEUTIC, ETHICS
COMMITTEES
Co-Chairs: Guido Rossi, Antonio Lepre

Development of health bill in Kenya: challenges and


lessons learnt
Lucy Musyoka, Kenya

Ethical implications of the collection of biological


material and relevant information
Mimmo de Cristofaro, Italy

Health law and its impact on defensive medicine


Lucy A. Knouse, USA

Is there an ethical ground for derogating from


individual integrity principles in favour of scientific
progress in clinical trials?
Claudio Buccelli, Italy

Patients rights as an indicator of health system


development
Fidan Rustamova, Azerbaijan
12:30-13:30
Optional lunch break

An opinion of EC Carlo Romano on continuation of


treatment in an anencephalic newborn
Ida Cerrone, Italy

13:30-15:00
NAPLES FEDERICO II UNIVERSITY ETHICS
COMMITTEE WORKSHOP (1)
ORGAN TRANSPLANTATION
Co-Chairs: Enrico Di Salvo, Roberto Catanesi

Hall A
Futile trials: ethical issues
Massimo Niola, Italy

Analyzing donation in XXI century: toward new


frontiers
Alessandro Nanni Costa, Italy
Opt-out organ procurement policies and good
communities: arguments to improve procurement
James L. Nelson, USA
Organ procurement: Spanish transplant procurement
management
Vincent Torregrossa, Spain
Harvesting cadaveric tissues for therapeutic
transplantation after judicial autopsy: the primacy of
ethics in a climate of regulatory uncertainty
Carlo Vosa, Italy
FEDERICO II NAPLES UNIVERSITY ETHICS
COMMITTEE & CIRB WORKSHOP (2)
END OF LIFE II
Co-Chairs: Franco Contaldo, Franco Rengo

An opinion of the EC Carlo Romano on continuation


of therapy in a newborn with a rare disease
Maria Antonietta Zinno, Italy

INFORMED CONSENT (3)


Co-Chairs: Deirdre Madden, Vered Windman

Hall D

Medical treatment of children and parental consent


in Ireland
Deirdre Madden, Ireland
Medical treatment of minors: child and family
autonomy and state intervention
Vered Windman, Israel
Patients right to informed consent in Republic Srpska:
legal and ethical aspects (with special reference to the
physical rehabilitation process)
Igor Milinkovi , Bosnia and Herzegovina
A narrative model for informed consent with youth
Michelle A. Mullen, Canada

Hall B

Advance health care directives: the living will between


self-determination of the person and physician
autonomy
Pietro Tarsitano, Italy

A call for consensus if the aim is protection: review of


vulnerability in research
Daima Bukini, Tanzania
CULTURALLY RELEVANT BIOETHICS FOR
Hall E
ASIA PACIFIC
Co-Chairs: Mary Mathew, Russell DSouza, Anu kant Mittal

24

Wednesday, November 20, 2013

The need to develop cultural relevant bioethics for


Asia
D. Balakrishnan, India
Bioethics from the Vedic tradition times application
to Asia
Manu Mittal, India
Novel methods in bioethics education in medical schools
Anu kant Mittal, India
Role of ethics committee in Kashmir University
Arshad Hussein, India
BIOETHICS GENERAL (7)
Hall F
Co-Chairs: Magda Slabbert, Anastasia Zakariadze
The dead teaching the living, Von Hagens Body Worlds
- art, entertainment, education or a violation of human
dignity?
Magda Slabbert, South Africa

Regional differences in cancer survival of patients:


ethical problems of health policy and clinical
governance
Rosalba Caldarazzo, Italy
Doing right for patients: a grounded theory on
physicians understanding and negotiation of ethical
dilemmas
Rhodora C. Estacio, Philippines
Whistleblow while you work: is it ethically acceptable
for doctors to use the media as a means for blowing
the whistle?
Chantal Cox-George, UK
INTERCULTURAL BIOETHICS & LIFELONG
LEARNING WORKSHOP (5)
DNA & INTERCULTURAL IDENTITY
Co-Chairs: Cinzia Caporale, Giacomo Sado

Hall I

The public perception of neuroscience


Agnes Allansdottir, Italy

Institute of bioethics clinical ethics consultation of


Universit Cattolica: analysis of an experience
Dario Sacchini, Italy

Mind as an emergent property


Pietro Calissano, Italy

Violating dignity by offering organs for sale? A critical


evaluation of dignity in the current debate
Zmrt Alpinar, Switzerland

Genomic studies and ethical issues in the China of the


third millennium
Daniela Caruso, Italy

Bioethical dilemmas in front of the challenges of


contemporary world-teaching, learning, research (TSU
experience)
Anastasia Zakariadze, Georgia

Perspectives of medicine and genomic-omics


Giuseppe Novelli, Italy
From bioethics to neuroethics
Elisabetta Sirgiovanni, Italy

Demand for circumcision of males is on the increase


in Italy: ethics problems
Maria Gloria de Bernardo, Italy

ETHICAL DECISION MAKING


Co-Chairs: Donrich Jordaan, Patrick Schuchter

RESEARCH ETHICS (3)


Co-Chairs: Guy Enosh, Daniel Fu-Chang Tsai

Intuition in clinical reasoning


Laura Leondina Campanozzi, Italy

Hall G

Hall J

Power relations in research encounters: implications


for ethics in research
Guy Enosh, Israel

The regulation of surrogate motherhood in South Africa:


a human rights analysis of the genetic link requirement
Donrich Jordaan, South Africa

Ethical considerations in racial inclusion for clinical


research
Glenn Ellis, USA

A pluralistic, multi-methodological model in clinical


ethics
Evyatar Shayevitz, Israel

Maximum risk standard in biomedical research


Joanna Rozynska, Poland

Evaluation of training activities in the field of ethics


and health communication in Albania
Adrian Hoxha, Albania

The moral obligation to participate in medical research


Daniel Fu-Chang Tsai, Taiwan
About patients, inventors, journalists, scientists and
IRBs (to say nothing of the institutions): CCSVI and MS
Antonella Piga, Italy
MEDICAL ETHICS (7)
Co-Chairs: Ahmad Ayesha, Patricia Oliveira

Organizing spaces for everyday ethical reflection - a


narrative approach in clinical ethics consultation
Patrick Schuchter, Austria
MEDICAL LAW (3)
Hall K
Co-Chairs: Tiziana Maria Devoti, Adila Abasova

Hall H

Rape - a terminal condition of trauma: why palliative


care is a better approach than psychiatry
Ahmad Ayesha, UK
Disruptive effects in patients with burn aftereffects
Patricia Oliveira, Argentina

On the urgent need to codify international bioethics


law and to form a unified and specialized systems of
international and national bioethical courts
Victoria Tretiakova, Ukraine
International legal protection of childs medical rights
and bioethical issues
Aytan Mustafayeva, Azerbaijan

Wednesday, November 20, 2013


How development of the international bioethical
legislation influences on Azerbaijan laws
Adila Abasova, Azerbaijan
Pharmacists-promoters of good health: new profile of
professional responsibility
Tiziana Maria Devoti, Italy
15:00-16:30
NAPLES FEDERICO II UNIVERSITY ETHICS
COMMITTEE WORKSHOP (2)
ORGAN TRANSPLANTATION
Co-Chairs: Enrico Di Salvo, Roberto Catanesi

Hall A

More professionals in ethics committees


Carlalberto Leone, Italy
Ethics committee opinion on a case of surgery in autistic
child
Loriana Paciello, Italy
Information and consent, analysis of the exhaustiveness
of communication and adequacy of information in
biomedical trials with the participations of the expert
in psychology
Adriana Scuotto, Italy
Informed consent, the role of psychologists as
communication experts
Arianna Iorio, Italy

Ethical issues in the transplantation of uterus


Fabio Policino, Italy
Sharing opinion and participative research: from people
expectations to independent information in organ
donation either in hospital than in territorial services
Elena Giancotti, Italy
Organisational determinants in procurement and
transplantation pathway: from evidence review to
organizational toolbox
Fabiana Rubba, Italy
Sociological model of donation
Giulia Mancini, Italy
FEDERICO II NAPLES UNIVERSITY ETHICS
COMMITTEE & CIRB WORKSHOP (3)
END OF LIFE III
Co-Chairs: Paola Izzo, Mario Di Luca Natale

25
9

Hall B

End of life care and risk of overtreatments: an


introduction
Franco Contaldo, Italy
Theological reflection on pain and suffering
Ignazio Schinella, Italy
An ethics of responsibility for managing end-of-life
processes
Giuseppe Lissa, Italy
Therapeutic obstinacy: notes for an analysis of endof-life bioethical issues
Emilia DAntuono, Italy
The life-prolonging measures (aggressive treatment)
in legislation of foreign countries
Francesco Catapano, Italy
Therapeutic obstinacy
Alfredo Marinelli, Italy
Legal aspects of therapeutic obstinacy
Donisi Carmine, Italy
The damage of therapeutic fury
Casella Claudia, Italy
NAPLES FEDERICO II UNIVERSITY ETHICS
Hall C
COMMITTEE WORKSHOP (3)
CLINICAL TRIALS, DILEMMAS THERAPEUTIC, ETHICS
COMMITTEES
Co-Chairs: Antonio Lepre, Dario Sacchini

INFORMED CONSENT (4)


Co-Chairs: Daniel Sperling, Carlo Pasetti

Hall D

Physician financial and organizational interests: the


revised legal doctrine of informed consent and bioethics
Daniel Sperling, Israel
The role of informed consent in assisted reproductive
technologies
Faiza K. Aliyeva, Azerbaijan
Information, awareness, decision-making: observational
study of clinical ethics applied to progressive chronic
diseases
Carlo Pasetti, Italy
Off label medical treatments in neuro-cognitive
disorders: competency of the patient and validity of
informed consent
Felice Carabellese, Italy
THE ROLE OF BIOETHICS IN MEDICAL
EDUCATION IN ASIA
Co-Chairs: Russell DSouza, Tran Huong

Hall E

The call of the Davui: heralding an era of change for


the Pacific
Sharon Biribo, Fiji
Conflict of interest between the institutional goals for
advancement of knowledge and institutional ethics issues and solutions
P. Thangaraju, India
Bioethics curriculum in medical education in Indonesia
Sajid Darmadipura, Indonesia
BIOETHICS GENERAL (8)
Hall F
Co-Chairs: Irada Huseynova, Ahmed Binsumeit Khitamy
Badawy
Resolutions of regional and biopolitical issues in
situation of historical and cultural diversity in the
Caucasus
Irada Huseynova, Azerbaijan
Bioethics in the system of fundamental universal human
and national values
Nigar Kalandarli, Azerbaijan

26

Wednesday, November 20, 2013

The Omani National Committee for Bioethics: making


regulations and drawing up legislation, with special
reference to embryonic stem cell research and end of
life issues
Ahmed Binsumeit Khitamy Badawy, Oman

The European partnership


Barbara Ciampella, Italy

The truth and meaning of the human embryos life:


from ancient Greece to the contemporary bioethical
debate
Emilia DAntuono, Italy

Prevalence of speech language communication


difficulties in Italian young offenders
Anna Giulia De Cagno, Italy

Healthcare professionals well-being at work: the case


of an Italian region
Giuseppe Villani, Italy
RESEARCH ETHICS (4)
Co-Chairs: Charles Weijer, Tapani Kernen

Hall G

The use of the screening tool in Italy


Simona Silvestro, Italy

Recommendations for speech and language therapy


in the juvenile justice
Tiziana Rossetto, Italy
RISK MANAGEMENT AND QUALITY
Hall J
Co-Chairs: Helen Malka-Zeevi, Pablo Simn-Lorda

Ethical issues in cluster randomized trials in health


research: an overview and implications for education
of researchers and research ethics committees
Charles Weijer, Canada

Clinical risk management and medical and legal sides


in the implementation of the telemedicine on more
than one medical facility in the transfusion medicine
service of the Rome B Local Health Unit
Giancarlo Carbone, Italy

Placebo controlled clinical trials: how rationale for the


use of placebo is justified
Tapani Kernen, Finland

Can ethical evaluation be an alternative way of


preventing medical errors?
Andreas A. Prokopiou, Cyprus

Ethical issues identified in research proposals reviewed


by the school of health sciences research committee
Numa Vera, Fiji

Raising the awareness of error reporting as part of


organizational culture and patient safety
Helen Malka-Zeevi, Israel

Not a dead giveaway: human remains and the


researchers responsibilities
Mark Spigelman, Israel

Content of syllabi of public health ethics courses in


accredited U.S. programs and schools of public health
Pablo Simn-Lorda, Spain

The ethics of research in palliative care in an HIV


homeless community in South Africa
Therese Maarschalk, South Africa

MULTICULTURALISM (1)
Hall K
Co-Chairs: Aline Albuquerque, Maria Teresa Tassinari

MEDICAL ETHICS (8)


Co-Chairs: Marek Czarkowski, Jining Li

Hall H

Hospital ethics committees in Poland - first attempts


Marek Czarkowski, Poland
Development of ethical committees in the Chinese
hospitals and protection for the patients rights
Jining Li, China
Ethical aspects in treating diabetes mellitus
Agung Pranoto, Indonesia
Professional interpersonal relationships involving
physicians - Croatian perspective
Marko urkovi , Croatia
Conscientious objection in emergency contraception:
is it (a) right?
Costantino Ciallella, Italy
ITALIAN FEDERATION OF SPEECH
Hall I
THERAPISTS WORKSHOP (1)
YOUTH OFFENDING AND SPEECH AND LANGUAGE
THERAPY (YOSALT)
Co-Chairs: Tiziana Rossetto, Giuseppe De Michele
The YOSALT Project
Raffaella Citro, Italy

Intercultural bioethics: the use of human rights tools


for conflict solution
Aline Albuquerque, Brazil
Individual counseling as efficacious strategy for
eradication of Female Genital Mutilation (FGM) in
immigrant women living in South Italy
Luciano Gualdieri, Italy
Umuntu ngumuntu ngabantu: an Afrocentric
approach to bioethics
Tambu Muoni, Jersey
The person: medicines end, not means - analysis from
a salutogenic perspective
Maria Teresa Tassinari, Italy
Living in a shell of something Im not: transsexuality
and bioethics viewed from the Jewish-Christian
perspective
Mathias Wirth, Germany
16:30-17:00
Coffee break and poster session

Wednesday, November 20, 2013


17:00-18:30
Hall A
SIOT COMMISSION FOR VOLUNTARY
ACTIVITIES AND INTERNATIONAL COOPERATION
WORKSHOP
INTERNATIONAL COOPERATION
Co-Chairs: Maurizio Piazza, Elio Sena
International cooperation in emergency situation
Maurizio Piazza, Italy
Ethics and surgical care in mid-term development
program income countries: paradigm shift
Marco Foletti, Italy
OPBG clinical & surgical services in developing countries
Lorenzo Borghese, Italy
Ethics and empathy in the therapeutics relationship
Elio Sena, Italy
Commission for volunteering and international
cooperation
Michele Saccomanno, Italy
NAPLES FEDERICO II UNIVERSITY ETHICS
COMMITTEE & CIRB WORKSHOP (4)
END OF LIFE IV
Co-Chairs: Agata Bonaudo, Sabino De Placido

Hall B

Futile treatment in neonatology


Roberto Paludetto, Italy
Extraordinary life-saving measures in ICU
Antonio Corcione, Italy
Therapeutic obstinacy in geriatrics
Franco Rengo, Italy

27
9

Bioethical aspects in the health care of refugees during


the 2011-2012 immigration emergency in Southern
Mediterranean
Antonio Tuccillo, Italy
BIOETHICS AND THE LAW
Co-Chairs: Radmyla Hrevtsova, Chongqi Wu

Hall D

Conscientious objection, law and bioethics: the right


to disobey law based on moral, religious or
philosophical convictions and its interface with bioethics
Selma Aparecida Cesarin, Brazil
The interplay of bioethics and health law: global and
local dimensions
Radmyla Hrevtsova, Ukraine
Bioethical regulation in a pluralistic society
Pawel Lukw, Poland
Initiate thinking on joint development of bioethics
and disciplinary building of health law
Chongqi Wu, China
Legal status of embryo in the context of stem cell research
Vinko Galiot, Croatia
PUBLIC HEALTH
Hall E
Co-Chairs: Milica Prostran, Marie-Genevive Pinsart
Public role of the medical profession in the changing
world
Iva Miteva, Bulgaria
Compulsory and recommended vaccines in
development age: the importance of voluntary assent
Rosagemma Ciliberti, Italy

The dilemmas of the trial patients with end-stage


Mario Giuliano, Italy

Childs vaccination refusal by parents: an event


changing the face of the power
Marie-Genevive Pinsart, Belgium

Psychological support to the family in the life-end


Valentina Battimiello, Italy

A human rights conscience in public health


Jane Wathuta, Italy

The management of the emotional stress of parents


in paediatric oncology
Fabio Borrometi, Italy

Is networking the key for improving the situation of


patients with rare diseases in Serbia?
Milica Prostran, Serbia

End of life-care: economics and management aspects


Giovanni Persico, Italy

ORGAN TRANSPLANT, ETHICS AND


THE LAW
Co-Chairs: Agata Bonaudo, Eliezer I. Klainman

About the choices between home care and hospice


Carlo Musella, Italy
NAPLES FEDERICO II UNIVERSITY ETHICS
Hall C
COMMITTEE WORKSHOP (4)
ETHICAL PROBLEMS THE TASK OF AID TO THE PEOPLE
IN EMERGENCY SITUATION
Chair: Luigi Sacc
Humanitarian aid and medical emergency response
relief in international disasters: recovery of medical
paternalism vs. diffusion of patient autonomy
Fabio Ciciliano, Italy
Proposal for the realization of a European civil
protection module for the forensic pathology and
disaster victim identification
Laura Moscatello, Italy

Hall F

The analysis of the productization of organ


transportation in the angles of ethics and laws
Yunliang Chen, China
The principle of autonomy and the principle of justice
on organ transplantation
Melania Borgo, Italy
Transplantation of human organs: universal panacea
or one of the ways to save the life?
Nataliya Hnatush, Ukraine
Organ transplants - rational and ethic problems
Eliezer I. Klainman, Israel
Human organ transplantation in Singapore
John Y.H. Liow, Singapore

28

Wednesday, November 20, 2013

RESEARCH ETHICS (5)


Co-Chairs: Barry Poata Smith, Katherine Wade

Hall G

A discussion on ethical research in the humanities


analyzed by a Brazilian Research Ethics Committee
Deise Juliana Francisco, Brazil
When less is more: raising and challenging expectations
around indigenous research consultation in New
Zealand
Barry Poata Smith, New Zealand
Non-therapeutic research with neonates: challenges
from a European perspective
Katherine Wade, Ireland
Ethical committees role in the definition of priority
levels of care pathways: off label drugs use
Maria Rosaria Romano, Italy
MEDICAL ETHICS (9)
Co-Chairs: Nurbay Irmak, Debora De Bartolo

Hall H

Professional ethics in extreme circumstances:


responsibilities of attending physicians and healthcare
providers in hunger strikes
Nurbay Irmak, USA
Are there evidences for harm in tube feeding in patients
with advanced dementia?
Reuven Friedmann, Israel
The ethics enigma of the cancer pain in Italy: from
pharmacological therapy to the application of a method
of psycho-social care integrated
Debora De Bartolo, Italy
Womans right to refuse treatment during childbirth
Zuzana Candigliota, Czech Republic
ITALIAN FEDERATION OF SPEECH
Hall I
THERAPISTS WORKSHOP (2)
BIOETHICAL IMPLICATIONS IN THE CLINICAL PRACTICE
OF SPEECH AND LANGUAGE THERAPY: ACTIONS WITH
COMPLEX PATIENTS
Co-Chairs: Roberta Citro, Giuseppe De Michele
The action of the speech therapist and the conflict
about the right thing to do
Franca Balbo Mossetto, Italy
The role of speech and language therapist in senile
age communication: the importance of the ethics and
respect for the person
Marta De Mattia, Italy
Disorders of consciousness and awareness in severe
acquired brain injury: bioethics compare with speech
therapy
Angela Lucia Fogliato, Italy
Bioethics and pediatric palliative care: the contribution
of speech and language therapist
Alessandra Renzi, Italy
CONSTITUTIONAL LAW AND BIOETHICS
Co-Chairs: Roy G. Spece, Tomas Dolezal

Hall J

The U.S. Constitution and bioethics: mutual


illuminations
Roy G. Spece, USA
Ethical issues in international legal acts and
constitutional law of the Republic of Azerbaijan
Sona Kalandarli, Azerbaijan
Medical law under the Strasbourg influence: on a road
to ius communae?!
Tomas Dolezal, Czech Republic
MULTICULTURALISM (2)
Hall K
Co-Chairs: Eli Buchbinder, Osaretin James Odia
Self-determination in intervention with Arab battered
women in medical community clinics in Israel
Eli Buchbinder, Israel
The relation between law, religion, culture and medical
ethics in Nigeria
Osaretin James Odia, Nigeria
Psychological vulnerability in the Reception Centre for
Asylum Seekers (CARA) of Crotone, Italy
Erika Angeletti, Italy
Maternity and immigrant women
Elena Carovigno, Italy
Islam and palliative care
Kartina A. Choong, UK

Thursday, November 21, 2013


09:00-10:30
Hall A
INPS WORKSHOP
SOCIAL SECURITY MEDICINE AND BIOETHICS:
REFLECTIONS AND PERSPECTIVES
President: Massimo Piccioni
Co-Chairs: Stefano Castaldo, Vincenzo Rio
The relief of suffering in the history of medicine and
of the invalidity pension insurance: comparisons, ethical
considerations, disease and benefits
Vincenzo Martignetti, Italy
Bioethics and social security medicine resources: the
antinomy between ethics and economy, medical and
legal evaluation and regulatory harmonization
Andrea Cavalli, Italy
Gene therapy and neurotechnologies in neurological
patient: possible applications, prognostic implications
and bioethical considerations
Angelo Moroni, Italy
Psychiatric morbidity in the elderly: current therapy,
disability and ethical considerations
Nicola Di Matteo, Italy
Cancers, biological therapy and disability: prognostic
and ethical aspects
Onofrio De Lucia, Italy
FERRARA UNIVERSITY INTERDIPARTIMENTAL Hall B
CENTRE OF VICTIMOLOGY WORKSHOP (1)
IMMIGRATION, DIVERSITIES, VIOLENCE
Co-Chairs: Francesco Maria Avato, Rosa Maria Gaudio
The medical doctor and the clandestine people: the
Italian vision
Sara Chierici, Italy
A woman portrait based on the Code of Lek Dukagjini,
the medieval Albanian customary law: a profane point
of view
Francesco Maria Avato, Italy
Slaves of their persecutors, prisoners of their own
body: when handicap becomes a business
Miroslava Vasinova, Italy
Violence on pretty women: simulation or help
request?
Roberta Pollicino, Italy
Forensic investigation about violence against women
Salvatore Tarantino, Italy
NAPLES FEDERICO II UNIVERSITY ETHICS
Hall C
COMMITTEE WORKSHOP (5)
ETHICAL ASPECTS OF MODERN MEDICINE I
Co-Chairs: Sabino De Placido, Rino Froldi
Anatomical specimens of human origin on display: die
and become a piece of art and rich
Sabato Romano, Italy

29
9

Evidence-based medicine and good clinical practice


in modern medicine: advantages or problems for the
patient?
Nunzia Cannovo, Italy
Teaching bioethics in medical schools
Domenico Del Forno, Italy
DEATH AND DYING (1)
Hall D
Co-Chairs: Davor Derencinovic, Silvana Cortese
Advance directives in Romanian medical and juridical
practice
Maria Aluas, Romania
Gypsy women perspectives on end of life decisions
and advance directives
Ins Maria Barrio Cantalejo, Spain
How would you like to die? Greek opinion leaders on
science, arts and politics reply. A Greek conception of
good death and the contemporary pathophysiology
of death
Konstantinos GI Vazouras, Greece
Criminal offense of assisted suicide - new laws and old
dilemmas
Davor Derencinovic, Croatia
The role of the family in end-of-life choices
Silvana Cortese, Italy
BIOETHICS GENERAL (9)
Co-Chairs: Ames Dhai, Paolo Benanti

Hall E

Developing policy for biobank research in South Africa:


the Wits human research ethics committee (medical)
approach
Ames Dhai, India
The ethics consultation: which role in biobanks
governance?
Luciana Caenazzo, Italy
Ethical paradigms for the evaluation of
neurotechnologies in human enhancement
Paolo Benanti, Italy
INAIL WORKSHOP (1)
Hall F
PROFESSIONAL RISKS I
Co-Chairs: Vittorio Fineschi, Adriano Ossicini, Pietro Iacoviello
Bioethics and the centrality of the person: the correct
medicine approach retirement
Daniela Marchetti, Italy
The ethics of safety and biological monitoring of
workers
Maurizio Manno, Italy
INAIL and pathology work: an overall protection while
respecting the principle of humanization of medicine
Emanuela Turillazzi, Italy

The role of citizens in genetic research


Lucia Terracciano, Italy

The diagnostic requirements: the insurmountable limit


between clinical needs and medical-legal social security
Vincenzo Vecchione & Francesco Burlin, Italy

The role of international stakeholders in genetic research


Elia Meccariello, Italy

RESEARCH ETHICS (6)


Co-Chairs: Jihad Makhoul, Anna-Maija Pietil

Hall G

30

Thursday, November 21, 2013

Protecting or policing? Researchers' views of IRB


challenges to their research
Jihad Makhoul, Lebanon
Do the patients participating in clinical trials understand
information about clinical trials?
Asta Cekanauskaite, Lithuania
Ethical principles in clinical research: views of the nurse
managers
Anna-Maija Pietil, Finland
Lived experiences of research ethics chairs: embracing
the ethics creep
Retha Visagie, South Africa
Ethical analysis of the scientific research on animals:
the practice of the research ethics committee in the
Medical University of Sofia
Vihren Petkov, Bulgaria
Ethical and legal issues in the context of clinical research
using vulnerable populations in India
Sarojini Nadimpally, India
ENVIRONMENTAL BIOETHICS (1)
Co-Chairs: Jos Bicudo, Ccile Bensimon

Hall H

Public-private partnerships in the water sector: ethical


considerations raised by the marketization of water
Ccile Bensimon, Canada
Bioethical implications of the effect of benzene
exposure in respiratory functions of Kaduna refinery
plant workers and petroleum pump workers in Kaduna
State, Nigeria
Fatima Lami Ciroma, Nigeria

IPASVI ITALIAN PROFESSIONAL COLLEGES


Hall J
OF NURSES WORKSHOP (1)
NURSING ROLE, DECISION-MAKING AND
RESPONSIBILITY: MULTI-PROFESSIONALISM VERSUS
INDIVIDUALITY
Co-Chairs: Stefano Bazzana, Miriam Magri
Use of physical restraint in hospitals and nursing homes:
a multicentre cross-sectional study
Ermellina Zanetti, Italy
Narrative and the code of ethics: the instruments
for an ethic reflection on nursing practice
Paola Gobbi, Italy
Nurses and multicultural competence in nursing care:
descriptive survey in Italian Aosta Valley Health Agency
Guy Bertrand Aim Tchagou Dago, Italy
Professional dignity in nursing implicates patient safety
for Italian nurses
Alessandro Stievano, Italy
A motivational intervention to improve personal and
professional being of nurses: a mixed methods study
Andrea Giordano, Italy
ISLAMIC BIOETHICS
Co-Chairs: Vardit Rispler-Chaim, Emad Gith

Hall K

Islamic medical ethics: the employment of advanced


technologies in gender issues
Vardit Rispler-Chaim, Israel
Assisted procreation and abortion in the country by
Muslims
Maria Anna Filosa, Italy

Development of a bioethics proposal to implement a


reurbanization project in the central area of the city
of So Paulo
Jos Bicudo, Brazil

The effect of attitudes and beliefs of Jewish and Muslim


mothers on the intention to integrate Down Syndrome
children in Society
Sivia Barnoy, Israel

The WHO definition of health: a critical reading


Marianna Nobile, Italy

Principles and issues in the evaluation of parental


competency in Israels Arab-Muslim community
Emad Gith, Israel

SALVATORE MAUGERI FONDATION


Hall I
WORKSHOP
COMMUNICATION IN REHABILITATION MEDICINE:
ETHICS AND RELATIONAL CONTROVERSIAL ISSUES
Co-Chairs: Ines Giorgi, Carlo Pasetti
In search of a balance between technology and
humanization in palliative care
Anna Giardini, Italy
ALS and decision making
Marcella Ottonello, Italy

10:30-11:00
Coffee break and poster session
11:00-12:30
FNOMCeO /NATIONAL FEDERATION OF
Hall A
ORDERS OF PHYSICIENS & DENTISTS/WORKSHOP (1)
MEDICAL DEONTOLOGY
Co-Chairs: Antonio D'Avanzo, Angelo Fiori
Ethics, bioethics and medical deontology
Aldo Pagni, Italy

Percutaneous endoscopic gastrostomy (PEG):


communicational, cultural and ethics aspects
Francesco Cupella, Italy
In time and space locked-in: families face

Historical development of medical deontological codes


in Italy
Sara Patuzzo, Italy

vegetative state
Marina Manera, Italy

New code of medical deontology in Italy


Roberta Chersevani, Italy

Responsibility construction
Ines Giorgi, Italy

New frontiers in medical deontology


Maurizio Benato, Italy

Thursday, November 21, 2013


FERRARA UNIVERSITY INTERDIPARTIMENTAL Hall B
CENTRE OF VICTIMOLOGY WORKSHOP (2)
IMMIGRATION, DIVERSITIES, VIOLENCE
Co-Chairs: Francesco Maria Avato, Guido Casaroli
Immigration between hospitality and criminal law
Guido Casaroli, Italy
The protection network about asylum seekers: the
social point of view in Italy
Antonio Banchini, Italy
Ethical values of a multicultural and multi-ethnical
society: Aosta Valley Regions experience
Patrizia Scaglia, Italy
Ethics aspects on the mediation cross-cultural activities
in Aosta Valley Region
Fulvia Dematteis, Italy
NAPLES FEDERICO II UNIVERSITY ETHICS
Hall C
COMMITTEE WORKSHOP (6)
ETHICAL ASPECTS OF MODERN MEDICINE II
Co-Chairs: Sabino De Placido, Rino Froldi
The cesarean section under maternal request: ethical
legal implications
Vincenzo Graziano, Italy
Ethical aspects of sham surgery
Francesco De Micco, Italy
When the urge to change the appearance of the body
touches the aberration: ethical limits in aesthetic
medicine
Mariano Paternoster, Italy

31
9

BIOETHICS GENERAL (10)


Hall E
Co-Chairs: Caue Cosme Dutra da Silva, Ayesha Irshad
Tattoos and piercings: bioethical and educational
profiles between nature and beauty
Carmela Bianco, Italy
Toxicological screenings in safety sensitive jobs:
balancing costs and benefits. Ethics of resources
Federica Bortolotti, Italy
The present and the future of molecular diagnostic
tests: there are ethical concerns?
Caue Cosme Dutra da Silva, Brazil
An analysis of reproductive genetic technology and
assisted reproduction with a focus on ethical, religious
and legal challenges in Pakistan
Ayesha Irshad, Austria
INAIL WORKSHOP (2)
Hall F
PROFESSIONAL RISKS II
Co-Chairs: Vittorio Fineschi, Adriano Ossicini, Pietro Iacoviello
The professional responsibility of the medical-legal
evaluation process in social security: how to
homogenize technicality, training, law and ethics
Patrizio Rossi, Italy
Technical devices and interventions to support the life
of the relationship: the biopsychosocial approach to
the person with disabilities to work
Giovanni Cortese, Italy
Taking care of the person-injured worker through an
overall protection aimed at reintegration
Maria Rosaria Matarrese, Italy

Antiblastic drug manipulation in oncology departments:


environmental contamination levels, exposure risks,
formation/information role and possible consequences
for the sanitary personnel
Maria Pieri, Italy

The heritage statistical-information INAIL ethics as a


tool in the service of the society in respect of the
dignity of the person
Alessandro Salvati, Italy

DEATH AND DYING (2)


Co-Chairs: Esther-Lee Marcus, Ruth Horn

ENVIRONMENTAL BIOETHICS (2)


Hall H
Co-Chairs: Zohar Lederman, Vugar Mammadov

Hall D

End of life decisions in oncology decisions against


life-prolonging treatment in young patients
Katsiaryna Laryionava, Germany
An institution one cannot disparage: the long-term
marital bond and euthanasia in Haneke's film Amour
Esther-Lee Marcus, Israel
Nurses difficulties to talk with patients in the end of
life about health care decisions
Juana Mara Granero-Moya, Spain
Human honor solution process for the euthanasia and
willpower concept and the disputes resulting from the
differences between national laws and international
laws in terms of health law and basic human rights
Ne e etin, Turkey
Dignity and end-of-life decisions in England and
France
Ruth Horn & Angeliki Kerasidou, UK

For a new ethics and politics of bioculture


Franco Manti, Italy
Rights of citizens for healthy environment during
natural urban growth (right to silence)
Mahammad Imran Oglu Baziqov, Azerbaijan
Environmental medicine in the 21st century
Zohar Lederman, USA
Why we need to strengthen control on GMO food
products turnover
Vugar Mammadov, Azerbaijan
INTERCULTURAL BIOETHICS & LIFELONG
LEARNING WORKSHOP (6)
DIGITAL SOCIETY & EMERGENT RIGHTS
Co-Chairs: Carlo Pasetti, Mirella Scala

Hall I

Culture of innovation, connecting people: figures and


opportunities
Sveva Avveduto, Italy

32

Thursday, November 21, 2013

Policies of the Basilicata Region for the overthrow of


the digital divide
Vito De Filippo, Italy
Innovation, knowledge and future
Cristiano Radaelli, Italy
Meeting the challenge of future educational scenarios
Marco Rossi Doria, Italy

Consent of minors: bioethics point of view


Elena Nave, Italy
Consent of minors: clinical point of view
Roberto Rosset, Italy
Conscientious objection
Franco Alberton, Italy

Digital society: new chances and new differences


Giacomo Sado, Italy

Autonomy of professional practice and constraints of


healthcare organizations
Antonio Panti, Italy

The dark side of the digital divide


Lisa Somma, Italy

CONSULTA POSTER SESSION


Hall B
Co-Chairs: Eduardo Consiglio, Nicoletta Gasparini

IPASVI ITALIAN PROFESSIONAL COLLEGES


Hall J
OF NURSES WORKSHOP (2)
ETHICAL DILEMMAS: NURSING EDUCATION AND
NURSING RESEARCH
Co-Chairs: Monica Gazzola, Helga Zen

Archives of surgical pathology as a tool for


comprehension of biological behaviour of malignancies
Gabriele Margiotta, Italy

The nurses attitudes towards the use of physical


restraint: a focus group study
Monica Gazzola, Italy
Ethical difficulties in nursing, educational needs and
attitudes about using ethics resources
Cinzia Leuter, Italy
Narrative and bioethics themes within the nursing
education
Marina Negri, Italy
In search of salience: phenomenological analysis of
moral distress
Dina Moranda, Italy
Crushing and covert medications in nursing home:
prevalence and implications for practice
Anna Castaldo, Italy
REPRODUCTION, ETHICS AND LAW (1)
Hall K
Co-Chairs: Edna Raquel Hogemann, Elena Ignovska
Transnationalization on the technique of assisted
human reproduction
Edna Raquel Hogemann, Brazil
The legal position of sperm donors assisting single
women to reproduce
Elena Ignovska, Belgium
Assisted Human Reproduction (AHR) and the legal
concept of filiation
Martha Miranda, Kenya
Having a child after death: reproductive rights,
childrens interests and the regulation of technologies
Yun-hsien Diana Lin, Taiwan

The determination of death with regard to organ


transplantation: 20 min vs 2 min
Arianna Giovannetti, Italy
Accidental thawing of embryos and oocytes: legal
aspects and medico-legal profiles
Michela Cicconi, Italy
Post mortem fecundation rules in EU members:
the usage of sperm after donors death
Paola Mancarella, Italy
Cultural and ethical issues on female genital mutilation:
the Italian situation
Laura Panata, Italy
The future role of the invasive autopsy in the
investigation of deaths and possible alternatives
Italian Group of Young Medico-legal Doctors
The European legal framework for compassionate use
programmes: similarities and differences between five
member states to guarantee a better quality of life in
patients affected of serious and/or chronic debilitating
or life-threatening diseases
Sara Hemied, Italy
Compassionate use: Italian case law
Irene Catarinozzi, Italy
The use of unapproved drugs for compassionate use:
Italian law and re-emerging regulatory requirements
Laura Iovenitti, Italy
NAPLES FEDERICO II UNIVERSITY ETHICS
COMMITTEE WORKSHOP (7)
MISCELLANEA
Co-Chairs: Bruno Della Pietra, Paolo Rubba

Hall C

The travel of good death


Rosa Ferrara, Italy

12:30-14:00
FNOMCeO /NATIONAL FEDERATION OF
Hall A
ORDERS OF PHYSICIANS & DENTISTS/WORKSHOP (2)
BALANCE BETWEEN DEONTOLOGY AND LEGISLATION
Co-Chairs: Bruno Zuccarelli, Gian Aristide Norelli
Informed consent and advance directives for treatment
Roberto Longhin, Italy

Long lasting endemic fluorosis in the Vesuvius area


population: a matter of ethics?
Pier Paolo Petrone, Italy
Palaeobiological research and ethical implications for
treatment, study and conservation of skeletal human
remains
Giuseppe Quaremba, Italy

Thursday, November 21, 2013


The decision-making process with regard to the videoassisted thoracic surgery in eighty years old hesitant
individuals
Ciriaco Cecere, Italy
DEATH AND DYING (3)
Co-Chairs: Ehud Shalmon, Yuichi Minemura

Hall D

Advanced treatment directives: a comparative study


between Italy and Brazil
Marilia Pedroso Xavier, Brazil
Playing God at an intensive care unit: the Brazilian
case of Dr Virginia de Souza
Luciana Pedroso Xavier, Brazil
On the violation of self-autonomy of patients in lifethreatening condition: can a dying patient make a
reasonable decision?
Ehud Shalmon, Israel
End-of-life care in Andalusia, Spain
Maribel Tamayo Velzquez, Spain

FORENSIC MEDICINE
Hall G
Co-Chairs: Olufumilayo Yetunde Elegba, Andrea Baloghov
Development of molecular pathology infrastructure
in Nigeria: The emerging opportunities, legal and
ethical implications
Olufumilayo Yetunde Elegba, Nigeria
Ethical and legal problems in forensic medicine in Slovakia
Andrea Baloghov, Slovakia
WAR, SECURITY AND ETHICS
Co-Chairs: Mohd Zin Bidin, Barry Roth

Hall H

Ethics & military medicine: an analysis of medical civilian


assistance programs & the problem of dual loyalty
Sheena M. Eagan Chamberlin, USA

How do you know when its torture?


Barry Roth, USA

Metaphysical analysis of issues regarding human


identity in contemporary brain death controversies
Yuichi Minemura, USA

REFUGEES, IMMIGRANTS AND ASYLUM


SEEKERS
Co-Chairs: Edward S. Dove, Deborah Zion

Hall I

Hall E

The Confucian tradition of medical ethics in medical


humanities
Weijia Wang, China
Establishment and development of bioethics science
in Azerbaijan
Jalal Aliyev, Azerbaijan
The DNA databases between the need of justice and
the protection of individual rights
Ester De Luca, Italy
Ethical problems of susceptibility testing
Maria Chiarelli, Italy
Bioethical implications of synthetic biology: a
precautionary approach to risks of new science
Arianna Serra, Italy
CONFIDENTIALITY AND PRIVACY
Co-Chairs: Adi Liberty, Michael Lupton

Ethical issues in the clinical diagnosis of Huntington


Disease
Elena Salvatore, Italy

Medical ethics in war: a moral dilemma?


Mohd Zin Bidin, Malaysia

Living with an oncological pathology


Roberta Martino, Italy

BIOETHICS GENERAL (11)


Co-Chairs: Weijia Wang, Jalal Aliyev

33

Hall F

Medical information in a changing world: providing


information via phone calls to relatives of hospitalized
patients
Adi Liberty, Israel

Access to healthcare for undocumented migrants in


Belgium
Saphia Mokrane, Belgium
The biopolitics, ethics and law of compulsory DNA
testing of refugees
Edward S. Dove, Canada
Discrimination of migrants in health care: A systematic
literature review
Daniel Drewniak, Switzerland
About secrets and lies: ethics, stigma and asylum seeker
research
Deborah Zion, Australia
NURSING
Co-Chairs: Nili Tabak, Sarah Nissim

Hall J

Do caregivers have the right to refuse treating


terrorists?
Nili Tabak, Israel
Nursing students experiences coping with ethical
dilemmas during first clinical placement
Sarah Nissim, Israel

The ethics of the Veri Chip human implant


Michael Lupton, Australia

What they say: the ethical and moral conduct of nursing


students during study and clinical practice - a case
study
Debbie Muchnik, Israel

Medical data protection: a fundamental right in the


hi-tech and information society
Fernanda Schaefer Rivabem, Brazil

Therapeutic obstinacy: the nursing role between


autonomy and responsibility
Christian DallOlmo, Italy

34

Thursday, November 21, 2013

REPRODUCTION, ETHICS AND LAW (2)


Hall K
Co-Chairs: Giovanna Ricci, Stephanie Bernstein
Current situation of medically assisted reproduction
in Italy and jurisprudence of the European Court of
Human Rights
Giovanna Ricci, Italy
The rights of the unborn child and artificial reproductive
technologies
Ignatius Chikwado Okuta, Italy
Oocyte freezing - producing freedom or reproducing
fears?
Stephanie Bernstein, Germany
Human dignity and assisted reproduction: bioethical
challenges within the Nigerian context
Michael Etim, Nigeria
Is ART a test for conservatism? A Polish case
Anna Alichniewicz & Monika Michalowska, Poland
14:00-14:30
CLOSING SESSION AND DISPERSAL

Poster Presentations
Tuesday, November 19, 2013
T01
Acquisition of consent to medical treatment under
mandatory health: simple binding legal or the main
instrument for the promotion of therapeutic
relationship
Cristiano Barbieri, Italy
T02
Stability over time in the preferences of older persons
for life-sustaining treatment
Ins Maria Barrio Cantalejo, Spain
T03
Assisted reproduction in Italy: bioethical, juridical and
medico-legal dilemmas
Rosagemma Ciliberti, Italy
T04
Prison treatment and ethical dimension
Paolo Danesino, Italy
T05
Moral and legal responsibilities - dilemmas faced
in pharmacy - experiences from the Republic of
Macedonia
Merita Dauti, Republic of Macedonia
T06
Ethical standards and normative regulations in
the field of medical care in emergency situations
Alena Donika, Russia
T07
Linguistic and cultural validation of an instrument for
the analysis of ethical values of nursing students with
special reference to honesty and altruism
Stefano Finotto, Italy
T08
The act ethics in health care: the path of ethics
Raffaela Genzale, Italy
T09
The Interuniversity Research Centre on Bioethics of
Naples - activities on the bioethics of the beginning
life
Pasquale Giustiniani, Italy
T10
Current status of institutional review boards and
approvals of clinical research in oriental medical
hospitals in Korea: a survey
Jung Hee-Jung, South Korea
T11
Attitude, practice of clinical physicians in Vietnam
on medical errors and conflict of interest
Tran Thi Thanh Huong, Vietnam
T12
Preventive mastectomy: overtreatment or personal
harm?
Francesco Introna, Italy
T13
The cloning and its ethical-legal implications
Fatbardha Ismaili, Republic of Macedonia

35

T14
Dealing with violence in a combined organizational
structure - an instructive response from a therapeutic,
ethical and safety perspective
Ronit Kigli, Israel
T15
Health care guarantee in secondary health care telemedicine to the rescue
Hanna Kuusisto, Finland
T16
Missing person DNA data-base to counteract the illegal
traffic of organs
Massimo Lancia, Italy
T17
The foundations of the Italian medical ethics following
the finding of the Professional Codes of the Medical
Chamber of Istria (1897) and of the Medical Chamber
of Trento (1900)
Sara Patuzzo, Italy
T18
Emotional communication in helping relationships for
the treatment of disorders related to new forms of
addiction
Rocco Quagliariello, Italy
T19
A pilot study of pharmacy students perceptions
regarding ethical values, conscientious and religious
objections
Vojin Rakic, Serbia
T20
National growths characteristics of bioethics in Russia
Natalia Sedova, Russia
T21
Ethics, hemodialysis and patients with differing ages
Ronen Segev, Israel
T22
Professional dignity in nursing implicates patient safety
for Italian nurses
Alessandro Stievano, Italy
T23
The experience of ethics committees in the
Andalusian System of Public Health, Spain
Maribel Tamayo Velzquez, Spain
T24
Bioethics contribution to integral formation on higher
education
Valeria Trigueiro Santos Adinolfi, Brazil

36

Poster Presentations
Wednesday, November 20, 2013

W01
Ethical problems of integration of children with
disabilities in Bulgaria
Silviya Aleksandrova-Yankulovska, Bulgaria

W15
Post mortem fecundation rules in EU Members:
the usage of sperm after donors death
Paola Mancarella, Italy

W02
The Health Technology Assessment (HTA): the
distinction between innovation and new business
Rosalba Caldarazzo, Italy

W16
Archives of surgical pathology as a tool for
comprehension of biological behaviour of malignancies
Gabriele Margiotta, Italy

W03
Regional differences within the programmes of
screening for breast cancer: ethical problems of health
policy and management
Michelle Capasso, Italy

W17
Sensitization and incorporation of ethical practices in
pathology postgraduate curriculum in India
Mary Mathew, India

W04
Compassionate use: Italian case law
Irene Catarinozzi, Italy

W18
Impact of eastern socio cultural determinants on end
of life decision making
Princy Louis Palaty, India

W05
Accidental thawing of embryos and oocytes:
legal aspects and medico-legal profiles
Michela Cicconi, Italy

W19
Cultural and ethical issues on female genital mutilation:
the Italian situation
Laura Panata, Italy

W06
Ethics committees and GCP and GLP Rules
Susanna Davtyan, Republic of Armenia

W20
Bioethical aspects of pharmacotherapy of rare diseases
in Serbia: from the point of view of medical students
Milica Prostran, Serbia

W07
Socio-economic factors related to the withdrawal of
chloroquine (CQ) in the range of production plant
Malian pharmaceuticals
Samba Diop, Mali
W08
The future role of the invasive autopsy in the
investigation of deaths and possible alternatives
Italian Group of Young Medico-legal doctors
W09
The determination of death with regard to organ
transplantation: 20 min vs 2 min
Arianna Giovannetti, Italy
W10
Reasons for asylum seeking and medical certification
Luciano Gualdieri, Italy
W11
The European legal framework for Compassionate
Use Programmes: similarities and differences between
five member states to guarantee a better quality of
life in patients affected of seriously and/or chronic
debilitating or life-threatening diseases
Sara Hemied, Italy
W12
The use of unapproved drugs for compassionate use:
Italian law and re-emerging regulatory requirements
Laura Iovenitti, Italy
W13
Styles of bioethics education in Poland
Pawe ukw, Poland
W14
Nurses coping with ethical dilemmas during work
Helen Malka-Zeevi, Israel

W21
The ethics of treating adolescents with anorexia
nervosa: the case for justified paternalism
Tomas J. Silber, USA
W22
The strategic plan on bioethics of the Regional Ministry
of Health and Welfare of Andalusia (Spain): an
innovative experience in public policy
Pablo Simn-Lorda, Spain
W23
Should or must there be a finding of materiality
regarding, and disclosure of, physician financial conflicts
of interest that both patients want to know about
and that, when disclosed, affect their decisions whether
to accept care recommendations?
Roy G. Spece, USA
W24
Attitudes, perception and knowledge of bioethics
among physicians and post graduate trainees of
hospitals of Islamabad and adjacent regions
Rizwan Taj, Pakistan

UNESCO Chair in Bioethics 9th World Conference

Bioethics, Medical
Ethics and Health Law

Abstracts
Oral Presentations
(alphabetical order by author)

Abstracts of Oral Presentations

RAPE A TERMINAL CONDITION OF TRAUMA:


WHY PALLIATIVE CARE IS A BETTER APPROACH
THAN PSYCHIATRY
Ayesha Ahmad, University College London, UK
a.ahmad@ucl.ac.uk
This article separates rape from other traumas in a series of stages; (1)
clinical, (2) phenomenological, and (3) societal. The overall argument,
represented by each of these stages, is that despite much work to
deconstruct the rape victim identity, the effects of rape are irreversible.
PTSD is a unique diagnostic criterion because it specifies that there must
be an event external to the person to cause the abnormal condition. This
article claims that rape needs to be diagnosed as a disease. The further
point that this article will make is that rape is a terminal condition of
trauma and therapeutic models from a psychiatric framework are
redundant. Rather, a palliative care approach better captures the type of
management necessary for the clinical treatment of those who have been
raped. Finally, suicide tendencies in rape-related PTSD patients need to be
understood as an operational force of rape-as-a-disease rather than a
symptom of distress. In particular, this paper will explore ethical
implications for this reclassification of trauma in global contexts where
both psychological support and palliative care are under-resourced.

A NETWORK TO ENHANCE LIFELONG LEARNING


Aurealiana Alberici, Italian University Network for the Lifelong Learning,
Italy
In geopolitical environment which has gone through a deep change,
lifelong learning can be considered as guiding principle for global
equitable development, implying inclusive cultural models and policies.
Yet it is actually this risk of neo-liberal drift which generated
unprecedented social issues. The framework in which the following
reflections are placed, is basically defined by the adoption of a
perspective which considers, in complex global societies, the
development as a freedom. The network RUIAP, in the light of the
objectives recently identified in the framework of the Europe 2020
strategy, aims to reinforcing the role of lifelong learning in the higher
education as strategic resource to develop more inclusive and responsive
universities, in order to face the present crisis and design a future based
on intelligent, sustainable, inclusive development.

CONSCIENTIOUS OBJECTION
Franco Alberton, FNOMCeO Deontological Committee, Italy
deontologia@fnomceo.it
The term conscientious objection indicates a generic refusal to perform
actions which, even if imposed by law, are judged to be irreconcilable
with ethical, religious or ideological principals. Refusing treatment
assumes enormous relevance in the medical field, given the primary
interests of the individual and also the potential consequences for the
conscientious objectors of possible infringement of the law (omission).
There is, therefore, a difference between the objection contemplated and
allowed by the law as an exception to the obligation imposed and the
objection which, if implemented, constitutes an effective breach of the
law.
In Italy, conscientious objection as a right contemplated by law is
envisaged, in the health care context, in only three cases: in the
regulations on voluntary interruption of pregnancy, in medically assisted
procreation and in those regarding experimentation on animals.
Above all, in the first two cases the possible conflict with principles
deemed to be non-renounceable for a large number of citizens and,
therefore, also for many health operators, appears evident.
We can talk about illegal objection when the refusal involves actions
required by law without exceptions. In such cases, the person who raises
the conscientious objection and refuses the treatment may incur legal
consequences, while on a deontological level the problem may turn out to
be very complex. For the health operator, in fact, the possibility of
abstaining from activities which are in stark contrast with his/her
principles, is recognized. This right must, however, always find a just
equilibrium with the interests of the person who is requesting help.

39

INTERCULTURAL BIOETHICS: THE USE OF HUMAN RIGHTS


TOOLS FOR CONFLICT SOLUTION
Aline Albuquerque, Human Rights Secretariat at the Presidency of the
Republic, Brazil
aline.santanna@sdh.gov.br
The Universal Declaration on Bioethics and Human Rights adopted by
UNESCO in 2005 established that the importance of cultural diversity and
pluralism must be taken into consideration. However, such consideration
must not be used to violate human rights or to limit its scope.
Intercultural bioethics must deal with this tension. If, on the one hand,
the adoption of interculturalism as attitude facing different cultural
contexts implies the respect to differentiated cultures and urges that
these cultures are treated equally, on the other hand, incorporating
human rights as a technical-normative framework brings ethical-legal
barriers that cross through all cultures.
This article aims to point out the problem of using human rights as a
theoretical-normative mediator of the conflicts in bioethics that bear
elements of interculturalism. In other words, which tools are offered by
the human rights framework to solve such conflict?
The methodological steps adopted in this inquiry were:
i. analysis of the concept of intercultural conflict in bioethics, from the
perception developed by Colectivo Amani;
ii. study of human rights as common morals and tools of the culture of
human beings, based on Baumans and Beauchamps theories;
iii. investigation of the tools that human rights offer so as to solve
intercultural conflicts in bioethics. It was concluded that intercultural
bioethics must incorporate to its prescriptive and descriptive tasks norms
and institutions of human rights that ensure the participation and social
integration of the individuals from communities that are in cultural
conflict. Such measure will act as instruments for the solution of
intercultural conflicts.

OBSTACLES TO EFFECTIVE ETHICS EDUCATION OF


MEDICAL PROFESSIONALS IN BULGARIA
Silviya Aleksandrova-Yankulovska, Toni Vekov, Medical University-Pleven,
Bulgaria
silviya_aleksandrova@hotmail.com
Background: Medical ethics was introduced as a separate subject in
undergraduate medical education in Bulgaria in 1991. Each medical
university prepared its own study materials. Some university teachers got
ethical training abroad. In 2007 the ethics teaching programmes of all
Bulgarian medical universities were added to Global Ethics Observatory
database of UNESCO.
Although teaching of medical ethics has been introduced more than two
decades already, there are obstacles to its effective outcomes. The aim of
this report is to analyze these obstacles and to suggest approaches to
overcome them.
Discussion: The comparative analysis of ethics teaching programmes in
Bulgarian medical universities has shown similar topics and number of
teaching hours. The courses are scheduled in the first years of medical
studies when students still lack clinical experience. There is disproportion
in teaching hours between different medical specialties.
The acceptance of ethics in medical practice is controversial. There is
still wide misunderstanding over the subject of medical ethics. Ethics
education stands mainly as theoretical expertise and there is
insufficient motivation for application of dilemma training in clinical
settings. Additionally, there is lack of cooperation between the
universities. Every university uses different study materials and
educational approaches.
Conclusion: Several ideas could be applied towards increasing the
effectiveness of ethics education. The establishment of a National
association on bioethics could improve the cooperation between
educational institutions and experts in the field. Foundation of a
national bioethics journal would contribute for development of
bioethical studies. Post-graduate courses should be offered for
continuous bioethics training.

40

UNESCO Chair in Bioethics 9th World Conference

ASSESSMENT OF PARENTING COMPETENCE IN


INDIVIDUALS WITH MENTAL ILLNESS AND THE ROLE OF A
NEW KIND OF LEGAL GUARDIANSHIP IN ITALY
Linda Alfano, Rosagemma Ciliberti, Gabriele Rocca, Tullio Bandini,
University of Genova, Italy
lindaalfano@interfree.it
The contributions of psychological and psychiatric sciences on assessment
of parenting competence show that the support of the family, the
specialists involvement and the precociousness of the intervention
supporting the parent-child relationship may balance some limitations
that impair a mentally ill parent. In particular it seems that the continuous
support of an individual who is able to provide learning opportunities as
well as practical advice and assistance in daily tasks and who is in the
wings and ready for directly take specific charges and who is able to
support the parent-son relationship.
In cases of child custody, the expert witness, aiming at assessing the
parental competencies, needs to recognize not only the mental disorder
and its impact on the specific parental functions, but also the real
resources and tools that can be activated to improve the parental
competency.
New perspectives on assessment of parental competency and, in
particular, on the identification and development of measures aimed at
protecting the mentally ill parent may be offered by recent and innovative
institution in Italian legal guardianship, the so called sustaining
guardianship, introduced by Law n. 6 in 2004.
This figure may represent a useful resource to protect the different
dimensions of the personality of the mentally ill parent and to remove the
obstacles that hinder the expression of attachment.

IS ART A TEST FOR CONSERVATISM? A POLISH CASE


Anna Alichniewicz, Monika Michalowska, Medical University of Lodz,
Poland
a_alichniewicz@yahoo.pl, monikamichalowska@o2.pl
In the recent years there has been observed a rapid development of
assisted reproductive technology (ART) practices in Poland accompanied
by a rising acceptance of this type of medical service in Polish society.
Despite the fact that the need for the legal framework has been
recognized and discussed in Poland for ten years, there are still no legal
regulations of any of the main ART procedures, that is in vitro fertilization,
egg donation and pre-implantation diagnosis. In 2012 and 2013 two sets
of medico-moral guidelines were issued by the Polish Bioethical
Committee and the Polish Chamber of Physicians and Dentists,
respectively. In our presentation we would like to have a closer look at
the cluster of assisted reproductive issues in Poland. We would like to
focus on three main problems. First, we argue that the tension between a
rising acceptance of these technologies in the Polish society and a
conservative attitude still prevalent among the Polish political elites is the
main factor responsible for the lack of legal regulation of all ART
procedures in Poland. Secondly, we analyze the discrepancy between a
rather conservative approach adopted in the regulation issued by the
Polish Chamber of Physicians and Dentists and a more liberal stance
represented by the Polish Bioethical Committee. Finally, we examine the
discrepancy between the commercialization of ART procedures and the
language of gift and solidarity overwhelmingly employed in the
reproductive market.

THE ROLE OF INFORMED CONSENT IN ASSISTED


REPRODUCTIVE TECHNOLOGIES
Faiza K. Aliyeva, Zemphira H. Huseynova, Institute of Obstetrics &
Gynecology, Ministry of Health, Azerbaijan
vumammadov@yahoo.com
Today as a result of scientific advances in medicine, the use of assisted
reproductive technologies has become possible to overcome various
forms of infertility and the emergence of new human life.
However, in practice there are many questions related to new
reproductive technologies. Certain ethical and legal problems associated
with obtaining patient information and medical diagnostics for medical

intervention, methods of providing assistance and the possible risks,


consequences and impact.
There complexity judgments about how expounded physician information
is objective up to date as far as professionally and accurately set out the
specific situation.
Patients are the most vulnerable subjects of law. For the simple reason
that they do not have the medical knowledge.
Sings informed consent should be directed at overcoming the imposition
of the will of the patient and the doctors views about method of
treatment and legal protection of the patient from experiment, from
specialist research intentions and possible criminal violations.
With auxiliary reproductive technologies it must be taken into account all
the principles of informed consent:
1. Complete, detailed information providing
2. Giving understandable, accessible information
3. Competence of the patient to assess it
4. Voluntary consent
Informed consent in the application of methods of overcome infertility
should be a requirement before every medical intervention.

THE PUBLIC PERCEPTION OF NEUROSCIENCE


Agnes Allansdottir, University of Siena, Italy
The idea of a science that has become "too complicated" to be
understood by the general public has been largely emphasized especially
following developments in the physics of the early twentieth century. The
key elements of this approach is the need for mediation between
scientists and the general public made necessary by the complexity of
the scientific content: the identification of a class of professionals and
institutions responsible for such mediation (science journalists and, more
generally, the advisers, the museums and the citadels of science), on the
basis of a linear conception, educational and paternalistic communication,
they have therefore called to increase and to improving the quality of the
science public communication.

VIOLATING DIGNITY BY OFFERING ORGANS FOR SALE? A


CRITICAL EVALUATION OF DIGNITY IN THE CURRENT
DEBATE
Zmrt Alpinar, Institute of Biomedical Ethics, University of Zurich,
Switzerland
zumrut.alpinar@ethik.uzh.ch
Organ selling is prohibited since it is accepted as violating human dignity.
Although the dignity concept has received its due attention in the current
ethical debate, still it does not seem to have a clear meaning, by which a
consensus can easily be achieved. In the bioethical debates in general and
in organ selling debate in particular, it appears that dignity can either be
understood as having a function to foster autonomous choices or would
function as a constraint, which puts limits on individuals autonomous
choices. If it fosters autonomous choices, then one can argue for organ
selling by stating respect of autonomy. Since autonomous beings have a
right to decide whatever they would like to do with their own bodies, to
restrict their choices would fail to show respect for their dignity. On the
other hand, if it is a constraint, then there surely is a concern about what
autonomous beings are morally allowed to do with their bodies. So, is it
the autonomy of the persons that give them dignity or is dignity a value
different than autonomy of the persons? In this paper, after critically
evaluating the ethical debate evolving around these values, we will argue
that dignity should be understood as a social constraint, which would
clarify the dignitys role in the current ethical debate and its possible
function in real world context.

ADVANCE DIRECTIVES IN ROMANIAN MEDICAL AND


JURIDICAL PRACTICE
Maria Aluas, Iuliu Hatieganu University of Medicine and Pharmacy,
Romania
maria.aluas@umfcluj.ro
Lately, the Romanian doctors, especially those from the intensive care
services, have shown interest in the advance directives institution.

Abstracts of Oral Presentations


Romania has no special law on advance directives, besides that the
cultural and religious context is far from encouraging serious and
comprehensive debates on the legalization and implementation of these
documents. Romania ratified the Convention on Human Rights and
Biomedicine, which establishes the possibility to express your will in
advance, related to medical intervention on patients who aren't able to
do it, at the time of the intervention (art. 9). Also the Medical Deontology
Code (2012) states that patient wishes, decided in advance, will be taken
into account if he/she is not able to express it (art. 16). What happens,
however, in the day-by-day medical practice to the patients who are not
able to express their will regarding medical interventions, or those which
are in vegetative state? Who are the ones who decide? How these
surrogate decisions are received by doctors? What solutions offer the
legal practice in Romania in the case of conflicts between the ones who
must protect the rights of patients unable to express their will? What are
the right ways for those dealing directly with these situations? This paper
is the result of a few focus groups organized on advance directives in the
Romanian context, by our department. Physicians, surgeons, lawyers,
sociologists, social workers, psychologists, priests and bioethicists have
participated to this activity. The conclusion is that the regulation of
advance directives is a necessity for doctors and a great challenge for the
legal practice. Also the presentation will show the Romanian
particularities on these issues.

IMMIGRANT WOMEN FROM SUB-SAHARAN AFRICA IN


ITALY A SURVEY ON THE PHENOMENON OF INDUCED
EARLY ABORTION DURING THEIR IRREGULAR STAYING:
EPIDEMIOLOGICAL, ANTHROPOLOGICAL AND ETHICAL
ASPECTS
1

L. Andrissi , G. Mottini
1
Tor Vergata University, Italy
2
Campus Bio-Medico University, Italy
l.andrissi@unicampus.it, g.mottini@unicampus.it
Several studies have showed a high rate of Induced Early Abortion (IEA)
among irregular immigrants and refugees (up to 50% of pregnancies)
especially for those coming from Sub-Saharian Africa.
100 women (aged 27 in mean, 43 IEA), temporary living in the two largest
Reception Centres for Asylum Seekers (CARA) in Europe (Crotone and
Mineo, Italy), were asked to fill a questionnaire for epidemiologic aspects,
and semi-structured interviews were performed to identify the
anthropologic and ethic triggers that push to IEA and find solutions. The
main languages were English and French.
Statistical analysis shows that to come from urban settings, to be single,
Nigerian, with a low educational level and a poor knowledge on
reproductive cycle and family planning methods (natural, chemical,
chirurgic), was related to IEA (p<0,05). The most influential factors driving
to IEA were economic and cultural (fear of parents, ashamed to be
misjudged). Cultural, ritual and religious beliefs (foetus identity, when he
became a living human being inside the womb) can be both, push and pull
factors. The lack of their enlarged family, migration experience, fear of
the future have an important influence for the choice. Interviews report
interesting aspects of narrative based medicine and show how loneliness
and fear are the root causes that drive to IEA. To strengthen women
personality, create educational and moral certainties and supporting
networks, aimed at irregular immigrants, inside and outside the CARA, to
find mothers, grandmothers and aunts substitutes, it may be the right key
to help them.

PSYCHOLOGICAL VULNERABILITY IN THE RECEPTION


CENTRE FOR ASYLUM SEEKERS (CARA) OF CROTONE, ITALY
1

E. Angeletti , G. Mottini , A. Giuliani , L. Andrissi


1
University Campus Bio Medico, Italy
2
Istituto Superiore di Sanit, Italy
l.andrissi@unicampus.it

Introduction: The North Africa Emergency of 2011 caused the arrival in


Italy of more than 60,000 immigrants. During their detention period in the
CARA, a high incidence of major psychological disorders was registered.
Materials and Methods: 97 guests presenting psychiatric symptoms and
disorders according to the DSM IV (Diagnostic and Statistical Manual of

41

Mental Disorders). The differential disease incidence according to sex, age


and origin was the starting material of the research.
Results and Discussion: Data analysis shows statistically significant
differences (p <0.05) between Asian and Africans in terms of both global
incidence and pattern of psychiatric disorders,
Asians males have more personality disorders than Africans. Among
symptoms, intrusive thoughts and flashbacks, nightmares are dominant in
the Africans, sleep disorders, substance abuse, suicidal thoughts in Asians.
No marked differences in disease patterns in terms of their origin were
registered in women that generally displayed a different distribution of
symptoms with respect to males.
Conclusions: Asylum seekers may have lived in the past traumas of
different nature, so the identification of victims, the assessment of mental
problems and personal care plans during their detention is important.
Cases of Post-Traumatic Stress Disorders (PTSD) were not detected in
spite of the high prevalence of associated symptoms. It shows that there
is often an underestimate (Communication? Missing evaluation?) of the
actual psychological situation of guests, which can result in episodes of
self-harm and violence.
The need of a rapid (no possibility of long and accurate psychological
care) albeit efficient psychological help to immigrants tailored around
cultural specific features opens relevant (and still largely unexplored)
bioethical dimensions for the almost absolute novelty of the same idea of
psychiatric illness in the developed world sense in the migrant
populations.

ETHICS AN ESSENTIAL DIMENSION OF PRENATAL


DIAGNOSIS
Domenico Arduini, Tor Vergata University, Italy
arduini@med.uniroma2.it; nico.arduini@gmail.com
Since the 1970s, with the acquisition of new biomedical technologies it
has been possible to engage in a prenatal diagnosis of many conditions of
the foetus involving illnesses and malformations and to permit better
knowledge of many clinical situations.
The use of these prenatal technologies, together with the development of
models of assistance and guidelines, has certainly modified the scenarios
of obstetric care, promoting a greater and more aware use of integrated
diagnostic systems and a more aware request for information by couples
on the condition of the foetus. However, at times the lack of correct and
agreed upon scientific information and the absence of in-depth critical
reflection, from a bioethical point of view as well, has led to an automatic
request for, and use of, the new technological supply both by agents and
users themselves.
We should also recognise that an excessive medicalisation of pregnancy
and prenatal screening and the fear of medical-legal disputes have
nourished a defensive form of medicine. We have thus ended up by
fostering a hedonistic vision of existence which witnesses future parents
pursue, too often, objectives that are dominated by a prevalently
materialistic approach, with the loss of ethical values, of a religious sense
and of the sacredness of life. In reality, this is a field where great scientific
competence, a critical spirit and great balance at the level of decisionmaking are required.
We should thus uphold: 1. the importance of avoiding every negative
tendency based on eugenics, the claim to total control over procreation,
through a complete medicalisation of pregnancy, where the principle of
the envisaged quality of life prevails. On the contrary, we should stress
the ethical context of love and union between a man and a woman in
marriage as the only suitable context for welcoming life which
should always be seen as a gift. Medicine is at the service of this and not
of subjective desires or Prometheus-style projects of enhancement. 2.
Absolute respect for every human life from conception onwards, which
involves the exclusion of the principle of any direct abortion and any
disproportionate risk for the life and the health of the foetus. One is not
dealing here with a value that belongs to the objective sphere of women,
which should be respected, but of a principle that must guide the action
of every Catholic medical doctor or medical doctor of good will led by
upright reason. 3. Every use of invasive prenatal diagnosis must therefore
be governed by the basis of the principle of reasonable proportion
between risks (costs) and the benefits hoped for, with absolute respect
for the human life of the human being who has already been conceived.

42

UNESCO Chair in Bioethics 9th World Conference

CONSCIENTIOUS OBJECTION IN EMERGENCY


CONTRACEPTION: IS IT (A) RIGHT?

CULTURE OF INNOVATION, CONNECTING PEOPLE:


FIGURES AND OPPORTUNITIES

Mariarosaria Aromatario, Edoardo Bottoni, Simone Cappelletti,


Paola Antonella Fiore, Costantino Ciallella, Sapienza University of Rome,
Italy
costantino.ciallella@uniroma1.it

Sveva Avveduto, Director, Institute for Research on Population and Social


Policies of the Italian National Research Council, Italy

Emergency contraception is an important option for women who have


recently had unprotected intercourse or a contraceptive accident and
who do not want to become pregnant. When a woman needs emergency
contraception, time is critical. It is mandatory to distinguish between
emergency contraception pill (ECP), also known as "morning-after pill",
and the abortion pill. Like other forms of birth control, ECP prevents
pregnancy from happening in the first place; specifically it postpones
ovulation, so that sperm does not come into contact with an egg.
Among the methods used in the context of emergency contraception the
most common is a formulation based on Levonorgestrel (LNG), a readily
available and easily administered low cost drug, characterized by minimal
side effects.
The paper analyzes the available scientific knowledge on LNG mechanism
of action.
The authors aim is to stress out the proved absence of abortive action of
the drug in order to point out the lack of scientific reasons in the
conscientious objectors claims about this issue.
Given the great importance of protecting the physicians right to act
consistently with its personal, ethical, moral and religious beliefs, the role
of validated scientific truth in defining the limits of such right, cannot be
underrated.

THE NEW LAW ON RELIGIOUS CIRCUMCISION IN


GERMANY AND ITS LEGAL, ETHICAL AND POLITICAL
DEBATE
Diana Aurenque, Institute for Ethics and History of Medicine,
University of Tubingen, Germany
diana.aurenque@uni-tuebingen.de
The talk aims to illuminate the controversial decision of the German court
(2012) that ruled that religious circumcision of young boys constitutes
bodily harm. The focus of the presentation is to outline to what extent
invasive and irreversible physical interventions in boys who are unable to
consent should be carried out for non-medical reasons. With that in mind,
the new German law allowing religious circumcision of young boys should
be evaluated. In an attempt to tackle this issue, I will first elucidate the
basic problem of religious circumcision in Germany from a legal and
ethical perspective. Next, I will examine whether the legitimacy of
interventions in children should always be based solely on a medical
indication. In a further step, I will turn to the question of whether the
ritual circumcision violates the requirement of primum nil nocere. For this
purpose, benefits and potential harms of the circumcision of young boys
for non-medical reasons must be weighed. I will show that circumcision
does not provide any benefits and only poses risks to children. Then, I will
deal with the transformation of the circumcision debate in Germany from
a legal and ethical problem into a political issue. For this purpose, I will set
out to clarify the justification of the new circumcision law and
subsequently analyze this. Finally, I will draw the main conclusions from
the analysis.

THE MEDICAL DOCTOR AND THE CLANDESTINE PEOPLE:


THE ITALIAN VISION
Francesco Maria Avato, Sara Chierici, Rosa Maria Gaudio, University of
Ferrara, Italy
sara.chierici@unife.it
Italy is a land border with the States in which oppression and torture are
still perpetrate. The landings of illegal immigrants is coming in succession
since decades, without interruption. The immigration policy is based on
the activities of law enforcement agencies, national voluntary and health
care personnel.
The medical doctor, in particular, founded his own profession and find
justification for his actions in the Code of Ethics (Article 6) and the
legislation in force (Article 35 of Legislative Decree no. 286/98).

The presentation will address the question of the evolution of


connections among people up to the digital era, from different milieu
including epistemic communities. The culture of innovation accelerates
these processes and provides the appropriate nurturing base. Being
digitally educated equals nowadays to being literate and able to read and
write. But the digital divide is still very wide particularly for disadvantages
people and places.

IS IT ETHICALLY JUSTIFIABLE TO INVOLVE CHILDREN IN


NON-THERAPEUTIC RESEARCH?
Domnita O. Badarau1, Tenzin Wangmo1, Katharina M. Ruhe1, Anca Colita2,
1
Bernice Elger
1
University of Basel, Switzerland
2
Clinical Institute Fundeni, Romania
domnita.badarau@unibas.ch, ancacolita@yahoo.com
Background: Conducting non-therapeutic research with children is a
much debated topic. While acknowledging that research with children
requires special protections, it is also imperative for promoting pediatric
health interests. The need for more pediatric research is less contested
for studies entailing possible participant benefit than for non-therapeutic
research. However, research ethics literature is split when it comes to
non-therapeutic studies involving greater than minimal risk for healthy or
severely ill children.
Aims: We will differentiate between different non-therapeutic research,
involving healthy and severely ill child participants, and construct an
ethical analysis that supports the conduct of such research. This will be
achieved by deferring to requirements of undue risk, exploring views on
minimal risks and minor increase over minor risk, as well as burdens.
Discussion: Current interpretations of regulations and diverging ethicists
views make it difficult to define and measure risks in non-therapeutic
research. This leaves Ethics Committees reluctant to approve studies
including activities with an increase over minimal risk. Such incertitude
combined with fears of overburdening ill minor patients with studies
bearing no potentiality for direct benefit pose serious barriers to research.
We argue that strong ethical arguments either utilitarian or deontological
in nature should not be forgotten when assessing ethical permissibility of
non-therapeutic research. Without new findings gained from research on
all aspects of childrens health, the wellbeing and care of pediatric
patients will suffer. Children as a group may be vested in promoting
research and fostering altruism in children may be acceptable if negative
outcomes are reduced.

THE PROFESSIONAL DISCOURSE ON DESIRE FOR CHILDREN


AND PARENTHOOD IN MENTAL HEALTH SERVICE USERS IN
GERMANY REFLECTIONS OF THE PAST ON ACTUAL
ETHICAL CHALLENGES
1

1,2

Gisela Badura-Lotter , Silvia Krumm


1
Ulm University, Germany
2
Bezirkskrankenhaus Guenzburg, Germany
gisela.badura@uni-ulm.de
Introduction: When dealing with reproductive issues among mental
health service users, mental health professionals find themselves
confronted with complex ethical problems including teratogenic, medical
and psycho-social risks for mother and (unborn) child. Despite its high
practical relevance there is only scarce knowledge on the perspectives
and strategies of mental health professionals on reproductive/parenting
issues among their patients.
Methods: The study adopted a three-fold qualitative approach: In the first
phase, document analysis was performed on textbooks of different
disciplines (psychiatry, clinical psychology, psychiatric nursery and social
work in psychiatry) as well as practice guidelines of the corresponding
societies. In the second phase, group discussions with members of all
professional groups active on mental health teams were conducted. In

Abstracts of Oral Presentations


the third (current) phase, problem-centered interviews with members of
mental health teams have been conducted.
Results: Reproductive topics are rarely addressed in textbooks and
practice guidelines and related ethical challenges for present psychiatry
are only addressed in textbooks on social psychiatry. However, we found
that the memory of the history of German psychiatry during the Nazi era
is very present in the contemporary German psychiatric discourse. In the
group discussions, reproductive autonomy and the well-being of children
were found to be dominating principles. Professionals developed specific
strategies to avoid the ethical dilemma including subordination of child
welfare, de-professionalisation, giving rational advice, and resignation.
We provide a comprehensive matrix of the encountered ethical principles
and propose to intensify open discussions within and among the
psychiatric disciplines in order to resolve professionals uncertainties and
to approach taboos.

43

ETHICAL AND LEGAL PROBLEMS IN FORENSIC MEDICINE


IN SLOVAKIA
A. Baloghov, S. Farkaov Iannaccone, N. Bobrov, A. Ginelliov,
P. J. afrik University, Slovakia
andrea.baloghova11@gmail.com

OVERVIEW LEARNING IMPLEMENTATION OF BIOETHICS


OF MIDWIFERY EDUCATION IN INDONESIA

Forensic medicine comprises two of the worlds oldest and noblest


professions, law and medicine. There are specific differences in ethical
and legal problems comparing to other medical branches, such as: legal
status of the dead body, ethical standards in breach of the integrity of the
dead body, its working environment, additional to close cooperation with
civil service authorities. The moral duty of the forensic doctor is to
consistently fulfill the main tasks of forensic medicine, naming: analysis of
the causes of death, detection of non lege artis procedures and the
suspicions of criminal acts, prevention of negative social phenomena and
providing materials in order to clarify and prevent criminality. Forensic
medicine contributes to keeping the legality and stability of the law
system of the state.

Mohammad Baharuddin, Irma Sapriani, Agus Rahmanto, Ernawati,


Erina Windiany, Budi Kemuliaan Health Institution, Indonesia
shinta_0820@yahoo.com

THE PROTECTION NETWORK ABOUT ASYLUM SEEKERS:


THE SOCIAL POINT OF VIEW IN ITALY

Indonesia is one of the countries with the highest maternal mortality


rates; Professional skilled birth attendance such as a Midwife can greatly
reduce maternal and neonatal mortality. Midwives capacity to provide
quality services depends on the health system and its supporting
mechanisms for midwifery practice. In order to improve the quality
service of midwifery education to the Community, heavily influenced by
two main things. The two things are 1) evidence based services, 2)
implementing bioethics. Implementation of bioethics is strongly
influenced by the time of prior learning in the Classroom, Laboratory and
Clinical Practice. Initial studies of the Midwife Education in Indonesia
shows that bioethics is still not optimal learning in the classroom,
laboratory and clinical practice.
This study aimed to: 1) Know the description of the process and conduct
instructional time in the classroom, laboratory classes and clinical
practice, 2) Knowing that taught bioethics picture material, 3) Knowing
the implementation of bioethics in the clinical picture, 4) Knowing the
picture presented in the learning module bioethics.
This type of research is a quantitative study using a cross sectional study
design. Population and its sample was Master and Student Academy of
Midwifery in Indonesia. Midwifery School of the number 750 would be
taken sample of 261 School of Midwifery ( = 0.05, CI 95%).

Antonio Banchini1, Francesco Camisotti2, Federico Tsucalas2,


Rosa Maria Gaudio3
1
University Parma, Italy
2
Cooperativa Sociale Camelot, Italy
3
University Ferrara, Italy
antoniobanchini@gmail.com

THE NEED FOR A CULTURALLY RELEVANT BIOETHICS FOR


ASIAN PEOPLE

INTERNET, BIOETHICS AND TRENDS OF CONDUCT

D. Balakrishnan, SRM University Chennai, India; Chair, Lead Bioethics Unit


India, International Bioethics NETWORK UNESCO Chair
There are cultural differences between East and West. An attempt at
outright adaptation of Western bioethics thoughts will encounter
difficulties if not rejection in Asia. Transplanting or transferring bioethics
ides from one culture to another is similar to organ transplant where
rejection can be expected. Human cultures generally respond to new
ideas from different value systems in much the same way. Recently
biomedical ethics has received much attention in Asia. These have been
motivated by advances in medicine leading medical scientists to look at
the ethical issues arising from this program and from the impact of
globalisation and its relation to health care.
This paper will discuss these issues and suggest that Asian bioethicists
should develop a bioethics program that responds to their own cultural
contexts. At times western principals such as autonomy adopted will need
to re-interpreted and even modified if necessary in light to represent the
Asian culture and beliefs.

SPRAR (Protection Network for Asylum Seekers and Refugees (SPRAR) is


composed by hosting projects, led by local public authorities with the
priceless support of actors in the third sector like Cooperativa Sociale (for
example Camelot Officine Cooperative is an NGO member of SPRAR in
the province of Ferrara, since 2006). The aim of the activities is to ensure
integrated reception for asylum seekers and refugees that goes far
beyond the mere supply of accommodation and meals, and includes
complementary activities like information services, intercultural
mediation, legal assistance, psychological support, vocational training and
tutoring to reach socio-economic inclusion.
This local network and cooperative, especially through projects funded by
European Refugee Fund, gained specific expertise on reception and
assistance of asylum seekers and refugees belonging to vulnerable
groups, as persons with mental diseases and victims of torture.

Stephanie Barajas, Luz Maria Pichardo Garcia, Panamerican University,


Mxico
lpichard@up.edu.mx
In 1985 Steve Jobs predicted that computers would be essential in the
future, people will buy computers to have them at home and to join a
communications network that would reach across the country. This
prediction has been overcome around the world, connecting people from
diverse cultures instantly. Part of this site communications are social
networks, which are characterized by uniting people with common
interests. A major impact social media is having on culture, particularly in
the thinking and acting of young people. Movies such as Matrix and The
Network give an idea of what is shaping ways of being and thinking. A
clear example of the negative influence is the movie Untraceable, where
violence conducted by Internet users is unlimited. When people connect
to the Internet through these networks, they think they cannot be
identified in the same manner as in society, disinhibiting their way to be
online, enabling new behaviors that otherwise had remained repressed. It
is interesting to note that people who uses social networks to meet new
people for different reasons: getting partner, make friends, participate in
social or professional activities, political interests, and to some extent,
crime. Through the network communicate options in many fields, such as
abortion, sexuality, gender. It's amazing how easily you can access sites
where shows pictures, videos and opinions on preferences that may be
used for good or for worst.

44

UNESCO Chair in Bioethics 9th World Conference

THE EFFECT OF ATTITUDES AND BELIEFS OF JEWISH AND


MUSLIM MOTHERS ON THE INTENTION TO INTEGRATE
DOWN SYNDROME CHILDREN IN SOCIETY
1

Sivia Barnoy , Anna Biton


1
Tel-Aviv University, Israel
2
Hillel Yaffe Hospital, Israel
sivia@post.tau.ac.il
Purpose: In recent years, there is an awareness of the positive impact of
the integration of Down Syndrome Children (DSC)in society on their
development. However, people are not always willing to do so. The
present study investigated Jewish and Muslim mothers' attitudes and
beliefs towards integrating DSC children in society.
Design: The design was cross sectional. Data were collected during
August-September 2012 from 48 Jewish and 53 Muslim mothers of
normal children.
Methods: The study was based on the Theory of Planned Behavior (Ajzen,
1991). Data were collected using a questionnaire consisting of four parts:
demographic information, attitudes, beliefs, and behavioral intentions
toward integration of DSC from three aspects: among the close family,
with normal children, and in the school system. Data were analyzed using
SPSS 18, with a t-test for independent samples and Pearson correlation
coefficients.
Results: The results showed positive correlations between the intention
to integrate DSC in society and attitudes and beliefs regarding integration
of DSC in society in all three aspects. Jewish mothers held more positive
attitudes and beliefs towards the integration of DSC in society and had
more intention doing so, compared to Muslim mothers.
Conclusions: Attitudes and beliefs influence the intention to integrate
DSC in society. Intention was influenced by religion, probably reflecting
different social norms.

GYPSY WOMEN PERSPECTIVES ON END OF LIFE DECISIONS


AND ADVANCE DIRECTIVES
Ins M Barrio Cantalejo1, Miguel Melguizo Jimnez1,
Francisco Javier Castro1, Patricia Peinado Gorlat2
1
Primary Health Center of Almanjayar, Spain
2
Research Project Bioethics of the End of Life
imbarrioc@gmail.com
Background: The Spanish gypsy community has its own cultural and moral
values. These values influence the way of facing the end of life,
dependency and health decision making.
Objective: To explore the prospect of gypsy women at the end of life and
healthcare decision making.
Design: Qualitative study. 33 Gypsy women belonging to training and
social development groups of two municipalities. Were collected five
groups between February and December 2012.
Participants: It was felt that the age and the role of caregiver are the
variables that can enrich a speech about the end of life and decisionmaking in this context. Both of them were used as segmentation criteria,
looking for heterogeneity between groups and homogeneity and
heterogeneity inside the group: age and caregiver of dependents.
Saturation is considered when the ideas expressed were recurrent.
Results: Main ideas are extracted from the data: 1) Important role of the
family in care at the end of life, especially of women, and in the
healthcare decision making. 2) The opinion of the community exerts great
influence about personal or family decisions. 3) Different preferences for
one self and others in the care they wish to receive at the end of life. 4)
Ignorance and denial of living will. They want to take into account their
health preferences, but "without papers".
Conclusions: The success of care at the end of life on gypsy women and
their incorporation into medical decision making is necessary to consider
and respect the cultural heritage of this ethnic group.

PSYCHOLOGICAL SUPPORT TO THE FAMILY IN THE


LIFE-END
Valentina Battimiello, Arianna Iorio, Alessandro Leonti,
Domenico Del Forno, International Office for Bioethics Research of the
European Center for Bioethics and Quality of Life of the UNESCO Chair in
Bioethics Unit Ethics Committee Carlo Romano, University of Naples
Federico II, Italy
Dying represents the last stage of a human being life.
Dying is a difficult path to walk and provide support at such a time means
to help living.
Hence, the psychological support to die well becomes not only an action
fulfilling medical doctors duties, but also on ethical behavior.
The emotional stability of terminal patients strongly depends also on the
environment, and the role of the family is very important.
However, the family too is making the experience of the dying process
going through similar stages as the dying person. This process implies the
sequence of denial, rage, bargaining, depression, acceptance (Kbler-Ross
E., La morte e il morire, Trad.It. Di Zoppola C., Collana Psicoguide, ed.
Cittadella, 2008) and, at the same time, dynamics of affection changes
and reshaping of inter-subjective relationships.
The structure of the family is negatively affected because of conflicts of
role, communication difficulties, social isolation, disorganized or
exasperated involvement.
The examination, analysis and knowledge of these dynamics is
fundamental for organizing supporting therapies for the terminal patients
relatives in order to create the most suitable conditions for die well.
Such therapies must be part of supportive expressive models which
must be also of the information-educational type so as to facilitate the
understanding and the course of the disease that will lead to the fatal
outcome. It should not be underrated that, in these framework, the
medical staff will have to face highly emotional relationships and data
defensive system might be adopted consisting of exclusion of empathic
and psychologically supportive behavior, while the latter is essential in
order to involve the family in the daily assistance to the dying and, at the
same time, easing the traumatic experience by trying to reduce the felling
of anguish and impotence.

MAINSTREAMING AFRICAN ETHICS INTO THE BIOETHICS


CURRICULUM
Kevin Gary Behrens, Steve Biko Centre for Bioethics, University of the
Witwatersrand, South Africa
kevin.behrens@wits.ac.za
For the most part, bioethics is not taught very differently in Africa than in
other parts of the world. African students are schooled in the traditional
Western moral theories of deontology, utilitarianism, virtue ethics, the
ethics of care, and the like. The approaches of principlism and casuistry
are as central to the teaching of bioethics in African universities as in any
schools in the northern hemisphere. The value of these approaches to
students seeking to navigate the complex terrain of ethics in health care
and medical science should not be underestimated. Yet, Africa has its own
ethical notions and value theoretical constructs with the potential to
enrich our moral thinking.
In this paper, I reflect on a process undertaken in the Faculty of Health
Sciences of a South African university, in which a deliberate attempt has
been made to mainstream African ethics into the bioethics curriculum.
Firstly, I provide a rationale for why it is important that African moral
traditions be included in the curriculum. I argue that students are more
likely to embrace indigenous moral notions, that recognition of such
notions can contribute to the restoration of the dignity of African people,
and that our moral discourse can be enriched in the process. Secondly, I
describe some of the strategies employed to achieve the goal of including
African ethics in the mainstream of bioethics teaching. Finally, I propose a
revised version of the influential approach known as principlism: a version
that incorporates salient African moral notions for the benefit of
bioethics, generally.

Abstracts of Oral Presentations


ETHICAL PARADIGMS FOR THE EVALUATION OF
NEUROTECHNOLOGIES IN HUMAN ENHANCEMENT
Paolo Benanti, Italy
benanti@unigre.it, fr. paolo@gmail.com
Knowledge's improvement in neurosciences and large number of
neurotechnological application, big part of them over human beings,
should be well understood and evaluate to void serial ethical implications.
These experiments, often characterized by low invasiveness, are aimed to
better understand brain functioning and its relationship with the thought
and behavior. These trials have given a significant contribution to the
debate in the cognitive field, stimulated a philosophical debate about free
will-responsibility and attracted interest from the public. In this context
we show how ethics and bioethics should try to analyze how
neurosciences and neurotechnologies, with their progress, require to be
understood and analyzed mainly in relation to their impact on society to
answer with an effective governance. In our lecture we would like to draft
an outlook of this new frontier and let emerge how and why governance
of neurotechnology and enhancement drugs is urgently required. We will
summarize ongoing ethical paradigm that are now used to evaluate those
phenomena (Fear for uncertain, Equality and pursuit for happiness,
and Policy) and we will propose a new paradigm based on recent
acquisition of philosophy of technology that we call empiric turn.

NEW FRONTIERS IN MEDICAL DEONTOLOGY


Maurizio Benato, FNOMCeO, Vice President; OMCeO Padua, President,
Italy
deontologia@fnomceo.it
Technology today has spread to all professional and cultural activities
imposing codes of ethics which were, until today, unfamiliar to society.
Technology appears to have surpassed scientific knowledge to the extent
that some authors imagine situations of scientific delirium and
technical totalitarianism in which nature is viewed as a wicked
stepmother to be subjected and dominated while scientific knowledge
has become pure technical skill which often makes it independent of the
needs of man. Moral values appear today to be relegated to the margin of
science and research.
For medicine which is facing new technological realities post-genomics,
stem cells, xenotransplantation, neurosciences it is necessary to
formulate a new framework of ethical values.
Medicine, traditionally understood as that intellectual discipline
characterized by clinical observation, will therefore have to modify its
paradigms in the light of the new frontiers which have opened up in the
biomedical field.

PUBLIC-PRIVATE PARTNERSHIPS IN THE WATER SECTOR:


ETHICAL CONSIDERATIONS RAISED BY THE
MARKETIZATION OF WATER
Ccile Bensimon, University of Toronto, Canada
cecile.m.bensimon@gmail.com
Public-private partnerships have become increasingly popular as an
alternative model for the strategic promotion of, and solution to, complex
public health problems, such as in the water sector. These partnerships
are considered an innovative institutional mechanism that combines and
capitalizes on the strengths and capabilities of the public and private
sectors to accomplish purported common or overlapping objectives. Even
if such synergies exist, there is a much more fundamental process of
redefinition at stake when private interests become involved in public
health initiatives. Local governments are willingly, or perhaps
unknowingly, applying the logic of the market to the supply and
management of water; and, in doing so, literally redefining water-service
provision: water is no longer a public good provided by the state, but a
commodity subject to market pricing and market allocation mechanisms.
This process of water marketization - grounded in the libertarian
principles of market justice and economic equity, themselves embedded
in Kantian notions of justice and autonomy raises deep ethical issues. In
this paper, I question whether public-private partnerships are an
appropriate or feasible means of water provision by examining the
assumptions and transformative strategies underlying the process of

45

water marketization. I argue that when water is reconceptualized as a


commodity, principles of redistributive justice and social equity no longer
serve as the appropriate set of social objectives that weave shared
interests through a common good; but rather, it further entrenches a
Kantian (individualist) imperative that, at best, falls short of providing a
foundation for public health and, at worst, belies public health goals and
objectives, especially as it relates to water provision.

CINEMA AND TELEVISION: DEVELOPING SUBJECTIVE


DIMENSIONS TO DEAL WITH BIOETHICS
Moty Benyakar, Universidad del Salvador (USAL), Argentina
motybenyakar@fibertel.com.ar
Transmission of bioethics principles on bioethics has undergone several
transformations, from the written deontological codes to dealing with the
specificity of each situation, with active participation of students. The
uses of role- playing, dramatization, discussion through the affective
dimension, have been some of those developments. All of them focus on
the deployment of subjectivity is essential, not only for conceptual
development, but also in the clinical application.
In our latest research about the role of television series and films, we
focus on the interplay between live scenes presented on films and clinical
situations which professionals face, noting that the subjectivity was
enhanced and magnified by what was presented on the screen.
Both film and television series have two central roles in the development
of subjectivity: one as a pedagogical tool, in which the viewer in the
classroom is confronted with live situations and, from them, discussions,
debates, and new developments. On the other hand, we understand that
these problems that are lived and thought in the classroom, are also
included in the daily lives of professionals of different areas, as well as the
people in general, that face these situations.
In the world, 2.000 million people watch TV series per day. This shows
that bioethics takes part not only in the academic and professional field,
but also into the everyday population thoughts. Different uses of film and
television will be presented, for further development of subjectivity to
face the challenges that bioethics faces permanently.

SPECIFIC ETHICAL CODES FOR MENTAL HEALTH CARE


PROFESSIONALS DO WE NEED TO ANNOTATE?
Tal Bergman-Levy, Beer-Yaacov Mental Health Center; Secretary-General,
Israel Psychiatric Association, Israel
bergmantal@gmail.com
Mental health care and psychiatric practice constantly raise questions and
dilemmas in the clinical as well as in the ethical field. Ethical questions
regarding the balance between patients autonomy and the physicians
paternalism are being discussed on a daily base within clinical framework
of psychiatry Ethical codes were drafted by medical practitioners
associations to offer ethical guidance for physicians.
Do mental health caretakers require a separate set of "ethical tools", or
can existing "general" tools for doctors be utilized? In several countries
including Israel, a specific legislation was created by decision makers for
psychiatric treatment. A specific law sets the boundaries of psychiatric
care and limits compulsory care by defining the civil as well as criminal
procedures required for its implementation. Hence, do we also require a
specific /adapted ethical code for the profession?
Several psychiatric professional associations in several countries as
Canada, USA and Russia have created their own annotations of general
ethical codes for physicians. Cultural as well as historical reasons played a
significant part in the process. We will present and explore as a test case,
the specific situation of Israel where we have general ethical rules for
physicians, but not an adapted code for psychiatry we will present the
ongoing debate regarding this issue and we will further present an
empirical study aiming to examine the attitudes of Israeli Psychiatrists
towards professional ethics, and ethical codes.

46

UNESCO Chair in Bioethics 9th World Conference

OOCYTE FREEZING PRODUCING FREEDOM OR


REPRODUCING FEARS?
S. Bernstein, C. Wiesemann, University Medical Center Goettingen,
Germany
stephanie.bernstein@medizin.uni-goettingen.de
Introduction: Due to clinical improvement in vitrification the possibility
for healthy women to freeze unfertilised egg cells, so-called social
freezing, is likely to implement into clinical routine. This technique allows
women to postpone motherhood even after menopause.
While medical data exist, ethical analysis is scarce and information about
ethical evaluation of specialists in reproductive medicine (SRM) is lacking.
Material & methods: We systematically retrieved 23 articles with relevant
ethical content on this subject and, in 2011, conducted a quantitative
empirical survey with members of the biggest society for reproductive
medicine centers in Germany. In a questionnaire, we asked SRM for their
moral evaluation of social freezing in the clinical setting (response rate:
51.5%).
Results: We identified four major topics of the ethical debate:
reproductive autonomy, equality, postmenopausal motherhood and wellbeing of the child. SRM emphasize female autonomy (89.6%) and gender
equality (78.4%). A majority is concerned with the physical risk of late
pregnancies (56.6%).
Conclusions: While ethicists evaluate female autonomy and gender
equality in social freezing critically, SRM emphasize their importance.
SRM consider of relevance the medical risks of the procedure in late
pregnancies. Integrating these quantitative empirical findings in the
bioethical debate will result in a deeper understanding of the relevant
issues.

TATTOOS AND PIERCINGS: BIOETHICAL AND


EDUCATIONAL PROFILES BETWEEN NATURE AND BEAUTY
Carmela Bianco, Pontifical Faculty of Theology St. Thomas, Italy
karbia@libero.it
Tattoos and piercings can become a mask to hide behind?
Everything can become a mask if we use it for masquerading.
The tattoo is the anthropological roots of ancient and modern makeup
that refers to the mask understood as that which creates the face, which
gives it its social being. The tattoo is also an artistic decoration that should
be born by the deep desire to communicate yourself to others. Tattoos
must be able to "tell" the people who wear them, but if the latter
decorate their body with a message or image that does not belong, it can
cause the destruction of individuality. The tattoo is immortal. It can be a
permanent dress, a way to resist the unwanted transformations using a
piece of subjective identity, non-imitable, from which one cannot be
excluded.
Along with careful identification of psycho-sociological motivations that
drive a young man to want a tattoo, you need to traverse an education
that not only form a personality, teaches the knowledge of his own body.
Getting a tattoo means not only change the morphology of the body but
the risk of jeopardizing their health. Responsibility for their own health
also means being aware that a tattoo can procure mild side effects or
more severe depending on the initial state of health of the subject. Then a
tattoo only after a careful history following the favorable opinion of the
doctor and after a personal assessment aware. These initial objectives of
a path bioethical-pedagogical significant.

DEVELOPMENT OF A BIOETHICS PROPOSAL TO


IMPLEMENT A REURBANIZATION PROJECT IN THE
CENTRAL AREA OF THE CITY OF SO PAULO
Jos Pereira Wilken Bicudo, Ibero American Eco-Bioethics Network,
Brazil Unit
jbicudo@ciacity.com.br
Introduction: The Project, located in the Center of So Paulo, can be
understood as a proposal for urban planning to provide, organize and
coordinate interventions in the area, within a specified schedule. The
public and private decisions have an urban project, not only the
definitions of the laws for use and occupation of land and master plans.

Project Prepared: The Project has no specific regulatory value as a Master


Plan or Land Use and Occupation Law; it is a document of goals and, in
particular, proposals for multiple and diverse interventions. The Project is
not considered as something static: it can be modified and no doubt it will
be during the new discussions period and during its implementation.
Listening to Social Stakeholders: The social, economic and political
sustainability of an urban project lies in the leadership of the municipal
officials and in the engagement of local social stakeholders. An urban
project formulates a reflective position on the physical space, activities
and people that inhabit, work or circulate in it and consolidates from the
collusion between the public entities and the social stakeholders involved.
We found that nobody is satisfied with the area. All yearn for a better
quality of urban space, where garbage is not part of the landscape, the
homeless people can be treated properly, people can enjoy the economic
strength of the sectors that supply the polygon, residents, workers and
users can enjoy public spaces. The prospect of being affected by the
project and being required to adapt the way of living with the space,
having to adapt to the proposed changes to the area, create insecurity
and fear. Where well-being prevails.
Ethical dilemma based on disregard of the inhabitants can trigger health
problems due the fact that they do not participate as the tender offers.
Enabling the Implementation of the Project: The proposal for the
feasibility of the Project seeks to eliminate the main conflicts and consists
of a management model with key operational instruments to project
implementation based in the Eco-bioethics references: a program based
on bioethical issues that integrated teams allying all Departments of the
City Hall with the professionals from the CONSORTIUM, the various NGOs
and Civil Society entities

THE CALL OF THE DAVUI: HERALDING AN ERA OF CHANGE


FOR THE PACIFIC
Sharon Biribo, College of Medicine Nursing & Health Sciences:
Fiji National University, Fiji Islands
sharon.biribo@fnu.ac.fi
The sounding of the "Davui" or Conch shell in the Pacific symbolizes a
calling which is unmistakable. Solemn, honorable and somewhat esoteric
in its notes, the gravity it imparts to those who have heard it is
unforgettable. The Pacific now resounds with calls of this nature: for her
people to step out of the blue waters and embrace the waves of change.
Bioethics as a concept is not new to the region, but the applications and
interpretation have taken some time to make impact. It was as if a foreign
flower had been brought to sandy shores and expected to survive when
in reality, it was something familiar that needed the proper context,
understanding and nourishment to propagate and thrive. This paper will
take you through the Pacific: the milestones and achievements in
establishing bioethics in the region. It will outline the very real challenges
of culture and geographic isolation in shaping the landscape for change in
the region.
The College of Medicine Nursing & Health Sciences, formerly known as
the Fiji School of Medicine has been privileged to be a part of this
profound change. Through its longstanding association with organizations
such as UNESCO and the World Health Organization, much research and
capacity building has occurred over the last ten years. This paper will
highlight the significance of these foundational activities and how these
have influenced the current landscape of research bioethics in the region.
Just like the sounding of the Davui: The most profound of messages will
not have effect unless personalized for the receiver.

DECLARATION OF HELSINKI
Jeff Blackmer, Primary Ethics Advisor, World Medical Association;
Office of Ethics, Professionalism and International Affairs,
Canadian Medical Association, Canada
Jeff.Blackmer@cma.ca
Background: The Declaration of Helsinki (DoH) is generally considered to
be the pre-eminent guiding document in research ethics for physicians
participating in research studies, and for many Research Ethics
Committees around the world. First published in 1964, it has been
updated several times, most recently in 2008. By the time the UNESCO
meeting takes place, the WMA hopes to have completed another revision

Abstracts of Oral Presentations


th

of the document, and is also planning events in 2014 to celebrate the 50


anniversary of its initial adoption.
A working group was appointed by the WMA and tasked with the revision
process. Several meetings of the group were held, and expert conferences
were organized in Sao Paulo, Cape Town, Tokyo and Washington to gain
an in-depth understanding of the perceptions and opinions of
international experts and stakeholders. The policy was also circulated for
stakeholder input and feedback and over 120 total responses were
received.
Presentation: The working group put forward the revised DoH for
potential adoption by the WMAs General Assembly at its meeting in
Fortaleza, Brazil in October 2013. This presentation will focus on the
process followed during the review of the document, the discussions
which took place in Brazil, the final decision of the WMAs General
Assembly and the next steps in this process. It will also review the
revisions made to the document and the ethical rationale behind these
changes.

EVIDENCE, EXPERIENCE AND ETHICS-BASED MEDICINE


Jaroslav Blahos1,2,3, Vclav Vyskocil2
1
Czech Medical Association, Czech Republic
2
Charles University, Czech Republic
3
Central Military Hospital, Czech Republic
Evidence-based medicine represents a criterion of scientific medicine. The
evidence may be achieved by multiple sophisticated techniques as
imaging techniques, laboratory tests, computers and recently by
molecular and genetic studies. The results of these ultra-sophisticated
techniques are considered conditio sine qua non for diagnostics and
treatment. Medical students and young doctors have sometimes the
tendency to underestimate the classical examination and the personal
contact with the patient. At the extreme the overestimation of scientific
data lead the dehumanized medicine.
However, the art of medicine consists also in the doctors experience, his
sixth sense, and intuition. It may be argued that experience may lose its
scientific background over time but also the scientific results may give
misleading explanation over time.
Ethics-based medicine is another prerequisite of medicine. Medical ethics
has been an integral part of medicine since immemorable times and still it
is not taken sufficiently into account in the pre-graduate and
postgraduate medical education.

LEGAL ASPECTS IN EDUCATIONAL PROCESSES: DE IURE


CONDITO AND DE IURE CONDENDO
Agata Bonaudo, European Centre for Bioethics and Quality of Life
UNESCO Chair in Bioethics Unit, Italy
agatabonaudo@hotmail.com
In the light of legislation and jurisprudence there is a continuous
evolution of rights and duties belonging to professors and students.
Research and workshops take place, analyzing and debating, to overcome
main dilemmas, including ethical ones, and to deal with critical situations
arising daily at work.

ETHICAL COMMITTEES IN EUROPE


A. Bonaudo, E. Capasso, D. Faillace, R. Ferrara, N. Cannovo, M. Niola,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
The organizational structure of Ethical Committees in European Countries
differs from country to country.
The main difference concerns the establishing aspects, the rules
governing the evaluation criteria of clinical trials, the existence of specific
figures while the common denominator is represented by voluntaristic
membership.
Indeed, some Committees are independent entities with legal status
(France), others are part of the public administration (Denmark) some
others are organs of research institutes, hospitals or Universities (Italy) or
are established within private bodies and their activities are carried out
under strict controls.

47

As concerns the evaluation on criteria and the trials discipline, there are
Countries where clinical trials are submitted to only one law whereas in
others, like Italy, each aspect of scientific research is regulated by specific
norms.
In many European Countries like Turkey, a centralized procedure is
followed at national levels according to which it is the Ministry of Health
that express its judgment on the protocol under examination.
In other Countries research projects are evaluated at local (peripheral)
level.
In particular, at local level two typologies exist:
Regional or at district level (Belgium, Czech Republic, Finland, Latvia,
Lithuania, Netherlands, Norway, Slovenia, Sweden and Switzerland, and
the really local level of universities/hospitals (Italy, Bulgary, Estonia,
Germany, Ireland, Poland, Serbia, the United Kingdom, and Spain).
Almost all EU and ERA (European Research Area) countries have a
National Ethical Committee with leading functions for the other European
Countries, sometimes without any active role in the evaluation of the
trials, some other times acting as appeal evaluators of study projects
rejected at local level (Bulgaria, Cyprus, Denmark, Finland, France, Ireland,
Latvia, Lithuania, the Netherlands, Poland, Portugal, Switzerland, Sweden
and the United Kingdom).
In European Countries Ethical Committees, the layperson i.e. a member
who does not belong to the world of science and biology is present to
different extents, such as in Denmark where more than half of
Committees members are laypersons.
Another peculiar aspect is the number of local Committees.
Directive 2001/20EC following its principle of assigning trials to high
quality centers has eventually reduced the number of Committees in
Europe.
In Italy, Act 189/2012 dramatically reduced their number subject to the
population size (1/1.000.000) which involved a series of predictable
negative effects that will be analyzed in another paper.

OPBG CLINICAL & SURGICAL SERVICES IN DEVELOPING


COUNTRIES
Lorenzo Borghese, Cecilia De Rita, Davide Ponzi, Silvia Andena,
Childrens Hospital Bambino Gesu, Italy
lorenzo.borghese@opbg.net, mission.internazionali@opbg.net
It is over thirty years that OPBG is deeply involved in caring actions in
favor of children in need around the world (Africa-South East Asia, South
America) with the same major objective to serve the disadvantaged and
the poorest.
It is the purpose of this paper to show best medical practice along with
high level of attention to financial issues in order to address towards
sustainability.
Most of our Programs have been incisive towards clinical and surgical care
with outreach in rural villages (Mobile Clinics), and mostly regarding
training of medical and paramedical personnel.
Bioethics come close to Programmes as renal transplantation from living
donor such as OPBG has activated in Vietnam, hematopoietic stem cell
transplantation in Venezuela or initiating a neuro-rehabilitation Centre for
disabled children in Russia.
All OPBG Projects in Developing Countries have the goal basically to
ensure health governance concerned with guaranteeing that whatever
technical usefulness exist to improve health be delivered successfully and
efficiently to all those in need.
Impartial health care in accordance to ethically positive human values as
in the treatment of congenital heart defects, hand malformation surgery
or severe movement disabilities should be and are our evolving purposes
in caring.
OPBGs projects in developing countries have the peculiarity to aspire to
deliver the highest level of health care to everyone, with no
differentiation based on culture, ethnicity or religion. Our projects
involved for a great part partnerships and work with local organization
and local staff, in order to ensure a culturally sensitive approach to issues
connected with religion, culture and social structure. This is also the best
way to ensure a good outcome of the project. An example could be the
approach to malnutrition in the rural areas of Tanzania, where our
doctors studied how to prepare protein-rich meals based on local
ingredients and not only pills. Teaching these enriched meals to local
women had a very successful outcome.
Also, sustainability is searched within the country where we work. Highlevel medical services cannot be free of charge for all; excessive aid is a

48

UNESCO Chair in Bioethics 9th World Conference

model that failed in most middle-income countries. In Tanzania and


Cambodia we set up a system of interview/questionnaire that can
evaluate, in a culturally sensitive way, the economic level of the family in
order to charge upon income. We would like to implement the concept
that medical services are offered to everyone in urgent need, but also
that people that have a good income can contribute to make our services
always more efficient.

THE PRINCIPLE OF AUTONOMY AND THE PRINCIPLE OF


JUSTICE ON ORGAN TRANSPLANTATION
Melania Borgo, Mario Picozzi, Insubria University, Italy
m.borgo@studenti.uninsubria.it
The major religions of the world acknowledge and promote donation and
transplantation of organs, even if they often specify that the donation is a
matter of individual conscience, a single choice.
However, because of religious reasons, someone refuses certain
conditions that make possible the procurement and the outcome of
transplant. In fact, without being contrary to the organ procurement
someone requires to keep working each life support until cardiac arrest
occurred, while someone else would like to receive an organ, but they
refuse blood transfusion.
The first ones context the criteria of brain death because of ethical and
anthropological reasons: is it ethically acceptable to ignore their request?
Usually, in case of diagnosis of brain death, the Medical Direction
convenes a Board that ascertains clinically the death. After that, every
treatment is stopped and all the machines are turned off, the law
prohibits each kind of opposition, but what about the autonomy of those
who refuse these criteria? Moreover, respecting their request there
would be fewer resources for other patients.
The second ones, instead, refuse no more something about organ
procurement, but the transfusion (if they will ever need it during the
transplant). Furthermore, even if today there are some means to prevent
the transfusion, it is not possible to exclude it with certainty. Is it possible
to accept that they refuse transfusion? Is it imaginable to exclude them
from the waiting lists due to this motivation? Satisfying the requests of
these patients, the autonomy can be protected, but what about the
principle of justice? Is it possible to find a mediation?

HUNGER STRIKES THE LEGAL PERSPECTIVE


Malke Borow, Israeli Medical Association, Israel
malkeb@ima.org.il
The issue of hunger strikes among prisoners is rife with medical, ethical
and legal implications. The issue concerns the rights of the individual to
autonomy and choice versus the right (and some might say the obligation)
of the State to preserve security and the health of its residents.
The legal situation varies from country to country. Although all agree that
the basic principle requires consent to medical treatment and feeding,
they differ in their approach to prisoners whose life is in danger.
In Israel, a proposed bill was recently drafted that would allow the court
to give a physician authorization to force feed hunger striking prisoners
under certain conditions. Although the bill does not require the physician
to force feed, it is problematic in that it contravenes accepted
international law and medical ethics and shifts responsibility to the
physician to decide whether to risk the life of his patient or breach
medical ethics.

ETHICAL APPROACH AND PROFESSIONAL RESPONSIBILITY


IN WORKPLACE DRUG TESTING
R. Borriello, A. Carfora, P. Cassandro, R. Petrella, Second University of
Naples, Italy
renata.borriello@unina2.it
The workplace drug testing (WDT) has the potential to greatly enhance
health and safety in the workplace, by discouraging people from abusing
substances and reducing the likelihood of accidents and injuries.
However, the WDT also represents a privacy violation, and may cause
marginalization of drug users, by cutting off their access to employment
or social welfare.

The Italian legislation for WDT has been introduced by Unified Conference
no. 99/2007 and Law no. 81/2008 as improvement in safety, productivity
in the worksite and public health. The legislation calls for mandatory
procedures for screening tests (I Level) on biological samples for at-risk
workers, performed by occupational health specialists, and for
confirmatory tests by GC/MS or LC/MS/MS (II Level), performed by
forensic laboratories.
Therefore, the application of WDT implies some basic ethical principles,
that occupational health physicians and toxicologists need to employ, in
order to avoid the violation of the workers rights and to prevent disputes
about professional responsibility. These include, but are not limited to:
Right to Privacy and data protection: this is very important, since
WDT involves collecting sensitive data, both on use of drugs and about
medications taken which might influence the test result;
Informed consent: the employee has to know, ideally prior to taking
the job, that abstinence is an expectation, and that WDT is planned;
Quality assurance in Sample collection and screening/confirmation
testing: several critical factors can affect results, and lead to
administrative law disputes about use/non-use of illegal drugs. These
factors are numerous and consist primarily in specimen collection
procedures, chain of custody, contamination or adulteration of
samples, number of tested drugs and detection ranges, cut-off and
reliability of screening tests with regard to the differences in target
antigens. Therefore, it is necessary that WDT is conducted with
respect of analytical, legal and ethic issue in order to prevent damages
to workers through false positive results;
Provision of addiction counseling: this may include treatment and/or
rehabilitation in positive drug test cases, distinguishing between use
or abuse, with or without dependence;
Support in transitioning to more suitable employment if appropriate.
In this paper, some real cases are discussed, in order to highlight the
many ethical dilemmas posed by the management of alcohol and drug
problems in the workplace. These dilemmas involve a careful balancing
between the respect to involved individuals, and the obligation to
correctly manage the financial resources and to safeguard the safety of
other workers, especially when WDT involves the collecting of sensitive
data (such as the use of illegal drugs, or the assumption of medications).
In conclusion, WDT can have an important role in safety on workplace,
especially in the occupations where the employer and public is entitled to
expect the highest standards of safety and probity. Aside from this, there
is no justification for drug testing as a way of policing the private
behaviour of the workforce, nor is it an appropriate tool for dealing with
most performance issues. Even where drug testing does have a role it
should be approached with caution, and implemented in an ethical, fair,
transparent and inclusive way.

THE MANAGEMENT OF THE EMOTIONAL STRESS OF


PARENTS IN PEDIATRIC ONCOLOGY
Fabio Borrometi, Italy
The parents of children or adolescents with cancer develop situations of
high emotional stress from the time of diagnosis and throughout the
treatment. The idea that their son could die before them is so deeply
unacceptable to be approached with extreme difficulty. They live with
anguish their impotence and they feel affected in their role, primary and
instinctive, of protection of their children.
From a biopsychosocial perspective it can be said that cancer, in children,
is a family disease because it involves, directly and indirectly, all members
of the family. The parents, for their managerial, tutorial and reference
role, face a commitment that goes well beyond the simple "ensure the
best care" for their son.
Moreover it can be said that the ability of parents to cope with the
disease positively creates in the son the perception to be protected and it
improves his will to react to disease.
All health care providers who are treating children or adolescents with
oncological pathology should support the parents considering their
specific condition of emotional stress.
In particular they should be able to:
provide the parents with clear and coherent information at different
stages of the disease
interpret, understand and accept their emotional and psychological
reactions
encourage them to accept the support of a psychologist
promote the recovery of their resources and their parental role

Abstracts of Oral Presentations

keep in touch even during the remission of the disease


direct them towards organizations (foundations, associations of
parents, etc.) that can help them and support them in their practical
needs
assist them in the terminal phase of the disease and in the
bereavement.

TOXICOLOGICAL SCREENINGS IN SAFETY SENSITIVE JOBS:


BALANCING COSTS AND BENEFITS
ETHICS OF RESOURCES
Federica Bortolotti, Sara Patuzzo, Franco Tagliaro, University of Verona,
Italy
sara.patuzzo@univr.it
In all the developed countries, great attention is devoted to the policies to
fight the industrial accidents, which are among the major causes of death
and disability in the population. In Italy, the reports from INAIL in 2011
account for 920 deaths and 724,094 injuries.
In this context, a possible toxicological impairment of the employee has
often been reported as a crucial problem. A direct correlation between
chronic abuse of substances and increased risk of industrial accidents,
never unequivocally proved, finds support in the toxicological data
obtained in studies on traffic accidents, in which about 30% of drivers are
found to have been under the influence of alcohol or drugs at the time
of the accident.
Among the different measures adopted, with the Executive Order 12564-Drug-free Federal workplace (1986), the USA introduced the toxicological
screening of the employees of the public sector. In the following years,
several other countries have adopted similar measures.
The large scale use of expensive screening tests in populations in which
the positive cases are represented in minimal percentage (often around
1%) poses the problem of a correct use of the economical and human
resources. The main point of concern is that, even admitting a high
sensitivity of the tests (> 90%) and a high specificity (> 90%), if the
prevalence of substance abusers in the population is very low, the
predictive value of the screening is minimal. Strategy to solve this
problem will be discussed.

BEST PRACTICES OF CAMPANIA USR


Ugo Bouch, Regional Office for the School (Campania Region), Italy
The LSPCI (Languages for the multicultural school & multilingual curricula)
project is one of the best practices of the Campania USR (Campania
Regional Office for the school). It aimed to test the plurilingual and
intercultural curriculum in the first cycle of the school. It is a part of the
new educational strategy of the Council of Europe promoting intercultural
and multilingual education among the younger generation.

SOCIAL MEDIA AND MEDICINE: LEGAL AND ETHICAL


IMPLICATIONS
Jean-Marc Bourque1,2, Thorsten Hornung1,3, Daniel Lee1,4, Lawrence Loh1,5,
1,6
1,7
1,8
Stewart Morrison , Konstantinos Roditis , Xaviour Walker
1
Junior Doctors Network, World Medical Association
2
University of Western Ontario, Canada
3
Bonn University Hospital, Germany
4
Harvard School of Public Health, USA
5
Dalla Lana School of Public Health, University of Toronto, Canada
6
Barwon Health, Australia
7
Attikon Hospital, University of Athens, Greece
8
Mount Auburn Hospital, Harvard Medical School, USA
roditis.k@gmail.com
Introduction: The growth of social media platforms on the internet
represents both opportunities and threats to the way medicine is
practiced. In our review, we hope to address the basic legal and ethical
considerations surrounding the role of social media in the provision of
medical services.
Methods: The Junior Doctor Network (JDN) of the World Medical
Association (WMA) has recently presented a white paper on Social Media
and Medicine. Inspired by the WMA statement on the Professional and

49

Ethical Use of Social Media, this white paper explores the existing
literature, focusing among others on the legal and ethical aspects of social
media use in medicine.
Results: Social media use by physicians raises various legal and ethical
implications. Posting of inappropriate, abusive, personal, malicious or offtopic material may lead to legal sanctions and threaten the credibility of
the medical profession. Disclosure of information causing disturbance or
substantial interference with the provision of health care and the
permanence of digital content transmitted online may also have legal
implications. Health-care gaps in social media access among patients of
lower socioeconomic status, pose further ethical considerations. Specific
forms of pathology, for example status anxiety and other maladaptive
behaviours have also been described in this new field. Secondary data
usage from social media for research or public health purposes raises a
number of issues pertaining to patient privacy and confidentiality.
Conclusion: It is apparent that many of the legal and ethical
considerations in the use of social media are already reflected in the
standards and codes set out by physicians, institutions and regulatory
bodies alike. It is therefore important for policymakers and stakeholders
involved to work together to address and develop standards for
optimising social media usage and mitigating potential risk. There is a
tremendous potential in harnessing social media for health care, but
equally large potential pitfalls must be considered.

PERIPHERAL ARTERIOPATY AND DIABETIC PATIENTS IN


ENDOVASCULAR ERA: IS IT BIOETHICALLY WORTHWHILE?
Giancarlo Bracale, University "Federico II" of Naples; President, SICVE
(Italian Society of Vascular and Endovascular Surgery), Italy
giancarlo.bracale@unina.it
Diabetic patients who develop peripheral artery disease (PAD) are at risk
to lose one, or sometimes both, legs: this could lead to a poorer quality of
life and could be expensive for health care system. In diabetic patient, in
case of PAD and lower limbs ischemia, revascularization, particularly with
endovascular techniques, is the best option to avoid amputation, but it is
necessary to control the underlying disease: if the patient does not
control diabetes, surgery will often be ineffective. However, even wait too
long before revascularization could lead to amputation. Endovascular
treatment is very expensive, and medical companies put a lot of pressure
on surgeons and even on patients that seek for information, but in case of
a chronic disease like diabetes, the including criteria should consider the
patient's compliance to therapy and his/her continued adherence to a
strict regimen, leading surgeons to decide between postponing a
treatment until a good control of diabetes is achieved, leaving the patient
to suffer a prolonged pain and with the risk of a poorer outcome of
revascularization, and performing an immediate surgery, relieving the
pain immediately, but with higher risk of recurrence of ischemia, need for
more revascularization and, ultimately, the same risk of losing a limb.

LEGAL STATUS OF EMBRYO IN THE CONTEXT OF STEM


CELL RESEARCH
Juraj Brozovi, Vinko Galiot, University of Zagreb, Croatia
juraj.brozovic@gmail.com; galiotvinko@gmail.com
Successful application of products which contain some derivation of
human embryonic stem cells on one hand and moral doubts about such
application on the other resulted in debate which affected a variety of
fields of law. One of those fields is patent law. Such morally tainted
products caused great concerns both in the United States and European
Union. However, those two legal systems had a different idea about how
such moral question should be dealt with. Such solutions are a matter
discussed in this paper. They are observed from the point of view of the
courts of the United States and the European court of justice. While the
courts of United States deal with legal status of embryo in substantive and
procedural sense, determining whether it should be considered a thing, a
person or should it be observed as an interim category, the European
Court of Justice deals with recent legislation and standpoints on
patentability of the inventions involving embryonic stem cells and
influence of ethics on the patent law. Although they discuss different
matters, their opinions show the diversity of views about embryos, ethics
and law.

50

UNESCO Chair in Bioethics 9th World Conference

SOME ETHICAL ASPECTS IN MEDICAL & CLINICAL RESEARCH


1

Vlad Brumfeld , Rodica Feraru


1
Weizmann Institute of Science, Israel
2
Abarbanel Mental Health Center, Israel
Vlad.Brumfeld@weizmann.ac.il
The quality of the medical research may be adversely affected by subtle
ethical issues about which the researchers may not be aware. From
choosing animals for experiments to processing the data obtained from
sophisticated measuring instruments, every work stage leading to a
research article may be affected by ethical shortcomings.
Because the possible problems cover a wide range of fields, we are going
to present issues related only to two unrelated domains: excessive use of
statistics and over- processing of images.
The first part of the presentation will focus on the use and misuse of
statistical methods in medical research. We are going to point out that
clinical trials and subsequent statistical studies are essential, but they
have to be conducted only after the biochemical paths and/or
pharmaceutical activity are known in detail.
Imaging methods became lately one of the main tools of medical and
clinical research, but image processing and analysis has not yet become a
common place. The second part of this work will describe some potential
ethical problems that may arise from over processing or wrongly
processing images. Some examples of such potential problems will be
discussed.

DENTAL CARIES IN CHILDREN: SIGN OF ABUSE BY NEGLECT?


Claudio Buccelli, Aniello Ingenito, Pierpaolo Di Lorenzo, University of
Naples Federico II, Italy
According to epidemiological studies, dental caries affects 80% of the
population in industrialized countries.
In Italy, with a focus on the youngest cohorts, this disease affects 20% of 4
year-old children and 44% of 12 year-old children, with an international
severity index (DMTF: decayed missing filled teeth) of 0.81 and 1.09,
respectively.
A survey on a sample of 101 subjects from Campania aged between 3 and
18 revealed a 81%-prevalence of dental caries in this population, with a
DMTF score as high as 18 in permanent and 12 in baby teeth.
The research also showed that high DMTF scores correlate with poor oral
hygiene, low socio-economic class, poorly educated mothers and
unavailability of school canteen services.
Based on this evidence the clinical observation of dental caries involving
several teeth and extending to deeper tissues can legitimize the
hypothesis of passive abuse (by neglect) or, as an alternative, of social
disadvantage for economic and/or cultural reasons, favored by the
absence of public healthcare in the vast majority of the Italian regions,
primary and secondary prevention of dental caries and treatment are not
included in DRGs.
Neglect is by far the most frequently observed form of child abuse (50%)
that translates in failure to meet primary physical and medical needs,
affective deprivation and abandonment of subjects who are incapable of
tending to their own needs, which is the case of very young children.
The relevant literature shows that failure to offer the necessary dental
treatment to a child has major short-term and long-term consequences
on his/her health. Therefore, in case of suspected neglect, dentists are
morally and legally obliged to report the case to the concerned authorities
in the interest of the child.
In consideration of the above, our paper wants to offer a scientific
contribution aimed at promoting the awareness of specialists that signs of
children dental health can be telltale of neglect and at encouraging public
health authorities to consider dental caries prevention and treatment as
basic healthcare.

TEACHING BIOETHICS IN MEDICAL SCHOOLS


C. Buccelli, M. Niola, D. Del Forno, P. Di Lorenzo, M. Paternoster,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
This paper examines the reasons why the teaching of Bioethics and, more in
general, of Medical Humanities fits well in the degree course in medicine.

The continuous progress of biotechnologies applied to healthcare and the


impact they had on humans, the multitude of values of the society where
we live, health care provided in an impersonal and technicist way
sometimes, claims by patients of their decision-making autonomy,
constitute the substrate which has imposed a profound reflection on the
ethos of the medical profession.
In our experience modern medicine requires the promotion of an acute
awareness of moral problems in biomedicine. Since the beginning of their
degree course, is it therefore necessary to guide students of medicine and
surgery to a conscious use of conceptual, logical and cultural tools which
are required to cope with ethically difficult situations and to rigorously
adjust their positions on the matter. Just think for example of the
complexity of clinical situations related to birth and death.
Such training aims at maturing in the future physician the awareness of
his/her own professional role, by conveying theoretical information in the
field of ethics, and by training them to discern and rationally manage the
ethical problems they will encounter both in clinical practice and in
scientific research.
A therapeutic act is not only the restitutio ad integrum of an organ or
the normalization of laboratory parameters, but rather it is taking care of
the health of a person while taking charge of his/her suffering within and
interpersonal doctor-to-patient relationship which is the core essence of
medicine.
Bioethics, in its triple biological, anthropological and scientific articulation,
in this regard offers an essential perspective of synthesis to the end of
evaluating the quality and the extent of the acts of care the ultimate
purpose of which is the promotion of the wellbeing of those who suffer.
A course in Clinical Bioethics and Medical Progress was established at the
School of Medicine and Surgery at the University of Napoli Federico II in
2004. It is a course for students in the first year of the degree course in
the School of Medicine with the main aims of offering theoretical
knowledge in the field of ethics, of training students to discern and
rationally manage the ethical problems they will encounter in their reallife research situations and clinical practice, and of promoting the human
and professional qualities of students.
The course consists of 40 hours of class teaching, entrusted to teachers
with juridical, medical and ethical education from university structures
external to the University of Napoli Federico II, as well as of workshops for
small groups of students where real cases and real-life personal
experiences are discussed.
To date there has been a high rating by the students attending, 70% of
whom passed the final exam with high marks.

HARVESTING CADAVERIC TISSUES FOR THERAPEUTIC


TRANSPLANTATION AFTER JUDICIAL AUTOPSY:
THE PRIMACY OF ETHICS IN A CLIMATE OF
REGULATORY UNCERTAINTY
C. Buccelli, S. Romano, C. Vosa, M. Niola, International Office for Bioethics
Research of the European Center for Bioethics and Quality of Life of the
UNESCO Chair in Bioethics Unit - Ethics Committee Carlo Romano,
University of Naples Federico II, Italy
In Italy the norms on cadaveric organ and tissue transplant have evolved
through such a complicated process that nowadays the regulation is
neither homogeneous nor fully applicable.
We refer in particular to the so-called silence-means-consent law (L.
91/99) that states that failure to expressly declare willingness to donate
equals consent to donate.
Since no register of donors has yet been established, the temporary
measures are still in force, which annuls the effect of donation promotion
expected by the law itself.
The regulation on tissue harvesting for scientific research purpose or
therapeutic transplant from cadavers undergoing judicial autopsy is
particularly uncertain and undefined.
In this framework some perplexities were raised as to a joint project of the
Forensic Medicine Unit and the Heart Surgery Unit of the University Hospital
Federico II of Napoli, consisting in harvesting aortic and pulmonary valves
for transplants from cadavers undergoing judicial autopsy.
Cardiac valves, treated with antibiotics and preserved at low
temperatures, are potentially valuable biological prostheses (very reliable
and low-cost) to be used as an alternative to synthetic prosthetic devices.
Part of the forensic literature maintains that harvesting tissues from
cadavers undergoing judicial autopsy does not require any consent by the

Abstracts of Oral Presentations


subject as art. 10 of the Regulation applying the law L. 644/75 is still in
force; other authors are convinced that utilising these samples for
purposes other than diagnosis/autopsy is not allowed.
In this normative uncertainty, the EC has decided that ethical
considerations shall prevail and that the general rules regulating cadaveric
organ transplants are applicable also to organs harvested from cadavers
undergoing judicial autopsy.
In this way the circumstances of the death do not affect the fate of the
cadaver and the possibility that the defunct had expressed denial or the
family (duly informed) might oppose to donation is taken into
consideration.
This orientation has been received by the Judicial Authorities and when
judicial autopsy is required the judges check for any opposition or
condition to explant and, if it is the case, authorise the harvesting of
tissues for transplant during autopsy.
Thanks to this procedure it has been possible to solve a juridical dilemma
by applying a rule with a strong ethical connotation to allow for a
biomedical activity that has a high social value.

INSURANCE COVERAGE IN CLINICAL TRIALS IN THE


EXPERIENCE OF THE ETHICS COMMITTEE FOR
BIOMEDICAL ACTIVITIES CARLO ROMANO
P. Buccelli, I. Amirante, M.A. Zinno, D. Faillace, P. Di Lorenzo,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
Regulatory provisions aiming at guaranteeing an adequate insurance
coverage of those participating in clinical trials have evolved slowly over
time.
There was a change from the initial equivocal and improper definition of
coverage for compensation of damages, which is typical of material
liability and therefore not consistent with the reality and needs of civil
liability, although in the medical field, to the definition of damages, but
nothing has been specifically regulated in terms of maximum coverage,
deductibles and timing.
Later the Ministerial Decree D.M. 14/7/09 Requisiti minimi per le polizze
assicurative a tutela dei soggetti partecipanti alle sperimentazioni cliniche
dei medicinali (Minimum requirements for insurance policies to protect
the subjects participating in clinical trials of medicines) entered into force.
The Ministerial Decree represented a huge step forward on the road
towards a uniform and adequate coverage of people participating in
pharmacological research trials.
Later on, however, a new element of decision-making difficulties came
about in Ethical Committees with reference to the more and more
massive and widespread exclusion from insurance coverage of damages
due to a growing number of drugs already on the market ((isotretinoin or
acculane;
diethylstilbestrol
(DES);
l-tryptophan;
fenfluramine,
phentermine; talidomide; phenylpropanolamine; ephedra, ephedrine;
cisapride; Bis(2ethylexyl)phtalate (DEHP); bupropione; diazepine,
oxazepine, tazepine; dexfenfluramine; risperidone; remoxipride;
hydroquinone; statins (HMG CoA reductase inhibitors); retinoids; fibric
acids and their derivatives; products and preparations for impotence;
biogenerc drugs; Cox-2 inhibitors; neuromuscular blockers; seizure
medications, dopaminergic drugs; hydorxyquinoline and their derivatives;
latex; silicone; tobacco; mercury; contraceptives).
We deemed it interesting conducting a study on the congruity with the
most recent provisions of insurance certificates enclosed with trial
protocols submitted to the Ethics Committee Carlo Romano. It is
necessary to keep into account that the insurance coverage guaranteed in
a trial is in itself an indicator of ethicality of the same trial.
In the past three years, between the above-mentioned D.M. entering into
force in 2010 and April 2013, modifications have been requested to the
insurance policies for 191 protocols out of the 732 submitted to the Ethics
Committee, as they did not meet the legal requirements of protection of
people participating in the trials.
For the most part (65% of trials) it was necessary to request the inclusion
of the list of pharmaceutical drugs which, if taken, would lead to the
exclusion from the insurance coverage, into the forms of informed
consent to the trials. In several cases (14%) the insurance certificates
submitted did not meet the provisions of Law (language other than
Italian; exclusions were not specified; there were deductibles; inadequate
maximum coverage and period of coverage). Sometimes (in 8% of cases)
it was necessary to request the insurance certificate, which had not been

51

submitted. Other times (6% of cases) the Promoters were formally invited
to adopt adequate insurance coverage.
Multiple insurance inadequacies were found in several research
protocols. Seven out of the 191 protocols, which modifications had been
requested for, were rejected for failure to comply with the requests for
changes made in relation to inadequate insurance coverage.
The results of our study reinforce our belief that damage compensation
guaranteed to people participating in a clinical trial, by means of a
suitable insurance policy, is an essential protection tool for an appropriate
balance between ethical values, clinical risks and economic interests.

SELF-DETERMINATION IN INTERVENTION WITH


ARAB BATTERED WOMEN IN MEDICAL COMMUNITY
CLINICS IN ISRAEL
1

Eli Buchbinder , Rouzin Barakat


1
University of Haifa, Israel
2
Meuhedet Health Care System, Israel
ebuchbin@research.haifa.ac.il, rouzin.barakat@gmail.com
Women experiencing intimate violence seek medical help up to 2.5 times
more often than other women. Hence, the likelihood that medical staff
will encounter these women is high. The universal rather than stigmatic
nature of community medicine enables interaction with these women,
especially in collectivistic societies in which patriarchal values are
dominant and in which women are subject to social control. This is the
reality of many Arab women in Israel.
The presentation is based on a qualitative study, which consisted of 24
interviews with 12 Arab battered married women, who sought help in
community medical clinics in Israel. The interviews were conducted at two
points in time; the first at the initial contact with the social worker and
the second approximately three months later. A central theme that
emerged from the interviews was the womens wish to maintain their
self-determination in the encounter with the community medical clinics
social workers regarding their coping with the violence. The women
expected to retain the power to determine the boundaries of the
intervention within the professional relationship, which included
maintaining the exclusive privilege to choose the plan of action. The
discussion will focus on the consequences of maintaining the womens
self-determination from the ethical point of view in their relationship with
the health service professionals empowering them on the one hand,
and limiting them on the other.

THE TRIANGLE OF DEPENDENCE IN STEM CELL SCIENCE:


THE IMPACT OF LAW, ETHICS AND SCIENCE ON
STEM CELL RESEARCH AND THE PHENOMENON OF
STEM CELL TOURISM
Bianca Buechner, Indiana University Center for Bioethics, USA
buechner@health-law.de
Law and ethics regulate stem cell research and the treatment with stem
cell therapies in most parts of the world. Public attitudes form policies
and legal frameworks. Specifically, the interaction between law and ethics
and the use of ethics to justify legal standpoints and legal decisions play a
major role when regulating stem cell research and the use of stem cell
therapies. In this regard, the recent European Court of Justice (ECJ) case
Brstle v. Greenpeace e.V. (Case C-34/10, 2011) will be compared to the
US Court of Appeals for the District of Columbia Circuit case Sherley et. al.
v. Sebelius et. al. (610 F.3d 69; 686 F.Supp 2d 1; 644 F.3d 388; 776 F.Supp.
2d, 2012) concerning embryonic stem cell research as a case study. These
decisions demonstrate how law and ethics can influence science itself and
its governing policies. In addition, this project explores the impact that
these two decisions can have on the phenomenon of stem cell therapy
tourism (so called medical tourism).
To conduct such research, the different legal and ethical influences will be
emphasized which not only affect stem cell science policy and legislation,
but also stem cell research and stem cell tourism itself. This analysis is
indispensable for developing a sufficient international stem cell research
and therapy policy strategy. Law, ethics and science shape the necessary
triangle of dependence on the way to international consistency in stem
cell research and stem cell therapy tourism.

52

UNESCO Chair in Bioethics 9th World Conference

A CALL FOR CONSENSUS IF THE AIM IS PROTECTION:


REVIEW OF VULNERABILITY IN RESEARCH
1

Daima Bukini , Jon F. Merz


1
Muhimbili University of Health and Allied Sciences, Tanzania
2
Perelman School of Medicine at the University of Pennsylvania, USA
daimabukini@gmail.com, merz@upenn.edu
Background: Bioethicists have yet to reach consensus on the definition of
vulnerability, nor on the categories of vulnerable groups. This interferes
with the development of specific regulations to protect the vulnerable
groups from exploitation.
Aims: This paper provides a comprehensive review and assessment of the
categories of vulnerable groups in research based on the different
arguments and proposals made by bioethicists with the goal of building a
comprehensive framework for addressing the characteristics of, and
policy responses to address, research vulnerability.
Methods: Systematic literature review conducted of articles published
from 2000 - 2013; to ensure a comprehensive search, we used broad
search terms like vulnerability in research. Databases searched included:
EBSCO, JSTOR, PubMed and Medline and Google Scholar.
Results: Findings from the review indicate that all the proposals are
speaking on the same thing using different terminologies. The most
efficient way to categorize vulnerability should either be on economic or
cognitive bases. Guidelines and regulations to protect vulnerable groups
can originate from that distinction.
Recommendations: Bioethics discourse on research vulnerability has
been mired in problems of definition, with focus often on distinct groups,
what makes them vulnerable and what can be done about it. We find that
the characteristics of vulnerability are often shared amongst groups, and
turn our attention to developing mechanisms to protect vulnerable
groups from exploitation.

BIOETHICS AND OCCUPATIONAL SAFETY IN GENDER'S


STUDIES
Isotta Burlin, Mariano Paternoster, Pierpaolo Di Lorenzo, Massimo Niola,
Claudio Buccelli, Universit Federico II di Napoli, Italy
isottaburlin@libero.it
Analyzing the theme of occupational safety in gender's studies allows to
understand problems not yet solved in the field of equal opportunities,
despite the undeniable positive developments introduced in the Italian
Law by the "Consolidated Act on occupational safety and health"
(Legislative Decree 81/2008) which considers the latest European
Guidelines.
In Italy there is still a lot to do in order to reach equality, not intended as
refusal of differences, but intended as equal opportunity to access to
rights and services, as it can be seen in the latest INAIL (National Institute
of Work-related Accident Insurance) dossier dedicated to women's
occupational safety and health "Women, working safely" (7 March 2013).
The dossier demonstrates that women are less exposed to injuries on
workplaces than men but more exposed to injuries while coming back
home from work.
There are different reasons: in Italy women have different needs and risks
than men, women find often part-time, occasional or less remunerated
jobs, women have less chances to career advancement than men, women
suffer from gender inequalities because they spend more time on looking
after the family and doing the housework. All these factors add extra-risks
which have repercussions on working life.
It is certain that we need an alternative and innovative approach to solve
the problem of women's occupational safety and to improve their access
to equal opportunity: Bioethics has a fundamental role in reaching that
goal.
With its multidisciplinary approach Bioethics is not aimed to solve and
reject the actual differences between women and men. On the contrary,
Bioethics is open to pluralism, different ideas and opposing opinions:
thanks to a respectful debates new points of view can be examined, not
limited to a theoretical approach but extended to practical consequences
aimed at changing the status quo and at finding a flexible balance
adaptable to everyday life.

THE STUDY OF MASSIVE PSYCHIC TRAUMA AND


RESILIENCE IS FUNDAMENTAL FOR ETHICALLY INFORMED
PSYCHIATRIC DIAGNOSIS, TREATMENT, AND FORENSIC
EVALUATION
1

Harold J. Bursztajn , Omar S. Haque


1
Harvard Medical School, USA
hbursztajn@hms.harvard.edu
The current controversy regarding the American Psychiatric Association's
Diagnostic and Statistical Manual (DSM) points to a variety of significant
gaps that need to be independently addressed. The National Institute of
Mental Health has taken the lead in addressing the need for biomarkers.
There is a deeper need, one this group may begin to address, to create a
more valid biospychosocial, narrative-based training manual for
psychiatric diagnosis, treatment and forensic psychiatric evaluation.
Among the relevant omissions in the DSM is the neglect of any systematic
approach to Massive Psychic Trauma and its interaction with character
development and resilience.
The Lodz Ghetto (1940-1944), created for the enslavement, starvation,
and transit to extermination of Jews during the German occupation of
Poland, offers a crucible of how character may develop and manifest itself
in the context of massive psychic trauma. Whereas the transgenerational
transmission of guilt and other forms of suffering is well described in the
literature, the heritage of resilience is little studied.
One of the clinician authors parents' (HB) experiences in the Lodz Ghetto
resistance will be used as a starting point for understanding how patients
and their caregivers, both professional and family, can respond to and
develop in the face of helplessness, hopelessness, and horror. Examples
from that authors forty years of practice experience as a psychiatrist,
psychoanalyst, and forensic psychiatrist will be discussed. This will be
followed by a discussion by the clinician author in training (OH) as to the
relevance of resiliency awareness for bioethically informed clinical
training and continuing education programs.

CURRENT LEGISLATION IN THE FIELD OF


PREIMPLANTATION GENETIC DIAGNOSIS IN EUROPEAN
UNION MEMBERS
Francesco Paolo Busardo1, Paola Mancarella2, Matteo Gulino2,
Gianluca Montanari Vergallo2, Silvia Zoppis2, Paolo Procaccianti3
1
University of Catania, Italy
2
Sapienza University of Rome, Italy
3
University of Palermo, Italy
fra.busardo@libero.it
Preimplantation genetic diagnosis (PGD) is a diagnostic technique,
adopted to detect genetic diseases or characteristics in embryos obtained
after in vitro fertilization, prior to implantation. Taking into account the
continuous progresses in the area of Medically Assisted Reproduction,
which has generated a surplus of laws and ethical and social debates,
undoubtedly PGD represents a rather new medical field and constant
developments in medicine and new opportunities continue to defy the
attempt to respond to those questions.
In this work, the Authors reviewed the current legislation in the 27 EU
Member States trying to evaluate the different legislation pathways
adopted over the last 15 years and highlighting the different positions of
each Member, which show in several cases a process still open and far
from being completed. Numerous EU countries do not have laws that rule
PGD procedures, but only in certain cases (CY, IE, etc.) Guide lines,
which not fully analyse this important field of medicine, leaving numerous
unsolved issues.
Among those EU Countries with a specific legislation regarding PGD, very
different positions have been showed; from a liberal approach in BE, GR,
UK, ES etc., in which the access to PGD is allowed and the selection of the
embryos sex can be carried out when there is a medical indication of a
risk for a sex-related hereditary disease. In other countries such as DE,
only recently (February 2013) a rule regulating how PGD can be used in
practice, has been approved, after that the usage of PGD was in a legal
grey area for a long time. Finally, there are those Countries, e.g. IT, in
which a restrictive interpretation of Article 13 of Law 40/2004 has led to
deny infertile couples with genetic diseases the right to seek PGD
although the Italian Constitutional Court has more times expressed the
unconstitutionality of the rule.

Abstracts of Oral Presentations


FROM BONIFACIOS SERUM TO STAMINA METHOD:
THE OVERPROMISING OF ALTERNATIVE THERAPIES
Fabio Buzzi, Giacomo Tassi, University of Pavia, Italy
fabio.buzzi@unipv.it; gia.tassi@pec.it
From Bonifacios immunomodulant serum of the 50s to Di Bellas anticancer multitherapy of the 90s up to Stamina method against
neurodegenerative diseases of our time, history seems to be repeating
following courses and recourses. In fact, the protagonists are always the
same: a creative pseudo-science (that is opposed to by official science),
seriously affected patients and their relatives and, eventually, judges
(again the protagonists of ordinances and contradictory judgments). And
within the complexity of these events also thorny dilemmas - belonging to
the ethical-juridical universe - appear identical and recurrent,
synthesizable along these lines: what does therapy freedom mean? Is it
tolerable a tout cour right to health built on pietas and on human
compassion, and not on the rules of clinical experimentation and on
proved therapeutic efficacy? Is there a State reason that can impose
political and autoreferential decisions aimed at silencing social
tensions?
Exactly by appealing to the so called compassionate therapies,
regulated in our Country by the Turco-Fazio decree, an Onlus (Stamina
Foundation, established by Prof. Davide Vannoni, professor in the
humanistic field) supplies treatments with mesenchymal stem cells to
patients affected by pathologies that at the actual state of bio-medical
knowledge are unanimously considered to be irreversible (muscular
atrophy, connatal cerebral paralysis, ALS, Nieman-Picks syndrome).
These treatments are not only devoid of the necessary protocol
validation, but moreover they have been forbidden by AIFA in May 2012.
Nevertheless, thanks to courts intervention, to which patients addressed,
the prohibition has been bypassed by judgment, raising diffused stances
on the matter in the medical world.
In the shade of the noisy medical-judiciary-governmental querelle there is
the fact that the fragility and the hopeful credulity, especially when
medicine based on evidence (EBM) is forced to betray the expectations of
a satisfactory helpful outcome, are easy preys of alternative offers that
are now simply visionary, now more and more reproachfully
commercial.
Hence, there is to wonder to what extent bioethics, even before AIFA,
inquiring magistrature and governmental organs, can and should make its
voice heard, in expected consonance with that of deontology. Is it
respectful to the cornerstone of ars medica primum non nocere not
contrasting therapies that distance themselves from the consolidated
safety and efficacy regulations of the medicine based on evidence? Is it
good politics not only not carrying out, but even not formally allowing the
execution of treatments that its own technical organs (those of the Health
Minister: read AIFA) judge reasonably ineffectively and dangerous?
And, on top of all, does this type of therapies reply to the fundamental
criteria of benefit and not discomfort (maleficity) that with priority have
to apply to every biomedical treatment?
Our communication aims at analyzing critically this complex context.

THE ETHICS CONSULTATION: WHICH ROLE IN BIOBANKS


GOVERNANCE?
1

Luciana Caenazzo , Pamela Tozzo , Renzo Pegoraro


1
University of Padua, Italy
2
Fondazione Lanza, Italy
luciana.caenazzo@unipd.it, pamela.tozzo@gmail.com, renzo.pegoraro@
fondazionelanza.it
Starting from our experience of ethical counseling problems related to the
governance of biobanks, this work deals with ethical considerations in this
field. The role of ethics consultation (as a single consultant in
collaboration with the ethics committee) in the conflicts or dilemmas
generated by the biobanks management in public institutions deserves to
be explored.
Biobanks typically collect and store biological samples they are not static
projects, since biological materials and data are usually collected
continuously with defined and/or future research projects at the time of
biospecimen collection. Because their governance should also serve to
protect donors rights and stakeholder interests, we deepen the role of
the ethics consultation in planning, managing and solving the ethical
issues that are still involved in the biobanks governance. Although

53

informed con sent remains one of the most contested issues of biobank
policy, other ethical challenges also still require careful attention: these
include the protection of vulnerable subjects, the safeguarding of privacy,
the communication to donors of research results, conflicts over patenting,
access, and the need for open science, and the rights of donors to retain a
property claim or control over their tissues. Furthermore the ethics
consultant may be involved in a campaign of ethical education to ensure
that all researchers involved in biobanks are aware of their ethical
responsibilities, and donors are better equipped with an ethical
understanding of donation significance.

MIND AS AN EMERGENT PROPERTY


Pietro Calissano, University of Tor Vergata, Italy
For centuries philosophers have discussed about the origin and nature of
mind processes such as memory, emotions, consciousness. The
impressive, explosive growth of neurosciences provides new pathways to
visualize mind as an emergent process of brain activities which could also
have an impact on social events.

BIOETHICS IN CONTEMPORARY CINEMATIC NARRATIVES


1

Irene Cambra Badii , Alejandra Tomas Maier , Andrea Hellemeyer


1
Universidad de Buenos Aires, Argentina
2
Pontificia Universidad Javeriana de Colombia, Colombia
cambrabadii@psi.uba.ar, alejandratomasmaier@psi.uba.ar,
andreahellemeyer@gmail.com

This work studies how the articulation of ethics in contemporary


cinematic narratives enables us to study the power of thought.
Cinema, as a narrative, can provide material for discussion in relation to
different clinical fictions, from its interpretation. There are multiple ways
to understand a film according to the viewers interpretation. This
proposal broadens the understanding of problems considering successive
complexity matrices. Those matrices include not only what is established
by the particular moral or "to be", but also some singular dimensions that
act to supplement the established so far. All of them, including the
subjective components, are looked at analytically.
The research consists in using audiovisual material and other forms of
contemporary bioethical narrative, to empirically survey concepts in the
face of critical situations in the practice contemplated in the UNESCO
Declaration. The objective of this research is to investigate in what
manner the Universal Declaration of Bioethics and Human Rights
(UNESCO, 2005) has contributed towards the articulation between Ethics
and Human Rights in controversial scenarios in professional health care,
offering ways to access the degrees of complexity present in different
current and ethically controversial situations.

INTUITION IN CLINICAL REASONING


Laura Leondina Campanozzi, Giampaolo Ghilardi, FAST Istituto di
Filosofia dellAgire Scientifico e Tecnologico, Universit Campus BioMedico di Roma, Italy
l.campanozzi@unicampus.it, g.ghilardi@unicampus.it
The aim of this work is to address the concept of intuition and the role it
plays within clinical reasoning from a philosophical point of view. We
argue the necessity of a better understanding of this cognitive tool for the
possibility of sound clinical practice.
The present research is organized in three main sections.
The first part shows how intuition is a basic requisite in clinical reasoning,
in particular in the intellectual process of hypothesis generation. Drawing
upon both Poppers hypotheticdeductive approach and Wittgensteins
seeing as conception, we point out that the hypothesis formulated by
the physician are unavoidable and crucial in identifying of a specific
problem.
In the second section, we examine intuitive dimension and its major
features, starting from the review of the main philosophical perspectives
and of same emblematic cases studies. We acknowledge the scientific
dimension of intuition, so as to rid it of the prevailing uncritical
perception.
Finally, the third section outlines our interpretative proposal in terms of
an ecology of intuition: a way of articulating the understanding of the

54

UNESCO Chair in Bioethics 9th World Conference

same, which considers and describes both the context in which intuition
arise, as well as its content or intentioned object. We exemplify this
new approach supporting the need to go beyond two extremes. On the
one hand, the anarchical conception of intuition, that is to say, the idea
that it is not possible to establish the conditions that favour its
emergence, on the other hand, the economization of intuition which
refers to its translation into a merely quantitative dimension.

THE EVALUATION OF MALPRACTICE IS ALWAYS CARRIED


OUT PURSUANT TO THE CODE OF ETHICS?
Sara Campilongo, Alessandro Feola, Bruno Della Pietra, Second University
of Naples, Italy
saracampilongo@tiscali.it
This reflection doctrinaire stems directly from the professional
commitment that today, on a criminal and civil plan, it is becoming
increasingly burdensome for the multiplication of disputes about
responsibility medical professional from malpractice in which, in our
opinion, can be seen a role yet in second floor of the Orders of Medical
Doctors in the evaluation under the Code of Ethics of a correct
relationship between its members, a local and national level.
This lack of the Professional Association intervention has resulted, in
time, a widening of Defensive Medicine and the rise of associations, such
as the AMAMI and ARITMIA, whose mission is to contrast the frivolous
lawsuit (manifestly unfounded complaints toward the doctors) advanced,
often, on the basis of technical reports written by other doctors where is
hardly indicated the technical professional error and where it is often
unearths the unconscious and indifferent attribution of negligence,
carelessness and incompetence.
It has been recently presented in Milan (September 2011) a document of
self-regulation inherent Standards of behavior in the activity medicolegal drafted by AMLA.
It is fully endorsed this document of self-regulation that indicates a
path to follow in order to reduce the lack in the institutional activities
of Professional Associations in careful and proper application of the art.
62 of the current Code of Ethics; this path could limit the proliferation of
frivolous lawsuit through the application of disciplinary sanctions, at the
very least, can be traced the behavior of many consultants to respect the
wording of this article for which you require the association to the
medical examiner to a specialist of the same disciplinary sector of whom
is believed to have incorrectly for malpractice.

WOMAN'S RIGHT TO REFUSE TREATMENT DURING


CHILDBIRTH
Zuzana Candigliota, Czech Republic
Patient's right to autonomy in decision-making on health care is a
traditional issue in bioethics and law. However, insufficient attention has
been dedicated to this issue in women's deciding in connection with
childbirth. Possible explanation is that maternity care is dominated by
significant medical paternalism reasoned not only by protection of
mothers, but also unborn children. On the other hand, pregnancies and
deliveries are increasingly medicalised and some women reject such an
approach.
In recent years, first litigations concerning the right to refuse
interventions during labor and postpartum hospitalization has appeared
in the Czech Republic. Also the European Court of Human Rights began to
address women's rights in connection with childbirth.
I analyze case law in this field and possible trends in the future. I dedicate
attention particularly to case Ternovszky at European Court of Human
Rights and its impact on women's freedom of choice in maternity care.
Furthermore, I interpret the Convention on Human Rights and
Biomedicine and other conventions that address possible limits of
women's freedom. I give attention to concepts of human dignity and illtreatment. According to the Special Rapporteur on torture, Juan E.
Mndez, involuntary medical care often meets the features of prohibited
ill-treatment.
My conclusion is that limiting the right of women to make decisions
during labor is questionable because of possible interference with their
dignity. Involuntary interventions during childbirth will increasingly be
seen not only as an interference with the womens right to privacy, but
also as inhuman and degrading treatment.

EVIDENCE-BASED MEDICINE AND GOOD CLINICAL


PRACTICE IN MODERN MEDICINE: ADVANTAGES OR
PROBLEMS FOR THE PATIENT?
N. Cannovo, F. De Micco, A. Tuccillo, L. Paciello, M. Niola, International
Office for Bioethics Research of the European Center for Bioethics and
Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics Committee
Carlo Romano, University of Naples Federico II, Italy
Evidence-Based Medicine (EBM) was defined as the process of pursuing,
evaluating and systematically applying the results of contemporary
research as the basis for clinical decision-making. The rules of Good
Clinical Practice (GCP) define an international ethical and scientific quality
standard in designing, conducting recording and reporting on clinical
studies involving human beings, to the end of guaranteeing the safeguard
of the rights, the safety and the wellbeing of the people participating in
the study, in conformity with the principles laid down in the Declaration
of Helsinki and in its following modifications.
Both the above-mentioned tools synthesize the large amount of
information produced by the scientific community, and as such are
valuable aids in the diagnostic and therapeutic decision-making process.
EBM and GCP undoubtedly have the merit of guiding to the exclusion of
clearly useless or harmful procedures. However, the topic of this paper is
the consideration that we cannot overlook the risks of their misuse.
As a matter of fact, both EBM and GCP have a structural bias, as they are
the results of limited studies in terms of coverage of the sample analyzed,
and also because they have been developed on the basis of statistical
evaluations which can be applied to whole populations and not to single
subjects, and thus they are limited tools in their applications to single
cases.
Moreover, it is to be considered that EBM and GCP have become the
stone guest in legal litigations for medical malpractice as they have
become the protection shield of physicians in some cases and the
weapon of attack of patients in others.
In our opinion the initial definition by Sackett et al. should be restored
and enhanced, according to which EBM and GCP are to be used as the
basis for clinical decisions, as the indispensable educational tool for
healthcare workers, and as effective support in healthcare policy
decisions but still the basis.
EBM and GCP instead cannot replace the therapeutic alliance between
doctors and their patients, which is the core essence of their relations,
and which guarantees the best available therapy to patients and allows
physicians to apply what they consider the most useful diagnostic and
therapeutic approach to each single patient.
On the other hand, an uncritical adherence of doctors to the best
evidences of efficacy and to the recommendations of guidelines cannot
but prevent them from making gross errors, but it cannot be a guarantee
for them to have operated in the best interest of the patient and in the
most appropriate manner from the ethical and deontological point of
view.

THE ROLE OF INTERNATIONAL STAKEHOLDERS IN GENETIC


RESEARCH
N. Cannovo, V. Folliero, A. Russo, E. Meccariello, V. Graziano,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
Genetic research aims at improving public health by in-depth knowledge
and analysis of the human genome.
New technologies useful to predict monogenic diseases and common
pathologies caused by interaction of genetic and environmental factors
have been rapidly developed.
The WHO, the UNESCO and other international organizations play a key
role in the correct integration of genetic research and public health.
Nevertheless, there can be negative repercussions from genetics in case
of misuse or unauthorised use of genetic information.
Therefore, all the subjects dealing with the collection, preservation, use
and management of genetic information (stakeholders) should jointly and
constantly reflect on what is ethically required, acceptable or nonjustifiable in every action (policies, research programmes, etc.) pertaining
to public health and genomics.
The stakeholders represent the points of view of subjects with different
values and cultures and can play as mediators in international contexts.

Abstracts of Oral Presentations


Over the past few years multinational associations and entities dealing
with genetic issues have mushroomed thus disseminating ideas and
proposals internationally.
One example is P3G Consortium, a non-profit international organization
collecting information on activities carried out in the field of populations
genetics, in order to design and harmonize research strategies since the
interpretation of the role of genetics is not homogeneous in the various
European countries. New professions are also emerging, such as the
expert in European genomic policies or the expert in creation and use of
databanks. The stakeholders will play a key role in protecting citizens
rights in this scenario and in avoiding the risk of a genetic apartheid.
Disclosing genetic information may bring about a high cost in
psychological and social terms because of the risk of discrimination and
biased public perception of a person.
In our grossly deterministic society, a special significance is attributed to
the genetic features of a person. The stakeholders shall guarantee every
single citizen is protected from a misuse of genetic information, limiting
its treatment to therapy or to justified circumstances such as scientific
research.

REGIONAL DIFFERENCES IN CANCER SURVIVAL OF


PATIENTS: ETHICAL PROBLEMS OF HEALTH POLICY AND
CLINICAL GOVERNANCE
Michele Capasso3, Rosalba Caldarazzo2, Dario Capasso3, Aldo Capasso1
1
IRCCS San Martino IST National Institute for Cancer Research, Italy
2
AORN Santobono-Pausilipon, Italy
3
AOU Federico II, Italy
aldocapasso@tin.it
The cancer deaths in Italy constitute about 30% of all deaths and are the
second leading cause of death in the general population. In 2008
malignancies were responsible for over 120,000 deaths.
Estimates of CNESP - ISS of standardized rates of mortality, incidence and
prevalence of tumors, contained in the Document Ministerial address for
the fight against cancer in the period 2011-2013, show that significant
differences persist among the different Regions.
Most of the tumors tend to present a chronic, for which the following
relation holds: Prevalence = Incidence x Duration of the disease.
The median survival of cancer patients in Italy is of 6.12 years after
diagnosis in men and 8.56 years in women, but there are considerable
regional variations, with a clear north-south gradient: survival in men is
higher in Veneto (7, 09 years old), Friuli Venezia Giulia (6.86) and
Lombardia (6.62) and lowest in Basilicata (4.58), Sicilia (4.59), Campania
(4.72), Puglia and Calabria (4, 96); in women is greater in Liguria (9.23),
Lombardia (9.08) and Toscana (8.99) and lowest in Calabria (6.25),
Sardegna (7.02), Basilicata and Sicilia (7,12). The life expectancy of cancer
patients in the southern regions is also reduced by a third compared to
the best-performing regions.
In all regions the average duration of the disease in women is consistently
higher than that in men, documenting a higher lethality of cancer more
accidents in males.
We need to overcome the spatial inhomogeneity, optimizing policies for
the prevention and treatment diagnostic, therapeutic, and rehabilitative
care.

55

achievable through the cooperation of everyone and that affects


everyone, including future generations, which plays, therefore, a
synchronic and diachronic scope and cannot be compressed within the
limits of a mere right to medical care, as it implies wider obligations of
prevention, including environmental, protection of places of living and
working and training and health education and also interacts with the
overall pattern of development of society.
Health is a necessary condition for equality of opportunity and differences
in health status between social classes should be a matter of careful
reflection on ethical and legal, being able to make even more accentuated
and other inequalities threaten social welfare. The right to health is an
interest in the service of all other legitimate interests and the recognition
of its ethical value is a prerequisite for reconciliation and mutual support
of the fundamental rights of the individual with the interests of the
community.

OFF LABEL MEDICAL TREATMENTS IN


NEURO-COGNITIVE DISORDERS: COMPETENCY OF THE
PATIENT AND VALIDITY OF INFORMED CONSENT
1

Felice Carabellese , Antonio Leo , Donatella La Tegola ,


Federica Veneziani1, Chiara Candelli1, Caterina Bonfiglio2,
Giancarlo Logroscino1, Roberto Catanesi1
1
University of Bari, Italy
2
IRCCS De Bellis, Italy
leo.med@libero.it, donatella.lategola@gmail.com
Due to an increase in life expectancy, neuro-cognitive disorders (i.e.
dementia) are heightening their incidence. In neuro-cognitive disorders,
psychotic symptoms and behavioural dysfunctions are common and
atypical antipsychotic drugs are considered, at moment, preferred
treatments. However in Italy their use in older adults with behavioural
abnormalities is off-label. The off-label medical treatments are regulated
by Law N 94/98 and authorizes their prescription only after the
obtainment of patients written informed consent. Informed consent is an
essential prerequisite for any treatment in order to give to the patient a
fair degree of conscious adherence to medical treatment (Cassation
Court, Civ., Section III, n. 19220/20.08.2013). The protection of
constitutionally guaranteed personal rights should be a health cares
primary goal, especially in the case of elderly patients, because of their
fragility and relational isolation. The adoption of specific legal protections
forms complying with the regulations in force, together with an adequate
information seem to be a useful way to safeguard the persons
fundamental rights, as pursued by the bioethics.
For this reason we have designed formats for adult person and
Parents/Guardian ad litem/Custodian/Administrative Support for
interdicted, incapacitated or beneficiary. In our forms, scientific evidences
of efficacy and safety of proposed off-label treatment reported in the
literature are explained. This work fills an important gap in bioethical in
the implementation of bioethical principles in the clinical setting.

HEALTH PROTECTION BETWEEN ETHICS AND LAW

THE CLINICAL RISK MANAGEMENT AND THE MEDICAL


AND LEGAL SIDES IN THE IMPLEMENTATION OF THE
TELEMEDICINE ON MORE THAN ONE MEDICAL FACILITY IN
THE TRANSFUSION MEDICINE SERVICE OF THE ROME B
LOCAL HEALTH UNIT

Michele Capasso1, Dario Capasso1, Rosalba Caldarazzo2, Aldo Capasso3


1
AOU Federico II, Italy
2
AORN Santobono Pausilipon, Italy
3
IRCCS San Martino IST National Institute for Cancer Research, Italy
michelecapasso@tin.it

G. Carbone1,2, D. Funaro1, D. Piergiovanni2, G. Nucci2, R. Serafini1,


2
M. Gabbrielli
1
Rome B Local Health Unit, Italy
2
University of Siena, Italy
giancarlo.carbone@aslromab.it, giancarbone@gmail.com

The Italian Constitution considers the protection of health as a


fundamental right of the individual and collective interest, are expected
to be insured free medical care to the indigent and states that health
treatments are voluntary, except as specifically provided by law, which,
however, cannot violate the limits imposed by respect for the human
person.
It is a law of "fourth generation", not only opposable to the State and
payable by the State, but also the premise for all other rights, which is
combined with the obligations from the state of social solidarity and
recognition of the individual. It 'not just a right of citizens, but "universal"

Introduction: It is well known that the law by decree 183/2012 as regards


the health safety, which has become law on October 31 2012, decrees
that the judge, in accordance with Article 1176 of the Civil Code, in order
to prove the health workers guilt, takes into account that the guidelines
and the good practices, supported by the National and International
Scientific Community, have been respected (art.3.1).
This regulation, together with the introduction of new rules, has obliged,
also in the transfusion field, to draw up clear and shared guidelines aimed
at helping the health workers of the immunohematology and Transfusion

56

UNESCO Chair in Bioethics 9th World Conference

Medicine Service (SIMT) and of the health associations in order to manage


the clinical risk at best.
Discussion: Since August 2012 the immunohematology and Transfusion
Medicine Service of the Local Health Department of Rome B, using the
telemedicine, has reorganized its own activities following the managing of
the suburban health facilities, and in particular those of the Policlinico
Casilino Hospital, at distance.
This new organizational method, in addition to helping the reduction of
the delivery time and the managing costs in terms of human and
technological resources, has allowed to revise and reorganize the
managing activities including the workflows of the personnel.
In order to minimize the possible problems due to the fact that the
technical personnel has been followed by doctors at distance and so that
they work autonomously, clear and shared guidelines of the activities to
follow have been drawn up.
At the same time Training Courses have been organized and made which
have been attended also by the technical personnel of the medical lab of
the Policlinico Hospital.
Results: Since August 2012 up to now, trought the managing at distance,
using the telemedicine, over 500 blood components units (packed red
blood cells, platelets, and fresh frozen plasma) have been assigned.
Since February 2013 the Units have been assigned with the method called
"type and screen"; this method, reducing the time of assignation of the
Units, regarding the donors typed, allows a better managing of the stocks
of the packed red blood cells.
This new procedure, in addition to improving the quality of the
performances of the Immunotransfusional Service of the Rome B Local
Health Department from an economic point of view with a saving of
about 350.000 euros (200.000 euros for human resources and 150.000 for
medical instrumentation) has allowed an increase of the operational
standards and of "know how" of the technical personnel and the doctors,
widening the professional and operational know how of both.
Conclusions: The new method implementation has allowed not only to
save from a direct and indirect economical point of view but also to
renew all the procedures, removing the old ones; the new method has
been also useful to determine and remove "old" problems and to make
the technical personnel more responsible.
Working in that way the transfusion safety has been improved from a
management point of view of the clinical risk not only in terms of quality
but also in terms of involvement of all the personnel.

MATERNITY AND IMMIGRANT WOMEN


Elena Carovigno, Sergio Schettini, Azienda Ospedaliera Regionale S. Carlo,
Italy
e.carovigno@tin.it
When women are doing well, the whole world is better (Amartya Sen,
Nobel Prize for Economics)
Immigrant women in the countries of Europe are nowadays millions. Most
part of them are healthy and in the prime of reproductive life. In Italy,
about 10% of births regard immigrant women, whose contribution to
fertility is becoming increasingly relevant. At the same time, attention is
growing about reproductive health issues and related different forms of
maternity protection, implemented by the western welfare systems,
today considered a necessary challenge to civilization.
Who works in obstetrics and gynecology department of is fully aware that
the number of foreign patients hospitalized, has increased significantly in
recent years. This implies, from the practical point of view and care, new
and complex situations. Health professionals must deal with such
situations relying more on common sense rather than on fixed protocols.
One of the first problems encountered by women in relation to
pregnancy, childbirth and child care, is the deep sense of isolation:
uprooted from their entourage family and friendship, their cultural
references related to maternity are to give birth alone or in the presence
of a husband or a friend from the same country, in hospitals aseptic
between professionals who have difficulty understanding them.
Taking care of health care issues connected with migrations is an
inevitable phenomenon, being the world patterned by prolonged political
and economic crises and affected by asymmetrical distribution of wealth,
in order to deal with issues applying humanity and conscience, we should
promote a consciousness-oriented bioethics understanding of different
cultures, preparing medical staff to a culture of 'hospitality and solidarity
while in the observance of ethics and the law.

TREATMENT PROSPECTS IN SEX OFFENDERS WITH


PARAPHILIC DISORDERS: PHARMACOLOGICAL
ANDROGEN DEPRIVATION BETWEEN THE NEED FOR
SOCIAL DEFENSE AND THE RIGHT TO HEALTH
Roberta Carrossino, Gabriele Rocca, University of Genoa San Martino
Hospital, Italy
The development of alternative treatment paths to imprisonment for sex
offenders with paraphilic disorders is a topic of great interest among
researchers in criminology. It has long sparked an intense debate,
especially regarding the prospects of a pharmacological treatment.
In light of the recent scientific achievements concerning the definition and
treatment of paraphilic disorders, the purpose of the present study is to
investigate the existence and the international scope of treatment
programs that are alternative to detention for sex offenders.
Our study will chiefly focus on the effectiveness of the hormone therapy
(the so-called "Androgen deprivation") in the prevention of criminal
recidivism.
From a methodological point of view, after the presentation of the
program in use in the State of New York (USA), we will analyze and discuss
the results of a selection of the scientific articles published in English since
year 1990. These were selected either through an internet search
(Medline, Scopus, Google Scholar, Embase And Psycinfo) based on the
keywords "sex offender", "paraphilia", "drug treatment" and "androgen
deprivation", or by a manual search of the references cited in the articles.
Many treatment programs are being used both in Europe and in US.
In general, these programs consist of a first evaluation stage on
individuals that are in probation, which classifies them according to an
increasing level of "risk"; this is followed by a treatment phase, which
involves the use of hormonal substances (testosterone antagonists and
GnRH agonists) and psychotropic drugs (SSRIs).
The data emerging from the literature suggests a certain degree of
effectiveness of the antiandrogens in particular of the GnRH agonists in
the prevention of the risk of criminal recidivism, even though the long
term viability of such therapies needs to be substantiated by further
research. The combination of a pharmacological treatment with
psychotherapy was found to be more effective than the monotherapy
alone, while a cure should in any case be continued for no less than 3 to 5
years.
Certainly, the role of anti-androgen therapy in the treatment of sex
offenders with paraphilic disorders carries important consequences of
bioethics nature. These are highlighted by taking into account the goal to
strike a balance between the need for social defense and the right to a
free choice of care.

REVISITING THE INFAMOUS PERNKOPF ANATOMY ATLAS:


HISTORICAL LESSONS FOR MEDICAL LAW AND MEDICAL
ETHICS
PA Carstens, GP Stevens, University of Pretoria, South Africa
pieter.carstems@up.ac.za, philip.stevens@up.ac.za
The Pernkopf Anatomy Atlas was compiled during the Nazi era in Austria
(1938 to 1945) by Eduard Pernkopf, professor of anatomy and director of
the Anatomy Institute at the University of Vienna. Initially, the Atlas has
been hailed as a classic masterpiece of unsurpassed beauty, with
reference to the anatomical illustrations, until it was discovered in the
1980s and mid-1990s that Pernkopf and his talented illustrators (all
ardent Nazis), used human material obtained from executed Nazi victims
of terror to illustrate the Atlas. In addition, it transpired that the
illustrators have signed some of the illustrations with offensive Nazi
insignia (the swastika and the SS-bolts). Amid international
condemnation and outrage, the debate has raged on whether the Atlas
should be rejected or continued to be used. This paper revisits the Atlas
with specific reference to transgressions of medical law and ethics, the
question as to the continued use of the Atlas, as well as the startling fact
of the complicity of the medical and legal professions in providing
legitimacy which the Nazi regime needed for the implementation of their
political ideology. Ultimately, this paper assesses the lessons to be
learned from this historical, but contaminated publication. It is argued
that the principle of moral complicity, the right to human dignity, and,
ultimately, civilisation all militate against the continuous use of the Atlas.

Abstracts of Oral Presentations


GENOMIC STUDIES AND ETHICAL ISSUES IN THE CHINA OF
THE THIRD MILLENNIUM
Daniela Caruso, Macerata University, Italy
Since China's involvement in the Human Genome Project and its
completion of the sequencing of the rice genome, the country is
establishing a prominent place in genetics and genomics. Nevertheless, a
significantly lower level of standards in Bio-Medical regulation, or a
weakness in enforcing the related legislation, has the potential to lure
researchers to conduct experiments in China that contradict bioethical
standards. Can the differences between China and 'the West' be used as
an excuse for the current situation? Will the impact of China's new role in
the world fuel the global cultural antagonisms and ideologies of cultural
ethical relativism?

IMMIGRATION BETWEEN HOSPITALITY & CRIMINAL LAW


Guido Casaroli, University of Ferrara, Italy
cld@unife.it
As it is well Known, immigration policies involve two different kind of
needs that are difficult to balance for a number of reasons: on one hand,
the need of public security and the related perception by resident
nationals; on the other hand the need of migrant people to enjoy the full
respect of their fundamental human rights.
This preservation will illustrate the complex and problematical
development of the legislation on immigration and the related case-law.
The aim is to evaluate the state of the art in the research of a balance
between the aforesaid needs, a difficult but essential goal in the subject
at stake.

POSITIVE ATTITUDE CHANGES IN BIOETHICS STUDENTS


BEFORE AND AFTER SURVEY APPLICATION
Mara Casas, Panamerican University, Mxico
mcasas@up.edu.mx
Introduction: The development of an ethical compromise in medicine
students involves a challenge. The Bioethics courses have been
established, but traditional classes had not been enough. We have been
working in improve in our students an interest in bioethics, so we have
been trying to generate diverse academic scenarios that promotes the
integration of ethical principles to practice and give to students significant
experiences.
Objective: Encourage among medicine students, through their
participation in a survey, reflection and interest regarding bioethics
dilemmas.
Method: A questionnaire was applied to35 students enrolled on the
bioethics course during their 8th semester about interest in bioethics
class topics. The students apply a survey about confidentiality in their
hospital to 155 doctors, residents and interns about confidentiality cases.
After analysis and reflection of results, the same first questionnaire about
interest in bioethics topics was applied again to the students. The
comparative results showed an important improve of interest (42%),
knowledge (62%), bioethics application in medicine (71%), pertinence of
survey as teaching strategy (74%).
Conclusion: The survey method, applied and analyzed by bioethics
students is an interesting strategy to improve their attention in bioethics
dilemmas, because introduce them to reality and repercussion of this kind
of decisions in patients management.

THE DAMAGE OF THERAPEUTIC FURY


Claudia Casella, Italy
The grounds on which there is a need for an accurate investigation on the
nature of the problems caused from the infliction between suffering and
unneeded pain is without a doubt, on a human level, that of the end of
life. In this last phase of existence it is difficult to deny that the suffering
and the psycho-physical discomfort that often characterizes that of the
terminally ill should be rightly otherwise considered.

57

Here in fact is a question on which it is worth thinking about. Is it right to


configure, in our system, a law on the compensation of the loss of fury,
persistence or excessive therapeutic treatment?
As evident, it is a case that from a long time has brought up many
discussions and debates for the difficulties we meet when referring to
types of indemnifiable problems, the quantity, and the subjects,
legitimate to act in law to achieve the relief of those principally affected,
and the need to untie the knot of what is intended for extraordinary and
not proportional treatment and what the remedy available to the will of
the patients justice of proportion of the treatment. The dilemma is
nourished by a problem other than new aspects, connected to the duties
attributed to the medical operator and the boundaries of the guarantee
of his position, even with reference to the consent of the patient. In
particular, it refers to the profile of responsibility of the doctor, which on
expressed demand of the patient there is surgical intervention in the
attempt to delay the moment of death, even though for the medical
science that treatment cannot with good reason benefit the patient.

THE STAMINA CASE: BIOETHICAL ISSUES


Filomena Casella, Marianna Longo, Pietro Ferrara, Raffaele Di Guida,
Raffaele Landi, Second University of Naples, Italy
f.casella_@libero.it
Recently in Italy, the scientific community has been involved in the case
law and the politics in the activities of Stamina Foundation for the
"method", based on adult mesenchymal cells, which is used by this
Company in the treatment of many diseases.
The publicity in the media raised by the cases of some citizens, following
an order of the AIFA which forbade the use, who asked to be subjected in
any case to this procedure coming up to appeal to the judiciary, have
forced the hand of the policy that is was forced, by decree, to authorize
this treatment in 32 patients enshrining the application in the context of
compassionate care.
The decree was converted into Law 25 March 2013 No 24, which has
created a dangerous precedent of non-validated therapies from the
medical assembly, but rendered valid by political and judicial decisions
under the influence of public opinion to the search for safe treatments for
some diseases which are still incurable, renewing the emotional wave of
similar cases that are repeated over the decades.

CRUSHING AND COVERT MEDICATIONS IN NURSING


HOME: PREVALENCE AND IMPLICATIONS FOR PRACTICE
1

Anna Castaldo , Camilla Boeri , Giordano Andrea , Talia Melo ,


5
6
Renzo Bagarolo , Miriam Magri
1
Institute Don Orione, Milan; Milan Nursing Council (Collegio IPASVI), Italy
2
San Giacomo Hospital, Italy
3
Foundation IRCCS Neurological Institute C. Besta, Italy
4
San Raffaele Hospital, Italy
5
Foundation Don Gnocchi, Italy
6
Foundation IRCCS Istituto Nazionale Tumori; Milan Nursing Council, Italy
anna.castaldo.mi@alice.it
Objective: To assess the prevalence of altered (crushing and covert)
medications in residents of the nursing homes; and explore the adherence
to the administration indications provided by pharmaceutical companies.
Methods: Between January-February 2012 a prospective observational
study was carried out using the following methods: observation of the
drug administration, analysis of clinical documentation, and a brief
interview to nurses who administered medications at each unit of the
participating nursing homes. The sample consisted of 697 residents at
three nursing homes in Milan.
Results: Each patient took an average of 7.5 medications per day, whose 6
were per Os. Forty percent of the patients took oral crushed medications.
Of 2639 drug administrations, 785 were crushed and among these 43%
were administered not in adherence to the pharmaceutical indications.
Twenty percent of patients took the drugs hided in drinks and food. Main
referred cause for crushing and hiding was swallowing disorder. Patients
who were administered altered medications had more cognitive and
functional deficits, compared to those who received them intact
(p<0.001).

58

UNESCO Chair in Bioethics 9th World Conference

Conclusions: Several government, business and professional


multidimensional programs are needed, including monitoring of adverse
events, and, among these, those associated with drug administration.

PROFILES OF LEGAL SIGNIFICANCE OF ADVANCE


DIRECTIVES FOR MEDICAL TREATMENT:
EXPERIENCES TO COMPARISON

THE NURSES ATTITUDES TOWARDS THE USE OF PHYSICAL


RESTRAINT: A FOCUS GROUP STUDY

Roberta Catalano, Second University of Naples, Italy


robcatalano@libero.it

Anna Castaldo , Miriam Magri , Ermellina Zanetti , Carla Noci ,


3
1
1
1
Monica Gazzola , Paola Gobbi , Giorgio Carniel , Elisa Crotti ,
Giovanni Muttillo1, Stefano Bazzana2
1
Milan Nursing Council, Italy
2
Brescia Nursing Council, Italy
3
Aosta Nursing Council, Italy
mgazzola@ausl.vda.it; ipasviaosta@gmail.com
Objectives: This research derives from a first multicentric research that
investigated the prevalence of physical restraint in hospitals and nursing
homes. The aim of study was to identify nurses motivations, attitudes,
values and feelings with reference to use of physical restraint, and factors
favoring it.
Method: This qualitative study was conducted through focus groups. The
sample, enrolled on a voluntary basis, consisted of 60 nurses, 40 ward
sisters and 30 nursing directors working in nursing homes and hospitals in
Italian provinces of Aosta, Brescia, Milan, Lodi and Monza and Brianza,
and who had already been investigated in the first research. The
interviews of 16 focus groups were recorded and transcribed verbatim,
with the consent of the participants. Content analysis of the data was
validated by the moderators together with the observers.
Results: Nurses experience a variety of emotions, often ambivalent and
conflicting, when they apply physical restraint to a patient: anger,
compassion, frustration. With regard to the attitudes and beliefs, the
groups discussed following issues: definition of physical restraint in terms
of restriction or safety (for patient, family, other patients and staff), and
frequency and duration of restraint: from extraordinary intervention (as
indicated in Nurses Code of Ethics) to mainly ordinary intervention.
Conclusions: The study highlighted the conflict experienced by nurses,
especially when restraint was used as a routine practice. Despite the
presence of discouraging factors, this research shown the need and
intention expressed by nurses to implement every evidence based
intervention strategy that can reduce use of physical restraint.

The paper builds on the analysis of the profiles of the legal significance of
advance directives for medical treatment in Italy, and aims to highlight
the convergences and divergences between the Italian experience and
that of some other countries, not only in Europe (Spain, UK, Belgium,
Holland, Switzerland, Israel), which governed in a more or less organic and
complete the phenomenon of advance directives. The privileged
perspective of the comparison between different experiences allows you
to identify issues and difficulties that have been faced in all systems
considered, and, for this way, it allows to carry out a study to select and /
or develop possible proposals for solutions for these issues and
difficulties.
The broad list of subjects about which it is expected the discussion is as
follows:
1. Advance directives for medical treatment: problems and prospects in
the Italian experience. 2. Principles and solutions in Europe. - 2. The
experience of some European countries: the document de voluntades
anticipadas in Spain. -3. (continued) The living will in the UK. 4.
(continued) Statements assets and choices of euthanasia in Belgium,
Holland and Switzerland. - 5. The original approach adopted in the State
of Israel. - 6. Issues arising from the comparison between the experiences
examined and possible solutions.

UNIVERSALITY OF HUMAN RIGHTS AND CULTURAL


DIVERSITY: SOME THOUGHTS FROM THE PERSPECTIVE OF
MIGRATIONS
Giuseppe Cataldi, University of Naples L'Orientale, Italy
The Report deals with the question of the balance between respect of
Fundamental Human Rights and assertion of diversity and plurality of
cultural values. The problem appears nowadays as a
tremendous priority, for the State domestic legal orders' closure due to
the measures adopted in consequence of international terrorisms. How to
turn a security problem in a matter of rights and mutual enrichment?

BIOETHIC(S): BRIDGE TO THE FUTURE (OF SPORT)


Franco Bruno Castaldo, University of Naples Parthenope, Italy
franco.castaldo@uniparthenope.it
Faced with the rapid progress of biotechnology and biomedical
knowledge, the discoveries in the field of genetic engineering and the
increasing ability to manipulate human life and the ecosystem, Potter
believed that the only way to ensure the survival of humanity was
building "a new discipline that combines biological knowledge (bio) with
knowledge of the system of human values (ethics) 'a discipline that acted
as a' bridge 'between scientific knowledge and humanistic knowledge in
order to use with wisdom 'new knowledge so as to improve the quality of
life of future generations.
Currently the word Sport is the one that makes us understand the term
globalization; in the last London Olympics there were 204 participating
nations. The Assembly of the United Nations is actually made up of 193
member states.
Always the last Olympics marked the previous record of world: Viewers in
billions London 2012: 4.80. The communicative and evocative power of
the sports is unimaginable, or rather, is known all too well: there are
many positive aspects tied to the sport; are increasing more and more
negative ones.
We need a bridge that brings together the value of the sciences related to
the bios (all sciences, including economics), with the knowledge of the
system of human values (ethics) in the kaleidoscopic world of sports,
there is indeed a necessity, that in the training and governance of the
sport, as well as the presence of the CEO (Chief Executive Officer) there is
also the presence of a CEO (Chief Ethics Officer).

THE LIFE-PROLONGING MEASURES (AGGRESSIVE


TREATMENT) IN LEGISLATION OF FOREIGN COUNTRIES
Francesco Catapano, Italy
There is a correlation of the topic aggressive treatment with other
themes related to "end of life" and in particular with the living will.
In USA, after the cases "Quinlan" (1976) and Cruzan (1988) it has stated
the general principle of "best interest of the patient" that is the best
solution in the interest of the patient.
It is originated the term Medical futility that indicates a clinical
intervention without any utilities to achieve a specific objective for a
particular patient.
In May 2012, the Senate of Argentina has approved the "worthy death
law" (Ley de muerte digna), which recognizes the right to refuse
therapeutic procedures totally disproportionate in relation to the
possibility of improvement, or that produce excessive suffering.
Even in Uruguay on March 18, 2009 was approved by Parliament the law
on aggressive treatment.
European Council has taken a position on issues relating to the rights of
the patient and dying with the resolution No. 613 of January 29, 1976 and
recommendation No. 779 of January 29, 1976, and with the
recommendation No. 1418 of 1999.
In 1993 the Supreme Court of the United Kingdom (Divisional Court), in
the case Bland, believed that doctors do not have the obligation to
administer unnecessary treatments, according to a scientific evaluation of
the condition of the patient's life, and that do not respond to his best
interests.
The Medical Capacity Act has established a legal framework for those
unable to make decisions autonomously and for early declarations of will
(for the case of a contingency of inability).

Abstracts of Oral Presentations


In Spain under the law No.41 which came into force in May 2003, the health
service must be appropriate to the circumstances and proportionate to the
needs of the patient; You must act in favour of the same and must be
respected his dignity.
In Germany the living will, into force on 1 September 2009, provide that the
doctor in charge should indicate which medical interventions are
appropriated to the conditions and the prognosis of the patient. The doctor
and the administrator discuss these measures, bearing in mind the
willingness of the patient as the foundation of the decision.
In France there is a law of April 22, 2005, known as "the law Leonetti", that
takes the name from the parliamentary (doctor), author of the legislative
initiative.
Certain rules are limitations and/or prohibitions to doctors to prevent the
life-prolonging measures (aggressive treatment); other rules regulate the
patient's right to manifest his will that put obstacle to the practice or the
danger of life-prolonging itself.

BIOETHICS AND SOCIAL SECURITY MEDICINE RESOURCES:


THE ANTINOMY BETWEEN ETHICS AND ECONOMY,
MEDICAL LEGAL EVALUATION AND REGULATORY
HARMONIZATION
Andrea Cavalli, Italy
andrea.cavalli@inps.it
The relationship between ethics and economics cannot be separated from
the historical analysis carried out by Smith and Marx and the subsequent
synthesis carried out by Weber, who has reassembled the unit between
ethics and economics abolishing the reciprocal hierarchies. In this view,
the ethical norms are a historical product that influence economic forces,
which in turn modify the ethical standards, according to a circular process
in development, but not exclusive: the ethical norms are influenced by
conflicts of interest and similarly the economic development (or the lack
of development) is hindered or favored by ethical values.
On the basis of these doctrinal paradigms, a special role is played by the
art. 38 of the Italian Constitution, which sets out a framework within
which ethical values and solidarity of social security must be harmonized
with the economic conditions necessary to achieve them.
Without prejudice to the aforesaid constitutional protection, a basic
question that now arises in the welfare sector is the need to predict the
effects on the economic process induced by instances innovative,
different or just more broad and diffuse. Equal importance is covered by
the identification of the most appropriate tools for their implementation,
in a globalized world in which new subjects appear realizing or requiring
ethical and economic behavior, such as enterprises, unions, supranational
and international organizations.

BIOETHICS AND HUMAN RIGHTS PROTECTION:


THE ROLE OF FORENSIC EVIDENCE
Rossana Cecchi, Simona Napoletano, Alessandro Mariani,
Miriam Catanese, Cristina Sestili, Italy
rossana.cecchi@uniroma.it
There are 200 million people in the word living outside the country where
they were born, of these, nearly 10 million are refugees and asylum
seekers, the Amnesty International Report 2012 reveals that torture is
practiced in almost 101 countries. The prevention of torture and the
treatment of its victim are issues that involves an increasing number of
physician in western countries.
After the II War and the failure of domestic government in individual
rights protection, International Community began to draw up a series of
norms started with the Universal Declaration of Human Rights as a moral
standard of achievement, followed by the adoption of Treaties declaring
that human being exists as subject of international law. In this historical
and political context, physicians can become active voices promoting
human rights principles, as members of the larger medical community
and trough the involvement in International Organization, such OHCHR
and its special procedures.
This paper proposes an analysis of the ethical issues involving medical
profession in its relationship whit the victim of torture, among the
different legal and international fields. The Authors examine the ethical
dilemmas that distinguish forensic practice whereas the physicians role
become more investigative, as well as therapeutic, since he has to judge

59

whenever the patients story is legitimate. Forensic documentation can be


considered a very important tool to use in litigation of torture, for battling
impunity, for the redress of survivors, for rehabilitation, and it is
fundamental in documenting specific techniques and in educating people
about this phenomenon.

THE DECISION-MAKING PROCESS WITH REGARD TO THE


VIDEO-ASSISTED THORACIC SURGERY IN EIGHTY YEARS
OLD HESITANT INDIVIDUALS
C. Cecere, F. Policino, M. Cicalese, University Federico II Naples, Italy
Objectives: The elderly patients may have diminished awareness about
the risks, the complications and the benefits with regard to surgical
interventions. In these patients the decreased ability to understand the
passages of a clear, complete informed consent is not the equivalent to
the mental incompetence. Usually these are eight years old inattentive,
hesitant, tired and disheartened individuals. In these cases the
participation of members of the family and of acquaintancy that enjoy
patients confidence may be very useful to the patient for a better
understanding of the points of informed consent before the acceptance
or the refusal of the operation. The aims of this study were to evaluate
the role and the usefulness of this participation in these cases.
Methods: In a series of 28 of eight years old patients (male, 16; female,
12; age range, 81-89 years) with recurrent pleural effusions 17 were
hesitant to take a decision about VATS (Video Assisted Thoracic Surgery)
after medical meeting with the surgeon and the anesthetist. The
participation of persons that enjoyed hesitant patients confidence was
requested in order to help the single patient to remove his doubts and
hesitations, to understand the risks and the advantages of the proposed
operation clearly and to facilitate the decision-making process at last.
Results: The participation of persons that enjoyed hesitant patients
confidence played a leading role in the understanding of medical concepts
and in the decision-making process: 15 (88%) accepted the operation
whereas 2 (12%) refused the VATS.
Conclusions: The role of persons that enjoy patients confidence is crucial in
the decision-making process with regard to surgical interventions in eight
years old hesitant individuals. Their participations safeguard the patients
autonomy and facilitate the informed consent process for the medical staff.

DO THE PATIENTS PARTICIPATING IN CLINICAL TRIALS


UNDERSTAND INFORMATION ABOUT CLINICAL TRIALS?
Asta Cekanauskaite, Vilnius University, Lithuania
asta.cekanauskaite@gmail.com
The paper aims to analyse the problem of informed consent in clinical
drug trials. Understanding of the provided information is one of the basic
components of a persons sound and informed decision to participate in a
clinical trial. Our research evaluated informedness about clinical trials of
patients participating in clinical drug trials in Lithuania, with emphasis on
the informedness about key elements of clinical trial design (placebocontrol, double-blindness, and randomisation). An anonymous survey of
patients participating in clinical drug trials was conducted for the
purposes of this study.
The results of the study reveal that the legal framework sets the basis for
adequate informedness about clinical trials of clinical trial participants,
however, patients participating in placebo-controlled clinical trials are
insufficiently informed about clinical trials. Patients participating in
placebo-controlled clinical trials are better informed about the rights of
clinical trial participants than about clinical trial design, however,
informedness about design is a more important condition for overall
informedness. The majority of placebo-controlled clinical trial participants
do not understand at least one of the three key elements of clinical trials
design and they tend to interpret the scientific methods used in clinical
trials therapeutically.

METAETHICS AND BIOETHICS: PSYCHOPATH CASE


Nenad Ceki, University of Belgrade, Serbia
ncekic@f.bg.ac.rs; n.cekic@sezampro.rs
The externalism/internalism debate about the very nature of moral
motivation is one of the most intense disputes in contemporary meta-

60

UNESCO Chair in Bioethics 9th World Conference

ethics, but not only in meta-ethics. It has internal connection with


bioethics, psychology, medicine, etc. A famous philosophical definition of
bioethics is: As a species of practical ethics, bioethics exhibits a complex
and contested relationship to philosophical theory. On one hand, many
who teach and write in this interdisciplinary field are philosophers who
naturally believe that their specific contribution to the fieldtheir
expertise if you willconsists in the application of distinctly
philosophical methods, including various kinds of ethical theory, to
practical problems arising in biomedical research, clinical medicine, and
public health. The particularly intriguing fact is that bioethics nowadays
is usually qualified as a branch of ethics, but not as a branch of
philosophy. The widespread discussion about the nature of moral
motivation (internalism/externalism dichotomy) obviously is a part of
bioethics, but meta-ethics, as well. This debate is directly concerned
with biology, medicine and various kinds of empirical investigations. I
would like to explore the following three problems
It is quite obvious that multidisciplinarity is a fact in these areas of
inquiries. However, there are two reasons for further analyses. First,
should we have to obey some boundaries between some disciplines
biology is obviously a branch of medicine, medicine is not, all those
disciplines are not philosophy. The authors thesis is that
multidisciplinarity is valuable. However, some clear boundaries between
scientific and other disciplines have to be observed because that
observation is a guarantee of fruitful multidisciplinary discussion.
Secondly, the author offers little illustration that could show that, in some
cases, those boundaries between disciplines are not quite visible. The
problem of psychopath motivation is a fairly clear example. Is it
psychopath motivation - moral motivation, impaired motivation or not a
motivation at all?

THE HUMAN EMBRYO


David ern, Charles University in Prague, Institute of State and Law of the
Czech Academy of Sciences, Czech Republic
david.p.cerny@gmail.com
One of the most discussed problems in contemporary bioethics concerns
the moral status of the human embryo. Briefly, we can distinguish two
main approaches to the philosophical evaluation of the moral status of
the human embryo: the first approach is functional, the second approach
is ontological. According to the first approach, the human embryo can be
defined in functional terms in respect to some preferred function it can
manifest (sentience, immediately exercisable capacity of thought,
consciousness etc.). Supporters of the second approach to the definition
of the human embryo understand it as a member of the same ontological
kind adult human beings are falling under. In my contributions I argue for
the second philosophical position: I am trying to show that the human
embryo is a fully-fledged member of the human kind, that it is indeed a
person (defined ontologically) and that animalism is true meaning that
our personal identity and persistence do not include any psychological
facts.

AN OPINION OF ETHICS COMMITTEE CARLO ROMANO


ON CONTINUATION OF TREATMENT IN AN
ANENCEPHALIC NEWBORN
I. Cerrone, D. Faillace, L. Terracciano, V. Graziano, M. Paternoster,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
This paper illustrates a case where the Ethics Committee Carlo Romano
issued an opinion on the continuation of resuscitation in an anencephalic
new-born of 18 days, intubated since birth for artificial ventilation.
Whether to start and to continue treatment of newborns with severe
medical conditions is a largely debated issue in paediatrics.
Although technology breakthroughs offer new tools to tackle congenital
abnormalities and pre-term deliveries, the decision as to whether starting
and whether continuing care is very difficult in every single case.
In the case above, in the exclusive interest of the baby and regardless of
any perspective organ donation, although possible it might be, the EC
deemed it was worth continuing clinical care with ordinary therapies only,
since any resort to extraordinary means would configure futile care

(expressly forbidden by the Italian Code of Medical Ethics) in


consideration the negative prognosis of the baby.
The EC also recommended proper doctor-parent communication in order
to p inform the family about the babys clinical conditions and receive
informed consent to the therapeutic strategy proposed, highlighting that
doctors are entitled to refuse any request for treatment that is in contrast
with their consolidated scientific principles and ethical beliefs, although
taking on the responsibility for all diagnostic-therapeutic act performed.

CONSCIENTIOUS OBJECTION, LAW AND BIOETHICS:


THE RIGHT TO DISOBEY LAW BASED ON MORAL,
RELIGIOUS OR PHILOSOPHICAL CONVICTIONS AND ITS
INTERFACE WITH BIOETHICS
Selma Aparecida Cesarin, Universidade Cruzeiro do Sul;
Centro Universitrio So Camilo, Brazil
selma.cesarin.adv@gmail.com, selcesarin@gmail.com
Conscientious objection arose in the Middle Ages, based on religious
aspects and it has migrated to other areas, including Medical area. The
conscientious objector refuses to fulfill what is not in accordance with his
principles, as a matter of moral, philosophical or political convictions.
There is a large discussion about the physicians right of conscientious
objection. In Brazil, the current Code of Medical Ethics (2009) establishes
the physician right to refuse to perform acts which, although legal, are
contrary to his conscience. However, Ministry of Health technical rules
does not recognize the conscientious objection right if there is risk of
death, if there is no other physician or if medical omission can cause harm
to the patient. Thus, it is clear that autonomy is not unlimited. If there is
no other doctor, one will have to answer on behalf his professional
prerogatives and non-maleficence and beneficence of the patient. Law
commandments are coercive. Among them, conscientious objection is an
exception because it justifies and authorizes law disobedience, without
facing penalties. Conscientious objection is provided differently in each
state: one in the Constitution, in ordinary laws in others, and only in court
decisions in other ones. Respect personal convictions without harming
others, refusing to obey the laws, as a matter of moral, philosophical or
political convictions assume sense of justice and defense of the right and
they are moral capacities of ethical people. Thus, the connection of
conscientious objection, Law and Bioethics presents a rich field of study
and discussion.

HUMAN HONOR SOLUTION PROCESS FOR THE


EUTHANASIA AND WILLPOWER CONCEPT AND THE
DISPUTES RESULTING FROM THE DIFFERENCES BETWEEN
NATIONAL LAWS AND INTERNATIONAL LAWS IN TERMS
OF HEALTH LAW AND BASIC HUMAN RIGHTS
Nee etin, Izmir University and Ege University (student), Turkey
nesecet@yahoo.co.uk
While the treatment protocols prolong human life, it also created people
who are confined to bed, who survive with the help of various treatment
devices and other people, who are isolated in pain, and who feel
degraded.
There are international differences about euthanasia and willpower, will
representing right, different practices between the international law and
national law cause a chaotic situation among the patients and their
families.
Knowing that currently there are 400 thousand Alzheimers patients in
Turkey and that there will be 14 million Alzheimers patients in the USA in
2050, will the treatment and caring expenses of people without insurance
and nobody to take care of them be covered?
Religious and political authority and Positive law imprison life beyond the
willpower of human. Ignoring the existence of disbelievers may be
considered as the violation of minority rights. The right of the patient to
refuse treatment should be evaluated as a part of euthanasia. Just as
there are people refusing blood transfusion as a result of his/her religious
believes in cases where blood transfusion is compulsory; and just as there
are studies to include halal-forbidden definitions of medicines in their
leaflets. The person is the only owner of the right having the willpower to
choose whether to bear or not to bear the pain and suffering he/she will

Abstracts of Oral Presentations


experience to live longer. Not the politicians, healthcare personnel,
religious authorities, or their families.
When ethical committees accept the right of euthanasia, the euthanasia
tourism would be prevented.
This would eliminate patient hierarchy being applied in practice, whether
consciously or unconsciously, and the lack of attention due to personnel
and technical incapacities for the people who chose to live. The criteria
regarding brain death is changing in time. The fact that patients diagnosed
with brain death may be treated in the future because retrospective
studies cannot be done and also the legal problems in organ transfers
should be considered.
While the person has the right with his/her free will in any situation that
may be harmful for his/her body in the consents sought for the experiments
in health improvements, he/she does not have the right regarding his/her
own body in case of suffering, and he/she is forced by the laws to live; and
this makes it mandatory to rearrange the laws. Accepting the willpower of
person within basic rights would eliminate the legal gap.

MIGRATING MODERNITYS
Iain Chambers, University of Naples, Orientale, Italy
Speaker intends to talk of the refashioning of modern society, cultures
and identity in the light of the planetary migrations that have historically
constituted the hubris of the modern world. The principal scope of these
considerations is to render explicit the idea of migration as central to the
historical and cultural processes that continually renovate our being
positioned in planetary perspectives and possibilities. This, in turn,
transforms the question of migration from a marginalised socio-economic
problem into a profound critical challenge, leading to the adoption of
what we might consider to be the multiplicities of a migrating modernity
that is not only ours to define and manage.

NOTHING IS WHAT IT SEEMS PRENATAL DIAGNOSIS IN


POLAND
Weronika Chanska, Jagiellonian University Medical College, Italy
weronika.chanska@gmail.com
According to the Polish legal regulations prenatal diagnosis is offered to
women belonging to the established risk groups and provided on a basis
of general health insurance. However, the number of prenatal tests
carried out is much lower than in other European countries. Moreover,
despite of being included into state-funded health care procedures, the
access to prenatal tests is still highly restricted in some parts of Poland.
The small number of genetic centers and their uneven geographical
distribution are partly responsible for the situation. But there are other
social factors limiting the access to prenatal diagnosis. For instance, it is
still pretty common practice to base the decision whether a woman
should have prenatal examination on a private (usually religious based)
opinion held by her doctor.
Polish medical experts express conflicting opinions on prenatal diagnosis.
At one extreme are these demanding full access to all prenatal tests, at
another those who express strong reservation about them and point out
that women should be better informed about the risk of miscarriage in
result of prenatal examination. The most extreme proposals call for
complete withdrawal of prenatal tests.
The aim of the presentation is to analyze how prenatal diagnosis was
introduced and then put into practice in a specific cultural and socioeconomic context of Poland. The presentation will focus on explaining the
discrepancy between legal regulations concerning prenatal diagnosis and
the way it is practiced in Poland. The opinions of Polish women will be
quoted as well as the tactics they use to navigate complex health and
social care system. Finally, a comment will be made on how market forces
change the access and practice of prenatal diagnosis.

THE ANALYSIS OF THE PRODUCTIZATION OF ORGAN


TRANSPORTATION IN THE ANGLES OF ETHICS AND LAWS
Yunliang Chen, Central South University, China
aliang1992@yahoo.com.cn
The imbalance between supply and demand of organ transplantation in
China has seriously restricted the development of organ transplant

61

technology. If the organ transportation was accepted into product range,


it will surely help to expand the donor source, and also protect the quality
of organs transplanted. Because of advances in medical technology and
the changes of ethical believes, the organ transplantation is becoming
increasingly popular. We should replace the theory of Absolutely
Negate with the one of Certainly Limit, in order to establish a unitive
organ trading markets. Whats more, we also need to make
corresponding laws or regulations, so that to regulate the access and
trade of organs.

NEW CODE OF MEDICAL DEONTOLOGY IN ITALY


Roberta Chersevani, OMCeO Gorizia President; FNOMCeO Deontological
Committee, Italy
deontologia@fnomceo.it
The new code of medical ethics represents the hard work of very
motivated colleagues and experts, that have evaluated the latest code
published in 2006, maintaining the main, unchanged ethical principles,
and adding or updating statements according to the changes that are
happening in medicine.
The Code is not a state law, but a standard of conduct to guide the
behaviour of the physician, listing specific duties and obligations.
It must be coherent with evolving modernity of medicine, that comprises
the environment, social economical issues, inter professional relations,
end of life ethics, balance between therapy and futility, life-long learning,
quality and appropriateness, the important role of risk management and
continuous advancing technological issues.

WOMEN AND CHILDREN FIRST: AN ETHICAL CHALLENGE


FOR THE DEVELOPING WORLD
Frank A. Chervenak, Laurence McCullough, NYPH-Weill Cornell Medical
College, USA
fac2001@med.cornell.edu
Women and Children First is a familiar phrase and comes down to us
from the heroic sacrifice of their lives by British soldiers on HMS
Birkenhead in 1852. Women and Children First, the New York
Declaration of the International Academy of Perinatal Medicine, has
defined biases in the allocation of healthcare resources for women and
children in the developing world. In this presentation we identify
challenges to the just allocation of resources for fetal, neonatal, and
pregnant patients and provide ethically appropriate responses to these
challenges. We distinguish substantive justice from procedural justice and
identify biases against perinatal patients related to both substantive and
procedural justice. We then identify ethically justified responses to these
biases that perinatalogists should adopt in reforming organizational and
public policy by responsibly advocating for fetal, neonatal, and pregnant
patients, whose healthcare otherwise is at risk of unacceptable
compromise.

PLANNED HOME BIRTH: AN ETHICAL CHALLENGE FOR THE


DEVELOPED WORLD
Frank A. Chervenak, Laurence B. McCullough, Amos Grunebaum,
NYPH-Weill Cornell Medical College, USA
fac2001@med.cornell.edu
This presentation addresses the recrudescence of and new support for
planned home birth in the developed world. We emphasize that patient
safety and show that planned home birth has unnecessary, preventable,
irremediable increased risk of harm for pregnant, fetal, and neonatal
patients. We document that the persistently high rates of emergency
transport undermines patient safety and satisfaction, the raison detre of
planned home birth, and that a comprehensive analysis undermines
claims about the cost-effectiveness of planned home birth. We then argue
that obstetricians and other concerned physicians should understand,
identify, and correct the root causes of the recrudescence of planned
home birth; respond to expressions of interest in planned home birth by
women with evidence-based recommendations against it; refuse to
participate in planned home birth; but still provide excellent and
compassionate emergency obstetric care to women transported from
planned home birth. We explain why obstetricians should not participate

62

UNESCO Chair in Bioethics 9th World Conference

in or refer to randomized clinical trials of planned home vs. planned


hospital birth. We call on obstetricians, other concerned physicians,
midwives and other obstetric providers, and their professional
associations not to support planned home birth when there are safe and
compassionate hospital-based alternatives and to advocate for a safe
home-birth-like experience in the hospital.

CORD BLOOD BANKING PUBLIC OR PRIVATE?


Antonio Chintera, University of Naples, Italy
a.chiantera@aogoi.it
Altruistic donation vs personal use of umbilical cord blood: an ethical
dilemma.
Stem cells from umbilical cord blood are used for allogenic hematopoietic
transplantation in young and adult patients. Altruistic donation of
umbilical cord blood has been widely sponsored in several countries by
Scientific Societies and National Authorities. During the last decades more
than 500000 umbilical cord blood units have been donated for unrelated
use.
In some countries, however, private banks offer the opportunity of
storing umbilical cord blood for personal (family) use only.
The opportunity of altruistic vs personal use umbilical cord banking is
cause of controversial opinions from a clinical and ethical point of view.
Most of clinical experiences of hematopoietic transplantation have been
conducted using unrelated donors, but in the recent year the number of
transplantation using cells from related donors has been increasing with
favorable results. Further, the clinical relevance of related umbilical cord
blood banking for personal use may change, if umbilical cord blood will be
useful for tissue repair in degenerative diseases (such as diabetes and
Parkinson's disease).
From an ethical point of view, it has been suggested that there is little
social justification for private umbilical cord blood banking, as it provides
no benefit to the community and little benefit to parents, due to the low
likelihood of requiring umbilical cord blood later in life. However,
psychological reassurance and safeguard of the future should be
considered among the reasons for personal use banking.
Logistic aspects are also to be considered. In some areas public banks do
not offer logistic support, thus reducing the opportunity of choice for the
couple.
While the scientific knowledge improves, information to the parents is the
most important ethical aspect. Several studies have suggested that most
of couples have only limited information on umbilical cord blood storing.

FROM CONSENT TO CHOICE: THE ETHICAL IMPLICATIONS


OF EMPOWERMENT-CENTRED HEALTHCARE
Luca Chiapperino, PhD student, University of Milan, Italy
luca.chiapperino@ieo.eu
The ethics of public health is currently facing the challenge of reevaluating patient autonomy in the light of the political, social and
scientific constraints characterising our societies. Among these,
prevention, early detection, and the necessity to reduce healthcare costs
for national budgets, play an increasing role within medicine. This state of
affairs has led to the development of a whole range of strategies within
different contexts, which aim at reforming healthcare. Such initiatives put
a strong emphasis on individual responsibility for both the improvement
of services offered by the system, as well as the wellbeing of the
population. I label such strategies empowerment-centred reforms.
The aim of my work is to analyse controversies arising from this paradigmshift. In particular, I build upon a critique to empowerment (Juengst et al.
2012) claiming that this approach is a mixture of paternalism and
authority putting the individual in a weak position. Siding with this
conclusion, I argue that empowerment-centred healthcare is hardly
defensible without a critical evaluation of its normative implications. In
order to ground this claim, I analyse the ethical flaws attributed to
different forms of paternalism (Dworkin 2010), and map the
empowerment approach depicted by Juengst et al. onto this taxonomy.
By doing so, I specify what kind of requirements a morally defensible
notion of empowerment should meet, in order not to be a problematic
instance of paternalism. Finally, I conclude by sketching an axiology of
empowerment aiming at rendering this approach an ethically defensible
guidance for public health.

IMMIGRATION POLICIES FOR THE SCHOOLS


Luciano Chiappetta, MIUR (Italian Ministry of University and Research),
Italy
Italy has chosen full integration of migrants in the school and intercultural
education as a cross-cutting, as background supplement that is common
to all disciplines and all teachers. Intercultural education rejects the logic
of assimilation, both the establishment and strengthening of ethnic
communities closed. It needs to fostering and promote the diversity of
nationalities in the composition of classes, rather than forming classes
according to cultural or religious backgrounds. We could say that these
characteristics define a possible Italian integration, an original path even
in comparison with other European countries.

GLOBAL BIOETHICS: HISTORICAL AND PRESENT


PERSPECTIVES
B. Chiarelli, University of Florence, Italy
antropos@unifi.it
Adaptive success and evolution are determined by how we interact with
the natural environment and all other forms of life (bios). Yet in our
pursuit to dominate the natural world, Man has lost sight of this basic
premise, and continues to exploit natural resources, to contaminate, to
consume more than necessary, and to misuse his reproductive capacities.
For this reason Global Bioethics emerged in the 80s, a culmination of
mental resistance on the part of many observers, who sought to
readdress the balance between Man and Nature a balance which must
be reinstated if we are to survive. Corrective measures are required,
which should be free from the influence of purely religious or political
influence, since their ideologies are frequently founded on strategies of
power, with little regard for the general well-being of all living species.
Global Bioethics, as opposed to Bioethics, was formulated by myself, Van
Rensselaer Potter, Antonio Moroni, Laura Westra and others, to
transcend the restraints of science, uniting it with the humanities to
create a new expanded consciousness, an alliance between life and the
environment in which all factors: environmental, biological, physical,
psychological, social and economic, recognize that they are
interdependent.

ETHICAL PROBLEMS OF SUSCEPTIBILITY TESTING


M. Chiarelli, I. Aquila, S. Boca, D. De Bartolo, S. Gratteri, C. Pileggi, C. Ricci,
A. Serra, P. Ricci, University Magna Graecia of Catanzaro, Italy
debora.debartolo@yahoo.it
Introduction: The progress in human genome research are opening the
door to a new paradigm for medical practice promising to transform
healthcare. Personalized medicine (PM) was founded with the purpose of
highlight the link between molecular and clinical profiles of an individual.
Therefore, the susceptibility and risk of disease could be quantified and
planned when persons are still healthy. However, even though less than
500 genetic markers of disease have recently been identified and
validated, it is important to note that the activation of these changes is
conditioned by the expression of proteins, the physiological variability and
exogenous factors.
Objective: The objective of this study is to evaluate the current state of
personalized medicine on a genetic basis, with particular reference to the
ethical implications.
Materials and Methods: A review of the national and international
literature was done. The literature search was done using the PubMed
NCBI.
Results: Actually there are many pressing ethical problems in the field of
personalized medicine. Firstly, measures of adequately implementing
informed consent for biomarker studies is discussed as well as issues of
confidentiality, data protection and individuals right to know / do not
know. Secondly, the predictive tests results can influence individual
wellbeing negatively or cause the discrimination of persons with
predispositions to certain diseases. Finally, the measures of PM can lead
to significant cost increases and, therefore, involve an additional financial
burden for healthcare systems. Consequently the problems of equal
access to healthcare services could further exacerbate.
Conclusions: Researchers and practitioners who are involved in the
development of PM can give valuable information (ex art. 33 of the Italian

Abstracts of Oral Presentations


Code of Medical Ethics) about the current state of development of the PM
and in ethical discourse on PM. Until now, the concepts of
individualized or personalized medicine have been inadequately
transmitted by the media that are producing considerable confusion in
physicians and citizens.

THE RIGHT TO SELF-DETERMINATION OF TERMINALLY ILL


PATIENTS THROUGH THE INTERPRETATION OF
CONSTITUTIONAL PRINCIPLES
Lorenzo Chieffi, Centro Interuniversitario di Ricerca Bioetica di Napoli
(C.I.R.B.); Second University of Naples, Italy
lorenzo.chieffi@libero.it
The analysis which concerns end of life decisions, allows the individual
to dispose of his body freely. The through the "planning ahead" of its
existence, in the presence of a persistent vegetative state, does not
exclude the use of interpretive techniques apt to verify the effective aim
of constitutional provisions which often tend to attribute opposite
meanings (freedom versus dutifulness) upon this topic.
In opposition to those who declare their willingness in drawing from the
constitutional foundation about the theory on the unavailability or the
inability of human life, others seem to incline towards different directions.
They believe they may get the reasons for the recognition of a wide
autonomy and self-determination, leading to an effect of dangerous
radicalization of the positions, that in some European countries (starting
from Italy) has so far been prevented, so to achieve a balanced regulation
of the terminal stages.
Many are the reasons by which patients have freedom over their own
body in consideration of the fact that human dignity has its prevailing
value.
Taking into view the historical reasons that led the founding fathers (in
Italy, France, Germany) to consecrate the self-determination of the
person, reduced by the Nazi medicine as a guinea pigs, today other
considerations, related to the presence of life-sustaining technologies,
have to be added.
Especially in the field of fundamental rights, including the goods are to be
counted from the personalistic involved therapeutic relationship, this
progress of exegesis, in favor of an affirmation of the freedom of
treatment, are also the result of strong pressure up / bottom from the
transnational law (ECHR, Oviedo Convention, the Charter of Nice,
Declarations UNESCO), developed by supranational bodies, also of legal
origin. The development of a movement of legal models, the outcome of
such interpretative stimuli, is therefore able to determine the progressive
expansion of the exegetical aim of the fundamental principles and,
consequently, our living Constitution.

THE ASSESSMENT OF MEDICAL PROFESSIONALISM


AMONG NEW PARAMEDICAL STAFF UNDER
POST-GRADUATE TRAINING PROGRAM
1

Chiung-hsuan Chiu , Chung-jen Wei


1
Taipei Medical University, Taiwan
2
Fu Jen Catholic University, Taiwan
meg_chiu@tmu.edu.tw, ph1004@fju.edu.tw
Introduction: Post-graduate training program to paramedical staffs was
introduced in the year of 2006 in Taiwan, and became one of the few PGY
program to paramedical staff reimbursed by government in the world.
This PGY program is set to accredit the infrastructure and faculty
development in order to assure the teaching quality for the new
paramedical staff, and ultimately enhance staffs core competency and
medical professionalism within two-year curriculum. Therefore, this study
aims to appraise the medical professionalism of new paramedical staff
under the training program.
Method: This cross-sectional study utilizes self-report questionnaire to
125 new paramedical staffs under PGY training program from March to
May, 2012. Questionnaire is developed based on the code of conduct
defined by Professional Associations, and we also checked with its
validation and reliability. Five constructs include medical knowledge and
clinical skill, attitude to patients, teamwork, duty to public health, and
protection of patient rights. Likerts 9-point scale ranges from 1 (lest
valued) to 9 (most valued).

63

Result: The result shows the better performance of PGY2than one of


PGY1 in overall evaluation of medical professionalism. Constructs such as
attitude to patients, teamwork, and protection of patient rights are
the improved ones after one-year training. Also, respondents report drop
on dimension of duty of public health compared PGY2 nurses to PGY1
ones.
Conclusion: Competency is a key stone to guarantee good quality of
patient care. PGY program play an important role to help new
paramedical staffs successfully meet the requirement of Professional
Association and expectation of society. Anyhow, more focus should be
placed to enhance the awareness of duty of public health.

ISLAM AND PALLIATIVE CARE


Kartina A. Choong, Lancashire Law School, University of Central
Lancashire, UK
Kachoong@uclan.ac.uk
Palliative care is experiencing an upsurge in interest and importance. This
is driven, paradoxically, by modern medicines increased ability to provide
effective pain relief on the one hand and an acknowledgement of its
limitation in delivering cure for certain diseases on the other. With many
Muslims suffering from such incurable diseases worldwide, they too are
now faced with the decision of whether to avail themselves of pain relief
offered within the framework of scientific medicine. But while the general
ethos of palliative care which is to promote the well-being of those facing
life-threatening illnesses is consistent with Islamic values, this paper
explores whether the same can be submitted for modern methods of pain
control. The investigation will be steered by three overriding questions.
First, if pain could, as highlighted in the Quran, lead to the expiation of
sins and that forbearance would be rewarded in the hereafter, how far
can Muslims seek pain relief and who should make the decision of what
pain threshold must be reached before this can be pursued? Secondly, if
dying is deemed as a time for reflection and reaffirmation of faith, can
Muslims receive pain control medications that compromise
consciousness? Thirdly, if Islam enjoins patients to persist with the search
for cure since God has not sent a disease without sending a cure for it
(Sahih Al-Bukhari), does resorting to palliative care signify that one has
prematurely given up hope? Through an exploration of these questions,
the paper aims to investigate how these perceived tensions between
Islamic principles and the modern regime of palliative care can be
resolved.

THE EUROPEAN PARTNERSHIP


Barbara Ciampella, Accoglienza & Integrazione, Italy
barbara.ciampella@aei.coop
The YOSALT Project afforded Ealing Council the opportunity to partner
with Accoglienza e Integrazione (A&I a social cooperative based in
Milan) and Federazione Logopedisti Italiani (FLI Italys national
association for Speech and Language Therapists) to conduct the first study
of SLCN prevalence in Italy. This partnership promoted the high value of
mutual learning across borders in a neglected area of social research and
displays a successful example of transnational cooperation to improve
social outcomes. A&I works from many years in actions for social inclusion
and young offenders are one of the targets of its services.

PROPOSAL FOR THE REALIZATION OF AN EUROPEAN CIVIL


PROTECTION MODULE FOR THE FORENSIC PATHOLOGY
AND DISASTER VICTIM IDENTIFICATION
F. Ciciliano1,2, L. Moscatello1,2, P. Di Lorenzo1, M. Paternoster 1
1
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
2
Presidency of the Council of Ministers - Civil Protection Department Emergency Management Office, Italy
The Community Mechanism for civil protection was established by the
Council Decision of 23 October 2001 and its main role is to facilitate cooperation in civil protection assistance interventions in the event of major
emergencies which may require urgent response actions. This applies also

64

UNESCO Chair in Bioethics 9th World Conference

to situations where there may be an imminent threat of such major


emergencies.
Civil protection assistance often consists of highly specialised equipment
and teams for tasks such as search and rescue, medical emergency care,
water sanitation. The civil protection response thus makes a vital
contribution in the immediate post-disaster phase.
A number of such specialised emergency response units have been set up
under the Community mechanism for civil protection to respond more
quickly to emergencies.
At the moment, there are 17 models of modules; these operational units
are prepared by one or more countries. They can be used for
interventions both within and outside the EU. They have to be available at
short notice and be able to work independently.
Aim of this work is the proposal of a new type of civil protection module,
related to the forensic pathology and, in particular, to disaster victim
identification (DVI).
DVI-Team is a multidisciplinary team, working in the context of major
emergencies, that provides a rapid response in order to the personal
identification of people who have died during the catastrophes or
disasters or other events of civil protection. The team must be able to
take action as soon as possible to prevent the post-mortem cadaveric
transformations that inevitably arise after the death and that advance
gradually due to the passing of time.
The key issues are represented by timely interventions, also in relation to
local authorities and the technical possibility to work through
international standard levels, trying to reach the prospect to provide right
answers in a short time, the technical possibility to make the necessary
sampling on the bodies, the real and sure conservation of biological
samples and quick contacts to send them at authorized laboratories for
the genetic identification (DNA tests).
The aim of this work is carry out an accurate analysis of risks, process the
competence to react to local adverse events, manage the crisis according
to emergency plans and manage an operational forensic pathology plan
on the involved territory.
The realization of shared intervention protocols, included the
psychological support to staff and to victims relatives, will be useful to
facilitate the operational procedures with other institutions responsible
for rescue operations. This coordination plan allows to avoid the
hampering in relief operations and tending to the preservation of the
status of place, that represents a fundamental aspect for the intervention
of forensic pathologists.

BIOETHICAL ASPECTS IN THE HEALTH CARE OF REFUGEES


DURING THE 2011-2012 IMMIGRATION EMERGENCY IN
SOUTHERN MEDITERRANEAN
1,2

1,2

F. Ciciliano , L. Moscatello , A. Tuccillo , M. Paternoster


1
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
2
Presidency of the Italian Council of Ministers - Civil Protection
Department - Emergency Management Office, Italy
The analysis of the causes of migration confirms that the push factors in
the emigration countries (armed conflicts, dictatorships, human rights
violations, environmental degradation and natural disasters, economic
underdevelopment, population growth, unemployment, spreading of
Western lifestyle, etc.) and pull factors of the destination countries
(economic opportunity, study and training, manpower request, family
reunion for asylum seekers, etc.) facilitate more and more the
immigration phenomena in Europe, especially towards Italy, that
represents the best gateway for the populations coming from Northern
Africa.
The revolutionary wave of demonstrations and protests rising in some
Arab countries (Tunisia, Libya, Egypt, etc.) called Arab Spring has been
the main factor, in the years 2011 and 2012, of the exodus of people
coming in Italy from the African countries touching the Mediterranean sea
but also from the sub-Saharan countries (mainly Somalia, Nigeria, Niger,
Burkina Faso, Ghana, Cte dIvoire).
For the Italian law, the right to health is a universal and inalienable human
right that must be guaranteed to everyone: citizens, legal immigrants,
illegal immigrants. In Italy, urgent and non-delayable medical care,
protection of pregnancy and maternity, health care in behalf of underage,
international prophylaxis, vaccination, prophylaxis, diagnosis and

treatment of all infectious diseases are rights recognized to everyone, also


to illegal immigrants.
Almost all immigrants coming in Italy have a normal physical and mental
health, also due to their young average age. This phenomenon, called
"healthy migrant effect, is owing to self-selection of those who decide to
emigrate. A lot of risk factors can threatening the health status: housing
degradation, poor sanitation, lack of income, underemployment,
unprotected and unsafe working conditions, dangerous jobs, depression
and lack of family support, differences in eating habits and climate
conditions, psychological distress due to adjustment problems and
uprooting from their origins, discrimination in access to health services.
One of the most important needs is represented by the preservation of
the health of immigrants, firstly in order to eliminate the risk factors and,
subsequently, to give the best chance of care in case of illness.
The principle of informed consent and the bioethical principle of
autonomy are fundamental milestones in the Western legal systems,
included the Italian one: these rights are exercised by freely and
voluntarily consenting or refusing consent to recommended medical
procedures, based on a sufficient knowledge of the benefits, burdens, and
risks involved. The ability to give informed consent depends on adequate
disclosure of information, patient freedom of choice, patient
comprehension of information and patient capacity for decision-making.
By meeting these four requirements, three necessary conditions are
satisfied: that the individuals decision is voluntary, that this decision is
made with an appropriate understanding of the circumstances and that
the patients choice is deliberate insofar as the patient has carefully
considered all of the expected benefits, burdens, risks and reasonable
alternatives.
The use of health services, also induced by high-risk behaviours, is caused
not only on the basis of a simple individual choice but many other factors
deeply influence the migrants
Discriminatory experience, language difficulties, current differences in
interpreting concepts of health and disease, unawareness and
disinformation about the local health system and health care institutions
represent negative external factors that produce under-utilization or
inadequate use of health services by the migrants.
The purpose of this work is to illustrate the procedures developed by the
Italian Civil Protection Department for the health care and protection of
migrants coming from Northern Africa in the years 2011 and 2012.

HUMANITARIAN AID AND MEDICAL EMERGENCY


RESPONSE RELIEF IN INTERNATIONAL DISASTERS:
RECOVERY OF MEDICAL PATERNALISM VS. DIFFUSION OF
PATIENT AUTONOMY
1,2

1,2

F. Ciciliano , M. Paternoster , L. Moscatello , C. Buccelli


1
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
2
Presidency of the Italian Council of Ministers - Civil Protection
Department - Emergency Management Office, Italy
Healthcare personnel in humanitarian organizations is often committed to
ensuring healthcare and the distribution of medical aid within
international interventions in areas of the world affected by crises
because of wars, draught, famine, epidemics and cataclysms.
Healthcare interventions are generally organized according to a system of
fixed healthcare facilities and mobile healthcare clinics.
Healthcare actions are guided by international standards of care and the
fundamental ethical rules of behaviour, amongst which those mentioned
in the UNESCO Universal Declaration on Bioethics and Human Rights.
In particular it is provided that patients receive a standard of care similar
to that ensured in the country of origin of the medical staff and that any
preventive, diagnostic and therapeutic intervention be performed only
upon free and adequately informed consent by the person concerned.
Humanitarian missions nevertheless are a test bench for the procedure of
information and the obtaining of consent to the medical act, due to the
possible following reasons:
a) prejudice of local populations against medical technicalities (in favour
of alternative medicines);
b) cultural subordination to the figure of the doctor;
c) marked information gap between patients and doctors due to cultural
and language differences;
d) distrust of information forms;

Abstracts of Oral Presentations

65

e) too many patients to treat in a short time (little time to devote to


information);
f) local cultural, social and legal differences with respect to the
ownership of the patient of the right to consent.
g) Medical care to orphans and abandoned children of different ages
h) Gender-related difficulties.
International ethical documents dealing with such issues (amongst which,
for sake of completeness and constant updating, we may mention the one
developed by the Nuffield Council on Bioethics) propose a series of
measures, which may be difficult to apply or which lend themselves to
misunderstanding (e.g. that is the case of the genuine consent).
Totally convinced as we are that adequately informed consent (as far as
possible and perhaps with the help of cultural mediators) is an
indispensable act of medical profession, we reached the conclusion that
in certain conditions there is a dangerous resort to medical paternalism
due to the tacit ineffective consent of the needy patient who feels the
need to accept the medical care offered by the humanitarian contingent
(also independently of information) In other conditions it is the same
humanitarian contingent which virtuously introduces and underlines the
principle of the respect of human rights and dignity in contexts where
patients were still subordinate or subject to the choices of doctors.
From that point of view healthcare personnel engaged in humanitarian
missions are vehicles for the dissemination of bioethical culture in
developing or otherwise vulnerable populations, and are agents of a
beneficial globalization of the principle of autonomy.

products such as benzene through inhalation is one of the systems most


commonly affected. Signs and systems include headaches, dizziness,
dyspnoea, reduced haematological indices such as haemoglobin
concentration, and reduced lung function parameters. Although
benzenes presence in various aspects of our daily life activities in the
home, work place, on the road and the general environment puts the
general population at risk of its hazards, those by virtue of their
profession at more regular exposure to it are at more risk to benzene
toxicity. This makes it very important for a regular periodic assessment of
the level of exposure to benzene and its metabolites in these workers
imperative. As best as the authors know such assessment has yet to be
carried out in the Kaduna refinery since its nearly two decades existence.
This present study aims to look into the harmful effects on respiratory
functions, and to evaluate the adequacy/inadequacy of safety measures
such as protective clothing at the refinery and petroleum pump workers
in relation to current bioethical standards/guidelines in Nigeria. A
questionnaire would be administered to appropriately selected samples
of both refinery and petroleum pump workers to collect relevant
information on exposure. Lung functions will be assessed by vitalograph
and the peak flow meter. Inferences from analysis of data collected would
be used to advice the relevant authorities for appropriate legislature and
policies for appropriate precautionary steps for a safer working
environment for the instant workers.
Acknowledgements: Kaduna State University, Kaduna, Nigeria, for
funding.

THE DONATION OF A PERSON'S BODY AFTER DEATH:


A QUESTION OF ETHICS AND SCIENCE

PRESENTATION THE YOSALT PROJECT

Rosagemma Ciliberti, Susanna Penco, Linda Alfano,


1
Alessandro Bonsignore , Francesco De Stefano
1
University of Genova, Italy
alessandro.bonsignore@unige.it
There is widespread agreement in the international scientific literature
that practice on a human cadaver and anatomical examination are both
essential for the development of surgical skills and biomedical research.
Human biomaterial in fact is an important resource in studying illnesses,
developing new therapeutic approaches as well as offering alternatives to
animal experimentation.
In Italy, unlike other European countries (Austria, Belgium, France,
Germany, the Netherlands, Spain, etc.), the possibility of using bodies
post mortem for study and research is hindered considerably by a scarcity
of donations.
Undoubtedly, the thought of one's body being dissected raises various
forms of psychological resistance: the body of the deceased becomes an
object (Krper), but will nevertheless be the body of a person (Leib), one
of whose options is to donate the body after death.
Current legislation in Italy (based on a Royal Decree going back to 1933)
does not address the issues raised by the donation of a body, which
include for instance: how the donor gives his/her consent; the binding
nature of the donor's wishes; the prevalence, if any, of a private law
concept of donorship rather than a public law one; the importance and
role of the wishes of the relatives and loved ones of the donor; the
standards of efficiency to be guaranteed by donee organisations
regarding the handling of bodies, their recomposition and return to family
members; the identification of appropriate regional research centres, etc.
The authors wish to draw attention to a proposed protocol for the
donation of a person's body after death, the use of the body, and the
steps required to ensure the utmost respect of bereavement.

BIOETHICAL IMPLICATIONS OF THE EFFECT OF BENZENE


EXPOSURE IN RESPIRATORY FUNCTIONS OF KADUNA
REFINERY PLANT WORKERS AND PETROLEUM PUMP
WORKERS IN KADUNA STATE, NIGERIA
F.L. Ciroma, M.S. Yusuf, A.H. Dikko, Y.Y. Dangata, Kaduna State University,
Nigeria
fatimaumaralkali@ymail.com, yohanest@dangata.freeserve.co.uk
Benzene, a main component of petroleum, is a well-documented
environmental toxin. It poses a variety of health problems to almost every
system of the body. Those on a regular and long term exposure are more
at risk. The respiratory system, for being in direct contact with petroleum

Raffaella Citro, Federazione Logopedisti Italiani, Italy


r.citro@tiscali.it
The Youth Offending and Speech and Language Therapy project was a
research project funded by the European Commission under its
Programme for Employment and Social Solidarity PROGRESS (20072013).Through the YOSALT project, Ealing Council carried out the first
known comparative study to investigate whether speech and language
therapy can have a positive impact on the lives of young people who have
offended. It was sought firstly, to add to the evidence base of the
prevalence of Speech Language Communication Needs amongst young
people who have offended; secondly, to measure the benefit of speech
and language therapy to these young people; and thirdly, to develop a
model and tools for other jurisdictions and organisations across the UK
and Europe to use and learn from.

COLLECTIVE CONSEQUENCES OF A VERY LONG LIFE:


THE RIGHT TO LIFE EXTENSION COULD / SHOULD BE
CONSIDERED A HUMAN RIGHT
Didier Coeurnelle, Healthy Life Extension Society, France
didier.coeurnelle@gmail.com
A longer and healthier life is enjoyed by the citizens who can benefit from
it.
This evolution is also positive for the whole society. It is better for the
economy, for a sustainable environment, for a peaceful society, for the
level of well-being in the society.
This speech gives a description of positive political, economic and
sociological aspects of a world with a largely delayed senescence.
The following aspects concerning life extension will be approached
accompanied with statistical information:
Economic consequences: lower health costs and questions related to
pensions.
Environmental consequences: the question of overpopulation and the
pattern of consumption of people advancing in age.
Harmonious society: ethical questions, lower rate of crime, higher rate
of happiness and a higher level of resilience.
The question of the moral necessity of health research funding will be
discussed. Should the State subsidize life extension? Taking in
consideration, medical progresses and the possibilities to accelerate
them, we can consider the right to health as defined in national laws,
national constitutions and international treaties under a new light. We
could consider scientific research for a longer life as a moral obligation or
a duty to rescue.

66

UNESCO Chair in Bioethics 9th World Conference

IS THERE AN ETHICAL DIMENSION TO CONTEMPORARY


HEALTH CARE REFORM IN THE UNITED STATES OF
AMERICA?
1

John P Conomy , Jill Mushkat , Massimiliano Nigro


1
Health Systems Design Corporation and Case Western Reserve
University, USA
2
Cleveland Clinic Foundation, USA
3
Italy
2br02b@msn.com
The answer to this tautology is resoundingly yes. That affirmation
requires a clear infusion of ethics and human rights into the formation of
current planning and operational implementation in the revolution within
American health care epitomized by Obama Care, now the law of the
land. Health care is an individual matter, yet for the individual as well as
the nation, freedom, democracy, the stability of government and its
institutions, national security and prosperity rest upon the physical and
mental health of people. To date, health care reform in the USA has
focused upon costs and access to health services. Currently the USA
spends more of its GDP on health than the aggregate GDP of most
countries on earth (nearly 18% of GDP, or about $3 trillion USD).
Conomy et al, Health Care Unesco
Health care outcomes are not commensurate. About 15% of people in the
USA lack effective access to health care. These inequalities and current
legislated solutions have led to public unrest calling into question the
tense, dynamic relationship between people, their government and their
health. This ethics-laden triangulation is not well explored within the USA.
Analysis of this ethical tension and derivative solutions consists of
national and individual balancing of the roles of paternalism and
individuality; between utilitarianism and private, human rights; and for
the USA, creating a workable, ethical balance among competing systems
of health resource distribution, namely capitalism and socialism. The USA
has the resources to do this: they consist of governmental and quasigovernmental entities; the examples of other nations; and the
commitment of the countrys eleeomosynary, educational and research
institutions. The remaining question for the USA and the world, given the
global, historic role of the USA in health, is whether or not the USA can
build the political will to carry what has begun with Obama Care to a
successful, stable, just and nationally acceptable solution.

END OF LIFE CARE AND RISK OF OVERTREATMENTS:


AN INTRODUCTION
Franco Contaldo, Federico II University Medical School, Italy
Nowadays End of Life Treatments (ELTs) can sustain life despite severe
and multiple organ dysfunction. ELTs may require advanced technologies
which may be expensive or low cost, complex or easy to manage, even at
home of the patient. Because of the nature of ELTs difficult decisions
often need to be made by the clinician about their usefulness not only in
terms of survival but also in terms of quality of life; not the least, a
rational use of financial resources should harmonize with humanitarian
principles to guarantee dignity of life at its end. Finally because at the end
of life many patients lose their psychological autonomy, becoming totally
or partially unconscious, the family / care givers are directly involved in
ELT decision process. Cultural, regional, social, national health economic
policies, family and previous individual disposal on ELT may influence and
contribute to the final decision.
Good communication between the physician and the family appears
essential and should clearly emphasize prognosis and quality of life. In
case, actually the most frequent circumstance, patient s are followed by
an interdisciplinary team all staff members need to be involved in the
final medical proposal to be discussed with family and/or care givers.
Although the largest number of medical and scientific societies, including
national and international artificial nutrition societies, state that they is
no ethical nor medical decision difference between withholding or
withdrawing life sustaining treatments, some controversy in particular
due to religious determinants may be expected. However there is
common agreement that in case of withdrawing life sustaining treatments
all procedures to limit any possible discomfort should be utilized.
In conclusion ELTs require a continuous effort to reach a global consensus,
at least as far as reasonable medical protocols to be properly discussed
with the patient (if possible), family and care givers. Collaboration of the
interdisciplinary care team, eventually well trained to communicate with

the patient and his/her family, appears a substantial aspect to prevent


overtreatments and guarantee patients dignity at the end of life.

CLINICAL ETHICS COMMITTEES IN SPAIN


Josep Corbella i Duch, Hospital de la Santa Creu i Sant Pau, Spain
jcorbella@santpau.cat
Ethics committees within the Spanish Healthcare System have different
functions within their different settings. Since the early 1990s all centres
that conduct clinical trials with drugs must have a clinical research ethics
committee (CREC). Their role is mainly to approve and oversee clinical
drug trials, aiming to protect participants rights, safety and well-being in
accordance with the Declaration of Helsinki. All CRECs are independent
committees made up of researchers and research promoters. They must
include physicians, pharmacists, clinical pharmacologists and nurses, as
well as non-healthcare professionals, one of whom is always a medical
lawyer. Since 2007, biobanks and centres that carry out biomedical
research of any kind must have a research ethics committee (REC) and
again they must be multidisciplinary and independent. RECS are governed
by legal regulations to safeguard individuals rights. At a voluntary level,
centres may set up Healthcare Ethics Committees (HEC). HECs have an
advisory, consultant role and promote bioethical training. Their structure
is not uniform in Spain. At a national level there is the Spanish Bioethics
Committee, which also has an advisory role. The co-existence of CRECS
and RECs is confusing. There is a need to clarify their legislation and
determine their function.

EXTRAORDINARY LIFE-SAVING MEASURES IN ICU


Antonio Corcione, University Federico II, Italy
corcio.ant@libero.it
Initiatives to improve end-of-life care in intensive care units face several
important barriers. These include inflated expectations for critical care
therapies, which are shared by many clinicians and many patients and
families; preoccupation with an unattainable level of prognostic certainty,
delaying attention to palliative needs; and fragmentation of the
healthcare team into separate silos of disciplines and specialties. Its
often really difficult to go through these barriers with relevant empirical
evidence. Specific strategies to improve intensive care unit palliative care,
including consultation by palliative care specialists, and palliative care
quality measurement are needed to be discussed.

THE INTERNATIONAL CODE OF ETHICS FOR


OCCUPATIONAL HEALTH PROFESSIONALS: A GUIDE FOR
THE PHYSICIANS WHO WORK FOR ITALIAN WORKERS
COMPENSATION AUTHORITY
Carla Corsi, Maurizio Carnassale, INAIL, Italy
c.corsi@inail.it; ma.carnassale@inail.it
The aim of occupational medicine is to protect workers health and to
promote the adaptation of work to the capabilities of workers taking into
account their state of health. The expression occupational health
professionals includes all those who provide occupational health services
within the framework of a multidisciplinary team approach. Doctors,
employers, social partners and workers have to deal with objectives
which may be competing such as the protection of employment and the
protection of health. At the same time all the occupational health
professionals have to find strategies for recovery and reintegration into
the working environment for workers after an injuries at work or in case
of occupational and work-related diseases. INAIL: Italian workers
compensation authority is now not just compensation but a global
protection system for all workers. Recent innovative provisions of law
ranging from prevention, medical treatment, rehabilitation and
reintegration in the social and working life put INAILs physicians in a key
role in the management of occupational health practice. The principles of
ethics and the values on which is based the International Code of Ethics
for Occupational Health Professional are the same for INAILs physician in
their daily work. Our aim at INAIL is to improve the health and the social
well-being of workers individually and collectively with integrity in
professional conduct, with impartiality, with respect for the protection of

Abstracts of Oral Presentations


confidentiality of health data. We have to face with accident at work and
professional diseases carrying out our tasks according to good practice
and professional ethics. In this article the authors want to analyze the
duties and obligations of INAILs physicians in the execution of their
functions in accordance with the rules laid down by the Code of Ethics.

TECHNICAL DEVICES AND INTERVENTIONS TO SUPPORT


THE LIFE OF THE RELATIONSHIP: THE BIO-PSYCHO-SOCIAL
APPROACH TO THE PERSON WITH DISABILITIES TO WORK
Giovanni Cortese, Superintendence General Medical Sector Curative
Health Benefits, and Rehabilitation and Prosthetic INAIL, Italy
g.cortese@inail.it
According to the ISO 9999/2011 standard, an assistive product refers to
any device, tool, equipment, or technical system used by a disable person,
that is specifically produced or generally available in the business
markets, to prevent, compensate, alleviate or neutralize an impairment,
disability or handicap.
The ICF (International Classification of Functioning, Disability and Health)
of WHO, describes the functioning and disability, as products of the
interaction between the person with the environment.
From ICF emerges the importance of the environmental factors that
highlight the negative side of the functioning that is translated as a
disability.
Assistive devices that are environmental tools play a decisive role in
improving the performance of the person in the interaction with their
surroundings. This is a crucial feature, which impact the quality of life.
Taking care of the injured worker according to the bio-psycho-social
model also includes measures to support reintegration into social life,
labor, sports and family, with the purpose to ensure the comprehensive
and integrated system of protection that the Institute intends to
guarantee to its own coverage.
The rehabilitation interventions to life are:
Support interventions to the person
Autonomy support interventions
Interventions for the integration and re-socialization
Measure to facilitate the return to work
Interventions for the promotion of sport.
The bio-psychosocial approach has been designed to give the person with
disabilities the ability to regain self-determination and a role in the family,
society and work.

THE ROLE OF THE FAMILY IN END-OF-LIFE CHOICES


Silvana Cortese, Italy
silvanacortese@yahoo.it
Contemporary times and end-of-life choices: The first part of the
relationship concerns the urgency and the present-day importance of
end-of-life choices.
Cases of individuals staying alive while affected by particularly severe
pathologies or even in a condition of suspended death
The second part introduces peculiar cases, trying to explain how Italian
Law manages such situations.
The key role of Family Law: This part analyzes the Italian Family Law,
emphasizing specific situations, as <common-law couple> or illegitimate
children.
The Englaro case and the reconstruction of the patients will. In Italy
very important and captivating was the so-called Englaro case: it
concerns a young woman, who, after a persistent 17 years vegetative
state, died after the interruption of the artificial feeding. Her father,
Beppino Englaro, as legal guardian, was able to organize a peoples
protest in order to have public acceptance of the patients will.
An overview of the situation at international level.
At the end you can find a general overview, concerning international
legislations.

67

THE ETHICS OF PREIMPLANTATIONAL DIAGNOSIS IN


SAVIOR EMBRYOS
Caue Cosme Dutra da Silva, Homero Januario Caramico, Rodrigo Fock,
Iuri Cosme Dutra da Silva, Clber Pinto Camacho
Student, Universidade Nove de Julho (UNINOVE), Brazil
Student, Centro Universitrio So Camilo, Brazil
Universidade Federal de Medicina (UNIFESP), Brazil
caue-dutra@hotmail.com
The genetic preimplantational diagnosis is a screening of gens, prior to
implantation in the womb, consisting in the analysis of one or two cells
from the embryo to research possible diseases. This technique, of recent
clinical use, allows the diagnosis of more than a hundred genetic diseases
and represents a major breakthrough for medicine.
The technique of preimplantational diagnosis is indicated, especially for
patients who are at high risk of transmitting genetic or chromosomal
abnormalities to their children and has the goal of prevention of transfer
embryos with genetic alterations to the womb.
While revolutionizing, the use of this technique brings some concerns: it is
possible to select embryos genetically healthy, but this procedure also
allows the realization of many other choices, like physical characteristics
or sex of the baby, which are banned in Brazil, by specific legislation of the
country, which only allows the detection of genetic diseases.
Besides the problem of sexing, another relevant issue is the so-called
"savior embryos", ie. the birth of children with the aim to realize a future
bone marrow transplant or a donation of umbilical cord blood in an
attempt to cure a brother that has a disease. Such cases increase every
day and should be treated carefully, because it can generate a lot of
psychological problems in the child, who may feel "used", by believing he
or she was created just to save the sibling.
There are not only legal, but also ethical and moral limits concerning this
technique. The choice of gender and certain physical characteristics such
as eye color or hair, and the birth of children considered "saviors
embryos" can generate discrimination even before it is born.
Thus, this work has the scope of analyzing the ethical, moral and legal
limits involving genetic testing of preimplantational diagnosis.

THE PRESENT AND THE FUTURE OF MOLECULAR


DIAGNOSTIC TESTS: THERE ARE ETHICAL CONCERNS?
Caue Cosme Dutra da Silva, Homero Januario Caramico, Rodrigo Fock,
Iuri Cosme Dutra da Silva, Clber Pinto Camacho
Student, Universidade Nove de Julho (UNINOVE), Brazil
Student, Centro Universitrio So Camilo, Brazil
Universidade Federal de Medicina (UNIFESP), Brazil
caue-dutra@hotmail.com
A Medicine where all human diseases genetic background can be studied
in a practical and fast way, choosing the best type of treatment and
effectively changing the natural course of a person's life, is no longer just
science fiction, as it was in a few years ago. Through new sequencing
technologies, the world is coming to a new era, more than any other time.
More than ever, there are concerns within moral and ethical aspects and
the need of predictions or guidelines.
Today is possible to genetic test for multiple congenital
anomalies, permitting detection of gains or losses of genomic segments
and a variety of techniques can be used to survey the entire genome for
copy number changes.
With the discovery of new technologies and, consequently, its increasing
in accessibility, the possibility to "scan" the genome of a human being
through the use of techniques such as "whole genome sequencing", also
called "next generation sequencing", and the use of DNA or RNA as
biomarkers, allows the achievement of the procedures in a much faster
and more effective way than ever, leading to a time where the potential
to revolutionize the understanding of human health and disease
physiology.
The precision of diagnostic testing is likely to continue to increase and the
cost to decrease Molecular genetic and genomic testing to guide
treatment of common conditions will increasingly be incorporated into
day-to-day medical practice
There is, however, the fear, when science develops much more than the
legislation. Once again, as in every great discovery, we face a "crossroad",
in which a minor misconduct can lead to a cold and inhuman society.
Important is the concern and attempts to forecast this subject, which, in a

68

UNESCO Chair in Bioethics 9th World Conference

short period of time, could cause tests without appropriate selection


criteria, just for the satisfaction of human curiosity, generating more harm
than good, due afflictions, encumbrance of the health system and
stigmatization. In the long run, we might even come across a "genocrat"
world in which our genes plays the major role in discriminating and
setting the future of our lives, much more than ourselves and our
meritocracy affect our lives, marriages, jobs and humanity.

WHISTLEBLOW WHILE YOU WORK:


IS IT ETHICALLY ACCEPTABLE FOR DOCTORS TO USE THE
MEDIA AS A MEANS FOR 'BLOWING THE WHISTLE'?
Chantal Cox-George, (student), University of Bristol, UK
cc0172@my.bristol.ac.uk
Professional guidance demands that doctors raise any concerns that they
have for patients in their care. Whilst this is the case, recent revelations
about inadequate standards of care in publicly funded hospitals and other
healthcare services raise questions about the existence of adequate
communication systems in the United Kingdoms National Health Service.
Currently, raising concerns outside of the organisation is not preferable
but can be legal under the Public Interest Disclosure Act. However, some
high profile cases show that when healthcare professionals have chosen
to raise concerns or blow the whistle particularly externally they
have encountered significant repercussions.
I propose that doctors have a pro tanto moral duty (in addition to their
existing professional duty) to blow the whistle when they believe that
patient care or safety is being compromised. I argue that it is possible to
provide ethical justification for doctors who, having failed to initiate a
response by raising concerns within the organisation, choose to utilise
external sources such as the media. I argue that whistleblowing so
publicly promotes the interests of not only patients but the NHS too, and
so the doctor does not violate his duty of loyalty to either party by doing
so. By comparing whistleblowing using television programmes to national
newspapers, I accept that certain sources actually require doctors to
violate the overarching moral duty to do no harm. I conclude that
doctors act more reasonably and in a more ethically justifiable manner if
they raise concerns to sources such as national newspapers that do not
require morally controversial behaviour (e.g. undercover filming) in order
to achieve their purpose.

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG):


COMMUNICATIONAL, CULTURAL AND ETHICS ASPECTS
Francesco Cupella, Italy
francesco.cupella@fsm.it
The PEG (Percutaneous Endoscopic Gastrostomy) is an alimentary probe
crossing the abdominal wall until the stomach and allows the nutrition in
absence of swallowing function or like supplement to the normal feeding.
Currently, the diffusion and extension of its execution in many
degenerative diseases involves some ethical issues. There is an absence of
certain evidence of procedure benefit especially in dementia,
amyotrophic lateral sclerosis, stroke dysphagia, permanent vegetative
state and terminal illness. Decision making should have a multidisciplinary
approach including care givers and including many ethical and legal
aspects.

PROFESSIONAL INTERPERSONAL RELATIONSHIPS


INVOLVING PHYSICIANS CROATIAN PERSPECTIVE
Marko urkovi1, Ana Boroveki2
1
University Psychiatric Hospital Vrape, Croatia
2
University of Zagreb School of Medicine, Croatia
markocurak@gmail.com
Physicians professional interpersonal relationships single out as a special
category of medical professionalism, namely medical ethics, and
represent a crucial element of physicians everyday practice having a
profound impact on all health care processes and the outcomes of those
processes. While physicians usually adhere to universal values of globally
defined norms of professionalism, they still can betray their
implementation in everyday practice. These lapses in professionalism can

have severe consequences, and according to scientific literature, they can


be forestalled across the continuum of becoming and being physician,
either by education or interventions. While this issue is perceived as
important in Croatian public and academic community, it is still
insufficiently explored. We will present our preliminary results that were
collected throughout two pilot studies, one from the eyes of the public
and one from physicians perspective, regarding professional
interpersonal relationships among physicians in Republic of Croatia. We
are also going to show the actual structure of medical education referring
to medical professionalism in our country and, by advising the latest
scientific literature, suggest possible new implementations.

HOSPITAL ETHICS COMMITTEES IN POLAND


FIRST ATTEMPTS
Marek Czarkowski1,2, Katarzyna Dwiarek1, Katarzyna Kaczmarczyk1
1
Warsaw Medical University, Poland
2
Center of Bioethics of the Supreme Medical Council, Poland
mczark@gmail.com
According to UNESCO guidelines, one of the four forms of the bioethics
committees in medicine are the Hospital Ethics Committees (HECs). The
concept of appointing HECs was frequently supported by the Polish
Chamber of Physicians & Dentists, the Polish Bioethics Society, as well as
the Polish Conference of the Chiefs of Medical Associations. In November
2008 a law was passed in regards to accreditation in public health. Under
this law, a statute of the Center of Monitoring Quality in Health System
(CMJ) was enacted. CMJ is accepted under WHO Collaborating Centre for
Development of Quality and Safety in Health Systems. In 2009, CMJ
published a set of Standards for Accreditation for Hospitals, in which it
was recommended, that every hospital: select a group of trusted
individuals to which, like an Ethics committee, employees as well as
patients might refer to, with ethical dilemmas. The purpose of this
project is to evaluate how the above guidelines are implemented in real
practice.
Among all hospitals which obtained CMJ accreditation (n=110), 38
account for the presence of HECs. The implementation of HECs was
evaluated with a survey sent to the hospitals. It was determined that
there is a wide range of names for HECs in Poland. On average, there are
6 members of HECs, of which 50% are doctors (individual HECs are
comprised of doctors only). The composition of HECs in other professions
is diverse and non-standardized (lawyers, nurses, physiotherapists,
economists, social lawyers, pharmacists, psychologists, medical
statisticians, patient representatives, clergy). Only about 25% of HECs
have rules, which in the absence of European Union or national legislation
is a threat for transparency and accountability of HECs. HECs tasks are
formulated in different ways, and also deviate from the accepted three
main objectives of HECs. HECs seldom give advice, and usually not more
than once a year. In conclusion: few Polish hospitals possess HECs, and
the composition, operation and workload are not always appropriate. To
ensure a reliable operation of HECs requires the development of relevant
legislation, standard operating procedures and well trained members.

THERAPEUTIC OBSTINACY: NOTES FOR AN ANALYSIS OF


END-OF-LIFE BIOETHICAL ISSUES
Emilia DAntuono, University of Naples Federico II, Italy
Therapeutic obstinacy is currently a crucial topic in ethical, bioethical,
legal and, also, specifically philosophical research. Philosophy and the
medical sciences are inextricably interconnected. Since their beginnings in
Classical Greece, philosophical reasoning and medical knowledge are
linked to each other by a genealogical nexus, relevant to their capacity to
produce values and rules of behavior which constitute a therapeutic
praxis in which knowledge and ethics intertwine.
My paper aims at highlighting, in a properly ethical-philosophical
perspective, some end-of-life issues by investigating particularly the
bioethical implications of the transition from the commitment to
preserving life, which has always been binding in medical deontology, to
therapeutic obstinacy.
By the term therapeutic obstinacy, which was adopted in medical
terminology in the second half of the twentieth century, is meant the use
of various therapies and technological means aimed at merely preserving
the survival of a human being in critical conditions and without any hope

Abstracts of Oral Presentations


of improvement. However, the identification of therapeutic obstinacy is
all but unambiguous. There is indeed an urgent need for a fundamentally
shared definition of the opportunities, limitations and legitimacy of
medical interventions in light of the current availability of medical and
pharmaceutical technologies.
My paper aims at analyzing the following issues:
The contentious aspects of such controversial practices as artificial
nutrition and hydration;
The overcoming of the absolute and meta-historical dimension of the
medical ethos, which should take into account the patients
subjectivity and capacity of self-determination in concrete existential
situations.

THE TRUTH AND MEANING OF THE HUMAN EMBRYOS


LIFE: FROM ANCIENT GREECE TO THE CONTEMPORARY
BIOETHICAL DEBATE
Emilia DAntuono, University of Naples Federico II, Italy
emilia.dantuono@unina.it
Science describes the stages of embryogenesis and delineates the
embryos biological identity. This paper draws on scientific conclusions in
dealing with the representation of the human embryo in history and with
the interpretation of its reality and meaning in relation to some critical
aspects of western culture. The question of prenatal human life is long
lasting. There are different answers to this question, depending on
particular eras and on the motivations that have inspired the researches
of philosophers, scientists, jurists and, recently, bioethicists. A wider
historical-philosophical perspective can, perhaps, help us to appreciate
that new and old are interdependent, with continuity as well as
discontinuity, and that not only the present era has faced crucial
questions, whose solution involves ethics, law and politics too.
The paper focuses on the following points:
1. The question of knowledge that triggered research on prenatal life in
the pagan world.
2. The great turn following the advent of Christianity and the
predominance of the quest for salvation as the main motivation for
the search for knowledge.
3. The modern era: the twofold nature of the quest for knowledge and
meaning. The momentous turn produced by the Scientific Revolution.
4. The twentieth and twenty-first century: A: the significance of the
Italian as well as international debate on the voluntary termination of
pregnancy in the 1970s; B: the historical emergence of bioethics and
the changes in the view of the embryo, following the relocation of the
issue of prenatal life into the wider context of the defense of life; C:
the current renewed attention to the embryo as a form of
otherness. The wide agreement on its value and on specific forms of
protection.

BIOETHICAL IMPLICATIONS OF GLOBALISATION AND


SOCIETIES IN TRANSITION
Russell DSouza, Chair, Asia Pacific Bioethics Network of the UNESCO Chair
Haifa; Centre for Asian Bioethics Initiatives and Studies, Australia; SRM
University, India
Russell.f.dsouza@gmail.com
As Political Economic and Social changes sweep across the globe the term
globalisation acquires a meaning much beyond geopolitics and economics
to include the globalisation of culture unleashing powerful forces of
sociocultural transition
Transition is taking place in Asia, Latin America and Europe with influence
in some form in most regions of the world and humanity; Transition and
Transformation are occurring at a rapid pace with its problems Thus
Globalization acquires a meaning beyond economics and trade to include
culture. New culture of change in the established encompassing values
traditions, norms etc. with these new ethical challenges in many areas
and importantly Bioethics arises
Globalisation presents formidable challenges with respect to the
promotion of health and future health prospects increasingly depend on
it. Globalisation however presents also a dark side new poverty, new
instabilities, new uncertainties and new risks. Governments are having
less control over flows of information technology, disease, mobility of
people arms and financial transactions whether licit or illicit.

69

Frequently the ethical and social implications of aspects of globalisation


are recognised only after the fact, thus leading to fragmented and hastily
implemented strategies to remedy or modify unforeseen consequences of
the globalisation process
rd
In 2005 the 33 session of the general conference of UNESCO adopted
the Universal Declaration on Bioethics and Human Rights. This declaration
outlines the principals that respond to ethical issues related to medicine,
life sciences and associated technologies as applied to human beings The
declaration established international standards for bioethics that are
grounded in a language of rights and at its core a pledge to safeguard
human dignity and human rights in the context of bioethics.
This paper will review the bioethical implication of Globalisation as it
applies globally and to societies that are in transition resulting from
globalisation. Financial driven globalisation of sponsored clinical trials for
new treatments, First world health care at third world pricesGlobalisation, Bioethics and medical tourism and the global market of
health services its ethical implications of these globalisation
consequences to the host societies. Finally this paper will make
recommendations to address the bioethical implications and will suggest
that resources be used to anticipate the major reasons for bioethical
concern surrounding globalisation and to forecast future scenarios and to
formulate appropriate new policy options in this field.

THERAPEUTIC OBSTINACY: THE NURSING ROLE BETWEEN


AUTONOMY AND RESPONSIBILITY
Christian DallOlmo, Ospedale San Bortolo, Italy
doc74it@hotmail.com
The therapeutic choices daily evaluated, selected and interpretated by
the doctors in the clinical practice turn up to be generally appropriate and
proportionate, thanks to the doctor's experience and according to the
best scientific evidences. In some extremely rare situations this decision
can appear exaggerated, or even futile, sometimes not concordant with
the patient's will and conception of the quality of life. This is the case of
therapeutic obstinacy.
The nurse has the ethical, professional and legal duty to execute what is
prescribed, in vest of guarantor of the correct application of the
therapeutic prescriptions. However, if the therapy results not
proportionate, useless and not in agreement with the patient's will, the
situation can cause to the nurse a circumstance of strong conflict, both
personal and professional. This conflict should be resolved through the
use of dialogue between nurse and doctor, due to avoid irreparable and
dangerous divergences that might even lead the nurse not to accomplish
what is prescribed, creating unacceptable situations of care management
impasse.
Always considering values of autonomy, responsibility and collaboration,
the nurse, on one hand, has to find a way to equilibrate correctly the duty
derived by his profession itself that clearly describes limits and contexts in
which he can act; on the other hand he has to face the ethic obligation to
avoid meaningless pain to the patient and to respect his declared choices.

INTEGRATION OF MEDICAL LAW AND ETHICS INTO


MEDICAL TRAINING AND PRACTICE: LESSONS FROM THE
NIGERIAN STORY
Yohanna Yanshiyi Dangata, Head, Nigerian Unit UNESCO Chair in
Bioethics; Kaduna State University Medical School, Nigeria
yohanest@dangata.freeserve.co.uk
Although the medical profession has been self-regulatory for time
immemorial, it has been characterised by malpractice for almost as long
its existence. This is not surprising for there has been no deliberate
integration of defined medical law syllabus into medical training until
th
about the second half of the 20 century, when medical law evolved in
response to outcry to inhumane practices in the profession. Henceforth,
has been the deliberate integration of medical law and ethics into medical
education in most developed countries. While this targeted oncoming
generations of doctors, the deficiency of knowledge of the subject
remained in pre-medical law trained medical personnel. Integration of the
subject into medical training to enable oncoming generations of doctors
to be adequately equipped for the medico-ethical dilemmas of the
profession, would resolve only the tip of the iceberg of the problem, for it
would take onward of three decades for doctors trained on the

70

UNESCO Chair in Bioethics 9th World Conference

premedical law curriculum to retire from practice. The Nigerian holistic


approach is a triad involving targeting the medical profession by
integrating medical law and ethics into medical training for entrants into
medical school as well as appraisal courses for premedical law trained
doctors trained; public education on their medico-legal rights thus
equipping them to be vanguard of medical malpractices; and evolution
and integration of health law into the judiciary remedial to doctor/
patient disputes. The present report is the preliminary installment of this
holistic approach to the impact of medical law and ethics on health
services in Nigeria.
Acknowledgements: Kaduna State University, Kaduna, Nigeria, for
funding.

EFFORTS TO IMPROVING BIOETHICS TEACHING IN THE


SCHOOL OF MEDICINE IN INDONESIA
M. Sajid Darmadipura, Head, Indonesia Unit, UNESCO Chair in Bioethics
sjdarmadipura@yahoo.com
Background: It is recently revealed that the outcome of Bioethics teaching
in the Schools of Medicine has been declining the latest 2 academic years.
We are trying to explore what might be the causes of it and what would
be the possible action to improve the teaching.
At current there are 74 schools of medicine in the whole country that can
be grouped into 2 categories, the earlier established and the later (year
2000 and forth, 9 schools) established ones.
Method: A workshop was held on October 10, 2013 which was attended
also by our AP Network Chief, Prof. Russell DSouza and Prof. Mary
Mathew, an expert from India.
Any possible cause and suggestions for improvement were explored
through a panel discussion. The panelist were the senior lecturers or
expert from the most outstanding schools (6 persons).The audiences were
the personnel involved in teaching, including the department chiefs and
secretaries and the chiefs of the specialist (clinical) program.
The main topics discussed were as follows.
Who has the right to teach bioethics in the school of medicine in pre
as well as clinical departments?
What materials/subjects/topics should be taught, limited to the
physicians competence produced by AIPKI (The Indonesian Association
of The Medical Institution) or others.
The method(s) of teaching, lecturing, small group discussion, etc.
The methods of assessment, MCQ, OSCE, case discussions, etc.
The methods of teaching in clinical setting or how could we bring
bioethics to the clinical departments.
Result: In short:
1. Senior lecturers or clinicians with some additional ethical background
or structured, standardized bioethics teaching course.
2. Standardized national competence for physicians is the core materials.
Other materials may be added as needed.
3. The method of teaching, lecturing, self (literature) study, discussion
(PBL Method)
4. The assessment. Assessment needs tool to assess. The currently
available methods are not acceptable. Short essay, OSCE are not
appropriate due to the big number of students. Case/vignette with
MCQ is considered as most appropriate at current.
5. Bioethics in clinical setting insists the clinician participants. Clinician
with bioethics knowledge is considered better than bioethicist or
philosopher. Case conference will the 4 square of judgment and ward
round are considered the best.

VERTICAL HEALTH PROGRAMMES: ETHICS & EFFECTS ON


INTEGRATED HEALTH CARE DELIVERY SYSTEMS IN AFRICA
Bege Dauda1, Istifanus Joshua2, Yohanna Dangata2
1
KUL Leuven, Belgium
2
Kaduna State University, Nigeria
bege.dauda@med.kuleuven.be, yohanest@dangata.freeserve.co.uk
A vertical health programme is one established to achieve specific
objectives for a specific condition or conditions. It may or may not have
links with other programmes. Many of such programmes originate from
donor organizations in developed countries for low income ones,
predominantly Africa. The stringent conditions and procedures set by the
donors can sometimes distort in situ integrated healthcare planning of

the recipient country. Such programmes are usually only for short
periods. The present paper makes a critical analysis of vertical health
programmes with respect to their challenges, advantages, disadvantages
and ethical implications on Integrated Health Care Delivery Systems in
Africa. We undertook full searches (May 2003 - April, 2013) of original
research, reports and reviews using Medline, PubMed, Embase and World
Health Organisation (WHO) Databases. Search words were advantages,
Africa, disadvantages ethical implications, integrated health care
vertical programmes, vertical programmes and Africa. Findings show
that donor organizations usually offer their interventions with specific
regulations on the receiving countries. The stringent conditions and
procedures set by donors sometimes distort existing integrated
healthcare planning and budgeting of the recipient country. These
findings show that, in spite of huge resources invested in vertical health
programmes in Africa, some of them are still very far from achieving their
set goals and objectives. This results from their strict unilateral approach
in exclusion of horizontal programmes of recipient countries. We suggest
a complementary approach that would allow symbiosis of both vertical
programmes and integrated health care systems thus facilitating each
other to maximize their potential for efficiency and cost effectiveness of
their respective objectives.
Acknowledgements: Kaduna State University, Kaduna, Nigeria and Centre
for Biomedical Ethics and Law, KUL Leuven, Belgium for funding

EVAR FOR ABDOMINAL AORTIC ANEURYSM IN ELDERLY


PATIENTS: BIOETHICAL ISSUES
Lazar Davidovic, Serbia
davidovic.lazar@gmail.com, vaskcl@eu.net.yu
Open repair (OR) for Aortic Abdominal Aneurysms is more likely to be
cost-effective than EVAR on average in patients considered fit for open
surgery. EVAR is likely to be more cost-effective than open repair for a
subgroup of patients at higher risk of operative mortality. These results
are based on extrapolation of mid-term results of clinical trials. How does
that affect patients who are older than 80 years?
Late survival depends very much on the patients' age at the time of
surgery. The life expectancy in this group of patients even with successful
AAA OR or EVAR is not as good as that of the age-matched general
population. At this age life expectancy is 6 years, and in patients older
than 85 years life expectancy is just 5 years. On the other hand annual risk
of rupture in patients with AAA diameter 6 to 7cm is 10-20%. Cost of
EVAR is at least 10,000 euro per patient, which is still extremely expensive
for many countries in transition. Regarding all these facts some countries
(in transition) are forced to reassess ethical point of endovascular
treatment. Simplified there are not enough endografs for all patients.
Vascular surgeon in this situation has to decide how, when and who
needs by priority this expensive graft. Of course this is not medical
question but question that burden vascular surgeons from countries in
transition. Should we consider octogenarians as the first group of patient
who will endure this problem? How to decide who is a priority endograft
patient and who is not? Finally who is better candidate for endovascular,
open surgical or medicament treatment from financial point of view?
These are just some of the questions still open and haunting many
vascular surgeons from countries with poorer healthcare system.

BIOETHICS, WORD CURING AND MUSIC THERAPY


Susanna H. Davtyan, R. Nemishalyan, A. Balayan, Republic of Armenia
susannadavtyan47@gmail.com
Only music has the power to create a character. It is possible to develop
true emotions through it. (Aristotle)
This abstract is the short representation of the report entitled Bioethics,
Word Curing and Music Therapy. It is known from ancient times that
music not only improves our mood but also cures from deceases. There is
a comparably new trend in medicine known as curing with music.
The curing effects of word and music therapy were still known in China,
India, Egypt, Armenia, Greece, etc. To have a positive effect on the organs
doctors prescribed musical recipes.
On most of the Italian musical instruments reached to our time from the
period of Renaissance one can found the following writ: music cures body and
soul. It should be noted here that not only listening to music but also playing
on musical instruments and singing has the same positive effect of curing.

Abstracts of Oral Presentations


The first serious research on the above mentioned facts was carried by
American writer-neurologist James Kornick in the USA in the 19th century.
It is interesting that for the studies he did not chose easily perceptible, popular
music of Verdi, Beethoven or Bach but Wagners music. He has studied the
effects of Wagner's music in the process of curing derangement. The works of
this composer had a positive effect. Since curing concerts have been organized
in the other hospitals too. After a number of years this practice and experience
was also used in European hospitals. The enthusiasm of doctors was great as
music had a relaxing effect and helped to cure neurosis and strengthened the
influence of medicine.
The selected topic also contains the information about the influence of
different musical instruments on human organs.
It is common knowledge that Nature consists of thousands of voices.
Music naturally being a series of voices has an influence on people, plants
and animals. It consists of a particular alternation of voices.
Our organism has an acoustic field and if music has the same or very close
acoustic character to it the desired influence will be achieved.
Armenian great composer Komitas having as basis the theory of four
elements carried out a very interesting and deep study elucidating the
way music cures. Music has a connection with soul and body as it is
generated in the world of emotions and then it gains a body.
The purpose of Music Therapy is to advance public knowledge of the
benefits of music therapy and to increase access to quality music therapy
services in a rapidly changing world.
All this is important to note here because music has direct connection with
Word Curing, voice is the crossroad where music and creative art meet.

THE ETHICS ENIGMA OF THE CANCER PAIN IN ITALY: FROM


PHARMACOLOGICAL THERAPY TO THE APPLICATION OF A
METHOD OF PSYCHO-SOCIAL CARE INTEGRATED
D. De Bartolo, I. Aquila, S. Boca, E. De Luca, C. Ricci, P. Tarzia, P. Ricci,
University Magna Graecia of Catanzaro, Italy
debora.debartolo@yahoo.it
Introduction: The role of pain medicine is extended to many debates
dealt with epistemology, anthropology and ethics. The pain is present in
36-61% of cancer patients in relation to the type of cancer, stage and
treatment. For this reason, the physician who takes care of the cancer
patient should be able to identify early the pain and know how to treat it
properly.
Objective: The objective of this study is to value the current state of pain
management in cancer patients, particularly in the Italian population.
Materials and Methods: A comprehensive review of the national and
international literature on cancer pain and its treatment was done. The
literature search was done using PubMed NCBI. Were considered only
English language papers, in journals mainly trade oncology and
anesthesiology.
Results: In Italy, the year 2010 marks a turning point in the fight against
pain, at least at the legislative level. With Law 38 of 15 March 2010
"Disposition for access to palliative care and pain therapy", supported by
both the secular and catholic bioethics, is effectively ratified the citizen's
right not to suffer. To date, however, a physician out of three ignores the
existence of the Act 38 and over 40% of patients with pain receives
ineffective therapies. Among the possible causes of this bad pain
management have been identified: the complexity of rules governing
prescribing and distribution of opioids; social and cultural prejudices and
resistances about intake of opioids; need for formative of health
professionals.
Conclusions: We point out the importance of the extension of
homogeneous multidisciplinary intervention programs for the treatment
of cancer pain and the incentive of specific training on the pain therapies
in oncology among all healthcare professionals. It is hoped that such
training to take place during the process of university education in order
to lay the groundwork to create a new culture of pain therapy.

DEMAND FOR MALE CIRCUMCISION IS ON THE INCREASE


IN ITALY: ETHICS PROBLEMS
Maria Gloria de Bernardo, University Hospital of Integrated Verona, Italy
gloria.debernardo@alice.it
The problem of circumcision for African immigrants is a crucial daily issue.
And we cannot wait for other tragedies to happen in Italy, before looking

71

for a solution. The ethical problem is that a kid can die because some
unauthorized person performed surgery without the essential sanitary
equipment. Given this emergency status, underlined by those who face
the immigrants problems daily, it seems indeed necessary to make a
further official step to avoid new tragedies, because Africans will in any
case keep performing circumcision. Either they go back to their country of
origin, or they fly to London, where the surgery can be carried out in
public hospitals. However, both solutions are extremely expensive, and
most immigrants cannot afford them. In Italy the circumcision surgery is
free in all cases of therapeutical prescription (for instance in cases of
phimosis). An obliging practitioner might prescribe circumcision even
though a real therapeutical need is not present. My intervention will
analyze the reasons for the health structures, describing the history,
evolution, and the conclusion, finally asking some important ethical
questions.

PREVALENCE OF SPEECH LANGUAGE COMMUNICATION


DIFFICULTIES IN ITALIAN YOUNG OFFENDERS
Anna Giulia De Cagno, Federazione Logopedisti Italiani, Italy
arl.lazio@fastwebnet.it
The screening tool included narrative and deduction tasks, observation of
non-verbal communication, self-evaluation questionnaire, evaluation by
key-workers. The objectives were:
Identifying:
The prevalence of communication disorders among young offenders
The profile of communication skills of each youngster
The lacking areas
Comparing:
Data obtained by the experimental group and the control group, in
order to analyze the differences.
All the subjects of the experimental group had difficulties in at least
one of the tasks; the individual profiles showed qualitative differences
in disorder severity in relation to each task; 23% showed inadequacy
in all the screening tasks. Though partial, these first results confirm for
Italy what is reported in the international literature on the prevalence
of SLCN in young offenders, compared to young people of the same
age group.

ETHICAL IMPLICATIONS OF THE COLLECTION OF


BIOLOGICAL MATERIAL AND RELEVANT INFORMATION
M. de Cristofaro, L. Terracciano, M. Moccia, P. Di Lorenzo, C. Buccelli,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
Bio-banks or bio-libraries are public or private institutions engaged in longterm preservation of human biological material and donors personal data.
By biological material samples it is meant cells, tissues, blood, DNA, as pool
of genetic information.
By personal data it is meant the genetic features, health and life style of
donors.
Bio-banks are certainly an advantage for the progress of science and public
health as they give large-scale access to demographics and the genetic pool
of worlds populations. Nevertheless there are concerns among citizens and
specialists that personal information and biological material can be used for
purposes other than those initially expected by donors.
In our opinion any biological material must be protected from any abuse.
The rules concerning the collection, preservation, treatment and processing
of biological samples and personal information should be harmonised at
world leve, reconciling the right to individual privacy and the possibility to
develop further scientific research.
On this matter the Ethics Committee of Universit di Napoli Federico II,
applies a procedure worked out some years ago to inform and acquire
consent to the use and preservation of biological material for scientific
research purposes, consistent with the indications for treatment of genetic
data issued the Italian Authority on Privacy.
This form for informed consent is divided in multiple sections, each one
presenting a range of options for patients so as to give them, on a step-bystep basis, the possibility to express their specific consent to every single
activity of research and, in case, to deny consent to any of them. Though
cumbersome it may look, this process lets donors receive thorough

72

UNESCO Chair in Bioethics 9th World Conference

information before deciding about the fate of the biological material that
still belongs to them.
This form will be illustrated in the paper as well as the rules for filling it in.

POLICIES OF THE BASILICATA REGION FOR THE


OVERTHROW OF THE DIGITAL DIVIDE
Vito de Filippo, Italy
Structured interventions of Basilicata Region aimed to overcome the first
generation of the Digital Divide. Infrastructure for Ultra Wide Band, Cloud
and decentralized services for the PA, the digital signature and services to
citizens has been settled and others will be realized. Policies of the Region
of Basilicata have been structured for the dissemination of the
Information Society in areas of "market failure."

INCOMPETENT PATIENT AND THERAPEUTIC DESTINY


Alessandra De Gasperis, Carlo Pasetti, Fondazione S. Maugeri, Clinica del
Lavoro e della Riabilitazione, IRCCS, Italy
alessandra.degasperis1987@gmail.com, aledg1987@gmail.com
A fundamental point is affirmed for the incompetent patient as well:
given that the legal system that puts the individual at the centre of its
own regulatory intervention and its values, such system cannot directly
impose nor tolerate the direct imposition of legal duties that harm the
patient's possibility to be the master of her own therapeutic destiny.
It cannot be maintained that the right to therapeutic autodetermination may be subtracted from the incompetent patient because
of her impairment.
In recent constitutional law thought, we see emerge the incompatibility
between a juridic approach imposing the obligation to be treated and the
personalistic approach embraced by our Constitution.
The patient's impairment, manifested in whatever form of incapacity, can
never lead ipso facto o ipso iure to damaging the fundamental rights of
the individual, and therefore to the violation of the principle of equality in
medical treatment. If we assume that the right to refuse treatment is "the
other side of the coin", in relation to the right to health, and given that
both are fundamental rights of the individual, we can therefore
understand and embrace the theory for which the exercise of both rights
cannot be impeached for the competent patient nor for the incompetent,
whatever her incapacity might be.

THE DNA DATABASES BETWEEN THE NEED OF JUSTICE


AND THE PROTECTION OF INDIVIDUAL RIGHTS
E. De Luca, I. Aquila, S. Boca, G. Cuda, D. De Bartolo, C. Di Nunzio,
C. Piccione, C. Ricci, S. Savastano, P. Ricci, University Magna Graecia of
Catanzaro, Italy
crisbn@hotmail.it; debora.debartolo@yahoo.it
Introduction: Currently is taking place a growing use of genetic material
for forensic investigative purposes. This trend was followed by the
creation of DNA databases. In this context, the United States and the U.K.
are the leading countries, where the genetic profile of many people is
found in a database.
Objective: The objective of this study is to analyze the problematic
aspects of the creation and management of DNA databases.
Materials and Methods: A review of the national and international
scientific literature and legislation was done.
Results: The Italian legislator, according to the Treaty of Prum (2005), has
ruled the field of DNA databases with the L. 30 June 2009, n.85. Although
this law represents a considerable progress in the identification of
offenders, many relevant problems remain unresolved also due to the
lack of guidelines. In particular, the use of public DNA databases is
generating doubts about their compatibility with the requirements of the
protection of privacy. At the same time the main problematic profile is
the high potential of errors in genetic correspondences. Furthermore
there is a risk that psychological distress may unduly result in suspected
or innocent people.
Conclusions: The DNA databases have an enormous positive influence
both in the battle against crime and in scientific research. However, the
review has shown the existence of many problems and limits mainly
about the protection of individual rights.

CANCER, BIOLOGICAL THERAPY AND DISABILITY:


PROGNOSTIC AND ETHICAL ASPECTS
Onofrio De Lucia, Italy
onofrio.delucia@inps.it
Probably no other medical discipline must face issues of Bioethic,
Deontology and Sociology as Oncology.
For the oncologist even the communication of the diagnosis and
prognosis, often watered down and incomplete, raises important issues of
ethics and can have possible juridical consequences (also in terms of
validity of patients consent to the treatments).
Clinical trials, which are a constitutive element of each medical treatment,
although guaranteed by the prior approval of the relevant ethics
committees, often raises the dilemma of continuing or not the trial when
the preliminary results of the study show a clear advantage in one of the
two treatments.
The multiplication of predictive genetic tests for oncogenic risks raises
important bioethical problems whose solution requires the introduction
of appropriate guidelines regarding the choices about prevention.
The ethical issues regarding aggressive therapy, palliative care and
preventive declarations of will are also well known.
This essay will examine in depth the social protection of cancer patients
with an ethical approach to disability that goes beyond the mere
economic protection, aimed especially to ensure reintegration into
society and the labor market to the long survivors.

BIOETHICS AND COMPULSORY HOSPITALIZATION:


THE EVOLUTION OF CRACK IN SO PAULO, BRAZIL
Ruy de Mathis, Ibero-American Network of Eco-bioethics, Brazil Unit
ruydemathis@yahoo.com.br
Cities are living organisms and therefore have their own dynamics; they
grow, shrink and need systematic care and attention of the public
authorities responsible for caring and taking initiatives in each of the
various areas involved in their development cycles. In Brazil, until the
early 90s, crack was not known or used by the population.
In So Paulo, capital, derelict buildings, construction sites, commercial
establishments and even some streets of a central area of the city quickly
turned into a stronghold of crack users and dealers. When the need for
primary social support and medical assistance is not fulfilled, problems
grow systematically. The enormous and ever growing group of people
gathered in what became to be known as the cracolndia was only the
tip of the immense iceberg of the problems that would arise. Thousands
of crack users living in dilapidated buildings wandering on the streets
showing severe signs of addiction with visible physical and psychosocial
disorders reflected thousands of destroyed families. Twenty years later, in
2013, the compulsory hospitalization on the request of crack users
families was approved in the city of So Paulo.
If we define bioethics as a new form of knowledge where biological
knowledge is combined with human values, we have to consider that the
adoption of these measures is an important step towards the physical
cure and social reintegration of these groups of users.
I think that now bioethics meets all the requirements to be the bridge
that will lead us to what I call "the second phase" of the compulsory
hospitalization measure: the reintegration of the citizens into their
families and society, in a productive way. It is a long, difficult and complex
phase that requires multi-focused and daily attention to the biopsychosocial segment of all involved and which will necessarily have to
bring together, closely but worldwide, the different professionals involved
in the study of and battle against crack.

COMMUNICATION IN SENILE AGE


Marta De Mattia, C.R.A.U.P. Centro Residenziali Per Anziani Umberto
Primo, Italy
martadmt@yahoo.it
When you become older? What is the difference in communication
between the elderly and adults? Is there any difference in communication
between elderly living in institutes and the ones living at home? All these
questions arise in everyday relationship between speech and language
therapist and institutionalized older or resident.

Abstracts of Oral Presentations


In senile age the modifications of language may be relevant due to several
factors involved in the planning and execution of language. There may be
some modifications in voice, in sense organs and in language skills. It
could be observed an impaired fluid intelligence (aimed in acquiring and
in first organization of notion), and a conservation of crystallized
intelligence (suitable for the final reorganization of conceptual learned
functions). [Horn and Cattell, 1967]
This work aims to analyse the characteristics of the language during the
senile age and possible deficits in behaviour of elderly in relation to their
interlocutor. The efficacy of our communicative behaviour, with respect
of persons where indicators of senility are detected, is not just a shared
responsibility, but its dependents on the interlocutor.
The communication with the elderly has an ethical relevance that is
expressed primarily in respect of the individual as such, thereafter with
the increase of all his experiences and education and as well as of its
cultural background.

ETHICAL ASPECTS OF SHAM SURGERY


F. De Micco, M. Paternoster, G. Addeo, M. Niola, P. Di Lorenzo,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
francesco.demicco@gmail.com
Sham surgery, also called placebo surgery, is simulated surgery without
therapeutic surgical procedure.
In surgical studies on surgeries the purpose of sham surgery is the isolation
of the specific effects, which are to be ascribed exclusively to surgery, from
the range of the possible incidental effects caused, for example, by
anaesthesia, by incision traumas before and/or after surgery and by the
patients perception of having received a regular treatment. In so doing the
placebo effect is neutralized.
The various issues, amongst which the ethical ones, concerning the resort to
and the need for placebo surgery arose with particular force at the
beginning of the 1960s when two controlled, independent, double-blind
against placebo studies were published on cardiac patients suffering from
severe angina pectoris. One group of patients had been operated on for
bilateral internal mammary artery ligation, while the placebo group had
received only skin incision but not artery ligation.
In the literature there are other examples of placebo surgery. In a placebocontrolled study on patients suffering from persistent abdominal pain the
comparison was made between the lysis through laparoscopy of adhesions
ascribed to previous abdominal surgeries, and considered as the cause of
the pain, and laparoscopy only, without lysis of adhesions.
There are other studies on the arthroscopic treatment of patients suffering
from knee arthralgia secondary to knee osteoarthritis, of patients with
tennis elbow and the treatment of patients suffering from spinal disc
herniation. More recently the experimental treatment of Parkinsons
disease by means of the administration of FCT caused sensation. In that case
patients in the control group were subjected to skull perforation (just like
treated patients) without receiving any treatment.
It is evident that placebo surgery entails remarkable ethical and deontological
issues, as patients in the placebo group are subjected to invasive procedures
without benefiting from the advantages associated to a treatment.
As a matter of fact, with reference to the sensational case of sham
administration of dopaminergic neurons from human embryonic cells in the
brain, we believe that there is no adherence to any ethical principle in
subjecting patients to skull perforation without any benefit for them.
Moreover we should ask ourselves what is the degree of information and
freedom of any patient who accepts the possibility of receiving such a
placebo treatment through informed consent.
If nowadays in the international scientific community the use of placebo in
clinical trials is still being debated, in our opinion the use of placebo surgery
is inacceptable as it causes pain and suffering and is invasive and dangerous.

PSYCHIATRIC COMPULSORY ADMISSIONS AT BEATRIZ


NGELO HOSPITAL: A REPORT FROM ONE YEAR EXPERIENCE
Maria Joana de S Ferreira, Portugal
mjoanasf@gmail.com
In Portugal compulsory admissions may be invoked in one of two ways:
via a standard procedure; or by an emergency department. Standard
involuntary placement takes place in three separate steps: application for

73

a court order, psychiatric assessment and a court ruling. In emergency


situations, once the assessment has confirmed the need for an
involuntary placement, the doctor on duty in the emergency room applies
to a court for the appropriate order. The court must then issue a ruling
within 48 hours. Although the underlying procedures are approximately
the same, the differences between the two groups of patients should be
taken in account as they probably bring to light the higher risk factors
associated with compulsory admissions.
We want to find out whether there are differences between patients
compulsory admission through the standard procedure and patients
involuntary treatment through the emergency department. Differences
between groups in not help-seeking behaviours may contribute to explain
differences in rates of compulsory admission.
On the basis of case-register data for the compulsory admissions at
psychiatric ward of Beatriz ngelo Hospital we analysed the differences
between patient groups (standard procedure and emergency
department) during the first year of the Hospital/Psychiatric
Department. Data were collected from the Soarian Clinicals information
system regarding for example their pathways to compulsivity, clinicianrated reasons for admission, hospital stays, services referral after
discharge and social and clinical characteristics. The missing data were
supplied by the courts information.
Characteristics of the patient that influence the risk of compulsory
admission by the two methods includes diagnosis and certain
sociodemographic and social factors (ex. living alone). Caregiver burden is
associated with compulsory treatment by both procedures. High
incidence of psychosis and compulsory placement within minority ethnics
through standard and emergency means should be a concern. Variations
in the way in which compulsory measures are applied persist, but there is
room for improvement in the monitoring of the effects of these
differences and the types of services that are available.

THE PHYSICIANS DUTY TO INFORM IN PATIENTS


DECISION MAKING PROCESS
Francesco De Stefano, University of Genoa, Italy
The acquired general rule, in democratic countries is that every person is
the owner of the legal right to determine what may be done to its own
body. In our country, according to the Principles of Italian Constitution
about freedom and self-determination (art. 2 and 13) and protection of
health (art. 32) conscious consent to medical acts is considered the
fundamental basis for a correct physician/patient relationship.
Moving from the mentioned statements, the quality (and quantity) of
information may be considered the core of patients decision making
process. Even if, in many cases can be very difficult for the physician to be
sure that information were adequately understood, the capillary
description of technical limitations and risks of proposed treatments is
still considered the gold standard in acquiring a valid consent, both in
every day practice and litigations in lawsuit.
Conclusively, to inform thoroughly patient about the risks and
opportunities of a proposed treatment may be the key to ensure the
respect of patients constitutional rights and an adequate protection from
exposure to legal action.

YOUR OWN PERSONAL GENOME: ETHICAL ISSUES IN


DIRECT-TO-CONSUMER (DTC) GENOMICS SERVICES
Amy Michelle DeBaets, Kansas City University of Medicine and
Biosciences, USA
adebaets@kcumb.edu
Direct-to-Consumer (DTC) genomics services, such as 23andMe and
deCODEme, offer testing and information about a wide variety of possible
genetic mutations, ancestry information, and genetic risk factors to
individuals without interpretation or intervention of a physician or other
healthcare provider. While there is much to be learned from this new and
relatively inexpensive availability of individual genetic information, there
are significant ethical risks as well.
This pilot study, covering the most widely used and least expensive
service (23andMe), is designed to provide an ethical analysis of research
practices, informed consent processes, data reports given on genetic
risks, traits, and ancestry data, and social media available through the
23andMe service. Some issues that were found include questions of:

74

UNESCO Chair in Bioethics 9th World Conference

Privacy, confidentiality, redisclosure, and discrimination


Consumers unknowing and uncertain involvement in research /
informed consent
Social media sharing of private health data
Racialization of genetics
Problems with data anonymization
Unmediated information / consumers lack of understanding risks
Validity / reliability questions
These significant ethical issues become critical to address as the services
expand to reach people around the globe, collecting vast genetic data with
minimal accountability for the ways in which the data are used. This ethical
analysis can be used as a first step toward better regulation and oversight of
the services, as well as fostering further study of the ways in which
consumers utilize the data to make healthcare and related decisions.

CULTURAL DIFFERENCES AND THE INTENTION TO


UNDERGO AN ELECTIVE ABORTION IN CASE OF A FETAL
ABNORMALITY
Sara Dejevsarov1,2, Sivia Barnoy1
1
Tel-Aviv University, Israel
2
Gertner Institute for Epidemiology and Health Policy Research, Israel
dejav_s@mac.org.il
Background: Technological developments in fertility led to early detection
of neonatal abnormalities, on the one hand. On the other, the recognition
of a woman's right to her body, led to legal changes which permit
abortion under different conditions. The decision whether to undergo an
abortion following the discovery of a fetus abnormality is effected by
culture and attitudes.
Methods: The study was based on the planned behavior theory (Ajzen &
Madden, 1986) and was conducted in three countries: Israel, Germany
and Cyprus. The questionnaire presented different scenarios where the
woman is pregnant and her fetus is diagnosed with an abnormality of
three types (cognitive, health related and esthetical) with different
severities. After each scenario the women were asked about their
attitudes, sense of control and subjective norms regarding performing an
abortion and about their intention to undergo an abortion.
Results: 340 women participated in the study (134 Israeli, 115 German
and 91 from Cyprus). The results show that positive attitudes towards
abortion were significantly correlated with the intention to abort. Culture
had an effect on attitudes with Israeli women more in favor of abortion.
Subjective norms differed by culture being lower in Germany as compared
to Israel and Cyprus. Sense of control was higher among Israeli women
feeling more control.
Conclusions: The intention to abort when a fetus defect is diagnosed is
influenced by culture. When the women feels more control, holds more
positive attitudes and there are higher subjective norms there is more
intention to abort with no regard to the type of defect and its severity.

ETHICS ASPECTS ON THE MEDIATION CROSS-CULTURAL


ACTIVITIES IN AOSTA VALLEY
Fulvia Dematteis, European Centre for Bioethics and Quality of Life
UNESCO Chair in Bioethics Unit, Italy
fulvia.dematteis@tin.it
On the report presentation, the main matter will be focused on the
mediation cross-cultural relating to the experience of training course and
jobs of all specific professional profile.
Following are the topics that will be discussed:
Fear, furor, unfeeling in the intimacy relationship.
How to build good capacity to relationship throughout different ethnic
groups.
No harm
Take care
To feel
To be patient
To be curious
Give space
Give to us a new possibility
To practice the imagination
To have an ethical vision of the life
Dispute survive

CRIMINAL OFFENSE OF ASSISTED SUICIDE


NEW LAWS AND OLD DILEMMAS

MUTUAL LEARNING TO OVERCOME THE RISK OF


SELF-REFERENCING IN HEALTH PROFESSIONS
1

experimental method. In this context a generic reference to professional


values may remain ambiguous and end up reinforcing this attitude of selfreferencing. Values without reference fall prey of those who have the
strength every time to redefine their content, preventing any real
confrontation, debate and mutual learning.
How can we overcome this self-referencing attitude? Reasonably
recognizing that what is true in our human experience is not irrelevant to
our work. We need to open the door to the cultural and educational
relations that express the full extent of our human experience and can
actually sustain our demanding profession. Proper laicity is not
indifference, but can be the engine of the new curriculum initiative.
As an example, at medical school and in CME programs for health
professionals, we perform the optional course The contribution of
Christian experience to health professions, followed by dedicated
periodical laboratories. The program includes encounters with effective
professional experiences that do not deny the relevance of motivations
and their impact on the technical action. This is an example that wishes to
stimulate similar and plural contributions. Our experience indicates the
need to favor positive interaction among professionals, aimed at
expressing judgments and initiatives on issues dealing with our
profession, having as starting point all resources of the human
experience. The confrontation that stems from such aperture should be
made methodical, to give energies to the new curriculum initiative.

Antonio Del Puente , Antonella Esposito , Vinicio Lombardi , Aldo Bova ,


Raffaele Scarpa1
1
University Federico II, Italy
2
P.O. San Giovanni Bosco, Italy
3
P.O. San Gennaro, Italy
delpuent@unina.it
The deterioration of the relationship between doctors and patients and
the loss of altruism and collegiality are today the most important
questions for the efficiency of the health professions. The UNESCO Chair
of Bioethics initiative to form a new curriculum of medical ethics is critical
in this scenario. Starting from our teaching experience we would like to
outline an aspect of current culture which jeopardizes this effort and to
suggest a supportive approach.
The technical-scientific culture claims to be the only approach which can
generate reasonable conclusions. This self-limitation of the reason
confines to subjectivity all the considerations on the complex unity of
the human being and its absolute value, which are absolutely reasonable,
although not demonstrable by experiment. Main consequence is the
mechanistic reduction of our profession that confines the medical action
to a neutral technique which is ineffective and against the spirit of the

Davor Derencinovic, University of Zagreb, Croatia


davorderen@yahoo.com
The role of substantive criminal law is, inter alia, to protect fundamental
values deeply rooted in the constitutional order. One of the most
important values on this list is right to life, which has been considered, at
least in European legal context, as a non-derogable right. In this regard,
right to life openly and undoubtedly put in question right of a person to
take his/her own life. One may assume that such right does not exist
irrespective the fact that suicide as such triggers no criminal liability for
the subject. On the other side of the spectrum, aiding and/or inciting in
another person suicide are not only wrong from the ethical perspective
but also amount to criminal liability known in most contemporary legal
systems. However, the approach to the banning/criminalizing of aiding
and inciting another person to commit suicide differs significantly in terms
of the motive, different legal characterization of various forms of
participation/contribution (legislator is often much more lenient to those
who just assist another person in dignified dying than to those who
influence his/her will to commit suicide) etc. This paper will examine
various legal aspects of assisted suicide from the perspective of recently
adopted Croatian criminal legislation as well as from the comparative
legal perspective. The jurisprudence of the European Court of Human

Abstracts of Oral Presentations


Rights in the most recent and relevant cases (i.e. Haas v. Switzerland) will
also be taken into due account.

PHARMACISTS PROMOTERS OF GOOD HEALTH:


NEW PROFILE OF PROFESSIONAL RESPONSIBILITY
T. Devoti1, M. De Padova2
1
President, Pharmaceutical Society of Valle dAosta, Italy
2
L.H.A. Valle dAosta, Italy
depadova@ausl.vda.it
The aim of this study is to underline the changing role of pharmacists over
the last few years with particular focus on professional responsibility.
Pharmacists traditionally prepared medicines prescribed by doctors and
since the 1960s were the purveyors of commercially produced medicine:
todays pharmacists have taken on a different role and are first-line in the
health care sector dealing with patients physical and psycho-physical
problems and/or wellbeing. The vast and unending supply of health care
and general sanitary products on the market require that pharmacists
now are able to answer to and solve any number of growing patient
needs. Thus pharmacists must adhere to and are subject to any violation
of all professional regulations dictated by law: imprudence, negligence,
failure to correctly observe and apply laws, regulations and orders are all
situations commonly faced by pharmacists of our times. This study
focuses on some specific aspects which should be observed and practised
by todays professionals, examples of good practice which protect and
serve both pharmacists and their patients.

DEVELOPING POLICY FOR BIOBANK RESEARCH IN


SOUTH AFRICA: THE WITS HUMAN RESEARCH ETHICS
COMMITTEE (MEDICAL) APPROACH
Ames Dhai, Yolande Guidozzi, University of the Witwatersrand, South Africa
Amaboo.dhai@wits.ac.za
Globally, growing prominence is being placed on the establishment of
Biobanks. South Africa too has joined the Biobanks Olympics. The
importance of research involving human genetic or genomic information
analysed together with other personal or health data for the
understanding of multi-factorial diseases has increased significantly over
the past few decades. This type of research is vital to improvements in
detection, prevention, diagnosis, intervention, treatment, and cures,
including those for the development of new products and services.
However, the open and evolving nature of biobanks has profound ethical,
legal and social implications for individual and group autonomy, informed
consent, privacy, confidentiality, secondary use of samples and data over
time, return of results, data sharing, and benefit sharing with
communities and premature, unplanned closure. Complexities also
emerge because of increasing international collaborations, and differing
national positions. Public consultation and involvement are very
necessary to the success of biobanking. Implementing national laws in an
internationally consistent manner is problematic.
This presentation starts off with a brief description of biobanks and then
goes on to discuss some associated ethical and legal complexities in this
context. It then describes the process utilized at the Human Research
Ethics Committee (Medical) at the University of the Witwatersrand,
Johannesburg in establishing its Biobanks Ethics Committee and
developing policy for the approval of the establishment of Biobanks and
Biobank Research. This Policy has been approved by the National Health
Research Ethics Council for inclusion in the countrys national ethics
guidelines.

IS THERE AN ETHICAL GROUND FOR DEROGATING FROM


INDIVIDUAL INTEGRITY PRINCIPLES IN FAVOUR OF
SCIENTIFIC PROGRESS IN CLINICAL TRIALS?
P. Di Lorenzo, M. Paternoster, M.A. Zinno, M. Niola, C. Buccelli,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
Biomedical research and experiments in humans shall be based on the
principle of the safeguard of the health (psychophysical integrity of the

75

person) and dignity of the person although pursuing their inherent goal of
acquiring new knowledge.
The Nuremberg Code was a turning point in the protection of the rights of
patients involved in experiments but only in later international ethics
documents the primacy and superiority of the individual over collective
interests in research protocols has been clearly stated.
The need for scientific trials to provide results that are useful for the
whole society is not ignored because otherwise trials on healthy
volunteers, which are of no direct usefulness to them, would not be
permitted.
Yet it has been clarified that the primary goal in scientific trials is to
acquire insights and find therapies useful for single individuals.
However, in our opinion the protection of the well-being and safety of
every single individual involved in a trial cannot be considered nowadays
in absolute terms with respect to the possibility of obtaining useful
knowledge for the whole society. After decades of trials on humans in
compliance with strict rules the authors deem there is new room, with all
due caution and juridical limitations, for solidarity-based derogations
from the individual psychophysical integrity principle in favour of the
society.
Hence, precise criteria are needed to allow for these derogations in
favour of the progress of mankind and in total safety. In this sense,
voluntarily giving up ones own psycho-physical integrity as a contribution
to research is not to be interpreted as a waiver of the constraints
protecting the individual rights of the patient involved in the experiment
but as the acceptance of risks by the patient after thorough assessment of
all time-related, dimensional, anatomical and functional aspects and
provided that all ethical and juridical norms are complied with.

THE PSYCHIATRIC DISEASE IN THE ELDERLY, CURRENT


THERAPIES, DISABILITY AND ETHICAL CONSIDERATIONS
Nicola Di Matteo, INPS, Italy
nicola.dimatteo@inps.it
The psychopathology of the elderly patients must necessarily deal with
some epistemological questions related to the meaning of the illness,
valuation of the symptoms, therapy and ethic limits of the medical
treatment. Its not only the usual simply question is the old age an
illness for itself?, we have also to face the inner anthropological sense of
the old age, despite the frequent non physiologic meanings, which the
present social cast of mind expect to attribute to the ultimate time of life.

DISORDERS OF SEX DEVELOPMENT: WHICH FRONTIERS IN


A SCIENTIFIC, BIOETHICIST AND SOCIAL DEBATE?
1,2

1,2

1,2

Francesca Dic , Maria Auricchio , Immacolata Parisi ,


2
1,2
1,2
Mariacarolina Salerno , Fabiana Santamaria , Paolo Valerio
1
Interuniversity Bioethics Research Centre, Italy
2
University of Naples "Federico II", Italy
francesca.dice@unina.it, francesca.dice.076@psypec.it
The birth of a child with a Disorder of Sex Development (DSD) raises many
questions about the psychological, medical, ethical, legal and social
theme: these are congenital conditions in which development of
chromosomal, gonadal, or anatomical sex is atypical and the most
common are Turner's Syndrome, Klinefelter's Syndrome, Congenital
Adrenal Hyperplasia, Morriss Syndrome and other conditions with
androgens reduced production or peripheral insensitivity. DSD are
diagnosed, in most cases, at birth, sometimes the difficulty in establishing
a correct diagnosis as earliest can cause a medical and psychological
emergency for the child and his/her family, especially about the gender
assignment. Once diagnosed, some children with atypical genitalia are
subjected, during the first years of life, to surgery to "normalize" the
appearance of the genitals, while other children will follow a
pharmacological therapy for a lifetime. Difficulties in the diagnostic and
therapeutic treatment, eventual gender dysphorias during the childs
psychosexual development, implications in the surgery and complex
issues about the informed consent in children and adolescents are open
questions that raise a delicate bioethical and social debate. Therefore, the
primary objective of the interdisciplinary team working in this field is an
integrated medical and psycho-social work, with particular attention to
the well-being of children with DSD and their families.

76

UNESCO Chair in Bioethics 9th World Conference

THE BALINT METHOD PRACTISING IN BULGARIA


Sv. Dimitrova, V. Hristova, G. Foreva, Trakia University, Centre DinamicaSofia, Medical Academy of Plovdiv, Bulgaria
svdimitr@abv.bg; svdimitr@mf.uni-sz.bg
Introduction: The work of Michel Balint is well known and appreciated in
all over the world, including Bulgaria. A number of Balint groups have
been created on primary health care level in Bulgaria in three university
towns Sofia, Plovdiv and Stara Zagora for three years by now.
Aim: The latest experience of the Balint method implication to be
described and analyzed, with a special accent on the ethical dilemmas in
the cases that are discussed.
Methods: focus group analysis, quality analysis of cases
Results: A certain difficulties due to the contemporary Bulgarian context
are underlined. Despite them, evidence for acceptability and usefulness in
practicing Balint method in Bulgaria is discussed. The importance of this
practice comes from good opportunity to share feelings, not only rational
arguments with peers and to find new ways of solving complex cases
especially when medical ethics is concerned.
In conclusions: Despite difficulties we expect a good perspective and
future development of Balint method in Bulgaria especially concerning
dissemination of this practice.

KNOWLEDGE, ATTITUDES AND PRACTICES OF NURSING


ETHICS MEDICAL STUDENTS IN MALI
Samba Diop, Awa Keita-Thera, Edwige Tongo (student), Seydou Diarra,
Kaourou Doucour, University of Science, Technology and Technology
Bamako, Mali
saibd@icermali.org
The ethics of care refers to care of the practical challenges in urban
African university hospital. Indeed, despite the teaching of medical ethics
and the existence of transnational biomedical research programs in Mali,
medical students practice without informing and obtaining the voluntary
and informed consent of their patients. This study aims to reveal the
knowledge, attitudes and behavioral practices of medical students in
medical ethics and nursing.
It is a descriptive cross-sectional study in random held in the Faculty of
Medicine and Dentistry and the university hospital of Bamako District
from March 2011 to April 2012 with 375 students in 3rd to 6th grade.
Students had heard, respectively ethics of care (97.9%), ethics of research
(72.5%) and medical malpractice (99.2%) and the right was their main
source. Only 10.4% of students interviewed knew the three basic ethical
principles and direct observations showed that the majority of students
did not give hospital did not inform their patients and did not require
their consent.
Two major lie in the lack of privacy during patient consultations and
request medical students to the academic teaching of ethics to be
followed by practical guidance in hospital.

INFORMED CONSENT IN CZECH REPUBLIC AND SLOVAK


REPUBLIC ETHICAL AND LEGAL ISSUES
Adam Dolezal, Czech Republic
adam.dolezal@zdravotnictvi.cz
This work deals with the relationship between legal responsibility and
informed consent in medical malpractice cases. The issue of informed
consent is examined in connection with legislation in the Czech Republic
and Slovakia, and individual court cases and trends in judicial decisionmaking in these countries are presented. Court decisions are then
compared with current bioethical principles and other bioethical theories,
and the cases are assessed according to whether such bioethical
principles were applied. The general aim of this article is to demonstrate
how the judicatory reacts to the results of bioethical literature.
Unlike in Common Law cases, Czech and Slovak legislation is based on the
natural law tradition of informed consent; so patients may have a right to
compensation in cases where psychological integrity is infringed upon,
because it is a due to the failure to respect of the autonomy of the
patient.
Furthermore, Czech and Slovak laws of informed consent are based on
subjective standards of understanding and disclosure. Therefore, the

adequacy of information is of paramount importance. With informed


consent, specific informational needs of the individual person should be
referenced and understood, rather than defaulting to the hypothetical
reasonable person (objective standards). Problems arise from using
subjective standards, as evidenced by individual cases; in such cases, the
causation between erroneous (or missing) disclosure and damage is
difficult to prove because plaintiffs usually testify that they would not
have consented if the risks had been fully disclosed, but their views might
be distorted by the experience of a negative outcome. Bioethical theories
suggest that subjective standards leave physicians at the mercy of their
patients' self-serving hindsight in court.
In conclusion the differences between the theoretical bioethical basis and
actual medical practice are so abysmal that it raises the question of
whether informed consent should be reviewed and edited by other
means. The basic problem is the persistent silence between patient and
doctor. The new consensus in medicine should be one that respects
patients as individual subjects.

MEDICAL LAW UNDER THE STRASBOURG INFLUENCE:


ON A ROAD TO IUS COMMUNAE?!
Tom Doleal, Czech Republic
tomas.dolezal@zdravotnictvi.cz
While the overall importance of European Union law for regulation of
medical intervention remains limited even after the Lisbon Treaty, this is
not the case of the European Convention for the Protection of Human
Rights and Fundamental Freedoms signed in 1950. This core instrument of
European human rights protection system guarantees now a classical set
of civil and political rights many of which many are of a direct concern for
medical intervention and their broader legal context. The most important
rights in this regard include the right to life (issue of artificial
insemination, abortion or euthanasia), the prohibition of inhuman or
degrading treatment (mutilating interventions), the right to personal
freedom (issue of obligatory medical treatment and detention), the right
to privacy (consent to medical intervention, compulsory treatment
including vaccination, medical privacy, personal data protection) or the
principle of the protection of human dignity (horizontal importance).
Moreover, case-law of the European Court for Human Rights seated in
Strasbourg empowered to scrutinize the respect of the ECHR in its
Signatory States has substantially contributed to the expansion of these
rights and freedoms which now seem to tend to recognition of right to
health and to favourable environment. Due to the binding character of
the ECHR for its Signatory States multiplied in some countries including
the Czech Republic by the special constitutional status attributed to the
ECHR with regard to domestic legal rules the ECHR has undoubtful
potential to lay down the European ius communae standard in the area of
legal aspects of medical intervention.

TOGETHER RATHER THAN SEPARATELY CONDUCTING A


DISCUSSION ABOUT ETHICAL DILEMMAS IN A REGIONAL
MULTIDISCIPLINARY MULTI-PROFESSIONAL FORUM
1

Sophy Dombe , Ruth Kaplan


1
Assaf Harofeh Medical Center, Israel
2
Academic Nursing School, Assaf Harofeh; Chairperson, Nursing Ethics
Bureau
sophydombe@hotmail.com
The option of prolonging patient's survival is sometimes accompanied by
the verdict of poor quality of life. Such situations raise ethical dilemmas
with respect to prolonging survival at the expense of quality of life.
About a decade ago, an Ethics Bureau was founded by the Israeli Nursing
Association, the role of which, is to cope with those ethical dilemmas
raised in the nursing practice. Over time, it became clear that even the
Ethics Bureau cannot provide an appropriate setting for discussing daily
ethical issues due to its loose connection with the events occurring in the
clinical fields.
Thus a regional ethics forum was established. It includes general, geriatric
and psychiatric hospitals and insurers (HMOs).
The new model enables collaboration and learning in various clinical
fields, while providing the opportunity to analyze ethical issues from
various perspectives. The forum has become a professional resource. Its
members experience obligation and responsibility to discuss the

Abstracts of Oral Presentations


dilemmas raised at their workplaces and to involve the teams in the
discussion and the solutions proposed.
Our vision is to create a multi-professional forum including specialists
from the medical and paramedical professions, who will share the ethical
dilemmas raised in their professional practice with specialists in the field
of nursing.
In conclusion, the model presented here may serve as a prototype for
establishing regional ethics forums over the country, which will serve as a
resource for the teams in their professional practice and a link between
the actual field and the National Ethics Bureau.

LEGAL ASPECTS OF THERAPEUTIC OBSTINACY


Carmine Donisi, International Office for Bioethics Research of the
European Center for Bioethics and Quality of Life of the UNESCO Chair in
Bioethics Unit Ethics Committee Carlo Romano, University of Naples
Federico II, Italy
This paper starts by acknowledging a contradiction: on one hand there is
unanimous consensus on the foundation of the prohibition of what is
known as therapeutic obstinacy, on the other there is disagreement on
how to identify it and on the ways it is practiced.
Hence a dangerous uncertainty for operators, that this paper aims at
sweeping away by reviewing current practices, international and national
regulations, codes of ethics and some significant judges sentences in the
light of the unstoppable scientific progress and the cultural diversity that
characterize contemporary society.
The respect of the prohibition of therapeutic obstinacy inevitably recalls
such phenomena as "therapeutic abandonment" and the hot topic of
euthanasia, in its problematic form called passive euthanasia, in
particular. The Author will delimit these concepts so as to provide
operators with useful practical criteria.
Some meaningful clinical cases will also be illustrated to exemplify the
results of the investigation
In conclusion, some short remarks will be put forward on new potential
fields of application of therapeutic obstinacy. The issues not of minor
importance concerning the liability from abuse of therapeutic obstinacy
will only shortly be alluded to since they will be thoroughly presented by
other authors.

THE BIOPOLITICS, ETHICS AND LAW OF COMPULSORY


DNA TESTING OF REFUGEES
Edward S. Dove, McGill University, Canada
edward.dove@mail.mcgill.ca
The intersection of genetics, bioethics, law, and immigration has received
little attention from scholars. The significance of this scholastic lacuna is
intensified in the case of refugees; solutions are acutely needed as a
result of recent changes in U.S. refugee policy. My paper will remedy this
lacuna and offer ways to devise solutions by analyzing the embedded
bioethical and legal ramifications of a new policy that took effect in
October 2012. The policy now requires refugees seeking family
reunification via the Department of States Refugee Family Reunification
Priority Three (or P-3) Program to undergo DNA testing to prove they are
legitimate, i.e., genetically related, family members. The U.S. has
previously used DNA testing in immigration and refugee matters on a
voluntary basis, serving as a last resort measure to verify an alleged
biological relationship where no other credible proof exists. This is no
longer the case for P-3 Program refugees. The putative purpose of the
differential treatment is fraud prevention, as well as alleged secondary
benefits such as increased national security and greater efficiency in
refugee claims processing. Yet upon close inspection, the forthcoming
policy generates significant concerns.
From a bioethical and legal perspective, required DNA testing unjustifiably
narrows the meaning of family, and may violate domestic laws and
international human rights instruments regarding voluntary informed
consent, privacy, and anti-discrimination. The paper posits that traditional
legal solutions may not represent the most suitable or promising remedy
to quell the tide of a collective march towards an intractable risk society
that views refugees as potential frauds. I propose some solutions that
mitigate the impact of the new policy, allowing for a nuanced
understanding of family and a firmer understanding of the inherent but

77

uncertain risks of DNA technology in the immigration and refugee


context.

DISCRIMINATION OF MIGRANTS IN HEALTH CARE:


A SYSTEMATIC LITERATURE REVIEW
Daniel Drewniak (PhD Student), Tanja Krones, Verina Wild,
Institute of Biomedical Ethics, University of Zurich, Switzerland
wild@ethik.uzh.ch
It is evident that some groups of migrants are vulnerable in relation to
health and medical care. The reasons for that are heterogeneous and
complex and range from structural reasons, like policy of integration, over
language barriers to discrimination in the health care setting. Indeed
several studies examine how migrants subjectively perceive
discrimination through health care personnel. The evidence on
subjectively experienced discrimination must lead to the assumption that
migration- and residence status influence medical decisions. In the
context of justice in health care provision this touches upon core ethical
values.
However, studies that confirm these findings by examining the behavior
on the side of health care professionals are rare. From a methodological
point of view the challenge exists how to empirically measure the
influence of social factors, like migration background, on the behavior of
the health care personnel without falling prey to a social desirability bias.
In an attempt to understand the influence of migration background or
ethnicity on the behavior of health care professionals we conducted a
systematic literature review. The aim of the review was to collect studies
that focus explicitly on the attitude or behavior of the health care
professionals and not on the subjective perception of the patients. After
defining a search term, relevant databases and inclusion criteria, we
examined title and abstracts of the studies. By reviewing the full texts of
all included studies we not only synthesized data but also evaluated the
quality of the methods used in the studies.
In our presentation we will 1) describe the method of our systematic
review, including the difficulties to evaluate the quality of the studies. We
will then 2) sum up the findings of our systematic review; Finally we will 3)
discuss our findings in the context of their ethical implications of justice in
health care in relation to health care provision for certain groups of
migrants.

COPING WITH RELIGIOUS PLURALISM IN PUBLIC


BIOETHICS DISCOURSE
Chris Durante, St. Johns University; Marymount Manhattan College;
McGill University, USA
c.durante@hotmail.com
This presentation will discuss the foundations of a method of discourse
for public bioethics commissions that can aptly cope with the difficulties
that arise when religious, cultural and moral differences are given due
recognition in bioethical deliberations regarding policies. Acknowledging
the need for shared guidelines and common codes and norms, this is a
method that seeks consensus without overlooking the importance of
respecting difference. While consensus does indeed entail agreement we
must always be cognizant of the fact that there are levels of agreement to
be achieved. Hence, this method proposes a multifaceted and multitiered approach to consensus building. Once interlocutors have arrived at
agreement regarding a set of norms or guidelines it will be argued that it
is necessary to invite interlocutors to recognize and affirm diverse
interpretations of a given norm. In this way it is my hope that the deeper
doctrinal disagreements that often ensue after initial consensus has been
reached can be avoided by providing a richer and more pluralistic basis for
interpreting shared norms. Furthermore, in cases in which attempts to
reach consensus have been exhausted and the prospects for agreement
upon shared truth claims seem unlikely, this method suggests that we
shift the focus of our inquiry away from more methods of ethical
agreement aiming at the discovery of mutual truths toward discussions of
those practices and behaviors interlocutors can respectively and mutually
tolerate. In this way an attempt to reach consensus regarding that which
each can permit once their fundamental disagreements have been
acknowledged in an attempt to accommodate one another.

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UNESCO Chair in Bioethics 9th World Conference

ETHICS & MILITARY MEDICINE: AN ANALYSIS OF


MEDICAL CIVILIAN ASSISTANCE PROGRAMS &
THE PROBLEM OF DUAL LOYALTY
Sheena M. Eagan Chamberlin, USA
smeagan@utmb.edu
Practicing military medicine is a morally complicated job. While physicians
are generally understood as owing moral obligation to the health and
well-being of their individual patients, military health professionals can
face ethical tensions between responsibilities to individual patients and
responsibilities to the military institution or mission. The apparently
conflicting obligations of the two roles held by the physician-soldier are
often referred to as the problem of dual loyalties and have long been a
topic of debate with the field of military medical ethics. This conflict lies at
the intersection between the profession of arms and the profession of
medicine, as institutionalized by the modern American military. This
paper examines the embedded case of medical civilian assistance
programs. These programs represent a programmatic example of the
problem of dual-loyalty, because these missions are characterized by the
use of medicine within the military for strategic goals. Thus, a physician is
expected to meet his obligation to his role as soldier, while also practicing
medicine. These programs involve obligations inherent in both roles of
the physician-soldier and thusly they serve as excellent exemplars for the
problem of dual loyalties at an institutional level. While humanitarian or
altruistic goals are often associated with the medical profession, the
strategic intent behind medical civilian assistance programs differs from
medicines humane purpose. This presentation will explain, explore and
analyze the history of these programs, which dates from the
Revolutionary War to today.

ENHANCING HUMAN PERSONS: DOES IT VIOLATE HUMAN


NATURE?
Jason T. Eberl, Indiana University Purdue University Indianapolis, USA
jeberl@iupui.edu
Debate concerning the enhancement of human capacities through
genetic, pharmacological, or technological means often revolves around
the question of whether there is a common nature that all human
beings share and which is unwarrantedly violated by enhancing a human
beings capabilities beyond the normal level defined by this shared
nature. In this presentation, I rehearse briefly some historical
philosophical views on what features might define human nature from
thinkers as diverse as Aristotle, John Locke, and Daniel Dennett noting
the emergence of a consensus upon certain key traits that define one, not
as human per se, but as a person who possesses inviolable moral
status as such. I will argue, based on this emergent consensus, that there
is a commonly shared nature among human persons. Understanding the
qualities of this nature, which include self-conscious awareness, capacity
for intellective thought, and volitional autonomy, informs the ethical
assessment of various forms of human enhancement. Some forms of
enhancement for certain types of capacities will be evaluated as not only
morally permissible, but even desirable from the perspective of what
constitutes the flourishing of human persons in our fundamental nature
for example, enhancing ones immune system or cognitive capacity for
memory. Other forms of enhancement run the risk of detracting from
human flourishing or altering ones nature in ways that would lead to
complicated social relationships with other human persons, with the
result that such forms of enhancement ought not to be pursued for
example, attempts to enhance ones emotive responses.

LAW STUDENTS AS AGENTS OF SOCIAL CHANGE MORAL


VALUES AND ATTITUDES IN ZEFAT COLLEGE SCHOOL OF
LAW
Yael Efron, Yaron Silverstein, Zefat College School of Law, Israel
yaele.law@gmail.com
Zefat Law School hosts a wide range of students from many cultures and
backgrounds: secular and religious, Jews and Arabs, Muslims, Christians
and Druze, men and women, young and old. The classroom in the school
is a microcosm of Israeli society, in all its forms. This atmosphere creates
opportunities for both active and passive learning of another culture and

assimilation and deepening the normative and moral world of each


student.
In this presentation we try to characterize major trends that led and lead
students from the Arab sector to study law at Zefat College, and the
practices which they want to take as future lawyers. The underlying
assumption of this study is that students hold certain values and norms,
expressing narratives of a minority, and later in the course of their
studies, they focus their activities in the enactment of these norms in
their society. The research question examined whether law school made
changes in these normative values, and in what areas the students want
to serve as agents of change in their fields later in their career. An
interesting question in this context concerns the status of the practice
within the traditional Arab society.

DEVELOPMENT OF MOLECULAR PATHOLOGY


INFRASTRUCTURE IN NIGERIA: THE EMERGING
OPPORTUNITIES, LEGAL AND ETHICAL IMPLICATIONS
O.Y. Elegba, M. Achi, J. Chok, I.A. Joshua, Y.Y. Dangata, Kaduna State
University, Nigeria
oyelegba@yahoo.com
While molecular pathology has taken hold and is fast advancing in many
developed countries of the world, its introduction in Nigeria is barely one
decade old, despite perennial challenges that have been posed by its
absence either for infectious diseases or for forensic pathology in
particular. Its recent inception in the country is not surprising given the
recent growing national awareness on the proliferation of cancer in
Nigeria, and the number of deaths arising there from, consequently a
compelling need for the establishment of physical and regulatory
infrastructure for the practice of molecular pathology in the country. For
example, there is increasing interest both in the private and public sectors
to invest in cancer research and management as well as the management
of diseases such as tuberculosis and Lassa fever. These provide a new
vista for the establishment of a national network of molecular pathology
laboratories in the country for their management. This paper, therefore,
examines the current stage of development of molecular pathology in
Nigeria, the hindrances to its development, the need for balance between
its pace of development and national needs; and finally proposes a
framework for the development of a national policy on molecular
pathology, and its linkage with the international network.
Acknowledgements: Kaduna State University, Kaduna, Nigeria, for
funding.

SACRIFICING PROPER PRACTICE ON THE ALTAR OF THE


BEAUTY BUSINESS? INFORMED CONSENT IN THE FIELD OF
COSMETIC DENTISTRY
Tracey Elliott, University of Leicester, UK
tracey.elliott@le.ac.uk
In recent years the UK has seen a growing demand for cosmetic
interventions, including aesthetic dentistry. The public, and young people in
particular, are increasingly aware, thanks to the mass media and the
seemingly unstemmable flow of stories relating to alleged or actual celebrity
cosmetic procedures, that their bodies (including their teeth) can be
modified to align them more closely with personal notions of ideal beauty.
Cosmetic dental procedures have therefore become increasingly accessible
and normalised. However whilst some cosmetic procedures (e.g. tooth
bleaching) may be seen as being non- or minimally invasive, others (e.g.
crowns or the provision of implants) are highly interventionist, and involve
the destruction of sound dental tissue. Within the profession, and in dental
journals, there has been much gnashing of teeth as to the appropriate
ethical stance to adopt in relation to aesthetic procedures, with some
arguing that there should be greater adherence to the daughter test
(would you do what you are proposing to do to your patient, to your
daughter?), whilst others argue that even radical treatment may be ethically
justified provided that the patients informed consent is obtained and the
objective of a better, whiter smile, to a satisfactory professional standard, is
achieved. This paper examines the issue of informed consent, critically
considering what is legally and ethically required of the aesthetic dentist in
relation to the provision of information about cosmetic procedures,
outcomes and tooth/implant maintenance, and assesses whether the
profession currently appears to meet these requirements.

Abstracts of Oral Presentations


ETHICAL CONSIDERATIONS IN RACIAL INCLUSION FOR
CLINICAL RESEARCH
Glenn Ellis, Strategies for Well-Being, USA
glenn@glennellis.com
Clinical researchers are expected to include racial and ethnic diversity in
their study samples. The inclusion of racial and ethnic minority
participants in health research is an important step toward improving the
health of all members of our communities.
However, in actual clinical practice, how one applies this concept is not
always clear.
Minority populations have historically and consistently been underrepresented in clinical trials. As a result, important information about how
medicines work in minority populations is not always available.
Additionally, the more diverse the participant pool, the more confidence
we have of the results and their benefits for all people. For many reasons,
certain groups participate less on clinical trials than others. This applies to
researchers and investigators as well.
The difculties that researchers experience in engaging research
participants, and potential participants experience in trusting research,
are based in historical and contemporary injustices that play out in
research, but originate in the social, political and economic context.
This presentation will explore some of the historical and cultural patterns
that continue to contribute to a lack of racial and ethnic inclusion in
clinical trials in the United States for both subjects and investigators.
Solutions will be offered on strategies, which can contribute to closing this
gap.

POWER RELATIONS IN RESEARCH ENCOUNTERS:


IMPLICATIONS FOR ETHICS IN RESEARCH
Guy Enosh, Adital Ben-Ari, University of Haifa, Israel
enosh@research.haifa.ac.il, adital@research.haifa.ac.il
In this presentation we examine developments in research relationships
between researchers and participants, in terms of research ethics, power
differentials, and the construction of knowledge. We explore the
evolution in perceptions of research participants, from being used as
subjects,
through
being
considered
information-providers
(informants), to becoming full research partners. The presentation
would encompass two dimensions of power relationships between
researchers and participants, the first focusing on power differentials in
terms of social status, and the second in terms of control over knowledge
and its production. Within this framework we claim that both content and
context of the interaction are sources of new knowledge. We will discuss
the reciprocal nature of research relations, power differentials, and
control over the production and dissemination of knowledge, as they
relate to moral stances between research partners. Furthermore, we will
examine the research relations between researcher and participants and
the ways in which the encounter between their respective worldviews
contribute to the construction of knowledge.

UNDERSTANDING THE SOCIAL FRAGILITY


Antonio Esposito, Universit di Napoli LOrientale, Italy
A short story around a nursery rhyme, the meeting with fragility that hold
beauty to faces, hands, stories that have found a place. The rupture of a
model marks an occasion, another space, across the border. Into the open
is the indecipherable effort and value, part of a language that does not
want to simplification.

DOING RIGHT FOR PATIENTS: A GROUNDED THEORY ON


PHYSICIANS UNDERSTANDING AND NEGOTIATION OF
ETHICAL DILEMMAS
1

Rhodora C. Estacio , Roberto T. Borromeo


1
University of the Philippines
2
De La Salle University, Philippines
rhodora.estacio@yahoo.com

The purpose of this qualitative study is to explore how Philippine medical


practitioners perceive and negotiate ethical dilemmas they encounter in

79

their clinical practice. The study used the grounded theory method of
Strauss and Corbin with in-depth, semi-structured interviews to
understand the lived experiences of twenty eight (28) participant
physicians whose age ranged from 27-70 years.
After open coding of transcripts of interviews, axial coding and selective
coding of emerged concepts, six distinct yet related categories were
identified namely: a.) the nature of ethical dilemmas, b.) causal conditions
triggering the dilemmas, c.) contextual conditions of the ethical
challenges, d.) intervening conditions affecting the negotiation of the
dilemmas,
e.) action/ strategies in resolving the dilemmas and f.) outcome/
consequence of the decision on these ethical challenges. Several
attributes under each of the six major categories were identified by the
study.
From the results, it can be concluded that the overarching motivation of
physicians in the negotiation of ethical dilemmas is Doing Right for
Patients, the core category that emerged after analysis of data. It is the
category that ties up all the other categories and can explain the six
distinct but related subsidiary categories and their attributes. Several
factors were identified as having an influence in the decision making
process of physicians; one of which is the limited impact of the ethics
courses during their medical education. Therefore, there is need for
development of new models of medical ethics education that is more
attuned to local health problems and issues as well as strategies for
horizontal and vertical integration of ethics teaching with the rest of the
medical curriculum.

DISORDERS OF CONSCIOUSNESS AND BRAIN DEATH:


MEDICAL AND ETHICAL CONSIDERATIONS
1

Anna Estraneo , Giuseppe De Michele


1
Salvatore Maugeri Foundation, IRCCS, Italy
2
Federico II University, Italy
Medical advances in life-sustaining treatments led physicians, patients,
and families to face major ethical challenges surrounding end-of-life
decisions. Although multimodal neuroimaging and neurophysiological
studies hold significant promise for a better understanding of the
pathophysiology of disorders of consciousness (DoC), the protocols for
diagnosis and management of patients with vegetative (VS) and minimally
conscious states (MCS) are not yet completely defined. The recent
descriptions of unexpected cortical activations in patients clinically
diagnosed as VS jeopardize our confidence in the capacity to evaluate
residual brain and cognitive functions in DoC patients and trigger serious
medical, ethical and legal debates.
Here we present a brief update on recent diagnostic, prognostic and
therapeutic advances in DoC that might provide a scientific basis to guide
physicians and patients families in decision making.
Also the concept of brain death owed its origin to intensive care
advances. Diagnosis of brain death is crucial for transplantation of
completely functional organs. Criteria for brain death definition are
widely used and standardized, but significant inconsistencies and
contradictions still remain and there is no worldwide accepted consensus
on the medical criteria for determining brain death. This raises essential
questions about the ethical issues involved in withdrawal of life support
and underscores the importance of clearly separating the diagnosis of
brain death and the decision to withdraw life support from the purpose of
organ transplantation.
As improvements in medicine and technology posed profound challenges
for our traditional concepts of consciousness and life, hopefully, further
scientific advances could help us in the management of these issues.

HUMAN DIGNITY AND ASSISTED REPRODUCTION:


BIOETHICAL CHALLENGES WITHIN THE NIGERIAN
CONTEXT
Michael Etim, University of Uyo, Nigeria
michaeletim@libero.it
Reproduction is a fact of life and assisted human reproduction signifies all
those techniques which involve the manipulation of germ cells, as a
substitute for natural procedures, with the finality of achieving
reproduction. Most of the techniques intra-corporeal, extracorporeal and micro-assisted-techniques developed in assisted

80

UNESCO Chair in Bioethics 9th World Conference

human reproduction have emerged as part of the response to the


challenges of human infertility. Infertility is a major reproductive health
problem in Nigeria, the bulk of the burden of the negative impact of
infertility is borne by women. Most techniques of assisted reproduction
are available in Nigeria. It is important to have an open bioethical
reflection in the country with regard to these techniques and their use.
There is virtually no regulation with regard to assisted reproductive
technologies in the country, the recommended prospect is that the
question of the current legal vacuum, needs serious attention. It is
important for us as a society to examine the question of human dignity
and assisted human reproduction. The expression human dignity
remains complex; however, its complexity as an over-arching principle
also gives it the profundity which is important in dealing with ethical
issues, especially those that touch upon human life, human responsibility
and human reproduction.

REGULATION OF MEDICAL EXPERIMENTS ON HUMAN


SUBJECTS: THE CASE OF ANTHRAX EXPERIMENTS IN IDF
Hedva Eyal, Israel
ehedva@gmail.com
My talk will address the regulation procedures of medical experiments in
IDF by exploring the case of vaccine for the anthrax virus. The vaccine was
administered to 716 Israeli soldiers, between 1998 2006. The
experiment was classified. It was exposed in the media in April 2007, after
a number of ex-soldiers who participated in the experiment complained
about medical problems due to the vaccination.
Using the experiment as the case study, I will analyses the motives and
the reasons for the regulation failures which took place during the
experiments and exposes which interests were plays in this case.
Additionally, it explores the conduct of the military system and the
reaction of the public after the case was exposed, and how the exposure
of the case influenced the regulation procedures of the medical
experiments on soldiers.
Exploring the decision making system helps understand the role of the
secrecy and power in the regulatory system of the experiments on human
subjects. It also contributes to defining the boundaries of the discourse
regarding the medical experiments on soldiers. Additionally I will examine
the influence of the civilian actors on the policy of medical experiments in
the army; the experiments that till the case at hand remained concealed
from the general public.

THE USE OF PLACEBO IN CLINICAL TRIALS:


A MATTER STILL IN PROGRESS
D. Faillace, L. Paciello, A. Tuccillo, V. Graziano, P. Paternoster,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
The use of placebo in clinical trials is still a thorny problem from an ethical
and deontological point of view, and is still a controversial issue from a
regulatory point of view.
The issue was addressed for the first time in the fifth revision of the
Declaration of Helsinki (Edinburgh 2000).
It was first decided to reserve the use of placebo only in cases in which
there are no effective treatments of the disease which is being
experimented with. Later in the notes clarifying the Declaration
(Washington 2002) it was specified that the use of placebo may be
admitted for compelling methodological reasons, or limited to minor
situations with low risks of serious and irreversible damage.
Such provisions, however, were not accepted by the pharmaceutical
industry and by large part of medical experimenters who instead consider
the use of placebo without constraints absolutely necessary, and
therefore refer to less restrictive criteria (Good Clinical Practices, Fourth
Edition of the Declaration, in Sommerset West).
The WHO and the International Committee of Medical Journal Editors, the
so-called Vancouver Group, are on the opposite side.
So, there is opposing duality between those who trust in the Declaration
of Helsinki perceived as the bulwark of defence of people participating in
a trial, and those who show a strong tendency to shift towards standards
of research based on effectiveness and usefulness, with utilitarian
impulses.

The position of our country remains unchanged as that of reference to the


Declaration, since the operational as well as conceptual binding
compliance with the Declaration is reaffirmed in the last ministerial
decrees. It is not possible to resort to placebo if known effective
treatments are available or if the use of placebo implies suffering,
prolongation of disease or risk.
Nevertheless, it is the experience of all ethical committees, including the
Carlo Romano one, that one of the main points of never-ending
discussion within the evaluation of trial protocols is precisely the role of
placebo plays in each given trial with repeated analyses of the guarantee
margins its use allows in order to protect the interests of the health of the
patients.
Starting from those assumptions, we analyzed the trial protocols
examined by the Ethics Committee for biomedical activities Carlo
Romano between 2006, the year when the D.M. 12 giugno 2006 came
into force, which reiterated the narrowness of criteria in the use of
placebo, and 2012. We realized that out of a total of 1552 trials, 137
envisaged the use of placebo.
Studies which proposed the use of placebo in their experimental design
were carried out in the following branches of medicine listed in
descending order: neurology (22.9%), internal medicine (19.7%), oncology
(12.5%), urology (9.5%), endocrinology and gastroenterology (7.3%),
haematology (6.6%), la rheumatology (4.4%), dermatology (3.6%),
paediatrics (2.9%), gynaecology (1.5%) and finally nephrology, plastic
surgery, diagnostic imaging, and orthopaedics. Nine trials could not be
approved due to their unjustified use of placebo: 2 trials due to the
known efficacy of another medication; 2 trials due to its unjustified
risk/benefit ratio with the use of placebo; 3 trials due to poor ethical and
scientific features of its proposed design; 1 trial due to the non-specificity
of the characteristics of the placebo; 1 trial due to both insufficient
information to the patient on the use of placebo, and to the design of the
double-blind trial, which did not allow to evaluate the preparation and
the following administration of the medication and of the placebo.
Nowadays the ethics of placebo is one of the most difficult issues in the
authorization process of a clinical trial protocol.
One of the moral and educational tasks of Ethics Committees should be
that of encouraging innovative research and distrusting those trials which
appear to be more protective in terms of risks for the patients but that,
exactly for this same reason, contain imperfections in their designs.
This type of clinical trials is only apparently more ethical but as a matter
of fact may result in a failure as it does not provide information that is
unambiguous and useful to health authorities.
Therefore this type of clinical trial requires several different
confirmations, and at the end of the experimental procedure the
cumulative risk may be even greater than that of protocols which are
apparently more unscrupulous but are scientifically more rigorous.

RESPECT FOR CULTURAL DIVERSITY AND PLURALISM


Joel Farcoz, Aosta Valley Region Ministry of Education, Italy
The Universal Declaration on Cultural Diversity adopted in 20001 points to
a dual interdependence of human rights and cultural diversity. Each
principle is to be considered in the context of the others principles, as
appropriate and relevant in the circumstances. This complementary is a
requirement to reach harmony. Taking into account that we live in a
pluralistic society, the principles of bioethics need to be valid for all
communities of human being. Pluralism is a value, provided there is
mutual understanding which is to succeed making ones good intentions
intelligible to all.

HUMANISING MEDICAL ETHICS: REFLECTIONS ON A


BIOETHICS OSCE IN A SOUTH AFRICAN MEDICAL SCHOOL
Robyn Fellingham, Steve Biko Centre for Bioethics, University of the
Witwatersrand, South Africa
Robyn.Fellingham@wits.ac.za
In this paper I give an account of the current method of assessing the
learning of bioethics in the medical curriculum in the Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg. Bioethics teaching
is largely coordinated with and integrated into subject specific blocks of
medicine. As a result the approach to assessing bioethics has been similar to
the approach taken to assessing other subjects such as pathophysiology,

Abstracts of Oral Presentations


microbiology, pharmacology and public health, normally with multiple
choice or short answer questions pertaining to a given case. This integrated
approach has merits, but the form of assessment also presents some
difficulties for the discipline of bioethics, which I discuss. Following this I
describe an experimental approach that was recently taken in the form of a
bioethics Objective Structured Clinical Examination (OSCE) including a
discussion of the simulated patient, scenario and the bioethical aspects it
aimed to assess. In addition I consider some of the perceived theoretical
strengths and weaknesses of a bioethics OSCE, addressing concepts such as
the humanities in medicine, the role of bioethics in medical education, and
narrative competence in medicine and suggest that bioethics OSCEs may
have the capacity to reintroduce a human element to the study of medical
ethics. I also consider some practical issues that arose within the context of
this particular OSCE and conclude by suggesting ways in which the process
could be revised and incorporated into the general assessment of bioethics
in the medical curriculum.

MEDICO-LEGAL ASPECTS OF SEXUAL VIOLENCE IN THE


PENAL CODES OF THE HISTORIC STATES OF ITALY DURING
THE FIRST HALF OF THE XIX CENTURY
Alessandro Feola1, Sara Campilongo1, Elisabetta Bernardel2,
1
Bruno Della Pietra
1
Second University of Naples, Italy
2
Roma Tre University, Italy
alessandro.feola@unina2.it
The theme of violence against women is very up to date inasmuch, in May
2011, member States of the Council of Europe have agreed to sign the
Convention on preventing and combating violence against women and
domestic violence.
In Italy, the theme has been debated on several occasions and by many
institutions since the early days of Roman Empire with the promulgation
of the lex Iulia De adulteriis coercendis. Of particular interest, for the
number and the variety of codes, is the first half of the XIX century, before
the establishment of the Kingdom of Italy in 1861, when the country was
divided into several states such as the Kingdom of Sardinia, the Kingdom
of Lombardy-Venetia, the Duchy of Parma, Piacenza and Guastalla, the
Duchy of Modena and Reggio, the Grand Duchy of Tuscany, the Papal
States and the Kingdom of the Two Sicilies. Each one adopted its own
legal system. Analyzing the penal codes in force in the various Italian
States in the first half of the XIX century and comparing them with the
codes of the Kingdom of Italy and of the Italian Republic we can say that
are two significant key-points. First of all has been a significant evolution
of the crime, before it was considered as committed against public
decency then as crime against the person. The second point is
represented by a distinction between the crime of indecent assault and
rape present in the codes of the XIX century; nowadays these two kind of
crimes are unified into the crime of sexual violence with a technical
evolution of the medico-legal investigation.

TOWARDS AN ETHICAL ANALYSIS OF PUBLIC HEALTH


REFORM: WHY IT MATTERS AMONG THE INDIGENOUS
COMMUNITIES IN THE PHILIPPINES
Klein R. Fernandez, Australian National University, Australia
klein.fernandez@anu.edu.au, fernandez.klein@gmail.com
While epidemiological bases and the social determinants of health are
now mainstreamed in the health planning, policy, and program
evaluation, ethical analysis of public health reform programs in the
Philippines is rarely looked upon. Thus, this study explores the ethics of
public health reform in the Philippines by investigating on the structural
relationships between the national government and local government
units as the principal providers of health services to the indigenous
population. It also focuses its attention to the structural dynamics
between and among social actors present within the health system.
In here, the life-stories of rural health doctors are interesting points of
discourse for they occupy a strategic proximity in the whole gamut of
power relations in health service delivery. As they become more engaged
with indigenous communities, they possess an emphatic understanding
that borne out from their daily interaction on the complex determinants
of indigenous health. As active players, each of their experiences is an
interesting sounding board of ideas to which future policies and programs

81

can be derived in a manner that reflects the real health needs of the
indigenous communities. Out of their narratives, this study follows a
Spinozan style of ethical analysis, which puts emphasis on the interrelated
aspects of knowledge system, positioning of laden interests, and the
formation of conative power to achieve the desired health outcomes.

THE TRAVEL OF GOOD DEATH


R. Ferrara, I. Cerrone, V. Maietta, M. Paternoster, M. Niola,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
In Italy any form of euthanasia is absolutely prohibited due to the declared
prohibition of voluntary homicide for particular moral and social values,
homicide of the consenting person and instigation to and helps with suicide.
Also to Medical Deontological Code prohibits any form of euthanasia.
In other European Countries such as Switzerland, Belgium, the Netherlands
and Luxemburg there are legislations which permit those activities
extending them sometimes to foreigners too.
In Switzerland, in full compliance with article 115 of the Helvetic Criminal
Law, punishing only those who for selfish reasons instigate someone to
commit suicide or help someone do so, agencies and associations have
been created to assist and support both Swiss and foreign citizens in the
sweet death procedure.
In the last decade a considerable increase in the number of people who go
to Switzerland to commit euthanasia has been reported, thus giving rise to
the so-called phenomenon of suicide tourism.
A great impact has had, in Italy, the case of L.M., a well-known political
journalist, who decided to put end to his own life in Switzerland, alone, no
relative accompanying him, though he was not affected from any
untreatable physical disease and his life expectancy was not so short.
In our country and increasing spread of websites has been observed which
aim at publicizing the activity of foreign agencies that promote assistance
and accompanying to assist death.
Therefore, ethical, deontological, clinical and legal considerations are
required as to this particular form of assisted suicide, the more so since
requests for it come from vulnerable subjects whose end of life decisions
are conditioned by the experience of their disease.

ASSISTED PROCREATION AND ABORTION IN THE


COUNTRY BY MUSLIMS
Maria Anna Filosa, Italy
filosa.mariaanna@libero.it
The purpose of the present discussion is to outline the international
regulatory framework of assisted procreation and of the 'termination of
pregnancy. Different cultures and different social and moral values in
which they move the various countries examined makes clear that the
rights about these treatments sometimes are difficult to recognized and
protected. Some recognized abortion only in case of danger to the
mother, while others, condemn a priori, without evaluating cases and
circumstances in which this is practiced. The Islamic countries have
conflicting guidelines. There are some that prohibit any act preparatory to
be put in place this specific treatment, while others, such as Turkey, for
example, admit that if the pregnancy is the result of incest or violence. In
short, the medical-legal is divided on one of the most debated and
controversial in recent years. What most compisce as still many countries
of the Mediterranean area have over the years modernized their
conceptions of life, so as to include this also the one that apparently could
occur once and its negation, but that is not another, in some cases, a
respect for those about to be born, and especially for women, is no longer
considered as a mere procreation or incubator, but identity as free to
make their choices freely and knowingly.

WHAT WENT WRONG? THE FULL DISCLOSURE POLICY TO


THE PATIENT
Vittorio Fineschi, University of Foggia, Italy
vfinesc@tin.it
The aim of this presentation is to investigate the behavior of
odontologists in cases when medical errors occur. Again, evaluating the

82

UNESCO Chair in Bioethics 9th World Conference

feasibility of adopting a full disclosure policy and the extent to which such
a policy can help reduce administration and legal costs.
When an error occurs it has a physically, emotionally and economically
traumatizing effect upon the patient. Patients suffer a range of negative
emotions including: sadness, anxiety and depression. In addition, patients
are angered by the fact that the error was predictable and could have
been prevented and they fear that further errors or adverse events might
occur. In any case, documented research shows that the patients and
their families expect those responsible to acknowledge their error and
give a reason for the adverse event. It is well known that iatrogenic
injuries are accompanied by a high degree of tension in the patientodontologists relationship; patients want information about errors which
can occur during treatment; moreover, it is their right to receive such
information. At the same time, the odontologist staff should consider it
their moral and ethical duty to acknowledge errors and discuss them with
the patient and family.
Much more studies have to be carried out to be able to comprehend the
ethical and economic impact of a full error disclosure policy.

IMMIGRANTS! HOW ITALIAN EMERGENCY HEALTH


WORKERS PERCEIVE THE OTHER PATIENTS
Paola Antonella Fiore, Mariarosaria Aromatario, Edoardo Bottoni,
Simone Cappelletti, Costantino Ciallella, Sapienza University of Rome, Italy
paola.fiore@me.com
Millions of people are caught up in the phenomenon of migration, but
they are not statistics! They are men and women, children, young and
elderly people, who are searching for somewhere to live in peace. (Pope
Emeritus Benedict XVI, during the World Day of Migrants and Refugees
summarized the condition of many around the world with this statement.
The same concept has been stressed in the annual Statistical Dossier on
Immigration report for 2012, from Caritas Internationalis, in which the
motto chosen was: They are not numbers.
In Italy between 1990 (when the geographical reservation was
withdrawn) and 2011, there were 326,000 asylum applications (archives
of the Ministry of the Interior); it is estimated that the 8.2 percent of
Italy's population is composed by immigrants. It is also estimated that in
the 2065 the percentage of immigrants in Italy will be near to the 22.9
percent.
The Aim of the Authors is to evaluate, through a questionnaire, the
different approaches of emergency health workers of an Italian hospital
between Italian and non-Italian patients and their eventual different
management.
The questionnaire was elaborated with the collaboration of specialized
and properly trained professionals, it is based on the USA PoRS
(Perceptions of racism score), adapted on the Italian cultural contest and
integrated with other tests such as the Empathy Quotient, the Implicit
Association Test and others. The data were analyzed and processed
showing interesting results that will be presented in the paper.

THE CONFLICT "ABOUT THE RIGHT THING TO DO":


BIOETHICAL IMPLICATIONS IN SPEECH THERAPY
A.L. Fogliato, F. Balbo Mossetto, Italian Federation Speech Therapists
Piedmont, Italy
franca.balbomossetto@aslto2.piemonte.it
In the decisions that Speech Therapist is required to take in various
situations of professional life there are always two components closely
interlinked, although conceptually distinct: mastering scientific and
technical knowledge, knowing what to do and how to do it; and reference
to values. And since each of us must be aware of all these components.
Ethical dilemmas in health care are common, with the consequence that
speech therapist, in his daily professional act.
The project work developed is intended to:

verify the state of art concerning knowledge and approaches of the


speech therapist to some aspects of clinical ethics and bioethics;

investigate actual training needs inherent in bioethics.


The idea was to conduct a structured interview using an online
questionnaire; it is aimed at speech therapists, graduates, beginners and
experts, which operate in Piedmont.
From a first analysis, it is evident that speech therapists must face many
practical experiences involving ethical dilemmas and the whole structure

of work: professional relationships, institutional roles, personal/


professional identity, relationships with the patient/care-givers.
This implies that basic and post-basic training should be not only
technical, but also organizational and relational.
In fact, in the present society, it is once again necessary to recognize,
uphold and support the right of the disabled person to rehabilitation,
remembering that each individual affected by disorders of
communication has a history, values and ideas about what is important
for himself.

DISORDERS OF CONSCIOUSNESS AND AWARENESS IN


SEVERE ACQUIRED BRAIN INJURY: BIOETHICS COMPARE
WITH SPEECH THERAPY
1

A.L. Fogliato , F. Balbo Mossetto , Sara Vesco , Carla Corbella , M.Beatrici


1
Citt della Salute e della Scienza di Torino, C.T.O./ M. Adelaide, Italy
2
Local Health ASL TO2, Italy
3
Hospital Martini, ASLTO1, Italy
4
Theological Faculty of Northern Italy, Italy
angelalucia.fogliato@unito.it

The subject of consciousness has fascinated human beings at least since


the period of the early Greek philosophers. In recent years an increase of
interest concerning the altered state of consciousness was observed.
Disorders of consciousness (DOC) raise profound scientific, clinical,
ethical, and philosophical questions.
Patients in minimally conscious state, requiring individualized
communication systems and targeted therapies performed by Speech and
Language Therapists, raise numerous bioethic questions and deontology
dilemmas for healthcare workers.
A brief review of some current views of consciousness and awareness is
provided.
Will be try a brief review of some current views regarding the concepts of
consciousness and awareness. In addition, it will be analyzed what are the
main disorders of consciousness and awareness found in patients with
Acquired Brain Injury, as well as areas in which the Speech and Language
Pathology (SLP) are involved.
It will be tried to analyze references in rules, bibliography and ministries,
national and international, ethical and professional standards the speech
therapist has to comply in their professional action.

ETHICS & SURGICAL CARE IN MID-TERM DEVELOPMENT


PROGRAMS IN LOW-INCOME COUNTRIES:
A PARADIGM SHIFT OUR EXPERIENCE IN SIERRA LEONE
Marco Foletti, Paolo Narcisi, Rainbow for Africa, Italy
marco.foletti@med.unipmn.it
Injuries in low-income countries still account for a considerable burden of
mortality and morbidity, and preventable long term disabilities due to the
unmet need for surgical trauma care are ethically unacceptable. However,
several ethical issues may arise when designing mid-term development
programs addressing this problem: equitable access to surgical care,
delivery of safe surgery according to the reference standards and ensuring
long-term follow-up. On the other hand, interventions have to be
sustainable in order to produce long-term results.
The authors will present a mid-term development program implemented
at hospital level in Sierra Leone (Bombali district), co-funded by the Italian
Ministry of Foreign Affairs and being implemented by three
NGOs/Nonprofit organizations, where the aforementioned ethical issues
where addressed by shifting the focus from delivery of surgical care to
training of the local healthcare personnel.
Over the past 18 months, after having renewed the hospital
infrastructure, local healthcare personnel was trained in emergency
medical trauma care, primary surgery for trauma and rehabilitation.
The authors will then discuss the ethical issues and the proposed
solutions arisen during the ongoing training program, and particularly
those related to the selection of the training beneficiaries, development
of the training curriculum itself and ensuring safe surgery is autonomously
delivered by local personnel at the end of the program.

Abstracts of Oral Presentations


IS THERE AUTONOMY OF THE WILL FOR MENTALLY ILL
PATIENTS? WHAT ARE THE ROLES FOR PATIENTS, FAMILY,
PHYSICIANS AND LEGAL AUTHORITIES? BRAZILIAN
SOLUTIONS AND PERSPECTIVES TOWARDS THE SUBJECT
ARE OBJECT OF THIS STUDY
Washington Fonseca, Fonseca & Motta Ferreira Sociedade de Advogados,
Brazil
washington@dfnadvogados.com.br;
washington_fonseca@wfonseca.com.br
This study aims to address the ethical and legal aspects involved in the
treatment of mentally ill and vulnerable patients. Is the autonomy of their
will applicable? Can it be respected? This study intends to discuss how
authorities, families and health teams deal with these issues. Also, how
the perception of reality can affect the patients will and decisions. How
the Brazilian society handle risk-taking decisions?
Ethical and legal discussions in this regard relate to human dignity
dignity of the patient. It is ethical/ legal to provide involuntary treatment
or in opposing manifestation of his/her will?
An important question that relate to human dignity in such cases is:
Where is the legitimate border line of the State, family and health teams
in order to interfere or allow the patient to decide what is the best
treatment for him/herself?
This presentation shall allow students, law and health professionals to
understand how Brazil handles these problems and limits imposed by the
Brazilian Constitution and Civil Rights.
How can these Rights of patients who find themselves in vulnerable
conditions be protected? What actions can be taken when there is no
discernment or limited discernment? What standards and criteria are
used for these vulnerable patients?

PUBLIC ACCOUNTABILITY AND THE ETHICS OF HEALTH


CARE REFORM DECISION-MAKING IN SWITZERLAND
Carina Fourie, Verina Wild, University of Zurich, Switzerland
fourie@philos.uzh.ch
Switzerland is in the process of implementing health care reforms, which
include applying a prospective payment system for the reimbursement of
hospitals based on a Diagnosis Related Groups (DRGs) classification
system. While research is being conducted on the ethical implications of
the implementation of DRGs, such as its effects on access to health care,
thus far little attention has been paid to the ethics of the decision-making
process underlying the reform. When it comes to the ethics of health care
reform, however, it is essential to consider, for example, how and in what
way the public is consulted in its implementation, monitoring and
evaluation. This paper will contribute to filling the gap in current ethical
research by evaluating the ethics of the decision-making process related
to the Swiss health care reform using Daniels et al.s (1996) benchmark of
public accountability. More specifically, we will consider the relevance of
two criteria of the benchmark for evaluating the reform: (1) the
availability of explicit, public, and detailed procedures for evaluating
health care plans, and (2) explicit and democratic procedures for
allocation decisions. (accountability for reasonableness).
On the basis of this evaluation, recommendations will be made about
how health care reform could be implemented in Switzerland so as to
comply with fairness. The analysis and application will also provide critical
feedback for developing the benchmark further. We will argue that (1)
accountability for reasonableness should not be limited to rationing
decisions, (2) the benchmark should be supplemented with additional
criteria and (3) the normative assumptions underlying the benchmark
need to be stipulated. For the Swiss context, the last point indicates that
the relationship between direct democracy and the normative
assumptions underlying public accountability is likely to be an essential
part of achieving fairness in health care reform.

83

THE VALUE OF THE GUIDELINES AND JURIDICAL


INTERPRETATION TO PROTECT THE PATIENT
Paola Frati, University of Rome La Sapienza, Italy
paola.frati@fastwebnet.it
The gradual spread, in recent years, of recommendations, guidelines and
protocols, while bearing witness to the need of the scientific community to
order medical knowledge in cognitive systems aimed to raising standards of
quality, it has in the past reassured the judiciary who, while appreciating the
undeniable value, appears to be critical with respect to their prevalence on
the right to health of the individual patient.
The Supreme Court in its judgment emphasizes the central role of evidencebased medicine, guidelines and reliable therapeutic practices, if supported
by the consensus of the scientific community. Supreme Court remember, in
fact, as "the guidelines constitute scientific and technological knowledge
encoded, metabolized, made available in a condensed form, so that it can
serve as a useful guide to guide smoothly, efficiently and appropriate
therapeutic decisions. You try to objectify, standardize the assessments and
determinations, and rescue them from the subjectivity of the therapist. The
advantages of this systematized work of orientation as much is known
obvious. "
Both the consultant that the judge cannot use the guidelines as a tool of
preconceived ontological reliability. Is essential to evaluate the source of
origin, the characteristics of the individual or the community that produced
them, its institutional form, the degree of independence from economic
interests conditioning. Interestingly, at this point, ask yourself some
questions of substance, recently invoked in an ad hoc written on the
guidelines, questions concerning the 'Statute of guidelines covering law,
including in relation to the process of formation of the same, to their variety
or origin'. Well, recent studies give us an inkling, perhaps a little suspect,
that the recommendations proposed by the guidelines are often based on
expert opinion and characterized by low levels of evidence, making them
subject to bias and partiality scientific guidance. Also, how to evaluate the
frequent conflicts of interest among the authors of the guidelines that may
be a problem, as they may affect the neutrality of recommendations? The
sad conclusion is that most of the guidelines lack transparency as to their
development of writing and the evidence supporting the recommendations
are often of very fine scientific consistency, by deriving greater transparency
regarding the construction method of the guidelines.
The guidelines are double-edged swords? It would seem so, and after the
introduction of the law 189/2012, we have to think about the guidelines as
instruments of legal work and not just as a reference for physicians and
patients.

CONDITIONS AND LIMITS OF PROTECTIVE MEASURES


INVOLVING CHILD'S REMOVAL FROM PRIMARY
ATTACHMENT FIGURES: PSYCHOLOGICAL AND ETHICAL
ASPECTS
Tiziana Frau, Sabrina Giorcelli, and coll., Italy
tizianafrau@gmail.com
The Weltanschauung in the era of globalization, characterized by the
domination of technological power and streamlining of processes, proper
to the modernity (Weber, 1922), has increased the predominance of
technical code and functions in spite of meaning and moral-ethical
reflection (Sandel, 2008).
The removal of the real caused by self-referential technical systems, often
leads to the underestimation of the mid-long term risk (Magatti, 2012).
The arguments in support of preventive actions or analysis of mid-long
term risks, tend to be weak due to the predominance of short-term
considerations. As a result, this underestimation of the risk exposes the
social and health system to constant unexpected emergencies.
In this general framework, the concept of "life" itself is resolved only in
the biological paradigm that cannot contain the meaning of life as
existence. The human being within the biological framework, reduced to
the status of mere body, is deprived of vital relations with its history and
its memory (Foucault, 1998).
In this sense, the decision about the insertion of a child in areas different
than those in which he has built its history, impacts vital aspects and has
bioethical relevance. Such decisions severe vital links that are essential
part of the subject, and thus require an assessment that takes into
account childs attachment.

84

UNESCO Chair in Bioethics 9th World Conference

The report aims to fully explore the psychological and ethical aspects of
this important subject.

ARE THERE EVIDENCES FOR HARM IN TUBE FEEDING IN


PATIENTS WITH ADVANCED DEMENTIA?
Reuven Friedmann, Shaare Zedek Medical Center, Israel
reufri@szmc.org.il
The question whether to sustain life of a patient with advanced dementia
by tube feeding is a serious ethical one, and as long as there are no real
evidences that can clearly show harm versus benefit by the physical data
obtained by controlled studies, the judgment should be only by ethical
arguments.
The Wisely Workgroup of the American Geriatric Society suggested not
recommending tube feeding for a patient with advanced dementia. They
recommended engaging individuals and caregivers in discussions which
examine the evidence base of the procedure. But their recommendation
rely on non-controlled studies, which seems to target their results
towards the desired end point; to withhold tube feeding in the patient
with advanced dementia, which can be accepted when discussed on
ethical basis only.
Most of the studies on which these recommendations rely on ignore
some crucial points:
The methods of tube feeding defer when comparing nasogastric tube with
percutaneous endoscopic gastrostomy (PEG) tube by many means (e.g.
aspiration, restrain, metabolic improvement), but most of the studies
cited did not make this distinction, and therefore their results show bad
outcomes.
At least two controlled studies showed significant better outcome for
patients in whom the PEG was inserted while otherwise stable medically,
compared with those whose PEG insertion was done during a
hospitalization due to acute illness. The PEG insertion for the patients in
the study which showed worse result in pressure sores healing or
prevention, were all hospitalized for an acute disease at that time. There
are no details about this point in the control hand fed group.
Were the patients with tube or hand feeding in the deferent studies really
comparable? Why the patients with PEG did had tube feeding, and why
were the patients with hand feeding fed orally? Not because they defer in
their feasibility in oral feeding? The survival rate of 79.9% in 180 days in
the orally fed group obviously shows that in this group oral feeding is
feasible!!!
It is suggested to leave the debate about tube feeding in the patient with
advanced dementia to ethical debate only, till there will be real controlled
studies.

LIFELONG LEARNING AS AN EMERGING RIGHT


Laris Gaiser, EMUNI (EuroMed University), Italy
The "Lifelong Learning" Centre of Naples LOrientale University and
EMUNI (Euromediterranean University) have promoted the Manifesto for
Lifelong Learning. The Manifesto for lifelong Learning as en Emerging
Right in Euromed area, was drawn up during two international meetings
and attended by scholars and representatives of the following
institutions: Institute for Lifelong Learning of the UNESCO (UIL) EMUNI,
Cedefop, EUCEN, ANQ Portuguese, Sectorial Training Center for Tertiary
Skills of Sousse (Tunisia), Ministry of Higher Education (Egypt), Ministry of
National Education (Morocco), the University of Hacettepe (Turkey),
Anadolu (Turkey), Nancy 2 (France), Tetouan (Morocco), Lisbon
(Portugal), Arab University of Beirut (Lebanon), University of Naples
"L'Orientale" (Italy)

PSYCHIATRIC TREATMENT CONSENT AND THE SUPPORT


TRUSTEE: FROM A NEW FORM OF GUARDIANSHIP TO THE
CURA PERSONAE
Diana Galletta, University Medical School Federico II Napoli, Italy
gallettad@email.it
The acquisition of the treatment consent, based upon correct information
of the patient, is a necessary condition of every medical performance.
Psychiatric treatments, as well, are not free from such condition, but they

may present difficulties in the concrete application of the regulations.


There are several grey areas in which the consent is incomplete or
uncertain. Therefore, its reliability and its fluctuations should be observed
in time using standardized tools, in order to avoid medical and legal
consequences both for the psychiatrist and the patient.
This sort of problem was faced by the Oviedo Convention (1997) section
dealing with the Protection of persons not able to consent.
In Italy the Support Trustee law (6/04) has shifted the keystone of the
guardianship from the economic affairs, like the judicial interdiction
agencies used to do, to the protection of persons (partially or completely
devoid of self-government), changing the traditional approach to the
guardianship of the mentally incompetent.
The Support Trustee in the psychiatric field as a therapeutic instrument is
useful in those situations when the guardianship is oriented towards the
cura personae, primarily in case of poor treatment compliance.
Moreover, in some cases (e.g. psychotic patients) the Support Trustee
acts as a guarantee of the treatment continuity.
The pliability of this new tool is due to its potential adaptability to the
protection recipients specific needs as well as its flexibility to be applied
in case of partial or temporary incapability, even for a short period of
time.
The authors will discuss the potential aspects of this new form of legal
protection.

FREE AND INFORMED CONSENT TO MEDICAL TREATMENT


AND VULNERABLE PERSONS
Nicole Gallus, Universit Libre de Bruxelles; Bioethics Advisory Committee,
Belgium
ng@galluslex.be, ngallus@ulb.ac.be
The Belgian Law of 22 August 2002 on the Rights of the Patient introduces
the requirement of the patients free and informed consent for any and
all medical treatment, its corollary being the right to refuse a treatment.
For vulnerable persons, incapacitated in fact or in right, the Law provides
for the patients representation by a legal representative, a contractual
proxy or the natural protectors by default, being the persons closest to
the patient.
This system, while indeed consistent with international treaties, is based
on a mechanism of representation not readily compatible with (i) the
personal and intimate aspects of the medical intervention, (ii) the
compromising of physical integrity and (iii) the right to privacy.
To address this difficulty, the Belgian legislator has reformed the rights of
vulnerable persons in accordance with the UN Convention on the Rights
of Persons with Disabilities of 13 December 2006, by focusing on the
ethical principles of subsidiarity and proportionality of any and all
interference with the personal rights of vulnerable persons.
To achieve this aim, the reform limits the scope of the representation in
medical law and favours the extrajudicial protection considered as least
prejudicial to personal freedom and dignity. The reform also aims at
safeguarding the autonomy of vulnerable persons to the greatest extent
possible, while preserving their right to express a personal will whenever
a lucid interval or an evolution of their physical or mental health allows
for it.
The Law thus aims at increasing the role of the vulnerable person in the
decision-making process in matters which are of concern to her/him,
depending on her/his possibilities.
At the same time, a trustworthy person will assist the vulnerable person
in expressing her/his will, or express this persons presumed opinion.

EVALUATION AND ACCREDITATION OF BIOETHICS


EDUCATION IN SRILANKA
Harischandra Gambheera, National Institute of Mental Health Colombo,
Sri Lanka
hgambheera@gmail.com
Majority of Sri Lankan People do not participate in decision making by
medical professionals regarding the management of patients. Sri Lankans
are of the view that decisions are of the best interest of the patient. As in
any other developing country the health literacy and the knowledge on
bioethics amongst its people are poor and they allow physicians to decide
what is best for them. There is no public discussion on bioethics what so
ever in Sri Lanka.

Abstracts of Oral Presentations


Knowledge on bioethics amongst health professionals are also not up to
the standards and up to date. Teaching bioethics is limited to a few
lectures conducted by departments of Forensic Medicine in most medical
schools in Sri Lanka. However there is no evaluation process at any stage
in the carrier. There is no general discussion on bioethics other than a few
professional organizations discussing ad hoc.
Interest in teaching bioethics and professionalism and evaluation appears
to be increasing in the recent past in medical schools and Postgraduate
Institute of Medicine. There is a discussion on improving teaching
methods and modalities of evaluation. The UNESCO unit established in
National Institute of Mental Health is contributing to this endeavour by
conducting lectures, workshops and symposia on bioethics in various fora
in Sri Lanka.

CONSCIOUSNESS: COGNITIVE NEUROSCIENCES AND THE


PROBLEM BRAIN/MIND
Massimo Gandolfini, Ospedale Poliambulanza, Italy
gandolfini-massimo@poliambulanza.it
The theme of the consciousness has always attracted mans speculative
endeavour. Philosophy, the historical owner of this subject, today seems
weak and inadequate in view of the advances made in the so called
neurosciences which with their weighty technological support
(neuroimaging and electrophysiological techniques) propose to
demonstrate how the consciousness is strictly the product of brain, just as
muscles generate force. They are defined neural correlates of
consciousness, that are the basis and biological mechanisms which
produce consciousness, neural networks and electrical and chemical
neurotransmitters.
On a functional level, today consciousness is defined as emerging from a
complex system of integrated and stratified information and the
addition of important achievements explains the how of the
development of conscious awareness. However, to understand how
does not imply directly to understand why.
The sense organs, the proprioceptive and motor systems, the selfreflective system are certainly necessary structures for conscious
elaboration, but the extreme complexity, coupled with the absolute
individuality, are not sufficient to explain the conscious phenomena.
The neural correlates appear like a substance imprinted and lived
experience, phenomena which happen first and shape the elaborate
conscious.
It means, therefore, the reversal of the system of reading consciousness:
the co-related biological neurons are not the starting point, rather than
the life experience in all its phenomenal value.
Here is begun the virtuous understanding, in strict collaboration with
knowledge, different and complementary disciplines, which without
invading others fields unnecessarily unit each element of knowledge
which allows an understanding of consciousness, differences which
make the difference between man and all other living things.
A rigid, mechanistic model of the relationship between
brain/consciousness seems inadequate, poor and weak in the light of
neuro-scientific progress, leaving open ample space in mans knowledge
and in his behaviour, which cant be reasonably reduced to anatomical,
chemical or electrical correlations.

THE MORAL CHALLENGES OF PREDICTIVE GENETIC


INFORMATION
Gsta Gantner, University of Heidelberg (EURAT-Project), Germany
goesta.gantner@wts.uni-heidelberg.de
The establishment of Whole Genome Sequencing or Exome
Sequencing for diagnostic purposes in the health care system will
produce an increasing number of individual health related information.
But most of the expectable findings are predictive. The predictive
potential of certain genetic information can yield a new type of patient
labeled as the healthy ill. Concerning the fact that every person is an ill
health, such findings of genetic predisposition create a new class of
patients who are coming to be referred to as the asymptomatic or
healthy ill: people who have no symptoms, but are predicted to develop
1
them at some undefined time in the future. But is such an
asymptomatic person a patient in need of help?

85

By genome sequencing a large number of risk information related to


health or genetic carrier status could arise. Acknowledging oneself as a
person who will be possibly sick or as someone who eventually will beget
a sick child determines self-conception and relations to others. As
predictive genetic information can yield a new type of patient, it yields
2
also a new type of responsibility, named genetic responsibility . Such
responsibility depends on the personal genetic information and can cause
the care for oneself, for family members, for possible offspring, and for
future generations. Genetic responsibility challenges autonomous
decision making in the Informed Consent procedure and signifies the
relevance of the right to know and the right not to know.
In my talk I will show these moral challenges of predictive genetic
information by discussing the concept of genetic responsibility. I will
focus on the clinical situation, genetic counseling and the possibility to
create procedures of Informed Consent which includes also family
members.

PRINCIPLES OF RESPONSIBILITY AND PRECAUTIONARY IN


THE USE OF ANTIBIOTICS AND ANABOLIC IN CATTLE:
A COLOMBIAN EXPERIENCE
Gina Lorena Garca, Universidad de los Llanos, Colombia
ginalorenag@gmail.com, ggarcia@unillanos.edu.co
This paper is based on part of her magister dissertation for Universidad El
Bosque, Colombia.
The use of antibiotics or steroids has been a practice commonly used by
farmers in Colombia to get more out of production and profitability in less
time. Among the most used are: Oxytetracycline as an antibiotic and as an
anabolic Boldenone Uldecilinato.
These products, according to national law, must be given by veterinary
prescription; however, in practice most of the traders sell these products
without veterinary prescription. Although antibiotics and anabolic have a
specific withdrawal time (time between the date of withdrawal of the
drug in the animal and the date offered food of bovine origin for human
food market), sellers and farmers do not you know, doing that at the time
of sacrifice animals have high levels of these products in their flesh, which
represents a high risk to animal and human health.
In this case, we need to invoke the precautionary principle and
responsibility. The responsibility principle in the sale of drugs by
prescription veterinary appropriate withdrawal times and ethic of
responsibility extended to animals. The Precautionary principle, to restrict
the use of antibiotics or steroids in animals destined for human
consumption, for the consequences that may come before the high
consumption of these food products of bovine origin, such as bacterial
resistance and hormonal changes.
Similarly, these principles of responsibility and caution should be
extended to the use of animals for food production, taking into account
animal welfare. Bioethics invites us to reflect on issues such as animal
rights and welfare, taking into account the animal as a living being with
rights, by reflection off if there is need to increase food production or
livestock at all costs if must assume a responsible position in front of the
animal welfare and caution against the use of these drugs for human and
animal health.

AN INTRODUCTION TO ANIMAL RESEARCH ETHICS


Samual A. Garner, HJF-DAIDS, Henry M. Jackson Foundation for the
Advancement of Military Medicine, USA
garnersa@niaid.nih.gov
Since the rise of the modern animal ethics movement four decades ago,
the philosophical literature about our moral obligations to animals and
the ethics of animal research has reached an unprecedented level of
sophistication; this is accompanied by an unprecedented level of social
concern and advocacy about laboratory animals. However, productive
discussion about the use of animals in research for human benefit in both
the bioethics and scientific community is rare. There is a wide spectrum of
views, ranging from very permissive to complete abolition of animal
research, as well as a range of more moderate views. After a brief
overview of the kinds of harms to animals in research (e.g., physical,
psychological, and social harms, death, confinement etc.), this
presentation will examine how justification of these harms is considered
and will include a range of views from least permissive to very permissive.

86

UNESCO Chair in Bioethics 9th World Conference

Key questions include: How valuable are non-human animal lives (what is
their moral status?)? What constitutes a good justification for taking
animals lives or causing them harm? Do most biomedical experiments
provide a strong enough justification for the use of animals? Should there
be limits on the amount of harm we can cause animals, and, if so, what
should these limits entail? The goal of this presentation is not to advocate
for a specific position, but to lay out the key normative issues and to
foster productive discussion.

DEFINING AN INTERDISCIPLINARY RESEARCH


METHODOLOGY LINKING LEGAL, NORMATIVE AND
EMPIRICAL ETHICS
lose Gennet, University of Basel, Switzerland
eloise.gennet@unibas.ch
As bioethics concerns various scientific disciplines and stakeholders, it
appears to be a great challenge for a researcher to define an
interdisciplinary research methodology which would allow the exhaustive
study of a topic and the providing of knowledge for regulators.
Several distinctions as to levels and disciplines can be made: bioethics law
and jurisprudence (axiomatic level), normative ethics (axiological level),
and empirical ethics (empirical level). Linking these categories is
challenging as the axiological level includes the concept of moral. In fact,
the latter is theoretically incompatible with empirical research (Humes
fundamental distinction between the is and the ought the
naturalistic fallacy), as well as incompatible with the fundamental
objective of the law (social organization rather than promoting the good
against the bad).
The theoretical literature on empirical and normative ethics, or on the
question of an empirical research methodology in law is plentiful. Yet a
study taking into account all these theories and trying to articulate them
in order to come up with a concrete interdisciplinary research
methodology does not seem to exist. This exactly is the aim of my
contribution, which forms the methodological background of my PhD
research project on European fundamental rights within biomedical
research more precisely, on the development of an ethical concept
(combined with the medical and legal ones): vulnerability. Indeed, based
on a strong theoretical background (positivism, Ross legal realism, legal
pluralism, principlism, Rawls Wide Reflective Equilibrium, Pragmatic
hermeneutics), I will define a methodology which could serve as a tool
for every research on a bioethics related topic. In the end, this
interdisciplinary research methodology could helpfully contribute to
regulating more efficiently.

HOMOPHOBIA AND CRIMINAL LAW


Gianluca Gentile, University Suor Orsola Benincasa Napoli, Italy
gianluca.gentile@unisob.na.it
Homophobia can be defined as an irrational fear of and aversion to
homosexuality and to lesbian, gay, bisexual and transgender (LGBT)
people based on prejudice and similar to racism, xenophobia, antisemitism and sexism (European Parliament resolution on homophobia in
Europe, 18 january 2006). Discrimination and hate against LGTB people
are not only a matter of individual idiosyncrasy, but are also embedded in
the structures of some law and cultural systems. Thus, there is a Statesponsored homophobia, as shown by those 78 States (roughly 40% of
UN members) which criminalize same sex sexual acts between consulting
adults. Less obvious but still worthy of attention is a Judge-sponsored
homophobia, by which I mean the bias in certain areas of judicial
decision making (e.g. the criminal defense of "homosexual panic", which
could be used to excuse violence toward gays). Conversely criminal law
can be used as a tool to fight homophobia, as it happens in those
countries where discrimination against LGTB people is a crime or is
considered an aggravating circumstance. Therefore the aim of the paper
is to investigate how culture influences laws (State/Judge- sponsored
homophobia), and at the same time how laws can change culture (Statesponsored anti-homophobia).

MEDICATION ABORTION AND CONSCIENTIOUS


OBJECTION
M. Giammaria, G. Ciancolini, E. Marinelli, S. Zaami, Italy
giammaria.marta@gmail.com
Medication abortion (also commonly referred to as medical abortion)
consists in interrupting pregnancy using specific drugs. Its an important
alternative to the surgical abortion, the only one used in Italy until a few
years ago, that involves performing surgical evacuation of the contents of
the uterus under general anesthesia, usually after the seventh week of
pregnancy.
Although there are several drugs suitable for the purpose, used alone or
in combination, the gold standard of medical abortion involves the
administration of mifepristone (RU486) followed by a prostaglandin,
usually misoprostol.
The introduction of RU486 has recently opened new scenarios, especially
about conscientious objection of health workers: in fact, the use of
medical methods of abortion, such as combination regimens of
mifepristone and misoprostol, requires the back-up of vacuum aspiration,
in case of failed or incomplete abortion, because these drugs are not
directly feticidal. Some health professionals, according to conscientious
objection, refuse to assist in such procedures.
The paper analyzes, therefore, legal and ethical aspects of the protocol
RU486, also in the light of a recent Italian sentence (Corte di Cassazione,
sez. VI penale 02.04.2013 n. 14979), confirming a conviction for omission
of official acts, against a doctor who had refused to lend assistance to a
patient hospitalized for medical abortion.

SHARING OPINION AND PARTICIPATIVE RESEARCH: FROM


PEOPLE EXPECTATIONS TO INDEPENDENT INFORMATION
IN ORGAN DONATION EITHER IN HOSPITAL THAN IN
TERRITORIAL SERVICES
3

E. Giancotti , G. Mancini , F. Rubba


1
Federico II University Hospital, Italy
2
G. dAnnunzio University, Italy
3
Napoli 1 Centro, Transplantation & Procurement Coordination Area, Italy
fabiana.rubba@unina.it
Advances in the sharing of best practices in the donation community have
contributed greatly over the last 5 years. Broader sharing of updated
guidelines and communication campaign with improvements in deceased
donor management have increased opportunities for organ donation.
However there are still many limitations in access to transplantation
across the globe and increase in oppositions. In order to obtain insight
into opposition attitude toward donation we intended to analyze
community imagination and expectation toward donation arguments.
We use participative methodology in order to obtain the core of
informative needs concerning donation.
We choose to utilize a simple modeling of open question and required
answers by using e-mail. E-mail was sent either to health concerned
people either differently concerned ones. In the e-mail we simply asked
age, sex and whatever would be informative needs.
We choose a sample of 300 people clustered from general population
Search has been conducted among different social and age conditions:
Student, Medical doctors, youth and aged people, housekeepers, priests
Evidence were assed following semantic criteria in 30 days
Prevalent informative attitudes (ethical concern, organisational
determinants, normative topics) and area of interest were assessed.
We found an almost total adherence of respondent (97% of adherence)
5 prevalent area of interest focused on prevalent questions:
What organs may be donated
Is the donor dead
What is religions stand point
When corneal donation may be possible
Our research demonstrated how simple models of participative research
can obtain organisational handily tools. The operational next step has
been to utilize the results in order to create an informative text, question
based.

Abstracts of Oral Presentations


IN SEARCH OF A BALANCE BETWEEN TECHNOLOGY AND
HUMANIZATION IN PALLIATIVE CARE
Anna Giardini, Italy
anna.giardini@fsm.it
In Palliative Care the main aims are preserving patients dignity, by
providing pain and symptom relief, spiritual and psychosocial support and
sustaining their families in all the illness progression phases that lead to
end of life. In these moments both patients and caregivers are confused
and scared. Their desire is to prolong life but reality imposes to preserve
from futile treatments and distress.
The amazing technological evolution in all health care contexts may
increase the patients and families confusion between possibilities and
aggressive treatment, between what is possible to do and what is best to
do, between the hope for a good survival even if brief or for a prolonged
survival which may become a prolonged agony only. Each patient in
palliative care must be considered as unique; there is no correct answer
to all the issues that end-of life raises. The palliative care team should
tailor for each single individual a balanced shared decision between
technology and humanization, having always in mind that dignity must be
the center of the intervention. We should search for a new ethical
hierarchy where technology must be instrumental to humanization, the
first proposes but it is the latter that gives the direction.

A MOTIVATIONAL INTERVENTION TO IMPROVE


PERSONAL AND PROFESSIONAL WELL-BEING OF NURSES:
A MIXED-METHODS STUDY
1

Andrea Giordano , Anna Castaldo , Miriam Magri , Claudio Cavalieri


3
4
4
5
d'Oro , Donatella Camerino , Paul Conway , Talia Melo Ferrari , Gaetano
5
5
2
de Angelis , Mariangela Corbo , Giovanni Muttillo
1
Foundation IRCCS Neurological Institute C. Besta, Italy
2
Milan Nursing Council (Collegio IPASVI), Italy
3
International virtHuman
4
University of Milan, Italy
5
San Raffaele Hospital, Italy
andrea.giordano@istituto-besta.it
Objective: To evaluate the impact of a motivational program on personal
and professional well-being of nurses, and to explore the experience of
the participants in order to better understand the effectiveness of the
intervention.
Methods: Between January-June 2011, 102 nurses participated to a
motivational program (virtHuman). This program was based on a
combination of different educational techniques, and consists of a twoday session (T0), a three-week interval, and other two-day session (T1).
One educator held the program with the aim to increase self-competence
in participants private and work-life. Participants completed the selfreported OSME (Organizational Stress Management Evaluation)
questionnaire at T0 and T1. A qualitative synthesis of the program was
also performed using content analysis. Data were collected from work
groups held during the program and divided into the following domains:
intention to change the current behavior, and barriers/facilitators to such
changes.
Results: One-hundred and two nurses successfully participated to the
program. Mean age was 43 (7.5) years, most were women (89%) and have
college education (95%). Participants demonstrated significant
improvements both for OSME personal well-being (mean change 3.9,
[7.7]; p<0.001), and for OSME professional well-being (mean change 3.4,
[7.4]; p<0.001) subscale scores. Qualitative findings showed that the
program was appreciated, increasing participants awareness of different
communication strategies. Moreover, participants identified several
aspects (e.g. healthy egoism, autonomy, professional acknowledgment)
that could facilitate positive behaviors either in private or work-life.
Conclusions: The motivational program was well-accepted by nurses, and
results emphasize the potential benefits in increasing positive behaviors
across life domains.

87

INFORMATION, AWARENESS, DECISION-MAKING:


OBSERVATIONAL STUDY OF CLINICAL ETHICS APPLIED TO
PROGRESSIVE CHRONIC DISEASES
I. Giorgi, A. Giardini, L. Moroni, D. Pain, V. Esposito, M. Padovani,
P. Baiardi, G. Villa, C. Pasetti, Fondazione S. Maugeri, Clinica del Lavoro e
della Riabilitazione IRCCS, Italy
carlopasetticp@gmail.com
Introduction: in the Italian culture an ethically complex issue encountered
relatively commonly by health care professionals is the family requests for
nondisclosure of advanced disease prognosis.
The aim of this observational study of clinical ethic was to assess patients
disease and prognosis awareness, and to assess the knowledge of new
tools, such as the Advance Directives. In addition, the association
between quality of life and decision making process in end-of-life was
analyzed.
Material and Methods: upon Informed Consent, 123 (M=74, F=49; aged
58-75) inpatients with progressive chronic diseases were assessed in
Cardiology (30), Hemodialysis (38), Neurology (23) and Palliative Care (38)
Units. Patients compiled the Information about disease and therapeutic
decisions Questionnaire (created ad hoc for this study) and the Mc Gill
Quality of Life Questionnaire (MQOL-It); caregivers, when available, were
administered the Caregiver Needs Assessment (CNA).
Results: QoL scores did not differ significantly among diseases except for
ALS patients, which reported lower scores in the Physical dimension.
Generally, 87% of patients stated a good disease awareness and only 11%
expressed their preference not to be informed by doctors in case of poor
prognosis. Only few patients reported a correct definition of
Overtreatment (23%) and Invasive procedures (57%), moreover 72%
did not know the meaning of Advance Directives. Caregivers (n=48) did
not show Information and Support needs.
Conclusions: As to end-of-life ethical issues further interventions in order
to improve patients decision making processes and to promote in
clinicians effective skills to communicate bad news are necessary.

RESPONSIBILITY CONSTRUCTION
Ines Giorgi, C. Sguazzin, Marina Manera, Italy
ines.giorgi@fsm.it
This talk focuses on the integration between responsibility principle and
hope principle according to Blochs perspective. In this theoretical
framework four clinical cases will be analyzed. Patients histories of life
and diseases offer breathing spaces about therapeutic choices and
sharing of responsibility through relations with different health care staff.

PRINCIPLES AND ISSUES IN THE EVALUATION OF


PARENTAL COMPETENCY IN ISRAELS ARAB-MUSLIM
COMMUNITY
Emad Gith, Psychological Services of Araba and International Center for
Health, Law and Ethics Haifa University, Israel
emadgith@gmail.com
For Arab Muslim citizens of the State of Israel, the Islamic religious court
(the Sharia) is the legal body authorized to deliberate and rule in cases
involving child custody, adoption, and guardianship. Under Sharia law,
mothers have custody of boys and girls until ages seven and nine
respectively, after which they are transferred to the custody of their
fathers. In the absence of a father, children are transferred to the custody
of their grandfathers.
The Sharia court is asked to rule in cases of parental competency, and to
do so it commissions a professional psychological assessment of parental
competency. Since it is culture-dependent, this assessment notably
involves a number of professional and ethical issues, while addressing the
following facts: the Arab civilization is a collective consisting of clans
(hamulot); mens status is higher than womens; and the parental duties
of fathers and mothers are very different.

88

UNESCO Chair in Bioethics 9th World Conference

Since psychological evaluation of parental competency refer to general


diagnostic data and authorized tools, they are not tailored to match the
Arab population. Almost all psychological services and mental health
centers employ psycho-diagnostic tests that, among other things, test for
the general level of intellectual performance. Yet, most examiners agree
that they must rely on their own experience and professional skills in
order to determine the etiology of a case or reach a diagnosis that reflects
the inner emotional or intellectual reality of a subject. Since the model for
evaluating parental competence in Israeli society in general is culturedependent, it is not practical for the Muslim community.
Therefore, there is a need to construct an evaluation model that
addresses this issue. Such a model must be based upon the principles of
Sharia law, take social differences into account, and provide psychological
tests that are tailored to the cultural context of Muslim Arabs in Israel.

THE DILEMMAS OF THE TRIAL PATIENTS WITH END-STAGE


Mario Giuliano, Sabino De Placido, University of Naples, Federico II, Italy
Despite significant advances achieved in cancer treatment and prevention
in the last decades, oncological diseases represent the leading cause of
death worldwide, accounting for 7.6 million deaths (around 13% of all
deaths) (2008 Globocan Data. http://globocan.iarc.fr/). Therefore,
evaluating novel anti-cancer therapies remains a major priority. Clinical
research is conducted following a series of steps, called phases; each
phase is designed to answer a separate research question. Phase I clinical
trials are the initial step of clinical research in human subjects and their
main goal is to evaluate drug safety and applicability. The use of healthy
volunteers to test new anti-cancer drugs in these trials is not appropriate
because of the likely side effects. Consequently, terminal cancer patients
who have exhausted all the conventional therapeutic options or for whom
there are no known therapeutic possibilities are typically selected for
these trials. In this perspective, early-phase trials can represent real
therapeutic opportunities for terminal patients, as well as crucial
gateways to the development of new anti-cancer therapies, possibly
useful for the entire cancer population. However, in these studies the
potential for therapeutic benefit is often low and the probability of side
effects high. Thus, there is considerable debate about the ethics of
terminal cancer patients participating in early-stage clinical trials. We
conducted a comprehensive review regarding all the ethical and legal
aspects of clinical research in terminal cancer patients.

COMMUNICATING BIOETHICS WITHIN FAMILY CONTEXT


Pasquale Giustiniani, Italy
pgiustiniani@libero.it
The Declaration no. 32 of the European Parliament stated that 2014 will
be the European Year for the reconciliation between working life and
family life. Conciliations policies are intended to provide tools that can
concile working sphere and family sphere, allowing each individual to live
as best as possible the multiple roles it plays inside increasing complex
societies.
Probably, the term conciliation is still too weak, since it records and
implies the existence of a conflict, of a logic that pits the job considering
it as a place of exact procedures, of schedules, rules, and management
and family, which on the other hand seems a sensitive place, an affective
environment made of warm and emotional relationships without clear
rules because nobody can rule the heart...
On the one hand the cold working environment, on the other hand the
warm climate of loving relationships, considered as an essential
condition for design and management of notable bioethical issues:
planned parenthood, procreation of new human lives, safeguard of the
nascent human life, initial choices about the schooling of those who are
the youngest members of the community, the division of responsibilities
between the couple and, first of all, the issue of the education.
The current trend is to educate and to form younger generations with
the sole purpose of making them capable to assume, at due time, their
own life orientation.
Reassert the value of education means to invite to pay attention not only
on the transfer of noetic packages or knowledges from one
generation to another, but also on the proposal (made with the aim of
orienting towards autonomous choices) of values, trends, ways of being in
the world and, above all, of family models even traditional ones (like
those related to the heterosexual family based on marriage), with which

the younger generation must face in order to make conscious and mature
choices.
In this direction, our research group proposes to exceed the terms of the
conciliation, speaking rather of harmonization, both within the intrafamily dynamics and in the relationships between labor (defined as the
area of productive work) and family (understood not only as a
consumers unit, but as a group that produces a social capital).
From a bioethical and biopolitical point of view, all these argumentations
lead to the following consequences:
1. The bio-political governance of future and new families will no longer
apply the logic of contrast between work and family, as if there is an
opposition between the strict world of the market and the more
flexible rhythms required by the familial relationship.
2. The education in the medium and long term will have to invite the
younger generation to a process of mentalization, in which the
following bioethical themes will have an increasing relevance:
a) careful and informed management of human sexuality and fertility,
in a quest for a balance between different possibilities offered by
modern technologies in the field of medically assisted
reproduction (this one, moreover, is a field of new work close to
the family);
b) growth of affective, relational and sexual bonds of couple, who will
have to become more compatibles with times and regulations
still too strict of work environments, organizations and places;
c) relevance of the educational element, and not only in terms of
instruction and formation, in the definition of the essential
features which must have new families, which are small producers
of relational and social capital, giving priority to the themes of
human care, equal gender opportunities, welfare of children and
young people.

NARRATIVE AND THE CODE OF ETHICS:


THE INSTRUMENTS FOR AN ETHIC REFLECTION
ON NURSING PRACTICE
Paola Gobbi, Giovanni Muttillo, Rosa Anna Alagna, Anna Brunoldi,
Maria Grazia Castoldi, Anna Maria Gallo, Lorena Marioni, Claudia Passoni,
Debora Rosa, Milan Nursing Council (Collegio IPASVI Milano, Lodi, Monza
and Brianza), Italy
paola.gobbi@ipasvimi.it
Objectives: The aim of study was about the narrative of nursing clinical
cases with an ethic value.
The research questions were: Does the Code of Ethics represent a
useful/valid instrument for a nurse who has to take a decision concerning
an ethic problem in everyday nursing practice? Each focus group (FG)
focused on the written narrative of real cases that happened in hospital
general units.
Materials and Methods: From October 2009 to February 2011, a monthly
FG was carried out at the IPASVIs venue, for a total number of 12 FG. The
participants were asked to describe a real experienced clinical nursing
situation which generated an ethic problem in the multidisciplinary team.
Topics were: nursing in preterm newborn, respect of the living will of
patients, informed consent, administering of abortion pill, nurse roles in
clinical trials.
The analysis was conducted using: the Code of Ethics articles related to
the problem and other documentations referring to the specific topic.
Results: Research questions were confirmed in 9 cases out of 11: nurses
take decisions also about ethic-deontological problems with reference to
the relation with the other person, with the patient, the family and the
colleagues. The Code of Ethics represents a useful, valid instrument that
can be used in nursing practice.
Conclusions: Study was the starting point for a change that is already
being carried out: a group of nurses systematically is meeting to share
through narration their professional experience which cant be eluded by
nursing profession.

DICTATORSHIPS REFLECT SOCIETAL FAULTLINES


Digvijay S. Goel, Southland Hospital, New Zealand
Digvijay.Goel@southerndhb.govt.nz
Objectives: Dictatorships afflict nations across the world randomly, from
Africa where primitive man evolved to Greece, the cradle of western

Abstracts of Oral Presentations


democracy. What does Hitlers Germany have in common with Pol Pots
Cambodia, Stalins Russia with Pinochets Chile, Mussolinis Italy with
Maos China? Are these random acts of God, or do they reflect a deeper,
shared malaise which renders these otherwise culturally, economically
and politically diverse countries vulnerable to despotic rule? This
intriguing question admits no ready, simplistic answer. The issues
involved are complex and merit interrogation from sociological and
psychological perspectives.
Purpose: To examine the proposition that identifiable societal faultlines
may have contributed to the divergent trajectories followed by India, a
vibrant, if at time chaotic democracy, and Pakistan, chronically under
military rule, following their creation in 1947, despite their common
ethnic, cultural and political heritage.
Methods: India and Pakistan were one country, one people, one
civilisation when they gained independence from British rule in August
1947. Subsequently, however, the two nations have followed divergent
trajectories. Using the case study method, the presentation examines
historical evidence to identify the causes underpinning this dichotomy.
Results: The roots of military dictatorships in Pakistan may be traced back
nearly three centuries to the ideological heritage of Shah Waliullah (170362), militralised into jihad by Sayyid Ahmed Barelvi (1786-1831),
articulated in an anglicised lexicon by Syed Ahmad Khan (1817-1898),
eventually culminating in the Pakistan resolution passed in March 1940 at
the Lahore session of the Muslim League. While Jinnah used the divisive
doctrine of distance to achieve his goal of a separate Muslim homeland,
he envisioned Pakistan as a modern, secular nation. Soon after his death
in 1948, however, Pakistan embarked on the path of Islamic
fundamentalism crafted by the Godfather of Pakistan, Maulana Maududi,
and carried to its inevitable culmination, the Islamization of Pakistan and
the perpetuation of military dictatorship by the Gods General, Zia ul Haq
Conclusions: Dictatorships mirror deeply entrenched and complex
societal faultlines going back in time which, given a fateful combination of
social, economic and political factors, widen and swallow democratic
institutions. Nations need to look back into their collective historical
unconscious to identify and deal with these critical issues if history is not
to repeat itself.

TOBACCO CONTROL POLICY IN THE EU:


PROTECTING PUBLIC HEALTH IN THE FREE MARKET
Iris Goldner Lang, University of Zagreb, Croatia
igoldner@pravo.hr
The negative effects of tobacco on public health have been subject to
concern and regulation by the EU for more than 20 years. Since the late
1980s the EU has been enacting tobacco-control legislation with the aim
to regulate tobacco products and restrict tobacco advertising. Its
objective has been to provide harmonised standards for tobacco
products, ensure consumer protection and curb tobacco consumption.
Having in mind public health risks, EU tobacco policy has, through the
years, become ever more restrictive, with the basic intention to
encourage tobacco users to quit, prevent tobacco initiation and protect
citizens from second-hand tobacco smoke. However, despite visible
achievements, the fact remains that smoking-related diseases are the
single largest cause of death in Europe today. Tobacco accounts for
700,000 deaths in the EU each year, with almost half of those dying
between 35-69 years of age, which is well below average life expectancy.
This paper will address the key EU legislative measures in the area of
tobacco control: the Tobacco Advertising Directive and the Tobacco
Products Directive. It will analyse the Proposal for a new Tobacco
Products Directive, its reasons, open issues and benefits. Special attention
will be laid on the balancing between the public health concerns and free
trade of tobacco in the EU. The nature of the public debate and, especially
the strategies pursued by the tobacco industry will also be taken into
account. The paper will conclude by examining areas where improvement
of the current tobacco control policy is still possible.

89

NURSES DIFFICULTIES TO TALK WITH PATIENTS IN THE


END OF LIFE ABOUT HEALTH CARE DECISIONS
1

Juana Mara Granero-Moya , Ins M. Barrio-Cantalejo ,


3
4
Antonio Fras-Osuna , Pablo Simn Lorda ,
Antonio Jess Ramos-Morcillo5, Serafn Fernndez-Salazar6,
3
Laura Parra Anguita, Pilar Pea-Amaro
1
Hospital S. Juan de la Cruz, Spain
2
Centro de Salud Almanhayar, Spain
3
Universidad de Jan, Spain
4
Escuela Andaluza de Salud Pblica, Spain
5
Universidad de Murcia, Spain
6
Hospital Sierra de Segura, Spain
nanigranero@gmail.es
Objective: To know the community nurses difficulties to talk with
patients in the end of life about health care decisions for their future.
Design: Qualitative methodology.
Location: Basic health zone.
Participants: Community nurses who are caring people in the end of life.
Main interventions: Fifteen recorded interviews after informed consent.
Analysis: transcription of speeches, coding of texts and grouping in
categories.
Results: Nurses find difficulties to talk with the patients about topics of
the end of life. These difficulties are: little time to talk, the familys role,
the patients beliefs, few communication skills and little training in these
topics.
Conclusion: Talking with people who are in the end of life about their
wishes or their values for this stage can be very positive. This can improve
the patients' autonomy, reduce their suffering, avoid entries in ICU and,
moreover, reduce the cost of health care in the last days. But, it needs to
improve nursing education and to introduce communication skills in the
usual practice.

THE CESAREAN SECTION UNDER MATERNAL REQUEST:


ETHICAL LEGAL IMPLICATIONS
V. Graziano, M. Paternoster, P. Di Lorenzo, M. Niola, C. Buccelli,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
The Cesarean section under specific maternal request implies complex
and sensitive ethical- deontological issues.
These issues bring about a difficult dialectic confrontation between the
fundamental right of the patient to free self-determination in the choice
of type of delivery as well as treatment and respect of the physician to act
freely, without any imposition, according to the present scientific
knowledge with reference to fundamental ethical values (articles 4 and
13, Medical Deontological code 2006) in the very interest of the patient
and in compliance with ones own professional dignity.
It has been often argued that a maternal request of a Cesarean Section
not justified by medical reasons does not conflict with the more general
principle of safeguard of health because it would be a therapeutic act
aiming at avoiding possible psychic damages related to labors pains and,
most of all, hypothetical damages to the fetus.
Such as argument makes the right to health prevails over the simple
obligation to preserve physical integrity and also in the light of the Italian
Constitution provisions analogously to what prescribed for voluntary
sterilizations and plastic surgery leads to the tenet that the voluntary
Cesarean section, deprived of strictly therapeutic motivations, does not
clash with any principle of legal legitimacy.
However, the refusal by the physician to carry out the voluntary Cesarean
section appears to be absolutely legitimate where the latter contrasts
with his/her technical- scientific as well as ethical-deontological
convictions provided that, of course, such a refusal does not immediately
and severely jeopardize the health of the assisted person.
In this respect, article 13 of the Code of Medical Deontology recognizes to
physicians the possibility of making their own choices of behavior in some
fields of activity.
Therefore, when no considerable and immediate injury is caused to the
pregnant woman/fetus (election situation) the medical decision is given
priority, whereas in case of great urgency the will as expressed by the
patient must be accepted.

90

UNESCO Chair in Bioethics 9th World Conference

In any case, the clinical condition that lead to the Cesarean section (under
the patient request and /or under the physicians proposal) as well as
those conditions that results in failing to perform it (even through under
election request) should be duly reported on the patients medical record
and documented by various examination i.e. imaging, lab tests and
specialistic consultation.
As conclusion to provide the patient with the correct information is
fundamental not only to obtain her consent concerning therapeutic
options, but most of all, to favor therapeutic choices that do not have any
negative impact both on the pregnant patient and the fetus.

LIVING WILL ACCORDING TO THE ITALIAN ACTS


Rosa Guarino, CIRB, Italy
rosaguarino@alice.it; guarinorosa3@gmail.com
The living will indicates the will of someone, when in his ability, expresses
the medical treatments he wants or not, when for any case he needs
them, especially when is not possible for him to express his dissent. This
document is considered an advanced directives concerning the treatment
even if the advanced instruction is a general direction expressed by the
patient in order to know which medical treatments he wants or not to
undergo. The living will indicates a very defined declaration containing
also the assistance for the religious purpose and the humanization of the
death.
It must be considered a very special object because it is referred to the
human life and in particular it is disputed for its legal characterisation. We
can easily understand that the living will in Italy is different from the will
expressed in the art. 598 c.c., for his effectiveness inter vivos and his not
patrimony act. We might even consider this phenomenon as a unilateral
atypical act according to art. 1324 e 1322 II comma cc. However, to
ascribe to it a legal value it should be compatible with the principles of
the legal system. The living will might be used to introduce to euthanasia,
forbidden in Italy because in contrast with the principle of human life
itself.
According to the jurists the question deserves a lot of attention because
the will is expressed when the patient is in his faculties and applied when
is no longer conscious. The living will should solve a lot of problems
referred to contemporary medicine: the technicality of medicine, its no
longer being human and incoming help from machines. It is going to be
very difficult the approval of the law concerning the living will and even
more difficult if the problems at the base are not solved.

BIOETHICS BETWEEN SCIENCE AND RELIGION


Willis Guerra, Flora Strozenberg, Edna Raquel Hogemann,
Federal University of Rio de Janeiro State, Law School, Brazil
willisguerra@hotmail.com
This paper presents some recent bioethics issues that have provoked
great polemics in Brazilian scientific, legal and politic circles. As one of the
major catholic nations, Brazil has a strong religious influence in its
national life.
Thus, abortion even in the case of anencephalic fetuses brings out
direct and indirect influence of the Catholic Church.
The direct influence can be seen through catholic organizations, but more
important is what can be called the indirect influence, i.e., the JewishChristian moral operated not only by the opponents but also by the
defenders of the cause.
The controversy was so dramatic that the constitutionality of the issue
was judge by the Brazilian Supreme Court. Transformed in a political
judgment, the legal procedure brought as amicus curiae scientific
associations pro and against the abortion and the Confederation of
Brazilian Bishops.
The judges took years to give a sentence, in part due to the direct
pressure of the Church and in part due to peculiarities of the Brazilian
legal system.
Finally, after examining the concept of life in the light of religion, law and
medicine, it became clear that in a lay state such concept is not a
monopoly of one science, even if this science is medicine. The legal
concept of life can and should be defined by the law and by the Brazilian
legal procedures.
The judgment pointed out that although medicine can be of much help
philosophy reveals itself as the best source of robust answers to these
issues.

ETHICAL AND SOCIAL ISSUES RAISED BY RECENT


RESEARCH IN EPIGENETICS
Caroline Guibet Lafaye, Philippe Descamps, Centre Maurice Halbwachs,
France
caroline.guibetlafaye@ens.fr, descamps.phs@gmail.com
For a few decades new advances in epigenetics research have highlighted
some biological effects that the standard genetic theory could not expect.
Thereby, the effects of methylation are likely to change substantially
ones genome expression and to be transmitted to the offspring and,
thus, affect several generations of descendants.
We attempt to highlight the ethical and societal issues raised by these
discoveries. As a first step, we will compare these issues to those raised
by genetic information. However, some issues are inherent to the specific
characteristics of epigenetic information, particularly concerning the
potential reversibility of these processes. We will then determine the
specific ethical issues raised by epigenetics, regarding four main areas:
1. Concerning intergenerational justice, the discoveries in epigenetics
raise the question of the responsibility of ascendancy towards its
descendants. Indeed, the behavior of the first might influence some
pathologies for the latter, mainly because of the heritability of
epigenetic modifications.
2. The epigenetic data also raise specific issues about environmental
justice to the public policies which we have to describe and clarify,
particularly in terms of liability and compensation for damages in
terms of environmental risks.
3. Epigenetics also raises issues about confidentiality and respect for
privacy, since the history of ancestry, and not only access to individual
genetic data, might provide therapeutic approaches or justify refusals
from insurers.
4. Finally, in terms of public health, taking into account epigenetic effects
raises the question of the division between policy and parental
responsibility.

COMMUNICATING ERRORS AND LEARNING FROM OWN


ERRORS: THE MEDIATION AS EDUCATIONAL INSTRUMENT
M. Gulino1, G. Montanari Vergallo1, F.P. Busard2, S. Serinelli1, P. Frati1
1
Sapienza University of Rome, Italy
2
University of Catania, Italy
matteo_gulino@libero.it; matteo.gulino@uniroma1.it
As for other professional activity, medical care includes the risk of
possible injuries and damages for final costumer. Technological progress
may contribute to make medical activity more complex, increasing the
number of medical claims with new specific medical errors. The
traditional legal system protects the quality of medical care, though it not
represents always a hundred per cent valuable solution. The risk to be
involved in a lawsuit makes doctors more reticent from share their
medical errors. Patient safety and improvement of medical care quality
represent the main goals of the clinical risk management that focuses its
activity on risks and medical errors reduction. Several studies showed the
relevance of communication in the patient-physician relationship and the
need to promote a more open-dialogue between patients and health
professionals.
Mediation may be included as a useful tool to promote dialogue between
parties and to minimize financial losses. Mediation gets parties to the
table and allows them to hear explanations behind medical errors or
complications and to hear apologies. Mediation is also useful for
collecting and reporting data on medical claims, in order to learn from
mistakes and improve quality of medical cares delivered by hospitals.
Taking into consideration the current Italian legislation ruling mediation in
the field of medical malpractice litigation, the authors will argue and
discuss the main barriers to alternative dispute resolution and how
mediation can be used to reduce medical errors.

Abstracts of Oral Presentations


BIOETHICS EDUCATION IN CLINICAL RESEARCH WITH
MODEL TOOL
1,2

1,2

Arja Halkoaho , Ville Leinonen , Kirsi Luoto , Tapani Kernen


1
University Hospital of Kuopio, Finland
2
University of Eastern Finland, Finland
arja.halkoaho@kuh.fi

Background: In clinical research scientific, legal as well as ethical aspects


are important. It is well known that clinical investigators in university
hospitals conduct their PhD-studies alongside their daily work. A
reconciliation of the work and studies are challenging. Aim of this project
was to create a web based learning environment (5 credits) in clinical
research bioethics and to find out if this method is suitable for teaching
bioethics. The course comprised of six modules: initial examination (to
assess knowledge in bioethics), information on research legislations and
permits of authorities, and writing an essay on research ethics,
preparation of own study protocol and final exam. All assignments were
designed with an idea that students can reflect them in their own
research.
Participants: 57 PhD-students (medical, nursing and dental sciences)
started and 46 completed the course.
Methods: Course evaluation was done by a questionnaire and the
response rate was 78%. Data were analyzed using quantitative and
qualitative content analysis.
Results: Course was seen useful and technically easy to perform. Students
were content with the guidance and teaching. Personal feedback from
teachers about own study was seen advantageous and increasing
understanding about own study. Course was also considered as valuable
for future research projects.
Conclusions: Ethical issues and legislation of clinical research can be
adopted more easily when students can reflect the principles upon their
own research project. Web Based teaching environment is a feasible
learning method for clinical investigators.

PRIMUM NON NOCERE V. CAVEAT EMPTOR


Ross W. Halpin, University of Sydney, Australia
rwhalpin@gmail.com
Commercialism: A new threat to medical ethics
The barbaric actions of Nazi doctors in medical research during the
Holocaust were the genesis of the creation of the Nuremberg Medical
Code of Ethics. It was expected this code and codes established by the
research institute, would be recognised, applied and respected by
governments, medical research centres, institutions, such as universities,
and pharmaceutical companies, funding and marketing drugs and
therapies.
For centuries medical practitioners have committed themselves to the
Hippocratic Oath the main tenet of which is to do no harm. Here again
German doctors in the name of ideology abandoned the Hippocratic Oath
during Hitlers term.
st
However in the 21 century are ethics at risk again? Has the scourge of
ideology as existed in Nazi occupied Europe been replaced by
commercialism. Has anything been learned from the Holocaust? What
factors have caused medical ethics to be undermined and even
abandoned?
Recent cases in which pharmaceutical companies as Pfizer, Glaxo Smith
Kline, Merck & company, Eli Lily have either incurred substantial fines or
have been subject to legal action is evidence that these companies have
conducted research and marketing unethically and illegally. In the
majority of indictments against pharmaceutical companies in the United
States over the past decade they have been found guilty of marketing and
selling off-label drugs aimed at the most vulnerable in our society;
children, adolescents and the aged. Deaths have occurred due to the
incorrect use of these drugs.
Research conducted in third world countries and sponsored by
universities, pharmaceutical companies and governments deemed
unethical and/or unscientific could not be authorised or conducted in
western developed countries. Some human experiments have resulted in
death.
Profit, it seems, has over-ridden ethics and humanity. Major
pharmaceutical companies are pressured by shareholders to maximise
profits and by governments to produce drugs that will be cost effective to

91

the health systems that in some cases are edging closer and closer toward
bankruptcy.
In respect to pharmaceutical companies profit and market share have
become the holy grail of both research and marketing. Has ethics been
overridden by commercialism and if so what are the repercussions?

CURRENT SITUATION AND ISSUES OF CONTINUING ETHICS


EDUCATION IN NURSING
Yuko Hamajima, Tokyo Medical University Hospital, Japan
mond.s24@gmail.com
Nursing ethics is gaining increasing importance due to changes in society
such as an elevated awareness of rights, advances in medical technology,
and the diversification of individual values in Japan. As a result of these
changes, nursing ethics has been a part of Basic Nursing Education at
schools and universities since 1997, when nursing ethics was inserted into
educational subject matter by nursing school regulation. However, the
methodology of nursing ethics is not concrete and confirmed. There is a
significant gap between growing ethical demands and the training offered
to deal with those demands. This gap is most pronounced in clinical
practice. Ward nurses in Japan face an average of one to three ethical
dilemmas each month, and as such, they need a methodological
framework to resolve these issues. Two areas can significantly improve
the nursing ethics framework in Japan: The first is through continuing
education. Unfortunately, there are currently no broadly accepted
guidelines for continuous education (CE) in nursing ethics. Each hospital
has different CE programs, and only 46 university hospitals (60% of all
university hospitals in Japan) include nursing ethics in their continuous
education programs. Among the programs that do provide ethics training,
there are no comparative or educational targets, and the content is not
comprehensive. The second is to utilize the bioethics committee, which
has been promoted by the Japan nursing society since 2006, for
discussion. Unfortunately most ward nurses underutilized this committee
due to time constraints or insufficient recognition.

BIOETHICS AND ITS CLAIMS FOR COMPETENCY


Jan Hartman, Jagiellonian University Medical School, Poland
jan.hartman@uj.edu.pl
Answering this question is of special importance in bioethics. What
depends on that issue is whether bioethics is rather to be a casuistry, a
kind of reflection supporting legislative processes and public discussions
on urgent scientific and medical problems, or is it supposed to take place
within the speculative core of moral philosophy, as its fully fledged part.
Myself, I opt for the pragmatic program and therefore for limiting of the
theoretical aspirations of bioethics, so that the circles dealing with these
issues acquire rising political significance. My argument is quite simple:
Hard practical philosophy, classical ethics and politics, rooted in its
traditional teachings from Socrates to Hegel does not provide us with
discourses congenial with the original theories of great philosophers,
discourses which would enable us to pass from general theory to detailed
practical problems, which are the true focus of bioethics. Thus, we have
the choice: either a conventional, fake references to classical thought in
morals, ornamenting the popular easy-to-understand arguments, typical
for bioethical discourses, or a sharp separation of the ground of hard,
speculative ethics from the ground of practical legal and political
argument, for which bioethics should constitute an effective intellectual
background, increasing its relevance and competence. My choice, to
repeat, is a self-limitation of the theoretical aspirations of bioethics in
view of its disability to catch up with the speculative advancements of
general ethics (which is due to its lack of practical relevance, by the way)
and taking into account the urgent social need for an effective intellectual
support for legislative processes and public discussions in the field of
medical and ecological practice. In my lecture I will present examples
illustrating my point.

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UNESCO Chair in Bioethics 9th World Conference

THROUGH THE SPECTACLES OF TOMORROW:


TOWARD A CASUISTIC MODEL FOR GUIDING CHOICE
IN HUMAN ENHANCEMENT ISSUES
Anders Herlitz, Sweden
andersherlitz@gmail.com
In this article, I address the question: How should liberal democratic
societies deal with new human enhancement technologies that arise?
We have, or should at least, move beyond the stage where human
enhancement is discussed categorically, convincingly addressed by Alan
Buchanan. Instead, we need to deal with new enhancement technologies
on a case-to-case basis, what Buchanan somewhat misleading calls a
balancing approach. Some human enhancement technologies are
good/acceptable. Some are problematic. Establishing guiding principles
will assist us in distinguishing acceptable from unacceptable
enhancements. Plausible examples include: precaution, justice, individual
liberty. In practice, principle-driven thinking will resemble a casuistic
approach that creates a taxonomy of the cases based on accepted
principles. Yet casuistry, it has been noted, is blind without over-arching
values, blind and open to be abused. Dealing with principles requires a
way in which to examine the specificities of cases, as well as normative
standards for evaluating the specificities.
In this paper, I make three claims concerning evaluations of new human
enhancement technologies: (1) In order to evaluate new human
enhancement technologies we are, implicitly or explicitly, relying on ideals
of what future societies ought to look like; (2) we need to shift the focus
of the debate to serious discussions on what normative ideals we want
governing us in human enhancement issues, we need to design spectacles
of tomorrow; (3) important values that should be included in ideals for
future societies that can be used to address human enhancement issues
are opportunity maximin and flexibility.

DOES A CHILD ON CHRONIC VENTILATION HAVE THE


RIGHT TO DEMAND HOME CARE?
Zafrira Hillel-Diamant, Dvora Ben Zvi, ALYN Hospital, Israel
Tsaffy@alyn.org
Medical and technological advances have enabled a new group of
patients to survive and be discharged to the community. In the past,
children and adults who remained, fully or partially, dependent on
mechanical ventilation, were forced to live in facilities able to provide safe
care. Today, these patients are able to lead safe and satisfactory lives at
home. Discharge to the community and participation in age-appropriate
activities such as school or work, is rehabilitations main goal. Ventilator
dependence is no longer a barrier to achieving this goal, but an issue to
contend with. Home-ventilation poses complex challenges for the patient,
the family and the community, and requires careful organization on all
levels.
The UN's Declaration of the Rights of the Child, adopted December, 1989
begins with stating: THIS DECLARATION OF THE RIGHTS OF THE CHILD to
the end that he may have a happy childhood and enjoy for his own good
and for the good of society the rights and freedoms herein set forth, and
calls upon parents, upon men and women as individuals, and upon
voluntary organizations, local authorities and national Governments to
recognize these rights and strive for their observance by legislative and
other measures progressively taken in accordance with the following
principles
What happens when the child's rights and his family's rights clash? Whose
rights take precedence? What do we do in cases where the parents aren't
able or don't want to take the child home? How does the medical staff
remain neutral? Who decides what is best for the family without passing
judgment?
These ethical dilemmas will be the focus of this presentation.

TRANSPLANTATION OF HUMAN ORGANS: UNIVERSAL


PANACEA OR ONE OF THE WAYS TO SAVE THE LIFE?
Nataliya Hnatush, Ukraine
n.gnatush@eklyps.net
Globally, the transplantation of human organs sphere exists more than 70
years. This period is characterised by developing the mass transplantation

practice, increasing the quantity of declarations and ethical documents


drew up by the professional associations, new guidelines and new
legislation developed and adopted in European countries, in the USA, Asia
and Africa. In spite of such respectful stage of development,
transplantation of human organs field in all over the world still is a
controversial complex of the topics for ethical, social, medical and legal
discussions.
In Ukraine, Law Human transplantation of organs and other anatomic
materials was adopted in 1999. And the fact of law adoption proves that
medicine reached the level of the physical control above the human
death that is why transplantation has become a serious social and cultural
issue from a focused medical sphere.
The necessary regulation approach for the transplantation of human
organs has to be influenced by the political will of the state, specifying
strict limits between legal and illegal facts, organising the severe system
of the transplantation authorities; by medicine, developing the scientific
base for the transplantation procedure, practical base for the prevention
and disease early detection; and by the society, creating the adequate
response for the modern challenges of transplantation, creating culture of
the donation and human solidarity. The lifesaving goal should be a part of
the health care culture. In the transplantation field the medicine has to
become a system of the interpersonal relations, characterised as a mutual
exchange.
There are a lot of ethical questions in the field of the transplantation on
human organs, connected with the moment of the persons death,
medical efficiency of the transplantation procedure, religion approach
and cultural challenges, economic benefits.
The main interrelated basic transplantation issues are a shortage of donor
materials and high price for the organs. From the national waiting lists
websites in the developed countries, it is clear seen that only one third of
patients on waiting list can get transplant. And such situation for the
organs demand favors to the transplantation commercialization and
development of the transplant tourism. People are starting to look for
other options how to survive, how not to die, travelling to purchase
organs illegally.
These indisputable facts have to make specialists generate the new ideas
and profound methods of the public health care and philosophy of human
treatment, starting from the prevention and early detection and finishing
with transplantation of human organs.

BIOETHICS EDUCATION IN A SOUTH AFRICAN UNIVERSITY


OF TECHNOLOGY A MULTIDIMENSIONAL BEST PRACTICE
APPROACH
Willem A Hoffmann, Tshwane University of Technology, South Africa
hoffmannwa@tut.ac.za
The Tshwane University of Technology (TUT), Pretoria, South Africa, was
established in 2004. As such, its research context is still in a formative
phase. The nature of research projects at a university of technology differs
in essence from those of the more traditional South African universities
with medical schools in being more focused on science, technology and
innovation. As a result, the kind of research proposals submitted for
ethics review are predominantly for non-therapeutic and technologyfocused research in the fields of health sciences, social sciences,
education, management sciences and the arts, while very few research
projects involving clinical trials are conducted.
Article 19(d) of UNESCOs Universal Declaration on Bioethics and Human
Rights encourages ethics committees to foster education in bioethics at
all levels. In the spirit of this declaration, the TUT Research Ethics
Committee (REC) designed and implemented a multidimensional bioethics
education programme at various levels within the universitys research
context. The content of the programme is fundamentally based on the
syllabus and study materials of the UNESCO Bioethics Core Curriculum,
together with scholarly knowledge and experience gained at the UNESCO
Ethics Teacher Training Course (Dubrovnik, Croatia, July 2012). The
programme is offered in the form of basic orientation lectures (1-2 hours),
basic orientation workshops (4 hours to 1-day) and comprehensive
workshops (2-days). The programme focuses primarily on the following
groups: REC members, postgraduate supervisors, postgraduate students,
research administration officers and members of South African and
Sudanese health professional interest groups (particularly in reproductive
biology, radiography and mental health). The presentation style is
predominantly interactive and includes a wide variety of case studies
(mostly from non-medical contexts), audiovisual material, moral games

93

Abstracts of Oral Presentations


and reading material to illustrate and engage with the most important
bioethics principles.
The main aim of this presentation is to describe and discuss TUTs
multidimensional best practice approach to bioethics education in a nonmedical university context on the African continent.

TRANSNATIONALIZATION ON THE TECHNIQUE OF


ASSISTED HUMAN REPRODUCTION
Edna Raquel Hogemann, UNESA UniRio/Rio de Janeiro, Brazil
ershogemann@gmail.com.br
This paper's purpose is to present a reflective analysis about the process
of transnationalization in which the technique of assisted human
reproduction has been going to the extent that such a procedure has
been revealed as a true "fertility tourism", offered through packages for
those people who have financial conditions, but cannot through natural
means to realize the dream of membership. Through the dialectic method
of discourse, promoting the comparison of the thought of many authors
who focus on issues such as globalization, commodification of human and
technical exacerbation detriment of humans and their interpersonal
relations, the author seek to introduce issues that are the order of day
with respect to this global market arising from the tremendous advances
reproductive techniques in a society marked by economic interests, it
turns much more to the consumer and considers the human being as an
additional asset to be sold, since its conception. The author acknowledge
that they cease for tourism human reproduction is a trade that is worth of
human frailty, because relying one of the most intimate aspects of life:
the desire to be a mother or father or ultimately, the perpetuation of the
species.

EXPERIENCING SECLUSION: A PHENOMENOLOGICAL STUDY


Dave Holmes, Stuart J. Murray, University of Ottawa, Canada
dholmes@uottawa.ca
The humanitarian, ethical, and legal issues associated with seclusion
rooms make them one of the most controversial management strategies
available. Despite this, the use of seclusion continues to be widespread in
psychiatric settings, with up to 20% of patients being secluded during
their stay in North American psychiatric hospitals. This study was
designed to shift the ethical discourse in a manner that is more
compatible with the lived experiences of psychiatric patients and the
nurses who care for them. Therefore, semi-structured interviews were
conducted with forensic in-patients and nursing staff in order to provide a
phenomenological exploration of the subjective experiences of forensic
psychiatric patients placed in seclusion, as well as the experiences of the
nurses who must seclude them. Phenomenology also facilitates an
understanding of the importance of the place of the lived body, a concept
that is largely ignored in mainstream bioethics. The results of this
research have the potential to help nursing staff consider the emotional
impacts of seclusion on patients, and encourage them not only to better
understand the experience of patients but also to prompt a
reconsideration of subjectivity and ethical practice in mental health care.

DIGNITY AND END-OF-LIFE DECISIONS IN ENGLAND AND


FRANCE
Ruth Horn, Angeliki Kerasidou, Ethox Centre, University of Oxford, UK
ruth.horn@ethox.ox.ac.uk; angeliki.kerasidou@ethox.ox.ac.uk
Dignity is one of the most controversial and yet commonly used term in
debates regarding end-of-life issues. The term dignity can take various
meanings. For example, it can be used to denote the respect owed to an
individual person or to signify the intrinsic value of humankind as a whole.
These two different understandings of dignity can inevitably lead to
different approaches to end-of-life decision-making.
This paper explores the meaning of the term dignity in two European
countries, England and France. Our philosophical and sociological analysis
compares public debates and legislation on end-of-life related issues in
these two countries. We will argue that in England dignity is most
commonly understood as respect for individual autonomy, whereas in
France dignity usually signifies respect for human life in a broader, holistic
sense. We will demonstrate that the difference in the conceptualisation

of the term leads to different ethical, and hence legal and practical
approaches to end-of-life issues. Our particular focus is on: (1)
withdrawing/-holding life-sustaining treatment; (2) respect for patient
preferences; and (3) assistance in dying.
Given the difference in the understanding of dignity, and the underlying
philosophical approaches it feels that there is still a long way to go before
we can establish common guidelines on end-of-life decisions across
Europe and beyond. However clarifying the use of the term dignity in
different discussions around Europe could hopefully facilitate this
endeavour.

EVALUATION OF TRAINING ACTIVITIES IN THE FIELD OF


ETHICS AND HEALTH COMMUNICATION IN ALBANIA
1,2

Adrian Hoxha , Genci Dervishi , Edjona Bici , Odela Risilia , Ola Hysaj ,
2
2
Imelda Kasapi , Klejda Risilia
1
Faculty of Medicine, Albania
2
National Association of Public Health, Albania
adrianhoxha@yahoo.com
Background: The health professionals (HP) by participating in ongoing
education trainings update their knowledge in accordance with the
criteria defined by the NCCE. Ethics and health communication was one of
the training modules.
Aim: Evaluation of training activities of HP in the field of ethics and health
communication.
Methodology: The study was conducted through an anonymous
questionnaire in 8 districts of Albania, in 2010 and 2012 and includes
participants in the ethics and health communication training as general
practitioners, pharmacists, managers and nursing staff. The data were
analyzed with statistical package SPSS 19.
Results: 194 HP participated in the training of ethics and health
communication. 32% of participants was male and 67% female. 30.9% of
the participants took part in 2010 and 69.1% of them in 2012. 46.9% were
general practitioners / family doctors, pharmacists 41.2%, 3.1% managers
and 8.3% nursing staff. 61.9% assessed as very high level the lecturer,
57.7% of them the subject content, 54.6% the audio-visual equipment,
58.2% discussion topics and 45,5% the hall where the training took place.
42.8% assessed the knowledge obtained in this training as very new. In
88.1% the participants stated that their expectations about the training
were fulfilled. The statistical analyzes indicate a moderate positive
correlative relation with 0,01 significance level between age and
assessment of new knowledge in these training activities.
Conclusion: It was noted that attendance doubled in 2012 compared with
2010. Older Professionals assessed the knowledge as new also because
their university curriculum did not include ethics and health
communications.

THE INTERPLAY OF BIOETHICS AND HEALTH LAW:


GLOBAL AND LOCAL DIMENSIONS
Radmyla Hrevtsova, Institute of Medical Law, Pharmaceutical Law and
Bioethics, Academy of Advocacy of Ukraine; Head, Ukrainian Unit,
International Network of the UNESCO Chair in Bioethics (Haifa)
radmila.hrevtsova@gmail.com
The existence and prospects of global bioethics and global health law as
distinct from international health law has been debatable issue. With all
that, globalization and integration processes occurring in the modern
world open new opportunities and present new challenges and threats
for peoples communities. This is outstandingly manifested in developing
and newly emerged countries.
A natural strive for finding common grounds that could be used for
developing general ethical standards and, where justifiable, also legal
standards, is a challenging opportunity. This ambitious goal, however,
brings new risks the approaches to assessment of and account for which
should be elaborated and agreed upon.
One of those risks is the desire to paint everyone with the same brush.
Usually this brush presents a legal standard originated from the welfare
states having well-developed legal systems. As is known, the effective
legislative permits give the signal for the society of a moral acceptance of
an allowed practice. By virtue of legislative authorization of certain
practices in the countries serving as models to emulate, the import of
such practices to other countries the population of which does not always

94

UNESCO Chair in Bioethics 9th World Conference

share the moral and ethical values and attitudes they are based on, occurs
(for example, euthanasia, authorization of same-sex marriages and
possibilities for such couples to enjoy assisted reproductive technologies
for their procreation, etc.).
Another risk is the legislative fixation of ethical principles acceptable for a
community, but with their formal utilization and emasculation of their
essence. The mandatory forms of informed consent diluting the essence
of the consenting process and the final authorization to research or
treatment is a significant example. This can also be exemplified by the
provisions appearing in legislations of the newly emerged states whereby
the independent ethics committees members are to be appointed by
the order of the health care institutions chief doctors.
At the same time, integration processes give great opportunities that
should be utilized to the fullest possible extent by all countries, especially
by the developing and the newly emerged ones. Implementation of the
best legal practices and solutions capable of resolving the burning issues
is one of such opportunities. In some newly emerged countries, for
example, there exists the issue of the two extracts from the medical
records when the patient suffering from a hard-to-treat disease
dangerous to life and his or her relative who the patients medical
information is disclosed to in full, get two extracts with different medical
data, including diagnosis. This situation can hardly be accepted from the
ethical and legal viewpoint. An important task is therefore the exchange
of experience and implementation of good solutions for such problems.
Cross-fertilization both between bioethics and health law and between
the bioethical models and legal doctrines dominating in different parts of
the world seems to be the main direction for the development.

extraordinary originality of cultures, traditions and customs of its peoples.


Since there is common bioethical issues, especially clearly appearing in
the modern period of globalization and integration of the States and their
economies and cultures, regional and national characteristics of
perception of new challenges and threats of rapidly disseminating
scientific and technical progress suggest development of public policies
with mandatory inclusion of local worldview, philosophy of life and
attitude to many fundamental values.
The main idea of the regional policies of the States of Caucasus region is
that human values are not considered separately from the scientific and
technological progress and achievements in the field of biology and
medicine, a human being is a part of nature and needs healthy
environment to survive. Moral responsibility and ethical choice should be
the main priority in the use of benefits of progress.
At the same time the philosophical and traditional features of Caucasian
people are focused on the integrity of an individual and his inner peace,
noninterference in the corporeal and spiritual essence of being. The
interaction of two global biosocial systems humanity and the biosphere
is in the focus of ongoing regional states biopolitics. They based on
bioethical researches, such as forecasting, expert assessments and
recommendations for leveling the negative impact of the man and his
inventions on a live cover of the planet.
These measures are complemented by appropriate legislative,
administrative activities to involve non-governmental organizations, nongovernment service providers to develop and implement initiatives in the
field of bioethics, to transfer the certain power to carry out any practical
or research work.

ATTITUDE, PRACTICE OF CLINICAL PHYSICIANS IN


VIETNAM ON MEDICAL PROFESSIONALISM

ESTABLISHMENT AND DEVELOPMENT OF BIOETHICS


SCIENCE IN AZERBAIJAN

Tran Thi Thanh Huong, Le Minh Giang, Nguyen Duc Hinh,


Hanoi Medical University, Vietnam
huongtranthanh@hmu.edu.vn; huongtran2008@gmail.com

Irada Huseynova, Jalal Aliyev, Azerbaijan National Academy of Sciences,


Azerbaijan
aliyev-j@botany-az.org, huseynova-i@botany-az.org

Background: Physician is typical profession in society. Longtime ago, the


role of doctor was a healer and the position of doctor was focused on
doctor-patient relationship. Recently, medical professionals faced up with
many challenges: the innovation of modern technology, market economy
impact, costing for health care increase rapidlythe role of doctor in
society is not only doctor-patient relationship but also the influences from
third party payment, industrial companiesthat is relationship between
physician association with society. Medical professionalism is defined as
contrast between physician and society. The Doi moi (renovation)
period in Vietnam started 1986 lead the changes in health care system. In
the social forum, there are many discussion concerning to fee for health
care services, health insurance, the cooperation between physician and
drug companiesThese issues are main commitments in medical
professionalism. But there are limited studies on the issue.
Objectives: (1) To investigate the attitude and practices from clinical
physician in Vietnam on medical professionalism. (2) To describe the
cognitive from clinical physician on medical professions value
Method: The cross-sectional study was implemented in 1078 clinical
physicians at different specialized in Hanoi, Hue, Hochiminh cities by selffilled questionnaire. The questionnaire included 10 commitments on
medical professionalism and Hartung professional value scale.
Results: Physicians value from doctors attitudes is prestige, supported
for the family members. Most of doctors were agreed with commitment
concerning to respecting patients, improving professional competencies.
There is gap between attitudes and practices concerning to medical error,
conflict of interest.
Conclusions: Medical professionalism needed to be added at the medical
ethics curriculum for medical students.

Following the global spread of science and technology, bioethics is also


becoming more global. At present, many international organizations
accomplish activities and have advisory agencies in the field of bioethics.
According to the recommendation of UNESCO, Azerbaijan National
Committee on Bioethics, Ethics of Scientific Knowledge and
Technologies was established in 1999 under National Academy of
Sciences. In 2005, a collection of papers on the problems of bioethics,
ethics of scientific knowledge and technologies was published. The
collection includes the researches who work in the science and education
centers on new directions. The published papers are dedicated to
elucidation of current problems of bioethics by outstanding Azerbaijan
scientists working in biology, medicine, informatics, etc. and activities
directed to their solving. The 18th session of the IBC of UNESCO was held
in Baku, 2011. The three-day session was organized by the National
Commission of Azerbaijan under the auspices of UNESCO jointly with
National Academy of Sciences. In the session, which lasted until June 2,
the ethical impact of traditional medicine, the state of bioethics in Eastern
Europe, as well as issues related to the execution of UNESCO declarations
on bioethics were discussed.

RESOLUTIONS OF REGIONAL AND BIOPOLITICAL ISSUES IN


SITUATION OF HISTORICAL AND CULTURAL DIVERSITY IN
THE CAUCASUS
Irada Huseynova, Baku State University, Azerbaijan
huseynova.irada.m@gmail.com
Historically Caucasus is a multicultural region with more than 50 ethnic
groups, peoples and nations. Being the crossroads of trade routes and
economic relations between East and West, Caucasus differs today by

BIOETHICS AND MUSLIM CULTURE.... A VIEW


Arshad Hussain, Mushtaq A Margoob, Rafiq Ahamed, North India
Bioethics Unit of the Network; Goverment Medical College, India
arshadtina@gmail.com
The strides in medicine and biology lead to challenges to established
cultural values of morality and ethics. Bioethicists worldwide are trying to
bridge this gap and provide an interface for discussions and debate
between the established norms and practices with innovations and
inventions of medicine and biology. Kashmir is a traditional Muslim
culture with modern and moderate world vision and outlook. We at
Government Medical College Srinagar an affiliate of Kashmir University
are in unique position to have vision of Islamic perspectives of various
bioethical issues and also the western view about bioethics. In Islam
human and life is regarded as supreme to be revered and protected."
whereas, if anyone saves a life, it shall be as though he had saved the lives
of all mankind."(Quran). From transfusion to cloning Muslims have a view
point about everything and the views are in conformity with established

Abstracts of Oral Presentations


bioethical practices. We also believe that when bioethics are part of your
value system, the practice of ethics becomes easy.

THE LEGAL POSITION OF SPERM DONORS ASSISTING


SINGLE WOMEN TO REPRODUCE
Elena Ignovska, University of Ss. Cyril and Methodius, Macedonia
elena_ignovska@yahoo.com, Elena.Ignovska@Ugent.be
United Nations goals on population and development confirmed the
WHO definition of health, embedding it in the context of reproduction
defining reproductive health as a state of complete physical, mental, and
social well-being and not merely absence of disease or infirmity in all
matters relating to the reproductive system and to its functions and
processes. Thus infertility is considered beyond medical, as also social
condition, promoting access to available reproductive technologies not
only to couples but also to single women.
Sperm donations have already intruded families, causing fragmentations
of the fathers roles into genetic, social and legal. The right of the child to
know the origin and to be taken care for by both parents is the preferred
scenario for the childs development (Incorporated in article 7 of the
United Nations Convention on the Rights of the Child). Sperm donors
participation in couples family projects partially satisfies these criteria as
long as it is not hidden under the veil of secrecy, and parental roles of
biological fathers are substituted by social, thus legal fathers.
Nevertheless, this is not a case in voluntarily single womens reproductive
projects.
Recent legislative policies give precedence of the truth about the act of
conception. Disclosure of the donors identity has shifted changes also in
donors attitudes, making them aware of the possibility of meeting the
child in the future, and possibly establishing regular contacts that may
look like family life (In context of Article 8 of the European Convention
of Human Rights). As a consequence, the number of donors decreased.
Those still willing to donate are more frequently associated with
reproductive, and not solely altruistic intentions.
The article will tackle the legal position of sperm donors assisting single
women to procreate from the relational perspective of rights and
responsibilities towards the conceived child and the mother in order to
investigate if establishment of fatherhood of the donor could be possible
(In terms of Article 6 (1) of the European Convention of Human Rights).

BIOETHICS AND AUTISM: SECURING THE MORAL


COMPASS OF CHILDREN WITH AUTISM IN DEVELOPING
COUNTRIES
1

Mona Indargiri , Felicity A. Crawford , Harold J. Bursztajn


1
Wheelock College, USA
2
Harvard Medical School, USA
mindargiri@hotmail.com

Within the past three decades scientists (example, Koch, 2005) have
uncovered a wealth of difficult-to-measure habits of mind that lead
people to happy and fulfilled lives. These include persistence, learning
from ones mistakes, responsible risk-taking, controlling ones impulses,
listening and responding with empathy, reading people, situations and
ideas (Costa and Kallick, 2008). These scientists theorize that ones
character is formed within ones unconscious mind. Others, like
psychologist, Timothy Wilson (2002), contend that the unconscious mind
does all of the work. Contrastingly, scholars who study autism put forth
three prevailing theories, which identify the inability of an individual with
autism to recognize or understand others intentions (example: beliefs,
fears, desires or wants) the very elements that were identified as
building blocks to success (Barnbaum, 2008), Given the centrality of the
aforementioned qualities how might educators and their families work to
secure the moral compass of children with autism? The impetus for this
question stems from a service learning work experience that lead the
authors to lead a workshop for parents of children with autism. These
parents sought the knowledge, the expertise and key understandings
about how to direct the inner lives of their children. The authors hope
that the question they pose for discussion would generate ideas for
collaborating to both develop studies and outreach programs aimed at
assisting parents and educators of children with autism in less resourcerich countries where access to well-established therapies and resources
are scarce.

95

CHILD ABUSE: EVALUATION AND GENERAL ASPECTS


Francesco Introna1, Valeria Santoro
1
University of Bari, Italy
francesco.introna@uniba.it
Dental caries is an infectious, contagious and multifactorial disease that
was recently identified as the single most common chronic childhood
disease. Its control and prevention should be a priority for dentists, as it
may lead to malocclusion, and other problems related to mastication,
phonetics and esthetics. Dental caries may also be a risk factor for
diminished self-esteem and a gradual reduction of the child's rate of
weight gain; such conditions can be remedied after appropriate
intervention however. The presence of persistently untreated dental
caries is becoming more widely recognized as part of the phenomenon of
child neglect or more specifically, dental neglect because dental caries,
periodontal diseases, and other oral conditions, if left untreated, can lead
to pain, infection, and loss of function, resulting in a lower quality of life
for the child. Moreover, the effects of Early Childhood Caries (ECC) can be
long-term, increasing the risk of dental problems later on in life, and
interfering with basic social functioning, as well as optimal growth and
development.
With the aim of describing the correlation between early childhood caries
(ECC) and the phenomenon of child neglect, a self-report questionnaire,
which recorded socio-economic, demographic and dental service use data
was provided to a randomly chosen sample of parents at three pediatric
health service centers in Bari (Italy).
The questionnaires were completed during odontologic visits. Of the 63
children examined, 61.9% presented with ECC, of which 47.6% were
classified as Wynes Type I; 12.7% were classified as Type II; and 1.6% as
Type III. Interestingly, the frequency of Types II and III were shown to be
higher in low-income families (chi-square=8.50; p=0.03). Dentists should
recognize childrens susceptibility to ECC and their exposure to risk factors
for neglect, thus facilitating a primary prevention visit.

THE CHILDHOOD TRAUMA IN THE BREAKDOWN OF


FAMILY RELATIONSHIP: CLINICAL & BIOETHICS ASPECTS
Angelo Maria Inverso, Italy
am.inverso@libero.it
Numerous research data seem to confirm the role of traumatic events in
the etiopathogenesis of numerous disorders, both physical and
psychological.
The early relational traumas caused by serious failures in the tuning
process in the relation of attachment, if combined with more relational
traumatic experiences, are significant risk factors in the development of
psychopathological problems. It is also known that, among the most
relevant traumatic factors, we can include separation and loss from
Attachment figures.
The current legal protection of child, although formally present in our
legislation, seem to be reluctant to develop assessment and intervention
tools to prevent the childhood trauma to the breakdown of family
relationships and to reduce its impact by improving the childs resilience
and its parental figures.
Far from uncritical acceptance to what is called therapeutic culture that,
determine the dynamics resilience un relation to trauma and the need to
assess the importance of relationship as protective factors essential to the
resilience capacity of humans.
The purposed workshop will open a discussion on the this theme through
interventions that illustrate either research data on the Attachment and
childhood trauma, or possible tools of assessment and protection of
children involved in such traumatic circumstances.

CIRED ACTIONS: STUDY CASES


Guseppina Iommelli, LOrientale University, Italy
CIRED (Interdisciplinary Centre for Research and Teaching Development)
workshops, disciplinary teaching between school and university, aim to
bring together the world of school and the university. In some workshops
CIRED also has tested Bioethics teaching. Here some study cases will be
discussed.

96

UNESCO Chair in Bioethics 9th World Conference

INFORMED CONSENT, THE ROLE OF PSYCHOLOGISTS AS


COMMUNICATION EXPERTS
A. Iorio, V. Battimiello, A. Scuotto, C. Pietroantuono, D. Del Forno,
International Office for Bioethics Research of the European Center for
Bioethics and Quality of Life of the UNESCO Chair in Bioethics Unit - Ethics
Committee Carlo Romano, University of Naples Federico II, Italy
In biomedical trials proper information is the means of choice to protect
human rights to independent decision-making and self-determination. In
the assessment of research protocols, the methods used to examine the
adequacy and exhaustiveness of written information to patients and the
procedure to acquire their informed consent are very delicate matters.
The informational material shall be drafted in a very clear-cut and
understandable manner so as to guarantee patients free and competent
decision-making inasmuch as both the informational material and the
informed consent form are an imperfect means to protect patients
health and not a way for medical science to defend itself.
Since September 2005, the EC Carlo Romano of Universit degli Studi di
Napoli Federico II, aware of the importance of these aspects when
assessing the ethical implications of trial proposals, has been applying a
procedure according to which an expert psychologist examines
informational materials and consent forms in order to guarantee the
information addressed to patients is intelligible.
In line with the Italian laws currently in force receiving the principles as
in the document Good Clinical Practice that have always emphasised
the fundamental conditions qualifying informed consent, i.e. good-quality
and intelligible information to guarantee competent and free choice to
the subjects involved in a scientific trial, the presence of a psychologist as
a communication expert has proven an indispensable asset in the
judgment process.
Based on a statistical analysis of the experts remarks and comments on
the informational materials received (over 500), it appears that most of
them, although compliant with the rules, would not communicate
adequate information to favour patients free and competent decisionmaking.

AN ANALYSIS OF REPRODUCTIVE GENETIC TECHNOLOGY


AND ASSISTED REPRODUCTION WITH A FOCUS ON
ETHICAL, RELIGIOUS AND LEGAL CHALLENGES IN PAKISTAN
Ayesha Irshad, Biocentre, Medical University of Innsbruck, and
Management Center Innsbruck, Austria
Ayesha.irshad@mci.edu
Assisted reproductive technologies (ART) and reproductive genetic
technologies (RGT) are intertwined and co-evolving. The later comprise
preimplantation genetic diagnosis (PGD), sex selection (either through
PGD or sperm sorting) and hypothetical genetic modification, all based on
concepts of optimizing outcome. RGT are used to overcome certain
forms of inherited disease and may serve the quest for a perfect baby (or
designer baby) and human enhancement. In addition, ART are
increasingly used to fulfill socially and culturally framed requests, e.g. for
family balancing or to enable post-menopausal women or homosexual
couples to have genetically linked children. The realm of ART and RGT is
loaded with countless ethical issues, particularly as different social
practices and legal regulations as well as economic inequalities within and
among countries create numerous vulnerable groups and chances for
exploitation.
In Pakistan, like in other countries, ART and RGT are well established and
offered to its citizens. However, there is little knowledge about the
spectrum of techniques being offered and used as well as the ethical and
legal debate referring to this field. Islam is the state religion in Pakistan
according to its constitution of 1973. As many aspects of ART and RGT
cannot be explained on the basis of Islamic teaching, it is currently unclear
how these technologies fit into cultural and religious standards. Here, I
will present an overview of the ART and RGT landscape in Pakistan and
analyze the practice in the context of Islam.

JUDICIAL INTERVENTION IN PRIVATE HEALTH CARE


POLICIES IN BRAZIL
Daniela Ito, Brazil

PROFESSIONAL ETHICS IN EXTREME CIRCUMSTANCES:


RESPONSIBILITIES OF ATTENDING PHYSICIANS AND
HEALTHCARE PROVIDERS IN HUNGER STRIKES
Nurbay Irmak, University of Miami (PhD Student), USA
nurbayirmak@gmail.com; n.irmak@umiami.edu
Hunger strikes have become a less remarkable form of protest, especially
for those who are imprisoned or who seek political change. Hunger strikes
present a serious ethical challenge for physicians and other healthcare
providers. On one hand, physicians have a duty to preserve life, which
may entail intervening before the hunger striker loses her life. On the
other hand, physicians duty to respect the autonomy of patients who
refuse medical intervention also entails respect for hunger strikers
decision to refuse nutrition. While this sort of conflict is ubiquitous in
health care, refusals of care for political ends has not had the same
degree of consideration as, say, refusals on religious grounds and such
refusals may be misinterpreted as a form of exploitation. Moreover, in the
case of prisoners, physicians may also have additional duties of obedience
to other authorities, sometimes the very same authorities that brought
about the hunger strike.
International medical guidelines state that physicians should follow the
uncoerced advance directives by hunger strikers. Since such directives are
rare, it is typically the case that physicians are left to decide for
themselves when they are faced with an unconscious striker considering
both her values, previously expressed wishes and her best interest. In this
presentation, the ethical responsibilities of physicians and healthcare
providers in hunger strikes are reconsidered. The presentation will offer a
practice guide for managing patients who resist medical care on political
grounds.

The objective of the present study is to discuss the reasons and the
solutions for the current need of Judicializing of the Private Health Care in
Brazil. The reasons for the transgressions committed by the Health
Insurance Plans to the detriment of rights and the interests of its insured.
The applicable penalties. What are the roles of the regulatory bodies?
Why does the State fail in promoting regulatory policies in this kind of
activity? The object of this discussion is the presentation of the Brazilian
reality, the solutions imposed by the Brazilian Judiciary Power and how
the companies in this segment act before the concession of judicial orders
in favor of the insured.
The civil and criminal liability of these companies agents and directors as
one of the feasible solutions. How the Brazilian legislation deals with the
issue. What are the legal applicable codes?
This study will allow the students, Law operators and health care
professionals to know, based on the Brazilian law and compared laws, the
difficulties and the solutions adopted by the Brazilian juridical system,
always considering the prevalence of the general principles of the Law,
and above all the principle of dignity of the human person over financial
and political interests.

THE REGULATION OF SURROGATE MOTHERHOOD IN


SOUTH AFRICA: A HUMAN RIGHTS ANALYSIS OF THE
GENETIC LINK REQUIREMENT
Donrich W. Jordaan, South Africa
mail@donrichjordaan.law.za
Surrogate motherhood in South Africa is regulated by a recent piece of
national legislation, namely the Children's Act of 2005 ('the Act'). The Act
makes provision for altruistic surrogacy, and outlaws commercial
surrogacy. Altruistic surrogacy is further tightly regulated, with the Act
requiring, amongst others, that the intended parents and the surrogate
mother must first approach the high court to confirm their surrogacy
agreement, before they may proceed with IVF.

Abstracts of Oral Presentations


One specific aspect of the Act is the 'genetic link requirement', which
entails that
in the case where the intended parents are a couple, the gametes of
at least one of the parents must be used to create the child; and
in the case where the intended parent is a single person, that person's
gametes must be used to create the child.
The effect of this genetic link requirement is that
an infertile single person (who because of infertility cannot contribute
her or his gametes) is effectively banned from using surrogacy; and
a couple of whom both persons are infertile are also banned from
using surrogacy.
It would therefore seem that the genetic link requirement creates a
paradox in the Act: While surrogate motherhood is intended to help
infertile persons, the genetic link requirement excludes these very people.
In this paper, I will analyse the human rights dimensions of the genetic
link requirement.

HUMAN RIGHTS AND NIGERIAN PRISONERS: ARE


PRISONERS NOT HUMANS?
Istifanus Joshua1, Y.Y. Dangata1, O. Audu2
1
Kaduna State University, Nigeria
2
College of Health Sciences, Benue State University, Nigeria
dristifanus@yahoo.com, yohanest@dangata.freeserve.co.uk
In Nigeria, just like many other parts of the world, one of the most
extensively discussed issues on the public agenda today is the increase in
crime rate and increase in prison population. Investigations revealed that
the prison services have been neglected more than any other criminal
justice agency in Nigeria. For example, most of the prisons were built
during the colonial era for the purpose of accommodating small number
of inmates. The aims of imprisonment are protection, retribution,
deterrence, reformation and vindication. Human Rights are the basic
guarantees for human beings to be able to achieve happiness and selfrespect; consequently in most jurisdictions, the Human Rights Act
confirms that these Rights do not stop at the prison gates. However, most
States fail to meet the Human Rights obligations of their prisoners. On
health, for example, every prison should have proper health facilities and
medical staff to provide dental and psychiatric care. This article highlights
some of the unmet needs of Nigerian Prisoners which include, inter alia,
living in unwholesome cells, delayed trial of inmates, lack of voting rights,
access to information, lack of conjugal facilities for married prisoners,
poor and inadequate nutrition, poor medical care, torture, inhumane
treatment and the need to protect Prisoners in a changing world. The
present report has policy implications for reforming prison services in
Nigeria, and countries that sing from the same song sheet with Nigeria on
prison services, to conform to the Fundamental Human Rights of
st
prisoners in 21 century.
Acknowledgements: Kaduna State University, Kaduna, Nigeria, for
funding.

ETHICS COMMITTEES IN POLITICS


THE MEANING OF ETHICAL DELIBERATION FOR POLITICAL
DECISION-MAKING
Corinna Jung, Ina Otte, Institute for Biomedical Ethics, Switzerland
corinna.jung@unibas.ch
Background: The number of ethics commissions in politics is increasing.
Most countries in Europe now have at least one established ethics
commission or council at command that is to provide ethical advice for
government or parliament: In 2001, for example, the Austrian chancellor
has put in place the so called Austrian Bioethics Commission; in the same
year, the German chancellor has appointed the National Ethics Council
(which was renamed German Ethics Council in 2008). In parallel, the
German Parliament appointed several short-term commissions like the
commission law and ethics in modern medicine (2000-2002) or the
follow-up commission ethics and law in modern medicine (2003-2005).
In Switzerland, the so called National Advisory Commission on Biomedical
Ethics was established by the Swiss Federal Council in 2001 and the
Federal Ethics Committee on Non-Human Biotechnology already in 1998.
Objective: The huge number of ethics committees worldwide may be
seen as an indicator that politics require advice on issues where a quick
answer to the question what is right or wrong is not easy any longer.

97

But how is ethical advice used in policy-making? How do politicians deal


with the provided ethical expertise?
Methods: document analysis and semi-structured interviews with
members of ethics commissions and politicians
Presented results: In our oral presentation, we will first focus on the
ethical advice provided by the various ethics committees and councils in
Switzerland, Austria and Germany. Then, on the basis of a case study from
Germany, we will analyse and illustrate the impact of ethical advice on
political decision-making.

LONG ACTING INJECTIONS ANTIPSYCHOTICS:


ETHICAL ISSUES
Irket Kadilli, Spedali Civili; University of Brescia, Italy
irket@hotmail.it
Long acting injections (LAIs) antipsychotics serves as reliable therapeutic
option for non-adherent and chronic psychotic patients. Their use in first
episode schizophrenia is proposed. To date, ethics of LAIs use is poorly
addressed.
Voluntarism: Often, mentally ill individuals have low education and
partial decision-making capacity to understand the risks and benefits of
the treatment proposed and the manner of medication delivery,
especially during an acute psychotic episode. In case of serious side
effects, (e.g. neuroleptic malignant syndrome, persistent long QTc, tardive
dyskinesia) LAIs delayed clearance (long half-life) might be clinically
concerning. Moreover involuntary treatment with LAIs is not clearly
established by law and clinical practice.
Beneficence: Guidelines about the use of LAIs exists, but unfortunately
LAIs are not optimally prescribed, thus shifting benefits and risks balance.
Current, LAIs long term efficacy (relapse prevention) and safety (e.g.
metabolic, neurologic) data are discordant or not available. Drug
registration requirements and patent expiration might play a role.
However being too permissive with LAIs (first episode use) or not inclusive
or using fixed rather than flexible doses might harm patients and disorder
outcome.
Justice: In US, minority ethnic groups (Black, Hispanics) are more likely to
receive LAIs than white patients; while in UK receive higher doses.
Fortunately, some recent European surveys shows positive attitudes of
patients and mental health staff regarding LAIs. The distribution of risks
and benefits and accessibility to evidence based healthcare practices is a
right and should be shared equitably in society.
Conclusions: Psychiatric advance directives, LAIs pharmacological
knowledge, government funding and public awareness are obligatory.

BIOETHICS IN THE SYSTEM OF FUNDAMENTAL UNIVERSAL


HUMAN AND NATIONAL VALUES
Nigar Kalandarli (Doctoral Candidate), National Academy of Sciences of
Azerbaijan, Azerbaijan
Nigar_qh@hotmail.com
Resolution of moral problems of bioethics requires not only medical
education and experience, but also of legal knowledge. Modern society
with its cultural diversity and pluralism needs to take into account
national specificities and traditional values.
In Azerbaijan, the urgency and necessity of scientific research in the field
of bioethics has been realized long ago. For an independent, sovereign
republic one of the typical priorities is moral attitude to life like
fundamental human values.
The postulates enunciated in the international documents assert the
priority interests of the individual:
I humanistic values and scientific and technological progress must be
integrated.
ii humanistic goals have priority with respect to research.
Following the path of self-development, Azerbaijan is committed to
universal standards of human rights to life, health, privacy and dignity,
according to national, cultural diversity, pluralism and mentality of the
people living in the country.
Starting from 1992, a number of important regulations aimed at the
protection of human rights have been adopted in the Republic of
Azerbaijan. Such laws as "On the protection of public health", "On health
insurance", "On Psychiatric Assistance", "On the pharmaceutical activity",
"On Sanitary and Epidemiological Welfare of the population," "Radiation

98

UNESCO Chair in Bioethics 9th World Conference

Safety", "On drug treatment services" and etc. are among them. The most
important of them is the act adopted in 1997 the Law "On public health
protection of the Azerbaijan Republic."
Bioethical processes implemented today in Azerbaijan are carried out in
close integration with the international. The right to a decent life and to
health care is a basic inalienable right enjoyed by every citizen of the
country. Assigned to the group of the most important social and cultural
rights, health insuring and protection, integrity, dignity and autonomy of
man have been declared in the very first national legal acts, including the
national Constitution.

ETHICAL ISSUES IN INTERNATIONAL LEGAL ACTS AND


CONSTITUTIONAL LAW OF THE REPUBLIC OF AZERBAIJAN
Sona Kalandarli (Doctoral Candidate), Baku State University, Azerbaijan
sona.qalandarli@mail.ru
Constitution of the Azerbaijan Republic joined to many humanistic
international acts, establishes the basic human rights such as the right to
life, to live in safety, personal integrity, health, life in a healthy
environment (Article 27, 31, 32, 39, 41). Today the main existing bioethics
law "Health Protection of Population of Azerbaijan Republic" contains
regulations on the rights of patients, the possibility to choose your doctor
(Article 24, Ch.IV), refusal of treatment (Article 27, Ch.IV), information
about your health (Article 25, Ch.IV) etc.
At the same time, national legislation limits recommended by
international documents patients right to detailed information by the
following: At the negative prediction of the disease all information about
it is passed to the relatives or legal representatives of the patient or at the
request of the patient the information are reported to him in a cautious
manner". The law also reflects the principle of refusal of the previously
given consent for treatment or clinical trials by patient (volunteer) or
legal representative (Article 37, Chapter VI).
The list of rights and freedoms the international agreements contained
are not unconditional and comprehensive for each state. National
legislation offers additional rights to citizens which are determined by the
nature and structure of the social system, the level of economic
development, historic traditions, moral and ethical characteristics. The
cultural diversity of different peoples, which is the source of sharing
innovation and creativity and the common heritage of mankind, cannot
be used counter to national peculiarities.
The interaction of international legal instruments in the field of bioethics
and national law is in accordance with the good will manifested by the
state.
In such cases, there is no violation of the sovereignty of the state. The
state itself, without outside imposing, fulfills international legal norms
according to the principles and traditions of constitutionalism.

Following this discussion I will argue that the time has come for courts to
recognize the existence of a new head of damage, namely, interference
with the right to autonomy. According to this approach, when a patient's
right to autonomy is infringed, that patient suffers an injury for which he
is entitled to compensation. This injury is unrelated to the existence of
physical injury or to proof that a different decision would have been made
by the patient upon becoming fully informed.
I will argue that recognition of interference with the right to autonomy as
a new head of damage is commensurate with the idea of patient
autonomy underlying the doctrine of informed consent. I will further
claim that adoption of this rule is consistent with considerations of
deterrence. Finally, I will suggest that recognizing this new head of
damage provides a solution to issues that go beyond the framework of
informed consent, such as claims for wrongful birth or wrongful
pregnancy.

HUNGER STRIKERS IN DETENTION THE ISRAELI


EXPERIENCE
Tami Karni, Leah Wapner, Malke Borow, Israeli Medical Association, Israel
malkeb@ima.org.il
Hunger strikes are a form of non-violent protest, often implemented by
prisoners, who have little or no other means at their disposal to voice
their protest.
The management of hunger strikes raises difficult ethical dilemmas. How
can a doctor reconcile his obligation to preserve life with the obligation to
maintain human dignity and respect autonomy?
International ethical consensus holds that a prisoner who willingly
embarks on a hunger strike is not to be force fed or treated against his
will. On the other hand, medical professionals are challenged by being
forced to stand idly by and watch a patient's condition deteriorate, even
to the point of death. Other ethical dilemmas include the fact that
keeping hunger strikers together can foment discontent and peer
pressure, but separating them (especially to solitary confinement) may be
undue punishment.
The Israeli Medical Association position recognizes the clash of interests
but states that a physician shall not participate in the force feeding of any
hunger striker or try to dissuade him from the action he has freely chosen.
Rather, the role of the physician is to explain the health risks involved,
and to regularly verify the hunger striker's wishes, including what he
wants done in case he loses consciousness.
Besides written guidance, the IMA provides an anonymous hotline for
prison doctors and access to an online course. The association is also in
regular contact with the Israeli Prison Service, the Ministry of Health and
the International Committee of the Red Cross to find acceptable ethical
and medical solutions.

INFORMED CONSENT, AUTONOMY AND COMPENSATION


IN THE TWENTY-FIRST CENTURY A CALL FOR A NEW
APPROACH

ETHICAL DILEMMAS RELATING TO THE DIAGNOSIS AND


TREATMENT OF PEOPLE WITH AUTISTIC SPECTRUM
DISORDER THE PSYCHIATRIC PERSPECTIVE

Nili Karako-Eyal, College of Management, Israel


ncaracoe@colman.ac.il

Nachum Katz, Geha Mental Health Center, Israel; Sackler Faculty of


Medicine, Tel Aviv University, Israel
nkatz@clalit.org.il

The patients right to autonomy has been protected under law through
the doctrine of informed consent for the past six decades.
From the mid- 1950s physicians have been under a legal and ethical duty
to inform the patient of proposed medical treatment. Ancillary to the
duty of disclosure is the physician's duty to receive the patients free
consent. At the heart of these rules stands the ex-ante recognition of the
patients right to autonomy.
However, apart from extreme cases which fall within the ambit of the tort
of assault, the patients right to autonomy receives protection ex-post
only if two conditions have been met: the patient suffered actual damage
and the patient can prove that had he been fully informed he would not
have consented to the treatment. Thus, protection of the right to
autonomy is subject to proof of actual damage and proof that a different
decision would have been made upon obtaining full information. A
patient whose right to autonomy has been infringed but who has not
suffered actual injury or cannot prove that he would have decided
differently is not entitled to compensation. Respectively, in neither of
these cases are legal sanctions imposed on the physician who infringed
the patient's right to autonomy.

Over the last few years as the number of patients diagnosed with autism
rose sharply, interest and discourse have greatly increased. At the center
of the discourse reside the many ethical questions that arise in autism.
The diagnosis of autism is relatively new and its definition changed over
the years thus resulting in a sharp increase in the number of patients
diagnosed with it.
A recent change though, resulted in a narrower definition. Thus many
people who were considered as having the disorder are suddenly
considered normative, raising significant ethical issues regarding the
power of professionals to maneuver diagnosis definitions, impacting
decisions on support and treatment for individuals.
Autism spectrum's definition includes people completely unable of
communicating and people with high cognitive and verbal ability, many of
whom claim to have just neurodiversity thus making diagnosis and
treatment unnecessary. They also object to research on changing
behavior patterns and on pre-natal genetic identification, diagnosis and
prevention in autism.

Abstracts of Oral Presentations


Another issue relates to studies on individuals in the spectrum, with
particularly low functional ability, who are under guardianship and unable
to provide informed consent. These studies are done without the
participants' awareness or consent.
The issue of treatment, once a diagnosis is established, is controversial
among professionals, families and patients. While many view this as a
variety of "normative" that needs to be recognized, understood,
respected and accepted rather than changed, others see the difficulties,
distress and suffering that need changing.
Regarding treatment what should be treated? Should stereotypical
behavior, characteristic for this condition, be reduced? Others perceive it
as anomalous and bothersome but the patients claim that it brings relief,
helps cope with changes or represents an attempt to have the
surroundings cater to their abilities and needs.
For those dependent on caretakers, should the treatment focus strictly on
the patients' needs or should caretakers' needs also be considered?
Much criticism has been voiced against the rigidity of some of the
treatment methods but it is hard to ignore their effectiveness and their
treatment achievements.
Those are only a few of the ethical conundrums arising from treatment of
people with autism spectrum disorders, their families and society at large.
It stands to reason that the more knowledge and experience we
accumulate on this topic the more issues will arise.

WHEN CAN A FAMILY PHYSICIAN REFUSE TO TREAT A


PATIENT?
Yisrael Katz, Israel
JRyisraelK@clalit.org.il
The physician has a moral and legal obligation to treat his patients. This
does not mean that he must treat everybody who enters his clinic nor
does it mean that he has to comply to all of his patient's requests.
In this essay I will try to explain under what circumstances a physician is
permitted (or maybe obligated) to refuse to treat a patient or refuse a
specific request for treatment. I will base my position on basic medical
ethic norms and, in addition, a Jewish ethical perspective.
Can a doctor refuse to treat a patient who does not have medical
insurance in his Kupat Cholim (Israeli HMO)?
When a patient has a medical emergency he should be treated without
delay. In a non-emergency situation, if the patient has medical insurance
but is not registered in the physician's HMO, treating him may lead to
medical and economic complications. In the Israeli setting most patients
may be safely referred to their own HMO without any damage.
There are two different models of primary care clinics. "Walk in clinics"
every patient can come to every doctor and receive treatment. This
model provides high availability of the doctors but it also has its
disadvantages, mainly in the area of continuity of care. The other model
assigns a personal physician to every patient. The physician knows his
patient well and has more responsibility for the coordination of his
patient's treatment. When working in this mode there is justification for
refusing to treat other patients. Nevertheless, when faced with an acute
problem, the physician should try to provide basic care to any patient who
arrives at the clinic.
Can a physician refuse to give specific treatments that a patient requests?
If in the doctor's opinion there is exposure to unwarranted danger in the
treatment, the doctor should refuse to give it. When the patient asks for a
treatment that is not efficient the doctor can consider it and in certain
situations he might give it. In many cases the treatment is effective but it
may cause damage to other patients or to the public health. Common
examples are patients who want to receive expensive medical evaluation
or treatment (at the expense of other more important interventions) or
receive urgent referral to a specialist (and make other patients wait
more). My position is that family physician should also weigh the benefit
of other patients, especially when the other patient is a "real" patient and
not only "statistical".

99

PAY FOR PERFORMANCE (P4P) AND ESTRANGEMENT:


MORAL TRANSFORMATION OF RESIDENTS UNDER A NEW
PAYMENT POLICY
Mustafa Volkan Kavas, Hasan Tut, Hande Ermi, Funda Aytekin, Duygu
Erkal, Turan Canmurat zgi, Ankara University School of Medicine, Turkey
kavas@ankara.edu.tr
Pay for performance (P4P) policy was first brought to Turkish Healthcare
System in 2005 as a part of a package of policies, called the Healthcare
Transformation Program, by which the government basically integrated
the system to free-market-economy. Through years, P4P has become the
main payment mechanism in healthcare. In the framework of this policy,
healthcare professionals labor is scored principally according to the
quantity of the medical applications they make, such as surgical
interventions, examinations or tests. Urgent results were the increase in
healthcare professionals workload, the emergence of futile medical tests
and operations, and competition for more payment among individual
healthcare professionals. P4P was widely debated on different platforms
especially by means of its negative effects on the conduct of professional
ethical values in clinics.
Traditionally residents represented the group of physicians who take on
the biggest part of workload in third-stage hospitals in Turkey. In this
study we focused on the changes in the working conditions of residents
with the emergence of P4P and how the policy influenced their
motivation to practice their professional values. We conducted 3 focus
groups with 24 residents from different institutions. The findings showed
that after P4P residents are more estranged towards their professions,
their patients and themselves as so-called lettered physicians. Less
motivation to practice ethical codes in the wards and a drastic loss of
hope regarding their future are worth mentioning. We believe that this
study can be a significant contribution to the ethics debates on healthcare
policies in Turkey.

EMOTIONAL INTELLIGENCE AS METHODOLOGY AND


DIDACTIC TOOL IN TEACHING BIO-ETHICS AT NURSING
SCHOOLS: PRACTICAL STEPS
Daniella Keidar, International Center for Health, Law and Ethics, University
of Haifa, Israel
keidaril@netvision.net.il
Human ethics deals with human values and human values are based on
emotions and emotional processes which are required by mutual
relations. Bio-ethics has to do with the veritable existence of mankind,
physically, mentally and emotionally. Therefore, the process of bio-ethics
teaching should evolve the students not only through their cognition, but
also through their emotions.
This lecture concerns the way of teaching bio-ethic in general and at
nursing schools in particular, or "how" to teach it. Bio-ethics teaching is
not just "another" theoretical subject. It lies in the soul and core of the
nursing and related professions. Its teaching is not only the mere
transference of the lecturer's professional knowledge and skills.
All domains of Bio-ethics should treat human beings as a holistic entity.
Medical ethics has to do with veritable existence of mankind, physically,
mentally and emotionally. The sensitive alliance between body and soul
generates dynamic processes either of motivation, desire, challenge,
determination, activity and achievement or of despair and abandonment
during periods of sickness and personal challenges which transport a
person into a world of different realities.
The cultivation of didactic skills by means of Emotional Intelligence (EI)
which one of its main parts is effectual communication should do much to
link the students emotions, mentality and behavior with the learning
process, converting their periods of study into joyous, thought-provoking
experiences, provided that their integration in the learning process has
been consummated.
My lecture brings my experience in enriching lecturers of bio-ethics in the
ways of using variable teaching methods and tools. My approach is to
reveal to the lecturers ways of creating in their students an emotional
involvement in the process of learning the subject. In order to reach such
an end I teach the lecturers to use didactic skills which will help guiding
them to bring their students to a level of connecting and combining the
learning material to emotional involvement. Such a combination will help
assimilating bio-ethics to their future personal and professional lives.

100

UNESCO Chair in Bioethics 9th World Conference

PLACEBO CONTROLLED CLINICAL TRIALS:


HOW RATIONALE FOR THE USE OF PLACEBO IS JUSTIFIED
1

Tapani Kernen , Arja Halkoaho , Anna-Maija Pietil


University of Eastern Finland, Finland
2
University Hospital of Kuopio, Finland
tapani.keranen@uef.fi

Ahmed Binsumeit Khitamy Badawy, Sultan Qaboos University, Oman


khitamy@yahoo.com

Background: Randomized controlled trials (RCT) are the gold standard of


clinical research. RCT often include placebo control thought the
justification of this method is actively debated. Ethicists suggest that
investigators should explain to the trial subjects why placebo is used
especially when an existing therapy is available. Also an estimate of the
risks associated with placebo arm should be given.
Objectives: Aims of the present study were evaluate how the use of
placebo is justified in clinical trials and how participants are informed
about possible risks of placebo treatment. The analysis was based on
review of study protocols, statements of the national principal
investigator, and participant information leaflets.
Methods: We scrutinized the records of the Ethics Committee of the
North Savo Hospital District from the year 2006 to the end of 2012.
Included in the present analysis were placebo-controlled clinical drug
trials. Altogether 52 studies were identified. We then reviewed the study
protocols, statements of the national principal investigator, and
participant information leaflets.
Results: Majority of the 52 studies were Phase III trials (n=40). In 42 trials
placebo was used in disorders in which standard therapy was available.
Seven of the trials recruited vulnerable populations (eg. children, subjects
with dementia). Eighteen of the study protocols (35 %) and 15 of the
statements of the principal investigator (29 %) provided a rationale for
the use of placebo. The justification of placebo was presented in only 12
(23 %) of the participant information materials. None of the study
protocols and only 9 (17 %) of the principal investigator statements
provided an estimate of the risks associated with the use of placebo
during the trial. Most of the information leaflets (46/52, 88%) failed to
describe possible risks of associated with the use of placebo.
Conclusions: The justification of placebo control is poorly presented by
the protocols and investigators of RCT. Furthermore, and even more
importantly, study participants may remain inadequately informed about
the risks and discomforts associated with the use of placebo.

MIND AND HEALTH AN AWARENESS PROGRAM FOR


MEDIA
1

THE OMANI NATIONAL COMMITTEE FOR BIOETHICS:


MAKING REGULATIONS AND DRAWING UP LEGISLATION,
WITH SPECIAL REFERENCE TO EMBRYONIC STEM CELL
RESEARCH AND END OF LIFE ISSUES

Asima Mehboob Khan , Rizwan Taj , Rachel Jenkins , Stuart Lancashire ,


1
Waqas Ahmed
1
Pakistan Institute of Medical Sciences, Pakistan
2
Kings College, UK
khanasima@gmail.com
Objective: The authors assess the effects of mental health awareness
training program on the attitudes and understanding of media
professionals.
Duration & Place: Two days training workshop was held in Department of
th
th
Psychiatry, Islamabad on 5 6 Oct 2012.
Method: Workshop was organized by Dept. of psychiatry, PIMS in
collaboration with Kings College, London, British council, THET and NHS.
Sixty media personals were invited for workshop including Senior
Journalists as master trainer (Print media and Electronic media), and were
randomly selected from Rawalpindi / Islamabad. A comprehensive
curriculum, involving the slides, videos, group discussions, question &
answer sessions and Stress management techniques. Structured pre- and
post-test were used for screening the knowledge of participants regarding
mental health.
Results: Score of participants on pre-test was 26.7%, while post test score
was 73.2 %. It showed that mental health awareness trainings can affect
the knowledge and attitude of journalists.
Conclusion: It was an informative and highly important training for media
representatives. All participants after training planned to write and
project mental health issues in media. In this way the extreme important
issue will get highlighted in society. More people will get oriented and will
seek treatment and be able to live healthier lives.

Seeking knowledge is compulsory in Islam. It encourages man to


contemplate and explore new horizons for the benefit of humanity. Stem
cell research is one of these new horizons that promises a wide variety of
benefits for humanity. However this scientific promise, has been
surrounded by ethical, moral and religious anxieties. More than any other
professional, a Muslim physician is confronted more frequently with
issues that demand Islamic legitimacy of his actions. He is always
challenged with controversial ethical issues which he is supposed to
decide upon: e.g. embryonic stem cell research, fetal rights with respect
to the woman's autonomy, therapeutic cloning, trans-sexual operations,
plastic cosmetic surgeries, extra-uterine conception, end-of-life issues etc.
These recurrent controversial and problematic issues sometimes puts a
Muslim doctor in a dilemma between the current medico-legal issues
based on secular law, which could contradict his Islamic guidelines and
principles.
The Omani National Committee for Bioethics whose membership include
renowned Muslim scholars, jurists, physicians, researchers and
humanities meet regularly and comes up with regulations and legislation
on bioethical issues for the Sultanate of Oman.
This paper will first review the duties and objectives of the Omani
National Committee for Bioethics. Secondly, the paper will highlight the
tools used by this committee in formulating the bioethical guidelines and
regulations for the country. Thirdly, the paper will examine the
committee's mutual relationship with other National Bioethics
Committees in the Arab and Muslim world. Finally the paper will discuss
the challenges facing this committee with special reference to stem cell
research and end-of-life issues.

ORGAN TRANSPLANTS RATIONAL AND ETHIC


PROBLEMS
Eliezer I. Klainman, Gefen Cardiac Health Center; Israeli Academic College,
Israel
klainman@zahav.net.il
Organ Transplants are no longer in the realm of science fiction, but are a
routine and accepted treatment. The source of the implanted organ may
be another person, living or dead, an animal, and most recently, a
genetically engineered artificial creation. Along with the medicalscientific-technological development that has taken place in this area,
many complicated ethical-moral issues have arisen, many of which have
no black and white solution. Thus, we are often faced with the need to
choose among the lesser of evils and to sacrifice a positive value in favor
of a higher and a more important value.
The approach and the solutions to such dilemmas change from society to
society and from one time period to another.
The moral-ethical questions in the realm of transplant are as difficult and
complex as are the scientific-medical problems. There is no doubt that we
must invest efforts in ensuring high moral standards that are equal to the
efforts made in the scientific medical realm. It seems that there are
certain moral principles which have to be incontestable:
The considerations for organ transplant must take into account
minimal risk to the donor and maximum chances of success for the
recipient.
Organs from deceased donor should be taken only after death has
been certified according to relevant definitions.
Organs must not be taken from a donor without his consent or the
consent of his family.
The life of animals is not equal to that of humans in terms of the
taking of organs for transplant.
All Men were created equal and therefore priorities for transplant
must be set in accordance with accepted medical criteria that do not
take into consideration who the recipient is.

Abstracts of Oral Presentations


HEALTH LAW AND ITS IMPACT ON DEFENSIVE MEDICINE
Lucy A. Knouse, USA
laknouse77@gmail.com
My interest is in the bio-law area that concerns the impact of wrongful
birth lawsuit rulings in the United States of America on the practice of
medicine. My presentation will focus specifically on the development of
defensive medicine as a way medical practitioners protect themselves
against multi-million dollar awards to plaintiffs who blame medicine for
the birth of their disabled children who they would have preferred to
have aborted rather than give birth to. This bio-legal area developed after
the passage of Roe v. Wade and began to flourish in the 1990s. It
corresponds to the proliferation of genetic testing and various pre-natal
testing techniques that allow for a greater awareness of medical
conditions for pre-born children. To help set the stage for this discussion, I
will recap a few medical cases that will provide enough background to
clarify the types of medical situations that have resulted in substantial
awards. Then I will explain the juridical issues that arise from these
lawsuits and the problems created which negatively impact the equitable
administration of justice for all parties involved in these suits. I will then
recap some of the unintended side-effects that hurt society by failing to
advance medical science for the welfare of the unborn.

ETHICS AND REGULATION OF AESTHETIC MEDICINE


A SINGAPORE EXPERIENCE
1

K.H. Koh , Y.H. Liow


Tampines Polyclinic, Singapore
2
Temasek Polytechnic, Singapore
koh.kim.hwee@singhealth.com.sg, liowhj@tp.edu.sg
1

Aesthetic medicine is currently a rapidly growing field in medicine. It


differs from conventional medicine in that the physician has moved from
the cure of diseases and relief of suffering, to enhancing bodily image and
feeling good. Many physicians, enticed by the lucrative and burgeoning
area of aesthetic medicine, are now jumping onto this bandwagon which
is traditionally helmed by plastic surgeons. However, unregulated
cosmetic and aesthetic surgery is a worldwide concern and the field of
aesthetic medicine clearly requires regulation. As a profession, physicians
are governed by their own code of ethics. Society trusts the medical
profession to regulate itself and abide by its traditional professional
standards. Physicians involved in aesthetic practice are also bound by the
same ethical principles governing traditional medical practices such as
autonomy, beneficence, non-maleficence, justice, and the principle of
best interests. Physicians that fail to meet the trust and professional
conduct and standards may result in loss of public confidence in the
medical profession, thus bringing disrepute to the medical profession. In
Singapore, the existing ethical guidelines appear to be inadequate to
regulate this emerging field. A number of recent court cases in Singapore
have raised several issues on aesthetic medicine and these have shed light
into certain medicolegal and ethical issues surrounding aesthetic
medicine. In this article, we will examine the recent changes in the
regulation of aesthetic medicine in Singapore as well as highlight the
ethical principles that govern the way aesthetic medicine should be
practiced.

YOUTH WORK AND ETHICAL REFLECTION:


STIMULATING INTERPROFESSIONAL ETHICAL REFLECTION
J. Kole, M. A. van den Hoven, Utrecht University, Netherlands
m.a.vandenhoven@uu.nl
In the field of youth work, many different types of professionals are
active, varying from social workers to psychologists, from pedagogically
trained professionals to police officers and custodians. Youth work is a
domain where professional moral dilemmas frequently occur, as it
concerns fundamental issues regarding parental autonomy, a childs
safety and well-being and the privacy of a home and a parental relation.
(1) When professionals are urged to cooperate more with other
professionals, in order to stimulate effective and efficient care, new
interprofessional dilemmas enter the fore, such as how and when to
share information about clients, or to be strict on patient confidentiality.
(2) In a research project we aim to identify the interprofessional ethical
issues that professionals encounter within the field of youth work, and we

101

develop sessions for moral reflection that address these interprofessional


moral aspects. (4) We made an inventory of these topics based on expert
interviews and focus group interviews. In this presentation we will both
present what topics were coded in the interviews, and how we aim to
distribute ethical knowledge on these topics within the field of youth
care. Not only did we develop sessions for moral reflection that are
offered to professionals in the field, but we also try to reach more people
by offering information on topics via a website and relate ethics teachers
and interested course participants together. The following topics are
specifically addressed: good professionalism, responsibility, professional
timidity, parental autonomy and professional confidentiality.

UNDERSTANDING WHY PEOPLE REFUSE TO PARTICIPATE IN


RESEARCH MAY STRENGTHEN MUTUAL TRUST & ETHICAL
STANDARD IN BIOMEDICAL RESEARCH: EXPERIENCES
FROM FOLLOWING UP REFUSALS IN KILIFI HEALTH &
DEMOGRAPHIC SURVEILLANCE SYSTEM, KENYA
Francis Kombe, Johnson Masha, Mary Mwangoma, Betty Kalama,
Hassan Alphan, Salim Mwalukore, Evasius Bauni, KEMRI-Wellcome Trust
Research Programme, Kenya
Fkombe@kemri-wellcome.org
Background: KEMRI/Wellcome Trust Research Programme (KWTRP) is a
busy multidisciplinary biomedical research programme in Kenya. Every
four months, over 260,000 people living in the Kilifi Demographic
Surveillance System are visited to collect their demographic data. This
forms the backbone of sampling for many epidemiological and clinical trial
studies. Between 2000 and 2010, 99 households (0.33) declined to give
their demographic information to the KHDSS team. We report on the
outcome of following up these households and its implication in the
conduct of ethical research in a rural community in Kenya.
Methodology: We visited the 99 households and systematically
documented their reasons for refusal. Discussion guide were used to
generate an open narrative account of perceptions, attitudes and
experiences underlying refusals. A detailed report of the discussion was
produced after each interview. Report analysis and workshop discussion
of emerging issues of the first 42 interviews identified key themes to
focus on in subsequent interviews. Content and thematic analysis was
conducted at the end of the 99 interviews.
Findings: 63% of the homes that refused were from the urban area. The
majority those who refused were men (59%). The most common reasons
given for refusing were; previous adverse experiences in research (45%),
inadequate interpersonal communication (41%), negative rumors about
research and study procedures (24%), concerns about levels and types of
benefits (24%) and religious background (14%). Majority were happy to
continue giving their demographic data after the follow-up. Following up
refusals could held to build mutual trust and ethical standard in research.

GENDER-BIASED PRENATAL SEX SELECTION:


INTERNATIONAL ORGANIZATIONS AND THE ETHICAL
REASONS BEHIND DEALING WITH THE ISSUE
Johanna Kostenzer, Management Center Innsbruck, Austria
Johanna.Kostenzer@mci.edu, johannakostenzer@gmx.at
A strong preference for male offspring and increasing rates of sex
selective abortions have been observed in numerous countries across the
globe leading to an imbalance of the birth outcome of girls and boys. The
natural sex ratio at birth ranges from 102 to 106 males per 100 females.
In certain Asian and most recently also in some Southeastern European
countries, distorted sex ratios have reached a level of up to 120 male per
100 female births.
The intended killings of female fetuses raise numerous ethical questions.
Ensuring sexual and reproductive health rights, preventing discrimination
and protecting future generations constitute key factors in this context.
The issue of prenatal sex selection is hence also of great concern to the
international community and United Nations agencies as well as the
European Union and the Council of Europe have put the issue on their
agenda.
International organizations share the need for action even though they
deal with the issue from different perspectives such as public health,
demography, gender equality or human rights. However, the extent to

102

UNESCO Chair in Bioethics 9th World Conference

which ethical implications play a role in this agenda setting process


remained unclear so far. My presentation will critically analyze if and in
what way ethical considerations play a role in priority setting of
international organizations in terms of gender-biased prenatal sex
selection with particular focus on Southeastern European and South
Caucasian countries concerned.

responses of students have been analyzed. As result typologies of diverse


semantic understanding have been proposed and the given responses
have been compared with the standard definition of euthanasia.

WHEN DOES HUMAN LIFE BEGIN ENDLESS


CONTROVERSIES?

CHRISTIAN ANTHROPOLOGY VS. THE NEW


ANTHROPOLOGY & THE QUEST FOR HUMAN PERFECTION

Asim Kurjak, Dubrovnik International University, Croatia


asim.kurjak@public.carnet.hr

Tomasz Kraj, Pontifical University of John Paul II, Poland


krtomasz@poczta.onet.pl

The list of necessary or sufficient conditions for being a person includes:


minimum intelligence, self-awareness, self-control, a sense of time,
futurity and the past, capability of relating to others, concerns for others,
communication, control of existence, curiosity, change and changeability,
balance of rationality and feeling, idiosyncrasy and neo-critical
functioning. The infrastructures of the above mentioned abilities reside in
the cortex that is well developed from the 30th week of gestation and on.
From that point of view, every neonate or fetus during the third trimester
of gestation are person, in a moral or an ethical context. There is no doubt
that the embryo and fetus in utero are human individuals prior the birth.
The child that is born is the same developing human individual that was in
the mother's womb. Legal capacity, as provided for by civil law, is an
ability of a natural person to enjoy rights and obligations. The human
being becomes a natural person at the moment of birth. If human life is
worth being protected by law only after delivery, for what reason does
perinatology exist and perinatologists fight for? Nowadays, lots of medical
treatments, interventions and even surgeries during pregnancy are done
for the benefit of the unborn child, and not due to the mother's health.
From legal perspective, it is better for a child to be born prematurely than
at the right time, since from the moment of birth child's life is protected
by law. From the medical point of view, this must seem as an absurd, as
the best environment for a child to develop is his/her mother's womb
during all the period of the nine month pregnancy. All the known
evidence support the human fetus being a true ontological human
individual and consequently a human person in fact if not in law.

In the current debate, we witness a conflict between the Christian


concept of man vs. concepts which justify in vitro fertilization (IVF),
genetic enhancement, or the reassignment of sexuality. Modern concepts
cannot disregard the historic perspective of the consistent doctrines
which the Catholic Church has maintained throughout her 2000 year
history and which constitute the precursors of contemporary bioethics.
Although she has adjusted specifics occasionally to address new
developments, she has always based doctrine on immutable core
principles. The current conflict lies neither in the novelty of the new
proposals, nor in a conflict between religious and lay worldviews, but
rather in concepts of man and human perfection. Some human traits may
be regarded as disordered and incompatible with a particular concept of
human perfection. The new proposals tend to involve physical changes
based on technological manipulation, with a goal of developing a superior
being, while Christian proposals do not seek to manipulate mans being,
but to develop his existing potential within criteria of acceptable reason.
The new proposals rely on a Cartesian view which constitutes a human as
his mind (cogito ergo sum), which has dominion over his body including
authority to reengineer it according to any project that mind conceives. In
contrast, the Christian concept views the human subject as a unity of
mind and body which may not be reshaped to meet a questionable goal
of human perfection. The technological tools within the new concepts are
in no way superior to the more personal attributes like virtues, perfection
of the human will, prayer, and ascesis within the Christian concept.

BIO-ETHICS ISSUES IN LITERATURE AND THE ARTS:


ECOLOGY OF THE SOUL MINI-ESSAYS
Emilija Kukubajska, University Goce Delcev, Macedonia
maria_kubaiska@yahoo.com
Ethical messages in literature and the fine arts represent core issues in
the course of civilization and its context in history, culture, society and
religion. This presentation is a practical proof in the literary genre of miniessays, in synergy with fine arts illustrations, both from Macedonian
authors. Moral messages seem to have no expiration date in their
application and reapplication in the course of human thought, despite of
its revising transformation and new bio-ethical utilization. This special
session proposal offers a gallery of both traditional and revised
worldviews on aesthetics and ethics as viewed in cases of vigorously
challenged issues of the 21st century. Samples on individual and
institutional level are being monitored by the creative imagination of a
poet and educator, and then simultaneously paired with fine art images
that complement the synergy of the visual and verbal interpretation of
ethical issues of today. Twenty seven samples are presented in a book of
artistic and poetic miniature essays on virtue and vice in poetry and the
arts, entitled Ecology of the Soul. Selection of this publication will be read
and visually presented at the conference special session.

UNDERSTANDING OF EUTHANASIA BY MEDICAL STUDENTS


Josef Kue, Masaryk University, Czech Republic
jkure@med.muni.cz
Both in the general public and in the professional communities, diverse
understanding of euthanasia can be found. This fact does not support any
meaningful discussion of euthanasia. So as a necessary prerequisite of any
euthanasia discussion a clear semantics of the term and concept called
euthanasia seems to be the starting point. The paper, contributing to this
clear semantics, investigates understanding of euthanasia by medical
students. As methodology an open question has been taken and the

MOVIES AND DRAMA RELATED TO BIOETHICS IN JAPAN


Mitsuyasu Kurosu, Tokyo Medical University; Head, Japanese Unit of
International Network of UNESCO Chair of Bioethics, Japan
krs-uou@tokyo-med.ac.jp
Movies and dramas are useful for bioethics education. Students and a
teacher are able to see them together and discuss bioethical issues. In
addition they can study culture, social system, history and so on. UNESCO
recognizes usefulness of movies, dramas and documentaries in education
and announced BIOETHICS CORE CURRICULUM SECTION 2: STUDY
MATERIALS ETHICS EDUCATION PROGRAMME in 2011. These materials
include movies, dramas and documentaries as well as cases and books.
However Japanese movies have not been adopted in BIOETHICS CORE
CURRICULUM SECTION 2, then I investigated Japanese movies and dramas.
The list of movies has recently been made up by the Medical ethics and
professionalism committee in the Japan Society for Medical Education
(http://jsme.umin.ac.jp/ba/eas/jmse_recommend_movies.html). The list
has 48 Japanese movies and 190 movies produced by other nations,
which are classified into 13 categories and are mentioned with title,
director, produce year, nation and keyword. Hereafter an each summary
of these movies should added to this list.
A DVD of dramas was produced for medical ethics education in 2009. The
DVD has 8 dramas directed by Yasushi Koshisaka. Running time of each
drama is around 20 minutes. The topics of the dramas are cancer
notification, treatment refusal, abortion, autopsy report, terminal care,
Down syndrome and so on. I have used this DVD in bioethics class for a
few years. The students ring after seeing the DVD. Because the DVD ends
up question and there is no answer in it. This DVD is very helpful material
for bioethics education.

ETHICS AND EVOLUTION


Peter Lachmann, University of Cambridge, UK
pjl1000@cam.ac.uk
Thomas Huxley in his book Evolution and Ethics stated that ethics
existed to counteract the cosmic struggle (of evolution by natural

Abstracts of Oral Presentations


selection). It will be argued that this is fundamentally incorrect and that,
far from counteracting evolution, ethics form the building blocks of
cultural evolution. This argument carries with it the conclusion that ethics
themselves must evolve and be subject to natural selection. While certain
ethical precepts altruism, respect for human life and truthfulness have
been shared by nearly all human moral communities over long periods of
time, others, such as attitudes to slavery, cannibalism, human sacrifice
and suicide, have varied widely. It follows that the idea of a natural law
underlying all ethics is intrinsically flawed.
It will also be argued that the evolution of ethics by natural selection is a
Darwinian and not a Lamarckian process and has no end in view. Indeed,
many current ethical prescriptions remain those appropriate to an
endangered species where increase in numbers is of paramount
importance. With the transformation of humans to an endangering
species where overpopulation and overuse of resources have become
critical issues, it is clear enough that further evolutionary change in ethics
is urgently required.

THE FULL DISCLOSURE POLICY: A DIFFICULT BALANCING


BETWEEN INFORMATION TO THE PATIENT AND
COMMUNICATION TO THE ODONTOLOGISTS
Alberto Laino, University of Naples Federico II, Italy
alberto.laino@unina.it
In the exercise of professional practice, it can reach the observation of the
dentist a patient with adverse event of a treatment made by another
therapist.
In such a circumstance arise challenging matters of ethical and
professional conduct in relation to the qualitative and quantitative
aspects of the information to be provided to the patient and, eventually,
what action to take against the colleague.
With regard to the first problem, is proposed the opportunity to
communicate to the patient his/her oral health, as well as any error
committed by the colleague. In such cases, the difficulty task is to
ponderate the right words
Regarding the second aspect, may be considered appropriate to establish
a dialogue with the colleague who gave care to the patient in order to
make informed about the damage appreciated, and about the tecnica
choose that led him to make that type of treatment.
Likewise, it should arise the opportunity to inform the Professional Order
about a treatment grossly negligent. Furthermore, it must be numbered
the possibility that the diagnostic mistake could be due to the same
clinician who appreciates it, rising an ethical obligation to communicate
the negative findings to the patient, providing any information and at the
same time to remedy to the negligent conduct after to disclose the
mistake to the patient.

END OF LIFE DECISIONS IN ONCOLOGY DECISIONS


AGAINST LIFE-PROLONGING TREATMENT IN YOUNG
PATIENTS
1

Katsiaryna Laryionava , P. Heuner , W. Hiddemann , E. Winkler


1
National Center for Tumor Diseases (NCT), Germany
2
University Hospital of Munich, Germany
katsiaryna.laryionava@med.uni-heidelberg.de

Background: With the progress in medical treatments and technologies,


decision-making at the End-of Life (EOL) in modern medicine has become
a complex process, involving a range of different psychological, social and
ethical aspects. The aim of this empirical study was to explore oncology
clinicians and nurses perception of difficult situations in their clinical
practice as well as their understanding of ethical problems regarding EOL
decision-making.
Methods: We conducted 29 face-to face qualitative interviews with
physicians and nurses working at the Department of Hematology and
Oncology at the LMU University hospital in Munich, Germany. The
interviews were analyzed according to the grounded theory approach.
The normative implications of the results were assessed.
Results: Asked about challenging situations in clinical practice physicians
and nurses named frequently decisions against life-prolonging treatment
in younger patients. Physicians arguments were often based on
psychological (emotional) reasons: young patients have not achieved a
reasonable length of life. However, this aspect was not mentioned

103

when asked about perceived ethical problems. The following aspects


were named as ethical ones: risk-benefit analysis and assessing of medical
futility of treatment, taboo around dying and death, economical
aspects, detecting of patients will and dealing with discrepancy between
the involved parties in the decision making.
Discussion: Dealing with young patients at the end of life was perceived
as one of the most difficult situation in clinical praxis but not as ethically
relevant. Young age was often named as explanation for trying further
aggressive treatments. The perception of treatment decisions in young
patients with advanced cancer being primarily a psychological problem
could lead to possible neglecting ethical aspects such as risks /benefits
consideration and consequently to overtreatment of young patients at
the end of life.

LEGAL PROTECTION OF PATIENTS' RIGHTS IN CHINA


Hong Le, Huazhong University of Science and Technology, China
13554045010@163.com
Based on the research of the current Chinese legislation, paper analyzes
legal protection of patients' rights in China's development stage and its
characteristics. Detailed analysis of China's current legislation that the
patients' rights has been covered by the current legislation in China, and
analyses current legislation situation, put forward relevant suggestions for
improvement.

ENVIRONMENTAL MEDICINE IN THE 21ST CENTURY


Zohar Lederman, Yale Interdisciplinary Center for Bioethics, USA
zoharlederman@gmail.com
One Health Initiative, Echohealth, and One World One Health, are
st
novel concepts\ paradigms\ initiatives in the 21 century which purport to
acknowledge and advance the inter-connectedness and inter-dependence
of human beings, animals, and the environment. Unequivocally, their aim
is to improve the well-being of all living creatures and the subsistence of
our environment. Recently, these varied projects have been receiving a
growing amount of attention and resources. However, at this time, no
one has examined the extent to which the actual practice of these
projects adheres with their aims and policy statements. Moreover, no one
has yet to assess the commensurability of these programs with existing
philosophical theories. These theories, such as Deep Ecology and
Biocentric Egalitarianism, have been discussed for many years in
environmental philosophy, and they seem to reverberate, mainly
subliminally, in the declared policy statements and aims of these projects.
Do the proponents of these programs view animals instrumentally? How
should we treat the environment? In this paper, I will provide an overview
of these different programs and examine whether their practice indeed
adheres with their proclaimed policies and goals. Next, I will briefly review
some relevant theories in environmental philosophy and assess whether
they parallel these varied projects. I suggest that a wholesome ground
theory is required to unite philosophy and practice, and recommend using
these philosophical theories in order to better understand ones role in
caring for humans, animals, and the environment, and to ameliorate the
well-being of all.

THE USAGE OF BIO-MARKERS IN CLINICAL SETTINGS:


ETHICAL REFLECTIONS (OBSERVATIONS?)
1

Antonio Leo , Felice Francesco Carabellese , Federica Veneziani ,


Donatella La Tegola1, Caterina Bonfiglio2, Chiara Candelli1,
1
1
Roberto Catanesi , Giancarlo Logroscino
1
University of Bari, Italy
2
IRCCS De Bellis, Italy
leo.med@libero.it, donatella.lategola@gmail.com
Biomarkers are quantifiable biological substances, characteristics, or
images that provide an indication of the biological state of an organism.
They also provide indications of both the potential effectiveness and the
potential hazard associated with a therapeutic intervention. In
neurodegenerative diseases biomarkers represent a promising approach
to staging the disease in order to identify clinical subgroups. Current
clinical research is focused on the use of biomarkers to improve early
detection of disease and pre-symptomatic detection of neuronal

104

UNESCO Chair in Bioethics 9th World Conference

dysfunction. The ethical debate related to this topic stems from the
dichotomy between the principle of autonomy and the principle of
beneficence. The rights of ownership and the future use for research of
biological samples with an informed consent for actual use provided are
still an unresolved problem. However the binomial of research interests in
using this data with implications for the entire community, together with
the bioethical interest of constitutionally guaranteed rights protection has
to be taken into account. From this results the authors interest to suggest
methodologies for the accurate acquisition of consent that provide to the
patient detailed information on the aims, purposes and procedures of
biomarkers investigation. The purpose has been pursued by the draft of
an application format of information sheet and an informed consent.
They point out the possible value of biomarkers as early diagnosis and
monitoring tools in neurodegenerative diseases. This formats also clarify
that the identification in blood or CSF of some markers don't express a
definitive diagnosis and underline that, at present, their validity as disease
progression index is still uncertain.

DEVELOPING ETHICAL UNDERSTANDING AND DESIGNING


A RUBRIC TO MEASURE PROGRESS
Marie Catherine Letendre, Marymount International Rome, Italy and
Bioethics International
mletendre@marymountrome.it
This paper examines both aspects of the question: what constitutes deep
ethical understanding and how can we measure the progress of achieving
an ethical aptitude?
The acquisition of moral reasoning skills by high school students,
undergraduate and graduate students is currently viewed as a necessary
and important skill set for preparation as knowledgeable citizens. We
have far too many examples of unethical choices on the part of
professionals and organizations and know well how such choices decrease
societys trust and harm individuals. Faculty members and researchers
have initiated efforts in various disciplines to teach ethics and/or
bioethics, improve ethics awareness, and implement best practices in
developing ethical reasoning skills. There has been an enormous increase
in research articles in the last decade on empirical research in ethical
decision-making compared to the previous four decades.
However, the topic of designing a methodology for assessing students
level of ethical achievement is currently not as robust. Admittedly, some
aspects of the moral reasoning process, namely reflection and the
ongoing adjustment of ones beliefs, moral principles, values, and factual
information, can present significant difficulty. This paper will describe my
efforts to date to develop a rubric for advancing students moral
reasoning skills as well as to present examples for use as a framework for
educators to better determine what level of achievement is appropriate.

ETHICAL DIFFICULTIES IN NURSING, EDUCATIONAL NEEDS


AND ATTITUDES ABOUT USING ETHICS RESOURCES
C. Leuter, C. Petrucci, A. Mattei, G. Tabassi, L. Lancia, University of
L'Aquila, Italy
cinzia.leuter@cc.univaq.it
NursEthics. 2012 Nov 27. [Epub ahead of print]
Ethical difficulties arise in health-care practices. However, despite
extensive research findings that demonstrate that most nurses are
involved in recurrent ethical problems, institutions are not always able to
effectively support nursing care professionals. The limited availability of
ethics consultation services and traditional nursing training fails to meet
the frequent and strong requests by health workers to support their
ethical dilemmas. A questionnaire was administered to 374 nurses
attending a specialist training and a lifetime learning programme in Italy.
The respondents reported a high frequency of ethically sensitive
situations, and they described the poor development of ethics support
and a scarcity of ethics training programmes. The results suggest the
importance of promoting ethics services that include consultation and
ethics training. A need for systematic ethics educational activities was
identified for improving the capacity of nurses to manage ethical issues in
patient care.
PMID: 23186939 [PubMed as supplied by publisher]

MEDICAL FUTILITY (MF) DOCTOR'S POINT OF VIEW


MEDICAL FUTILITY IN ISRAEL HEALTH CARE SYSTEM 2013
Avi Levin, Tel Aviv Sourasky Medical Center, Israel
levinavi@hotmail.com
Background: While the concept of medical futility dates back to the
Hippocratic corpus, and over the years has evolved, futility still remains
elusive and controversial. Efforts are aimed at allowing physicians to use
their clinical judgment to determine whether a particular treatment
would be futile.
This study seeks to explore how Israeli doctors in a leading tertiary
medical center define medical futility and why some continue to provide
such care.
Methods: A 55 item questionnaire was self-completed by internal
medicine residents and attending physicians on medical futility: whether
they would provide a potentially futile treatment, what factors they
consider when judging the effectiveness of a certain treatment and how
often is this issue encountered in everyday practice.
Results: Of 95 responding physicians, the majority (72 %) deals with
futility on a daily basis. 52% stated that the patient's quality of life is the
central part of the concept and 55% believe that rendering such care is
not a violation of their code-of-ethics. Nearly half of the respondents
(48%) felt that guidelines are appropriate and required. 45% believed that
financing consideration is not a part of the futility conversation.
Surprisingly, 61% denied providing futile care due to defensive medicine.
Interestingly, 54% of physicians admitted providing futile care which they
would refuse as patients under similar circumstances.
Conclusion: Medical futility is not yet a firmly established concept among
Israeli doctors. Futile care is provided but for reasons other than
defensive medicine or cost savings, reasons that reflects the unique
characteristic of Israel's healthcare system.

DEVELOPMENT OF ETHICAL COMMITTEES IN THE CHINESE


HOSPITALS AND PROTECTION FOR THE PATIENTS RIGHTS
Jining Li, Guangxi Medical College, China
ljn8494@126.com
The fast clinical development in modern society has led to various
bioethical problems. Our attentions are drawn to issues concerning
patients medical safety and dignity, and their entitlement to fair medical
services. The establishment of Ethic Committee in hospital provides
better protection to patients right of life and health. Formed between
late 80s and early 90s, Chinese Hospital Ethics Committee has made great
progress and its function has changed. From the beginning, the
Committee has been playing a role in enhancing medical ethics
construction, providing ethics education to medical practitioners,
reconciling medical conflicts, and conducting medical ethical assessment.
Nowadays, the Committee is also responsible for constructing and
supervising the medical ethical education of hospitals, and conducting
ethical review on bio-researches concerning human body, clinical trials
concerning medicine, medical instruments, human assisted reproductive
technology, researches on human embryonic stem cell, human organ
transplant technology, appliance of new medical technology in clinical
practice and etc. The existence of such organization keeps patients and
medical trail participants from illegal infringement.

MEDICAL INFORMATION IN A CHANGING WORLD:


PROVIDING INFORMATION VIA PHONE CALLS TO
RELATIVES OF HOSPITALIZED PATIENTS
Adi Liberty, Michal Itzhaki, Sheba Medical Center, Israel
adi.liberty@gmail.com; Michal.itzhaki@sheba.health.gov.il
The question of providing information to patients' relatives using "dated
methods", such as by answering phone calls, arises due to medical,
technological and social changes involving human rights.
The "morning sickness" affair of the pregnant British princess raised
awareness of the complexity of this issue. The nurse who provided
medical information on the phone realized that she had been cheated and
consequently committed suicide as she considered her act a serious legal
and ethical breach.

Abstracts of Oral Presentations


Similar issues are evident all over the world. In Israel, the Patient Rights
Act (1996) recognizes patients' rights to humane treatment and to
privacy. In 2003, the Israeli Ministry of Health issued a regulation
permitting health care providers to give information to the patient's
relatives as instructed by the patient in writing, but this regulation isn't
implemented in practice.
A survey of 180 Israeli registered nurses examined their knowledge and
perceptions of providing information to relatives on the phone. The
findings indicated that participants are not aware of this right and are not
familiar with the form required. When the caller identifies him/herself as
a therapist working at the same medical institution nurses tend to
provide information, but they do not provide information on the phone to
anyone identifying themself as a patient's relative. Most of the nurses
expressed a wish for official instructions regarding the issue of providing
information over the phone.

WOMAN'S RIGHT TO ABORT A VIABLE FETUS


Pnina Lifshitz-Aviram, Israel
Pnina.aviram@ono.ac.il
Late termination of pregnancy consists of, feticide followed by inducing
labor of an otherwise viable fetus, beyond 24 weeks of gestation.
The question remains, if the universal recognition of human rights, both
by the United Nation and by governments around the world, applies to
fetuses in their mothers' womb as well.
In Israel, termination of pregnancy at the viable stage requires, starting in
2007, the assembly of a specialized committee whose mandate is to
approve or reject the request for termination of pregnancy. Surprisingly,
since the development of these committees in 2007, no significant
changes in rates of approval were noticed. This may raise concerns
regarding the keeping of the rights of the fetus, as those may come in
contradiction to the parental wishes.
Is the fetus a human being, and as such, when is it entitled to human
rights, is an important question. As a human being, it has the right for
moral and legal protection, even from its parents. Some of its rights are
already being considered, by the mere existence special committees in
order to terminate the pregnancy. Other rights are less defined, thus not
protected at all.
The modern technology used today conveys great knowledge about the
developing fetus, some of which of diagnostic nature, and some of
statistical nature. This knowledge may be significant for parents, as they
might not want to give birth to an anomalous newborn. Prenatal
diagnosis begets expectation, which may lead to the proliferation of
requests regarding termination of pregnancy.

HAVING A CHILD AFTER DEATH: REPRODUCTIVE RIGHTS,


CHILDREN'S INTERESTS AND THE REGULATION OF
TECHNOLOGIES
Yun-hsien Diana Lin, National Tsing Hua University, Taiwan
yunslin@hotmail.com
In 2005, a Taiwanese military officer, Chi-hsiang Sun, died from an
accident. His fiance, Ms. Li, required Officer Suns sperm to be retrieved
so as to bear his child through artificial insemination. The Taiwan
Department of Health gave permission to the extraction of sperm but
later opposed to the posthumous reproduction. The sperm was finally
destroyed. In 2007, the Taiwan Artificial Reproduction Act responded to
instances of posthumous reproduction in a forbidding fashion. This article
will argue that the blanket regulation is overly broad that it may impose
substantial obstacle to an individuals autonomy in procreation, which
should be narrowly tailored under consideration of all the competing
interests.
Firstly, models of regulation from the restrictive to the permissive
approach will be discussed in light of protecting the procreative autonomy
of the deceased. Next, since the assisted reproductive technologies will be
performed upon the surviving spouse, she will need comprehensive
consultation in order to make autonomous choices. The contents, goals,
methodologies of such consultation and the system of collaboration and
referral will be the main concern. Lastly, the best interests of the resulting
child must be given due consideration. To reduce the uncertainty and
potential risks, issues of legal parentage and inheritance will be explored.
This article will conclude by proposing a comprehensive framework of

105

regulation where interests of the deceased, the surviving spouse, the


resulting child and social justice will be balanced.

DEVELOPING NEW/REFORMED PSYCHIATRIC SERVICES


WHAT SHOULD BE THE PRIMARY TARGET?
Muli Linder, Lev-Hasharon Mental Health Center, Israel
muli.linder@gmail.com
Creating a new set of psychiatric services is not a routine procedure. In
fact, it is a process that might not happen for decades, and when it does,
it affects lives of an incredible number of people, patients and
professionals. It involves politics, worldviews, values and money. It
requires legislation, budgets and time.
When a ministry of health and the insuring organizations are planning
such a dramatic move, they are expected to determine the standards of
care, first. This phase is when different points of view might collide, and
ethical issues may emerge.
A close looks on three different mental health systems (Britain, Italian and
Dutch) reveals some of these points of view, showing that standards of
care are not similarly prioritized in different countries.
What are the reasons for these differences? Population size? Culture?
Money? should these factors play a role when trying to determine
standards of care while addressing the ethical codes of health and mental
health?
Israel is going through a reform in its mental health services. The main
issue is transferring the responsibility on MH services from the state to
the HMOs, just like most other medical services in Israel. What are the
opportunities that come along with the changes? Are we violating any
unwritten ethical code by changing the "contract" between the state and
the patient?
Some of the uncertainties will be presented, along with some of the steps
taken so far, after the first out of tree years given to complete the reform.

HUMAN ORGAN TRANSPLANTATION IN SINGAPORE


1

Y.H. Liow , K.H. Koh


Temasek Polytechnic, Singapore
2
Tampines Polyclinic, Singapore
liowhj@tp.edu.sg, koh.kim.hwee@singhealth.com.sg

The Human Organ Transplant Act (HOTA) in Singapore was enacted for
the removal of kidneys for the sole purpose of transplantation from
deaths arising from accidents under a system of presumed consent. Since
then, it has undergone a series of major amendments to include the
recovery of the liver, heart and cornea in the event of deaths from nonaccidental causes, and to make provisions for the inclusion of Muslims
and the removal of the upper age limit of 60 years old to increase the
number of donors. Recent amendments to this law have also included the
regulation of living donor organ transplantation and the more
controversial reimbursement of organ donors for their loss of earnings
and expenses pertaining to the transplantation. The purpose of this paper
is twofold. It traces the historical developments in Singapore that led to
the adoption of an approach in presuming the consent of individuals in
donating his organs upon death. In doing so, it addresses the challenges
that a policy of presumed consent to organ transplantation has
presented. Next, we review an instance in Singapores legal history in
which the strict prohibition on financial compensation for organ
transplantation was tested. Here, the legal justifications behind the
courts decision will be discussed in tandem with the prevailing theme of
exploitation of the poor and socially disadvantaged.

AN ETHIC OF RESPONSIBILITY FOR MANAGING


END-OF-LIFE PROCESSES
Giuseppe Lissa, Italy
Few decades ago, Hans Jonas easily became a prophet a few, when he
argued that, in the face of the mutations produced, in each field, by
developments in scientific knowledge and their technological applications,
there would be need more and more of an ethic of responsibility to the new
type to address the great moral issues with which humanity should have
been compared.

106

UNESCO Chair in Bioethics 9th World Conference

This prediction appeared particularly good in the field of medicine, where,


as well as Hans Jonas had foreseen, the most shocking changes had already
occurred in recent decades. Here we must point out that if these changes
have affected every aspect of life, from its conception to its rise and its
develop, they have particularly affected and transformed the paths of the
last stage of life the ones who generally are precisely called end-of-life
processes.
Medical knowledge has allowed a significant lengthening of lifespan. In this
context the diseases of old age have gradually put more and more relevant
issues, launching unprecedented challenges to ethical reflection applied to
the great questions of life. You can, without fear of being proven wrong,
claim that in this landscape the issues related to serious diseases have
imposed with increasing clarity some problems that stand out for ethics and
vital importance on all others. I mean to risk, from those who practiced
medicine, of falling, in the case of serious diseases, often extreme, in the
practice of a life-prolonging treatment that acts as a counterbalance to the
request from the patient, subjected to the pressure of a suffering growing
up on the edge of the unbearable, to make use, with the assistance of the
physician, of euthanasias practices.
An ethic of responsibility is an ethical decision first of all pro-life. An ethic of
this kind would be an ethic for life. But how can consistently be when the
situation with which we must deal causes ethical agents in the field, the
doctor, the patient and the family background and the company, are to be
tossed between the opposing demands of having to avoid therapeutic fury
in all its forms without using euthanasias practices.
As it is known, the therapeutic fury can, according to the doctors, be
conjugated in three ways: therapeutic fury, diagnostic fury, experimental
fury. What is the note that unites these three behaviors? In each of them
you can, using the categories suggested by the great Je