by Giuseppe Battimelli
06 JUNE – Dear Director,
the professor. Ivan Cavicchi in the article of last 27 May acutely, with a dense and meaningful reflection, identified in the contribution of bioethics one of the possibilities for addressing the crisis of medicine on the one hand and consequently of health care on the other.
I enter the debate he urged above all as a doctor and bioethics expert, because in addressing the above issues the perspective can certainly be different from the philosopher, the politician, the health economist, etc. and then as a member of a scientific society the SIBCE (Italian Society for Bioethics and Ethics Committees) which refers to ontologically founded personalism.
First of all, it is true that bioethics as a discipline often appears self-referential and sometimes “mere theory” and this harms a growth itinerary, and in any case, even in the face of supposed limitations, the importance and usefulness of the tools and categories of analysis are recognized. really peculiar to it to provide valid proposals.
Did bioethics on the medical question and the medical crisis say little, even in the pandemic contingency? I really do not think so.
But to stay with the “crisis of medicine and the absence of bioethics” raised by prof. Cavicchi, we can briefly say the following.
The changes in health care and welfare policies that we face, however accentuated by the pandemic emergency situation due to the SARS-CoV-2 coronavirus, impose many and problematic questions concerning politics, health organization, law, legislation, medical ethics and deontology, bioethics.
In particular, especially in the most advanced countries of the Western world and with modern and avant-garde health systems, questions of extreme importance are certainly posed concerning the fundamental right to health and how this can be ensured and guaranteed always and in any case, especially in moments of serious health emergency, when the welfare system, concerning human and instrumental resources, and the measures to protect the population manifest serious difficulties.
It is certain that “the right to health” that the state authority must ensure is in the meaning of “health protection” as required by art. 32 of the Constitution, which gives rise to the obligations of the State to health services, as well as the freedom of treatment, in the collective and individual interest; even if it is questionable how, when and in what way, this right provides accessibility in fact and not by law, since from absolute it can be relative, partial and even impracticable or at least it can become problematic due to budgetary needs (and in fact, there is talk of a “financially conditioned” right) or organizational difficulties or the health emergency, as occurred during the Covid-19 pandemic.
In any case, in health systems with a solidarity and universalistic imprint such as the Italian one, the following are always essential: a) the principle of equality between people and equity of access to care, avoiding any form of discrimination; b) the non-negotiable principle of the value and dignity of every human being.
As we have seen in the pandemic era, the ethics of public health, through the application of scientific tools that are of reference for political decision-makers and is aimed at protecting the health of the community, cannot however be separated from a ethics in public health at the individual level where, even in the implementation of emergency measures, the patient’s personal freedoms and individual autonomy must be safeguarded.
If it is true that the essential principle of a health system is that of distributive justice, at the basis of which there is an equitable distribution of common resources and equality of access to services and benefits, fairness requires protecting the most important elements. weak in a society both for ethical and operational aspects, with regard to particularly vulnerable people, groups and categories, characterized by extreme fragility.
This introduces us as prof. Rightly reflects. Cavicchi, the principle of vulnerability, which we can say is the new principle of bioethics and bio-law, central and fundamental for the protection, respect and promotion of human (and non-human) life and also of the environment, which must inspire them. States, civil society, voluntary organizations, cultural agencies, etc. in the various forms of concrete realization.
This principle, conceived on the fragility and finitude of human existence, recalls the ethical, juridical and moral obligation of “taking care of”, especially on the part of the doctor in his professional activity, as an expression of the position of guarantee. It is certainly an innovative idea, which has close links with the principles of solidarity and justice and with regard to the medical art, with the “ethics of care”.
On the other hand, it must be said that health measures, in the light of consequentialist theories, can determine the occurrence, really concrete, of utilitarian practices also as a criterion for moral action, especially in the scarcity of resources (favoring those with greater chances of healing or those who is in greater danger of death? Consider the number of years of life expectancy of the patient or evaluate the quality of the particular current and / or future life conditions, determined by a certain pathology?).
The debate is still alive as to whether medicine should be recognized as having an “ontological” conception or is this a moment of transition towards a “historical” conception. While it is certainly true that medicine is also influenced by the dominant culture and by some objectives that society expresses in that particular historical phase, we believe that in any case it cannot ignore and disregard its intrinsic nature.
That is to say with Edmund Pellegrino that the aims of medicine are subject to a certain variability, while the aims specify the nature and are independent of the needs expressed by society; and we agree with Daniel Callahan who already in the past believed that prior to any examination of the medical crisis it is necessary to explore in what direction it should go in the future, what are the priorities and what changes are needed, and this must necessarily precede and not follow an evaluation. essentially of a technical, managerial and organizational nature (the role of the market and the state, cost control, cost-benefit analyzes, etc.)
Finally, we believe that the fundamental principles of personalist bioethics, never obsolete, such as the principle of the defense of life and health, the principle of responsibility, of sociality towards the common good and the principle of subsidiarity, can certainly offer both a theoretical and procedural orientation. in the face of burdensome but unavoidable decisions and balancing individual needs and those of the community in a balanced way.
Here then is that the reflections of prof. Cavicchi represent an important solicitation addressed to everyone and not only to bioethicists on fundamental questions about the crisis of medicine and its future that certainly need to be grasped and deepened.
Giuseppe Battimelli
National Vice President of the Italian Society for Bioethics and Ethics Committees (SIBCE)
06 June 2022
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