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      Physicians’ perception of the importance of ethical and deontological issues in a major Italian Province: pilot questionnaire and its validation

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          Abstract

          Background and aim: This study aims at validating a questionnaire on physicians’ knowledge and perception of deontological and ethical rules that guide the medical profession, in a major Italian Province. Methods: We designed an on-line survey questionnaire. Participants (N=200) were asked to fill in information regarding their demographic features and knowledge of the deontological code. Results: Concerning the preliminary data, the median total score on knowledge of the deontological code was 0.50. A significant difference in the total score was observed among education groups. Specifically, the median total score among subjects with a specialist qualification was significantly lower than among those with only a medical degree. Conclusions: The tested instrument and methodology appear to be efficacious and reliable. Our preliminary data indicate that knowledge of the rules concerning medical deontology and the related principles of medical ethics seems to be very limited. Therefore, the authors plan to implement a second phase of the study, which will consist of the questionnaire’ distribution to a broader and more representative sample. (www.actabiomedica.it)

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          Bioethics education in clinical settings: theory and practice of the dilemma method of moral case deliberation

          Background Moral Case Deliberation is a specific form of bioethics education fostering professionals’ moral competence in order to deal with their moral questions. So far, few studies focus in detail on Moral Case Deliberation methodologies and their didactic principles. The dilemma method is a structured and frequently used method in Moral Case Deliberation that stimulates methodological reflection and reasoning through a systematic dialogue on an ethical issue experienced in practice. Methods In this paper we present a case-study of a Moral Case Deliberation with the dilemma method in a health care institution for people with an intellectual disability, describing the theoretical background and the practical application of the dilemma method. The dilemma method focuses on moral experiences of participants concerning a concrete dilemma in practice. By an in-depth description of each of the steps of the deliberation process, we elucidate the educational value and didactics of this specific method. Results The didactics and methodical steps of the dilemma method both supported and structured the dialogical reflection process of the participants. The process shows that the participants learned to recognize the moral dimension of the issue at stake and were able to distinguish various perspectives and reasons in a systematic manner. The facilitator played an important role in the learning process of the participants, by assisting them in focusing on and exploring moral aspects of the case. Discussion The reflection and learning process, experienced by the participants, shows competency-based characteristics. The role of the facilitator is that of a Socratic teacher with specific knowledge and skills, fostering reflection, inquiry and dialogue. Conclusion The specific didactics of the dilemma method is well suited for teaching bioethics in clinical settings. The dilemma method follows an inductive learning approach through a dialogical moral inquiry in which participants develop not only knowledge but also skills, attitude and character. The role of a trained facilitator and a specific view on teaching and practicing ethics are essential when using the dilemma method in teaching health care professionals how to reflect on their own moral issues in practice.
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            Consequences of defensive medicine, second victims, and clinical-judicial syndrome on surgeons' medical practice and on health service.

            Increased knowledge in disease causes and progression, along with technological and technical advancements in their diagnosis and treatment, have led to increased expectations from physicians by patients and their relatives. The condition of "second victim" is known to affect caregivers that commit an error, and seriously impairs private life and subsequent practice. Besides, a condition has been described, the clinical-judicial syndrome, affecting caregivers at any moment during a medical litigation. In this scenario, physicians have started to practice "defensive medicine", aimed at protect themselves from liability rather than actually advancing care of patients. This paper represents the first review on defensive medicine with specific focus on surgery in an Italian setting. We reviewed the literature on the topic, with particular focus on surgeons and Italian current status, and provide the readers with a snapshot on these relevant issues, proposing strategies to prevent and reduce the practice of defensive medicine, and to support patients and physicians suffering from medical errors.
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              Respect for Human Vulnerability: The Emergence of a New Principle in Bioethics.

              Vulnerability has become a popular though controversial topic in bioethics, notably since 2000. As a result, a common body of knowledge has emerged (1) distinguishing between different types of vulnerability, (2) criticizing the categorization of populations as vulnerable, and (3) questioning the practical implications. It is argued that two perspectives on vulnerability, i.e., the philosophical and political, pose challenges to contemporary bioethics discourse: they re-examine the significance of human agency, the primacy of the individual person, and the negativity of vulnerability. As a phenomenon of globalization, vulnerability can only be properly addressed in a global bioethics that takes the social dimension of human existence seriously.
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                Author and article information

                Journal
                Acta Biomed
                Acta Biomed
                Acta bio-medica : Atenei Parmensis
                Mattioli 1885 (Italy )
                0392-4203
                2019
                : 90
                : 1
                : 56-67
                Affiliations
                [1 ]Section of Forensic Medicine and Bioethics, Department of Health Sciences, School of Medicine and Surgery, University of Genoa, Genova, Italy
                [2 ]Unit of Plastic and Reconstructive Surgery, San Martino Institute for Research and Care, Genoa, Italy; Department of Surgery and Integrated Diagnostics, University of Genoa, School of Medicine and Surgery, Genoa, Italy
                [3 ]Section of Biostatistic, Department of Health Sciences, University of Genoa, Genova, Italy
                [4 ]Department of Diagnostics and Public Health, School of Medicine and Surgery, University of Verona, Verona, Italy
                Author notes
                Correspondence: Alessandro Bonsignore, Section of Forensic Medicine and Bioethics, Department of Health Sciences, University of Genoa, Via A. De Toni 12, 16132, Genova, Italy E-mail: alessandro.bonsignore@ 123456unige.it
                Article
                ACTA-90-56
                10.23750/abm.v90i1.7647
                6502145
                30889156
                9484fdde-65c1-422d-aa74-96270392f3a7
                Copyright: © 2019 ACTA BIO MEDICA SOCIETY OF MEDICINE AND NATURAL SCIENCES OF PARMA

                This work is licensed under a Creative Commons Attribution 4.0 International License

                History
                : 29 August 2018
                : 21 January 2019
                Categories
                Original Article

                code of medical deontology,medical ethics,ethical principles,physicians’ knowledge,pilot questionnaire

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