A LIBERDADE RELIGIOSA EM ITÁLIA: “VINHO NOVO” EM “ODRES VELHOS” / RELIGIOUS FREEDOM IN ITALY: “NEW WINE” IN “OLD WINESKINS”

O presente artigo teve por objetivo analisar o direito de liberdade religiosa no contexto da ordem jurídica italiana, com o intuito de evidenciar os défices de liberdade ainda existentes nesse país europeu em relação aos grupos religiosos minoritários, bem como evidenciar a sua incapacidade de responder aos desafios do crescente pluralismo confessional. Para realizar essa tarefa, depois de uma breve análise histórica da política eclesiástica italiana, o artigo debruça-se sobre os aspetos principais do atual direito eclesiástico vigente nesse país, examinando tanto as fontes quanto o reconhecimento positivo da liberdade religiosa nas vertentes individual e coletiva. Deste estudo resultou que o atual défice de liberdade religiosa para as minorias é o produto, entre outros fatores, da pesada herança histórica desse país, da preservação de um inadequado sistema bilateral de relações entre o Estado e os grupos religiosos que favorece um leque restrito de confissões, do facto de ainda estar em vigor parte da legislação fascista sobre os cultos admitidos, bem como da escassa vontade reformista nesse campo demonstrada pelas forças políticas. Para resolver essa situação, na parte final do artigo, defende-se uma profunda reforma do sistema, que, em primeiro lugar, deveria passar pela aprovação de uma lei geral de liberdade religiosa que fosse comprometida com a liberdade e a igualdade. Ao mesmo tempo, sublinha-se que essa mudança jurídico-política deveria ser acompanhada por uma renovação de mentalidades no que diz respeito à liberdade religiosa e à integração da diversidade.Palavras-chave: Liberdade religiosa. Itália. Laicidade. Minorias religiosas

A Responsabilidade Civil Extracontratual das Entidades Religiosas

Tese de doutoramento em Direito, no ramo de Direito Público, apresentada à Faculdade de Direito da Universidade de CoimbraA presente dissertação tenciona averiguar em que termos o instituto da responsabilidade civil extracontratual se aplica às entidades religiosas, entendendo-se, com esta designação, o leque diversificado de grupos sociais, sejam eles pessoas coletivas ou entidades de facto, que exercem atividades de cariz religioso. Esta análise é realizada tendo em conta a ordem jurídica portuguesa, embora com frequentes remissões para a doutrina e a jurisprudência estrangeiras, nomeadamente às dos EUA, onde este tema foi objeto de numerosos estudos académicos e decisões judiciais. Até há poucas décadas atrás, esta questão era quase desconhecida tanto pelos juristas como pela sociedade civil em geral. Esta situação devia-se a vários fatores, de entre os quais se pode incluir: o temor reverencial que as pessoas e as instâncias jurisdicionais sentiam em relação às entidades religiosas; a pressuposição de que estas fossem sempre promotoras do bem; a existência de mecanismos eclesiásticos internos de resolução dos conflitos entre os fiéis; a aceitação tácita ou costumeira, por parte dos tribunais seculares, de muitas práticas religiosas. Hoje em dia, contudo, a situação apresenta-se diferente, devido sobretudo à descoberta de fenómenos desviantes dentro dos grupos religiosos (v.g., abuso sexual de menores, fraudes), aos conflitos gerados pelo intenso pluralismo confessional das sociedades ocidentais, à expansão da regulação jurídica estatal a todos os âmbito da vida, ao enfraquecimento da autoridade dos grupos religiosos em relação aos próprios fiéis e, por último, à renovada oposição ideológica, de algumas correntes de pensamento, contra o fenómeno religioso. A combinação destes elementos contribuíram para que, nos últimos anos, houvesse um aumento da litigância contra as entidades religiosas, principalmente com o intuito de obter delas a indemnização dos danos alegadamente causados. A aplicação do instituto da responsabilidade extracontratual às entidades religiosas representa, sem dúvida, uma exigência imprescindível, sendo necessário acabar com uma situação de impunidade que, no passado, fez de algumas destas formações sociais o terreno fértil para a prática de comportamentos desviantes. Todavia, são também patentes os riscos associados a uma aplicação cega de esquemas civilísticos pensados originalmente para outras realidades. A isto deve adicionar-se o perigo de a responsabilidade extracontratual se tornar uma arma ideológica, capaz de encurtar o perímetro da liberdade religiosa e implementar uma agenda política laicista. Com o intuito de evitar estes inconvenientes, na presente dissertação analisam-se, passo-a-passo, as várias questões levantadas pelas ações de responsabilização por danos das entidades religiosas. Neste sentido, começa-se por explicar qual o leque de entidades religiosas admitidas em Portugal, e qual o seu regime jurídico. A seguir, dedica-se uma considerável atenção às questões constitucionais que emergem nestes casos judiciais. Em particular, discute-se até que ponto os tribunais seculares se podem pronunciar sobre assuntos que, direta ou indiretamente, estejam relacionados com questões teológicas ou com a organização interna dos grupos religiosos. Examina-se, também, a necessidade de a responsabilização por danos destas entidades ser acompanhada pela ponderação entre o direito de liberdade religiosa e os outros direitos e interesses eventualmente lesados. Resolvidas as dúvidas constitucionais, tenta-se ver de que maneira a disciplina do Código Civil português acerca da responsabilidade extracontratual se relaciona com estes casos judiciais. Em particular, discute-se de que forma as normas gerais sobre a responsabilidade das pessoas coletivas devam ser aplicadas às entidades religiosas (art.os 165.º e 500.º). É também realizada uma releitura dos elementos constitutivos da responsabilidade civil, a fim de salientar as especificidades que costumam surgir nos casos sub judice. Por último, a dissertação analisa de forma pormenorizada algumas atividades e crenças das entidades religiosas que frequentemente estão na base de ações de responsabilidade civil extracontratual contra elas dirigidas. Para este efeito, são examinados tanto casos judiciais reais quanto situações meramente hipotéticas. Apesar da diversidade de tópicos, ao longo de toda a dissertação emerge sempre o mesmo objetivo, isto é: encontrar um ponto de equilíbrio entre, de um lado, a proteção dos direitos das entidades religiosas e da sua autonomia confessional, e, do outro, a necessidade de proteger as pessoas de formas abusivas de religiosidade ou de outros comportamentos desviantes no seio dos grupos religiosos.The present dissertation aims to analyse how Portuguese tort law’s general principles and specific rules apply to religious organisations, by meaning, with this term, the wide range of social groups, whether corporate or not, which have a religious scope or nature. Although this analysis is centred on the Portuguese legal system, it examines other countries as well, especially the US, wherein this topic has been given a considerable attention by legal scholars, as well as by courts. In the past, this topic was hardly debated in the academic contexts, and the idea to sue a church was considered peculiar or even blasphemous. This condition had many explanations, such as: the reverential respect courts and people felt regarding their churches and ordained ministers; the idea that religious organisations were always harmless; the authority churches held over their parishioners; the existence of internal disputes resolution systems in religious contexts and the tacit acceptance by courts of many religious conducts. Nowadays, the situation is quite different. The shocking revelations about clergy sexual abuse and frauds within some religious organisations have shown that these entities can be as harmful as any other. Nevertheless, this change has other reasons too, such as: the conflicts related to the extreme religious pluralism in western societies; the ever-increasing juridification process, which is now affecting the religious phenomenon itself; the loss of social authority of religious organisations over their parishioners and finally, the rise of a new ideological war on religion. All these elements lead to an increase in litigation against religious organisations, especially by persons who claim to be offended by clergy misconduct and seek a redress. Undoubtedly, the application of tort law to religious organisations is reasonable and desirable. Actually, the de facto impunity situation of the past might have prompted the religious deviance within many groups. Today, the exposition to civil liability may have the benefit of making churches more aware of their legal obligations and more careful about the ministers’ selection process. Nonetheless, many problematic issues stem from this application. In particular, some general secular laws can be inappropriate to a religious context and lead to unjustified and unnecessary burdens on religious groups’ freedom. At the same time, tort law can be easily twisted into an ideological weapon, as this field of law is a battleground for different social theories, as famously stated by William Prosser. In order to avoid both risks, this dissertation tries to examine, step-by-step and in a rigorous way, all the legal issues normally related to lawsuits against churches. Firstly, it presents a survey of the wide range of religious entities admitted in the Portuguese legal system, with a concise analysis of their legal regime. Secondly, a considerable attention is given to constitutional issues stemming from this kind of litigation. In particular, the dissertation tries to see if secular courts can resolve these disputes without becoming entangled in religious matters. Furthermore, it is suggested that, when genuine religious conducts are involved, the application of civil liability to religious groups should always be preceded by the weighing of the competing rights at stake. Thirdly, the tort law main theories are examined. In particular, vicarious liability is given great attention, in order to see if religious groups are vicariously liable for the injuries caused by their personnel. Other tort law issues are studied as well (e.g., wrongfulness, causation, clergy malpractice). Finally, the last part of this dissertation dwells on the religious conducts and activities that most frequently cause disputes and lead to litigation (priest-penitent privilege, counselling, brainwashing, religious discipline etc.). Real law cases from different countries are presented, as well as hypothetical situations. In conclusion, it is necessary to point out that, even if the dissertation focuses on many different topics, it has a main and specific purpose that can be summarised as follows: finding a balance between the religious organisations’ religious freedom defence, on the one hand, and the necessity to protect people from religious deviance or harmful religious activities, by granting them a remedy for their damages, on the other hand

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Comentário à jurisprudência do Tribunal de Justiça da União Europeia em matéria de vestuário religioso e discriminação no local de trabalho

Numa Europa cada vez mais plural e fragmentada, vacilante entre a aceitação do multi‑ culturalismo e a sua rejeição de sabor iliberal, coloca-se de forma cada vez mais intensa o problema da acomodação na sociedade das práticas dos grupos religiosos minoritários. Dentro desta temática, assume particular relevância a possibilidade de os trabalhadores manifestarem a própria identidade religiosa no local de trabalho, não tanto através de ati‑ vidades proselitistas – geralmente proibidas ou fortemente limitadas – mas pela simples utilização de símbolos (e.g., uma cruz) ou indumentária de conotação religiosa (e.g., o hijab, o quipá ou o turbante) que revelem externamente a sua profissão de fé. Apesar de se tratar de um tema que afeta transversalmente todas as religiões, inclusive as de matriz cristã, acaba por ser particularmente relevante para algumas confissões minoritárias, tais como os muçulmanos, os siques ou os judeus, que habitualmente utilizam símbolos visíveis e facilmente reconhecíveis que revelam externamente a sua identidade religios

A liberdade religiosa em Itália: “vinho novo” em “odres velhos”

The present article aimed to analyse religious freedom in Italy. Its main purpose was to show that in this European country this basic civil liberty is still inadequately protected as far as religious minorities are concerned. In addition, it tries to demonstrate that Italy is unable to respond efficiently to religious pluralism’s challenges. In doing this, after a short historical analysis, the article examines the Italian normative framework as it relates to religious phenomena, giving particular attention to its legal sources and to the components of religious liberty individually and collectively considered. From this survey, it emerged that the aforementioned situations are the result, among other reasons, of the historical Italian vicissitudes, of the preservation of a bilateral Stateand-religion relation system on behalf of a limited array of religious organisations, of the fact that the fascist statute on admitted churches still be partly in effect, and of the lack of political reformism in this realm. In conclusion, the article argues for a wide and serious reform. In particular, it advocates that an applicable-to-all and freedom-friendly religious liberty law should be brought into law soon. At the same time, it stresses that such legal reforms should be accompanied by a change of mentality, so important in a country still struggling to accept diversity in religious matters.O presente artigo teve por objetivo analisar o direito de liberdade religiosa no contexto da ordem jurídica italiana, com o intuito de evidenciar os défices de liberdade ainda existentes nesse país europeu em relação aos grupos religiosos minoritários, bem como evidenciar a sua incapacidade de responder aos desafios do crescente pluralismo confessional. Para realizar essa tarefa, depois de uma breve análise histórica da política eclesiástica italiana, o artigo debruçase sobre os aspetos principais do atual direito eclesiástico vigente nesse país, examinando tanto as fontes quanto o reconhecimento positivo da liberdade religiosa nas vertentes individual e coletiva. Deste estudo resultou que o atual défice de liberdade religiosa para as minorias é o produto, entre outros fatores, da pesada herança histórica desse país, da preservação de um inadequado sistema bilateral de relações entre o Estado e os grupos religiosos que favorece um leque restrito de confissões, do facto de ainda estar em vigor parte da legislação fascista sobre os cultos admitidos, bem como da escassa vontade reformista nesse campo demonstrada pelas forças políticas. Para resolver essa situação, na parte final do artigo, defendese uma profunda reforma do sistema, que, em primeiro lugar, deveria passar pela aprovação de uma lei geral de liberdade religiosa que fosse comprometida com a liberdade e a igualdade. Ao mesmo tempo, sublinhase que essa mudança jurídico-política deveria ser acompanhada por uma renovação de mentalidades no que diz respeito à liberdade religiosa e à integração da diversidade