Neuroscience and end-of-life decisions. New anthropological challenges for constitutional law: «Is Human Nature the only science of man»?

Nowadays, neuroscience permits the unveiling of interior elements of hu-man beings - the perception of pain, the presence of consciousness and even the will - in the absence of external manifestations. Physicians, indeed, seem capable of measuring the true mental state of individuals and their inner world through an elec-troencephalography or a functional magnetic resonance imaging. This new frontier affects the world of law and places heavy demands for lawyers embroiled in end-of-life matters. The present paper focuses on the use of neuroscientific acquisitions within end-of-life decisions, aiming to highlight two risks embedded in this use: the utmost deference towards science and scientific authority and the maximization of self-determination. The paper will provide, at the beginning, a framework of case law and end-of-life regulatory attempts; it will follow the analysis of the main challenges posed to law by advances in neuroscience. In the latter part of this paper, we will of-fer food for thought on the role of neuroscience and - in a broader perspective - of science in law

Oltre l’autodeterminazione: I confini del diritto nei casi Gard ed Evans

Uno dei temi pi\uf9 significativi e al contempo spinosi che il diritto \ue8 chiamato ad affrontare nell\u2019ambito delle decisioni di fine vita \ue8 il contrasto tra l\u2019affermazione della libert\ue0 personale e i meccanismi attraverso cui si invera l\u2019esercizio di tale diritto. Non sempre, per\uf2, il diritto \ue8 capace di disciplinare le particolarissime e travagliate vicende che riguardano la cura di pazienti non ancora dotati della capacit\ue0 di agire, quali gli infanti. Esempi emblematici in questo senso sono i recenti casi Gard ed Evans e le modalit\ue0 predisposte dal sistema britannico per regolamentarli: di fronte agli obiettivi ostacoli nell\u2019accertamento dell\u2019autodeterminazione del singolo, pu\uf2 dirsi esaustivo e soddisfacente il criterio del best interest of the child? Quale il rapporto tra questo criterio, sempre pi\uf9 ammantato di oggettivit\ue0 (di scientificit\ue0), e l\u2019esercizio della libert\ue0 degli esercenti la responsabilit\ue0 genitoriale?One of the most sensitive challenges that law is called to face within the end of life issues is the link between the recognition of the right to self-determination and the mechanisms through which this right is guaranteed and implemented. Nonetheless, there are situations where the right to self-determination cannot be seen as the lode star aimed to unravel the knot. Examples are cases involving children or infants whose choices are impossible to derive. When contrasts arise between doctors and parents, how can the law address these conflicts? In this perspective, the paper offers food for thought moving from the analysis of two cases: the Charlie Gard case and the Alfie Evans case. Can the best interest standard be considered as exhaustive? Which is the link between this criterion (moreobjective because based on scientific knowledge) and the parents\u2019 choices

L'AMMINISTRAZIONE DI SOSTEGNO: UNA VIA ALTERNATIVA AL TESTAMENTO BIOLOGICO?

The present dissertation intends to describe how the legislation regarding the \u201camministratore di sostegno\u201d,as interpreted by some judges, interacts with the constitutional provisions concerning the right to self-determination and more specifically the right to self-therapy. The research is organized in three chapters. The first one analyzes the informed consent as expression of the right of self-determination and the protection of this right for incapable persons. The second chapter sets out to identify the main features of the discipline of the \u201camministrazione di sostegno\u201d with particular regard to those interpretations that extend the powers of the \u201camministratore di sostegno\u201d to the informed consent given on behalf of a third person. The last chapter is structured in three parts: the first one tries to point out the limits of a recostruction ex post of the incapable's will throught the analysis of a recent case that involves the "amministratore di sostegno".The second part examines in details the most emblematic examples in which the role of the \u201camministratore di sostegno\u201d may be involved in the jurisprudence application as a possible substitute of the living will. The last part of the present chapter aims to examine the role of the \u201camministratore di sostegno\u201d within the living will bill that is going to be adopted by Italian Parliament

L’ordinanza 207/2019 della Corte costituzionale : convergenze e divergenze in una decisione di cauta (?) apertura

The paper briefly analyzes the Italian Constitutional Court\u2019s decision on assisted suicide and offers food for thought moving from the Court\u2019s legal reasoning to hypothetical future scenarios

Dall’identità alle identity politics: la rinascita dei nazionalismi nel sistema costituzionale europeo

The rise of identity politics is challenging European constitutionalism that, after the failed effort to create a demos under a Con- stitution, focused on the protection of human rights. When the demands for identity recognition cannot find spaces to be voiced, they may lead to forms of new populism/nationalism. Against such backdrop, how can constitutionalism help to manage this tension

Peri-Conceptional Intake of Folic Acid Supplement to Date: A Medical-Legal Issue

Folic Acid (FA) supplementation during pregnancy represents a so widespread and established recommendation all over the world, to be taken for granted sometimes. As a matter of fact, this vitamin supplement is worldwide recommended mostly during peri-conceptional period for its proved preventive effect on Neural Tubal Defects (NTDs), like spina bifida. However, The biological and clinical potential of FA is reassessing and this represents a hot topic in scientific community, mostly in consideration of the possible medical-legal implications. An overview is mandatory in order to keep in mind FA-related possibl

Are Italian medical societies bridging the distance from citizen and patients? associations? Results of a survey.

Introduction. In the framework of PartecipaSalute ? an Italian research project aimed to involve lay people, patients? associa- tions and scientific-medical representatives on the health debate ? we carried out a survey with the Italian Federation of Medical Societies. The aims of the survey were to know medical socie- ties attitude vs. patients involvement in research activities and healthcare setting and to find out possible projects conducted in partnership with patients associations. Results. A web-questionnaire with 17 closed questions, and three open questions has been prepared on the basis of some experiences published on the literature and through the col- laboration of members of the Italian Federation of Medical Societies. A total of 205 medical societies has been contacted by e-mail with a cover letter explaining the aims of the survey. At the end 74 medical societies completed the survey. Medical societies participating to the survey varied widely in terms of years of activity, number of members, and geographical distri- bution. Remarkably, 36 medical societies respondent organized collaborative initiatives with patients/consumers associations during the last three years. Among these, the most frequent were the preparation of written material for patients, organiza- tion of conferences or workshops, and health awareness cam- paigns. Moreover, 6 medical societies published documents on patients? rights but patients or their associations were involved in only 2 of these initiatives. Advantages and disadvantages reported by medical societies answering are also presented and discussed. Conclusions. In conclusion, to our knowledge this is the first survey on the value of patients? involvement conducted together with medical societies in Italy, and the results point the way to stronger collaboration in future between patients? associations and medical societies

Improving Healthcare Workers' Adherence to Surgical Safety Checklist: The Impact of a Short Training

Background: Although surgery is essential in healthcare, a significant number of patients suffer unfair harm while undergoing surgery. Many of these originate from failures in non-technical aspects, especially communication among operators. A surgical safety checklist is a simple tool that helps to reduce surgical adverse events, but even if it is fast to fill out, its compilation is often neglected by the healthcare workers because of unprepared cultural background. The present study aims to value the efficacy of a free intervention, such as a short training about risk management and safety checklist, to improve checklist adherence. Methods: In March 2019, the medical and nursing staff of the General Surgical Unit attended a two-lesson theoretical training concerning surgical safety and risk management tools such as the surgical safety checklist. The authors compared the completeness of the surgical checklists after and before the training, considering the same period (2 months) for both groups. Result: The surgical safety checklists were present in 198 cases (70.97%) before the intervention and 231 cases (96.25%) after that. After the training, the compilation adherence increased for every different type of healthcare worker of the unit (surgeons, nurses, anesthetists, and scrab nurses). Furthermore, a longer hospitalization was associated with a higher surgical checklist adherence by the operators. Conclusions: The results showed that a free and simple intervention, such as a two-lesson training, significantly stimulated the correct use of the surgical safety checklist. Moreover, the checklist adherence increased even for the operators who did not attend the training, maybe because of the positive influence of the colleagues' positive behaviors. As the results were promising with only two theoretical lessons, much more can be done to build a new safety culture in healthcare

Solidification behaviour and microstructure of A360-SIC P cast composites

In the present investigation, the solidification microstructure of Al based composites was studied. The materials investigated were a commercial A360 aluminium alloy and the corresponding composites reinforced with 10 and 20 vol. % SiC particles. The materials were cast under different conditions for a first set of laboratory tests, aimed at studying the solidification behaviour and the related microstructures. The reinforcement distribution in the cast composites revealed to be governed by the pushing action exerted by the matrix solidification front during casting, giving rise to clustering effects of the SiC at dendrite boundaries, especially in sand castings. Copper mould castings, experiencing reasonably high cooling rates during solidification, showed a very fine microstructure within which the segregational effects of the reinforcement was of limited relevance. SiC particles also revealed to be a site for heterogeneous nucleation of coarse Si crystals in the composites