Assessing malpractice lawsuits for death or injuries due to amniotic fluid embolism

Amniotic fluid embolism (AFE) is a pregnancy complication known to be extremely hard to diagnose, since it manifests itself abruptly and with no warning signs, presenting an incidence rate of about 1 in 40000 deliveries, and maternal morbidity and mortality ranging from 20% to 60%. Although almost a century has gone by since it was first identified (1926) and despite medical research having been conducted on such a syndrome, diagnostic procedures and treatment methods have not yet been clarified enough. Specific biochemical markers have been produced in research laboratories, but their clinical value results to be limited, given how rapid the pathological process moves forward. At the time being, no diagnosis is feasible which may effectively prevent the disease from occurring. Certainly, a multidisciplinary approach might contribute to saving the lives of mother and infant, as well as ensuring better life standards. The paper's authors aim to highlight the medico-legal issues, in light of several rulings from the Italian Constitutional Court as well as lower courts. The authors also advocate for the creation of a nation-wide registry meant to collect all signaled AFE instances so that research on this as yet devastating syndrome can be conducted based on hard data

Two sides of the same coin: educational and professional pathway for surgical residents

Aim: To provide a review of medical malpractice cases ruled by the Italian Supreme Court with the aims at identifying lawsuits targeting involved with surgical residents. Material and methods: Legal cases ruled by the Italian Supreme Court, from September 2020 to October 2020, pertaining to medical claims involving surgical residents were examined, using the main online databases. Results: Of a total of eleven (n=11; 100%) cases identified, four (n= 4; 36,4%) cases addressed the standard of care pertaining to the surgical residents' medical activity. The legal reasoning of the Italian Supreme Court does not focus on the manual skill in the resident's medical performance, but rather on the choice to accept to treat the patient, regardless of the participation of the tutor. Conclusions: The performance of the surgical residents is made more difficult due to their peculiar nature, characterized by the complex interactions between the directives given by the tutor and the need to guarantee patients' needs

Palliative care and covid-19 pandemic between hospital-centric based approach and decentralisation of health services: a valuable opportunity to turn the corner?

Italy was the first Western EU country to have dealt with the severe effects of the widespread Covid-19 virus since the pandemic began. Many healthcare services were negatively affected, and the delivery of palliative care has been no exception. The Italian healthcare system has suffered more than others due to public spending cuts. The hospital-based approach has not allowed all patients to receive appropriate care. This situation was brought about not only by the pandemic emergency but mainly by pre-existing shortages due to the cut in financial resources before the Covid-19 pandemic. For countries similar to Italy, it is necessary to develop territorialised health care, decongestion hospitals, and strengthen the Third Sector, particularly the voluntary sector

La disciplina giuridica della consulenza tecnica d'ufficio

The Authors comment on the articles of the civil code of procedures inherent to the role of Court appointed experts, in particular, forensic specialists, in civil suits, hereby outlining all of the activities required for supplying judges with the technical expertise they needs from taking on the obligation up to the accurate drafting of the expert opinion, hereby paying special attention to operational aspects and recent legislative reforms. They point out the sensitiveness and importance of the tasks assigned to the Court appointed expert, whose «replies» may «influence» the outcome of a trial

Is the team leading surgeon criminally liable for his collaborators’ errors? judges confirm responsibility and condemn an otorhinolaryngologist

In current healthcare, delivery of medical and surgical treatment takes place in a multidisciplinary manner. This raises the problem of distinguishing the conditions under which the person who has properly carried out his duties, respecting the related leges artis, can be held responsible for damages materially caused by another member of the medical team. Jurisprudence has developed the so-called “principle of trust” for which every member of the team can rely on the fact that other members are acting in compliance with the leges artis of their specialisation. The Supreme Court has limited the application of this principle. The authors examine the jurisprudence on responsibility of the team in otolaryngology and conclude that individual liability should be limited to the specific expertise of the individual specialist

Ethics and/or aesthetics? reflections on cosmetic surgery for adolescents

Cosmetic surgery entails various ethical issues, even more so in cases involving adolescent patients. Cosmetic surgeons need to take into account how modern societies consider physical appearance an essential component of everyday life, as well as the vulnerability of youths and adolescents. For that reason, it is imperative to thoroughly assess the psychological and emotional states, in addition to the motivations, of minor patients. That goal can be achieved through the use of the DAS-59, (the Derriford Appearance Scale)1 , an effective and dependable tool devised to evaluate the psychological difficulties and distress experienced by people living with problems of appearance. Prior to undergoing cosmetic surgery procedures, adolescents should be required to go through adequate counseling, over multiple sessions and extended to their family members as well, on account of the complex issues inherent in evaluating the risk-benefit ratio and a prospective patient's decision-making capability. A concerted effort on the part of surgeons, psychiatrists or psychologists is key in determining the real motivations behind a minor's decision to opt for cosmetic surgery in the first place. Possible psychiatric conditions may in fact prevent a minor from making a free, informed decision. From an ethical standpoint, cosmetic surgery procedures should be geared to serve the best interest of the minor patient, who may experience distress over his or her body image, from a health and psychological balance perspective and improve his or her social, affective and working life. Besides, cosmetic surgery should not be overly invasive compared to its potential benefits. Those procedures aimed at achieving ″ideal beauty″ are not desirable and ought to be banned. By virtue of such criteria, the authors have set out to evaluate the ethical admissibility of some aesthetic treatments. Thus, doctors should not consent to any request coming from their patients, but rather, intervene only in presence of an objective physical flaw or deformity, e.g. protruding ears, which have a potential to negatively affect social life and interactions

The reform of the Italian legislation on childhood immunization

Upon the proposal of the Italian government, Law n. 191/2017 has been enacted, meant to considerably raise the number of mandatory vaccinations, while leaving several others merely "recommended" (non-mandatory). Such a reform has proven necessary in light of the latest epidemiologic data reflecting a steady decrease in the rates of immunization coverage in most Italian regions over the past few years, including mandatory vaccinations. Court rulings that held vaccinations may have caused autism, or even a child's death, have probably contributed to decrease in coverage. Early interventions to mandate immunization had been put in place at the regional level, yet the Italian Government and Parliament have opted for a national piece of legislation devised to make mandatory vaccinations a requirement to gain access to the preschool system or day care services. The authors elaborate on the reform's contents and shed a light on the medical, ethical and legal elements underpinning the mandate to immunize children. As a matter of fact, possible risks arising from vaccinations are rare, and largely offset by the benefits to both the children and society at large. On the heels of the reform in question, the doctor-patient relationship is still at the forefront. In fact, citizens need to understand the value and usefulness of non-mandatory, recommended vaccines as well. Therefore, it appears necessary to improve the quality of vaccination counseling practices in childcare, but such activities need to take place within the framework of a broader strategy, centered on the fostering of a culture of prevention, backed by scientific research to the fullest extent possible

The importance of disclosing the conflict of interest (CoI) in the era of open access publishing

In pharmacological and biomedical sciences, most of the principle donators are progressively demanding open access as a condition in economical support, something which has already become common in various other areas1. The expression “open access” has been used since 2002: first in the Budapest Open Access Initiative (February 2002), then in the Bethesda Statement on Open Access Publishing (June 2003) and finally in the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities (October 2003). Open access was initially intended for scholarly journal manuscripts in order to provide an unrestricted online access to them. However, even though this term first appeared in the 2000s, free on-line access to journal manuscripts had started at least 10 years previousl

The static evolution of the new Italian code of medical ethics

Eight years since the last revision, in May 2014 the Italian code of medical ethics has been updated. Here, the Authors examine the reform in the light of the increasing difficulties of the medical profession arising from the severity of the Italian law Courts. The most significant aspects of this new code are firstly, the patient's freedom of self-determination and secondly, risk prevention through the disclosure of errors and adverse events. However, in both areas the reform seems to be less effective if we compare the ethical codes of France, the United Kingdom and the United States. In particular, the non-taking into consideration of the said code quality standards and scientific evidence which should guide doctors in their clinical practice is to say the least questionable. Since these are the most significant changes in the new code, it seems inevitable to conclude that the 2014 edition is essentially in line with previous versions. Now more than ever it is necessary that medical ethics acknowledges that medicine, society and medical jurisprudence have changed and doctors must be given new rules in order to protect both patients' rights and dignity of the profession. The physician's right to refuse to perform treatment at odds with his own clinical beliefs cannot be the only mean to safeguard the dignity of the profession. A clear boundary must also be established between medicine and professionalism as well as the criteria in determining the scientific evidences that physicians must follow. This has not been done in the Italian code of ethics, despite all the controversy caused by the Stamina case