Euthanasia and physician-assisted suicide for patients with depression. Thought-provoking remarks

Euthanasia and medical assistance in dying entail daunting ethical and moral challenges, in addition to a host of medical and clinical issues, which are further complicated in cases of patients whose decision-making skills have been negatively affected or even impaired by psychiatric disorders. The authors closely focus on clinical depression and relevant European laws that have over the years set firm standards in such a complex field. Pertaining to the mental health realm specifically, patients are required to undergo a mental competence assessment in order to request aid in dying. The way psychiatrists deal and interact with decisionally capable patients who have decided to end their own lives, on account of sufferings which they find to be unbearable, may be influenced by subjective elements such as ethical and cultural biases on the part of the doctors involved. Moreover, critics of medical aid in dying claim that acceptance of such practices might gradually lead to the acceptance or practice of involuntary euthanasia for those deemed to be nothing more than a burden to society, a concept currently unacceptable to the vast majority of observers. Ultimately, the authors conclude, the key role of clinicians should be to provide alternatives to those who feel so hopeless as to request assistance in dying, through palliative care and effective social and health care policies for the weakest among patients: lonely, depressed or ill-advised people

Covid-19 and medical liability: a delicate balance

During the Covid-19 pandemic, many countries around the world are considering whether and how to provide liability protection to front-line healthcare staff. The guiding principle of liability protection for physicians and others is to ensure that, in a serious emergency situation, health professionals can devote themselves exclusively to their work and to patient care, without the fear of future claims for unforeseeable, but above all unavoidable, injury, loss and damage caused by their conduct. Great care is needed to balance the interests and rights of all those involved. Liability protection could have risky consequences with the final result that doctors will not be protected, but institutions such as health facilities will be even if they were in fact responsible for foreseeable and avoidable damage

Psichiatria e bioetica. Un rapporto critico, uno stimolo alla riflessione

In the western world, especially in Italy, also legal attention to bioethical aspects is increasingly taking on importance in the debate at the medical, political and public level. In this debate, Psychiatry, as a scientific discipline closely integrated with the human and cultural, is underrepresented, little questioned on the many psychopathologal issues closely related to ethical aspects on complex themes. Against this background, Rivista di psichiatria, always keen to these topics, is designed to be a very special space for discussion with all the experts involved in mental health

The assisted suicide of Italians in Switzerland and the silence of psychiatry

The debate on different forms of request of death has taken on a broad dimension in public opinion over last years, often referring on profoundly differentiated and often opposing positions of principle. Beyond cultural, political or ideal positions, a further critical issue, often underestimated or quite not considered, concerns a person’s ability to express a valid consent to the request of death, according to the same criteria of validity of the informed consent to any medical act. This assumes particular importance in the case of assisted suicide. Assisted suicide represents a phenomenon in sharp growth in Western world. It is legal in many nations, and in Switzerland it is also allowed for foreign citizens, thus increasing the phenomenon of the so-called “tourism of suicide”. In addition to neoplastic and neurological diseases, depression has also been accepted as a disease that makes assisted suicide possible. This imposes profound clinical and ethical considerations, since depression is unanimously recognized as a treatable disease and since in its most serious forms, such as those in which suicidal ideation dominates, it can compromise the patient’s ability to express a valid consent to any medical act, including the assisted suicide. Furthermore, it is often overlooked that any serious and disabling somatic disease, source of intense and chronic suffering, carries the very high risk of the onset of unrecognized depressive conditions, able in turn to negatively influence the ability to express valid consent. Faced with this situation, which has involved a large number of Italian citizens in recent years, the personal and official voice of psychiatry is absolutely lacking, contrasting its silence with the opinions of those who do not want to take into account its potentially fundamental considerations

Nootropics use in the workplace. Psychiatric and ethical aftermath towards the new frontier of bioengineering

OBJECTIVE: The authors have sought to expound upon and shed a light on the rise of nootropics, which have gradually taken on a more and more relevant role in workplaces and academic settings. MATERIALS AND METHODS: Multidisciplinary databases have been delved into by entering the following keys: "nootropics", "cognitive enhancement", "workplace", "productivity", "ethics", "bioengineering". In addition, a broad-ranging search has been undertaken on institutional websites in order to identify relevant analysis and recommendations issued by international institutions and agencies. Papers and reports have been independently pored over by each author. This search strategy has led to the identification of 988 sources but only 64 were considered appropriate for the purposes of the paper after being selected by at least 3 of the authors, independently. RESULTS: The notion of an artificially enhanced work performance - carried out by the 'superworker' - is particularly noteworthy and resonates with the conception of contemporary work on so many different levels: the rising need and demands for higher degrees of flexibility and productivity on the job, the implications of a '24/7' society, where more and more services are available at any time, the ever greater emphasis on entrepreneurial spirit, individual self-reliance and self-improvement, and last but not least, the impact of an ageing society on economic standards and performance. CONCLUSIONS: Moreover, it is worth mentioning that human enhancement technologies will predictably and increasingly go hand in hand with gene editing, bioengineering, cybernetics and nanotechnology. Applications are virtually boundless, and may ultimately affect all human traits (physical strength, endurance, vision, intelligence and even personality and mood)

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

Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder

INTRODUCTION: Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. METHODS: A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry "A. Fiorini" Hospital, Terracina (Latina, Italy), was performed. RESULTS: The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium-high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. CONCLUSION: Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications

The effect of 1-methylcyclopropene (1-MCP) application before and after cutting on the shelflife extension of fresh-cut tomatoes

[ENG] Exposing partially ripe fruit to 1-methylcyclopropene (1-MCP) before or after cutting may be a useful supplement to proper temperature and relative humidity management for maintaining quality of fresh-cut fruit products. In this study tomato fruits were exposed to 0.5 ppm of 1-MCP for 24 hours, while tomato slices were exposed to the same concentration of 1-MCP for 6 hours. Untreated slices were used as control. Initially and after 3, 7, and 9 days of storage at 5 °C the following quality attributes were evaluated: flesh and skin color, firmness, total soluble solids content, titratable acidity and weight loss. In addition, respiration rate and ethylene production were measured. Fresh-cut tomato slices treated with 0.5 ppm of 1-MCP before cutting showed higher firmness retention than untreated slices, while slices treated after cutting showed an intermediate firmness value. Color development was delayed in both 1-MCP treated samples, which presented higher skin and flesh hue angle value compared with untreated slices. The initial decrease in skin hue angle value was reduced in slices treated either before or after cutting, while those treated after cutting showed the highest value of hue angle of the flesh. Application of 1-MCP did not affect the respiration rate, but slowed down C2H4 production in slices treated after cutting, compared to slices from untreated tomatoes. No significant effect of 1-MCP treatment was observed on titratable acidity, while for soluble solids content slices treated after cutting showed a value significantly higher than untreated slices. Application before processing resulted most effective for firmness retention, while all other effects were more visible when application followed cutting. [SPA] La exposición de tomate parcialmente maduro a 1-metilciclopropeno (1-MCP) antes o después del corte puede representar un método útil, sumado al control de la temperatura y humedad, para mantener la calidad del producto mínimamente procesado. En este estudio los tomates enteros han sido expuestos a 0,5 ppm de 1-MCP durante 24 horas, mientras las rodajas se expusieron a la misma concentración durante 6 horas. Como control se utilizaron rodajas de tomate no tratadas. Inicialmente y tras 3, 7, y 9 días de conservación a 5 ºC se evaluaron los siguientes atributos cualitativos: color (piel y pulpa), firmeza, contenido en sólidos solubles, acidez titulable y pérdida de peso. Además, se midieron la tasa respiratoria y de producción de etileno. Las rodajas de tomate tratadas con 0,5 ppm de 1-MCP antes del corte mostraron mayor mantenimiento de firmeza que las no tratadas, mientras que las rodajas tratadas después del corte han mostrado un valor intermedio de firmeza. El desarrollo del color se ha ralentizado en los dos tratamientos realizados con 1-MCP; las rodajas tratadas han mostrado un mayor valor del ángulo de tinta de la piel y de la pulpa respecto al control. La disminución inicial del ángulo de tinta de la piel se redujo en los dos tratamientos, mientras las rodajas tratadas después del corte han mostrado un mayor valor del ángulo de tinta de la pulpa. La aplicación del 1-MCP no ha afectado a la actividad respiratoria pero ha disminuido la emisión de etileno en rodajas tratadas después del corte respecto a las rodajas no tratadas con 1-MCP. No se ha observado efecto significativo del tratamiento sobre la acidez titulable, el contenido de sólidos solubles de las rodajas tratadas después del corte se ha mostrado más alto que el control. La aplicación del 1-MCP antes y después del procesado ha resultado más efectiva para el mantenimiento de la firmeza y del color, respectivamente

Duplication of the posterior cerebral artery: two case reports

The anatomy of the brain circulation is complex and variable.Autopsy studies and imaging techniques have detected anatomical variations of cerebral arteries (CAs) in 48–58% of the general population [1]. The duplication of the posterior cerebral artery (PCA) is a rare anatomic variant with a frequency of 2.3% [2, 3]. PCA duplication is characterised by the identification of a “true foetal” PCA, that originates from the internal carotid artery (ICA) and gives rise to the parieto-occipital artery, the internal occipital artery, the calcarine artery and the posterior pericallosal artery, associated with a PCA, that regularly arises from the basilar artery and gives rise to the posterior temporal artery [4]

Ferroelectric control of the spin texture in germanium telluride

The electrical manipulation of spins in semiconductors, without magnetic fields or auxiliary ferromagnetic materials, represents the holy grail for spintronics. The use of Rashba effect is very attractive because the k-dependent spin-splitting is originated by an electric field. So far only tiny effects in two-dimensional electron gases (2DEG) have been exploited. Recently, GeTe has been predicted to have bulk bands with giant Rashba-like splitting, originated by the inversion symmetry breaking due to ferroelectric polarization. In this work, we show that GeTe(111) surfaces with inwards or outwards ferroelectric polarizations display opposite sense of circulation of spin in bulk Rashba bands, as seen by spin and angular resolved photoemission experiments. Our results represent the first experimental demonstration of ferroelectric control of the spin texture in a semiconductor, a fundamental milestone towards the exploitation of the non-volatile electrically switchable spin texture of GeTe in spintronic devices.Comment: 18 pages, 4 figure