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  • Carlo Botrugno, PhD, BSW, LLM, LLB, is Assistant Professor at the Department of Legal Sciences of the University of F... moreedit
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The implementation of new technologies is usually perceived as a vector for stimulating significant changes to the status quo, allowing individuals to operate more quickly and efficiently. Technological innovation has passed from a... more
The implementation of new technologies is usually perceived as a vector for stimulating significant changes to the status quo, allowing individuals to operate more quickly and efficiently. Technological innovation has passed from a response to one or more perceived needs, to be part of the cultural identity of contemporary industrialised societies. Hence, it cannot only be seen as a social process, but it also refers to a peculiar "state of mind", which encompasses a huge range of positive feelings lying between the evaluation of the present and expectations of the future. This paper briefly retraces the history of technological innovation in healthcare, highlighting the bonds it holds with religion and spirituality on one side, and with law and normativity on the other. In doing so, it aims to show that the informatisation of medical practice and the digitalisation of healthcare delivery rest on an "ethical ambivalence" as they relegate some sources of knowledge to the background-those linked to the sensory perception of the doctor and the patient, as well as those deriving from the relational dynamics-while they create new forms of knowledge resulting from complex assemblages between material and virtual factors that unavoidably reshape medical practice and medical epistemology itself.
This work aims at disentangling the main challenges posed by the conduct of ethnographic research in bioethics on both a methodological and an ethical background. Although these challenges can be framed into the wider relations between... more
This work aims at disentangling the main challenges posed by the conduct of ethnographic research in bioethics on both a methodological and an ethical background. Although these challenges can be framed into the wider relations between bioethics and sociology, they talk to the need of integrating empirical research methods into bioethics. Indeed, bioethics is no longer satisfied with importing empirical findings produced in other disciplines. Rather, it seeks to promote research driven by the questions and perspectives that most interest scholars who belong to this community. This knowledge base can be fundamental to reorienting professional practices and innovating health care organization patterns that affect the protection of rights and respect for patients’ preferences, needs, values and expectations.
BOOK TALK 8TH MAY
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Practices, conflicts, negotiations and struggles
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The killing of George Floyd on 25th May 2020 has generated long-lasting protests and triggered a strong reaction and global social condemnation. However, besides brutal violence and killing, racism can take several forms. Unveiling and... more
The killing of George Floyd on 25th May 2020 has generated long-lasting protests and triggered a strong reaction and global social condemnation. However, besides brutal violence and killing, racism can take several forms. Unveiling and fighting the hidden racism is a major goal in the medical, healthcare, and bioethics spheres. Bioethics in particular must take action and contribute to dismantle racism and promote equality and respect, thus defending everyone's right to exist. To achieve this purpose, as argued in this work, there is a need to intervene at the roots of racism in bioethics, i.e. the production of knowledge relevant to our discipline and related subject areas. It is the epistemic ground indeed that informs the emergence of policies, practices, views, and perspectives, both racist and anti-racist.
R es um en Introduction: The reflection on the “socially mediated” character of technological devices is a classic theme of Science and Technology Studies (STS). Obejctive: Evaluate the socially engaged character of the Telehealth Brasil... more
R es um en Introduction: The reflection on the “socially mediated” character of technological devices is a classic theme of Science and Technology Studies (STS). Obejctive: Evaluate the socially engaged character of the Telehealth Brasil Redes project implemented in Brazil. Method: A favorable opportunity to reconcile the STS perspective with a broader view in the scope of research on the forms of territorial displacement of health care processes is the case of Telehealth Brazil Networks. Results: Its characteristics narrow the relationship between the network design and Unified Health System (UHS) purposes, offering useful elements to a theoretical-conceptual reading of the implanted service structure. In contrast to the telemedicine standard, the service of Telehealth Networks Brazil advances beyond the classic scheme of “social mediation” of technological artifacts, aiming to expand access to health care services guaranteed public health system, a factor that democratizes and red...
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Gli incontri della Clinica Legale in Bioetica
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Bioethics in Action Seminar series III
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The introduction of telemedicine services in prison represents a fundamental opportunity to improve healthcare access by inmates and detainees, and thus to enhance the effectiveness of right to health. However, while in the US a number of... more
The introduction of telemedicine services in prison represents a fundamental opportunity to improve healthcare access by inmates and detainees, and thus to enhance the effectiveness of right to health. However, while in the US a number of penitentiaries are already offering remote healthcare assistance, the overall interest towards the development of telemedicine in prison in Europe is still scarce. As for the Italian context, the few attempts made at political level to foster the spread of telemedicine in prison have been ineffective. In addition, initiatives reported in this field are not adequately supported, which is a main hindrance to their stabilization in the routine practice. In this essay, the state-of-the-art in the field is drafted and an overview of the main risks and benefits of telemedicine in prison is provided. A specific attention is paid to the Italian situation, especially in the light of the implications posed by the advent of the health emergency provoked by Co...
Contemporary healthcare systems are going through a "digital turn", i.e. the progressive incorporation of information technologies into daily practice, with the purpose of improving quality and increasing the efficiency of the... more
Contemporary healthcare systems are going through a "digital turn", i.e. the progressive incorporation of information technologies into daily practice, with the purpose of improving quality and increasing the efficiency of the healthcare-delivery process. Despite flourishing research in this field, legal scholars have shown a clear inclination for certain issues among which include data protection, confidentiality, licensure and liability. Nevertheless, there remains a need for a more comprehensive approach, through which to address the overall impact of the digitalisation processes on both the right to health and on healthcare system organisation. I argue that such an approach must be intended in terms of a <em>new geography of the right to health</em>, in which space, places, legal provisions, technological artefacts and relations of power converge, reshaping the content of existing rights and leading to the appearance of new ones.
Bioethics and Racism: Practices, Conflicts, Negotiations and Struggle(s)
The advent of the pandemic has renewed the centrality of health equity in healthcare and shown the urgency of reflecting on the factors that affect healthcare accessibility. In particular, there is a need to integrate the analysis on... more
The advent of the pandemic has renewed the centrality of health equity in healthcare and shown the urgency of reflecting on the factors that affect healthcare accessibility. In particular, there is a need to integrate the analysis on healthcare inequalities with the new disparities induced by the digitalization of healthcare. The article starts by highlighting three critical issues faced by the Italian NHS during the Covid-19 health emergency. After that, an overview of the main attempts made by the Italian Government to stimulate a digital transition of healthcare-delivery is provided. Finally, the interplay of conventional inequalities, digital divides and health literacy is assessed from a critical point of view and the risk of a two-speed right to health is emphasized. © 2021 Franco Angeli Edizioni. All rights reserved.
In un articolo del 1971 pubblicato su The Milbank Quarterly, lo studioso Abdel Omran presentava una teoria destinata a tracciare un solco nella storia dell’epidemiologia (e non solo). Dividendo la comunità scientifica di allora, Omran... more
In un articolo del 1971 pubblicato su The Milbank Quarterly, lo studioso Abdel Omran presentava una teoria destinata a tracciare un solco nella storia dell’epidemiologia (e non solo). Dividendo la comunità scientifica di allora, Omran sostenne che all’interno dei paesi industrializzati si assisteva a una «transizione epidemiologica», ovvero, al progressivo incremento delle patologie di natura cronico-degenerativa sul totale dei problemi di salute della popolazione, e alla contestuale riduzione dell’incidenza di quelle di natura infettiva. Nei decenni successivi, infatti, la gestione delle patologie cronico-degenerative divenne un punto di riferimento ineludibile di ogni discorso pubblico e non, relativo all’organizzazione dei sistemi sanitari all’interno dei paesi industrializzati, così come provato dalla sterminata mole di documenti normativi e di orientamento che, nelle ultime due decadi fanno riferimento alla gestione della popolazione anziana come una delle maggiori sfide dei si...
Despite being foreseen by the Italian Constitution, as of today, the right to social assistance has not been enforced yet, supposedly due to administrative and economic hindrances that still persist. A main attempt to move forward the... more
Despite being foreseen by the Italian Constitution, as of today, the right to social assistance has not been enforced yet, supposedly due to administrative and economic hindrances that still persist. A main attempt to move forward the effectiveness of right to social assistance has been carried out in 2000 with a general reform of the social care sector. However, the successive constitutional law nr. 3 of 2001 has vanished the overall sense and the potential impact of that reform, leaving the right to social assistance in a kind of legal limbo, i.e. suspended between its formal claim and its material indeterminateness. Hereafter is an attempt to retrace the recent evolution of this right, along with a critical analysis of the reasons that presumably induced the legislators to disregard its enforcement. In addition, several suggestions emerged in the debate about the attainability of the right to social assistance are included and examined.
European and national institutions increasingly rely on remote health care services to deal with main challenges arisen from demographic change and epidemiological transition in industrialized countries. The appearance of a new conception... more
European and national institutions increasingly rely on remote health care services to deal with main challenges arisen from demographic change and epidemiological transition in industrialized countries. The appearance of a new conception of care based on home-interventions and reduced access to emergence hospital is moreover encouraged by the severe economic constraints of the public health systems. In National context, although the recent approval of the first guidelines in the field, still remains some questions that need to be considered for the purpose of a coherent development of these services. Finally, it is addressed a suggestion arisen in the literature about a possible new dimension of health protection in the constitutional order, in the form of a “right to telehealth”.
O objetivo primário deste artigo é analisar a política de implementação da telemedicina, à luz das possíveis repercussões que a sua difusão pode induzir, quer na prática médica quotidiana, quer, mais em geral, na organização do SNS. A... more
O objetivo primário deste artigo é analisar a política de implementação da telemedicina, à luz das possíveis repercussões que a sua difusão pode induzir, quer na prática médica quotidiana, quer, mais em geral, na organização do SNS. A análise baseia-se em dados secundários obtidos a partir de atos normativos e relatórios publicados pelo Ministério da Saúde e pela Comissão Europeia, tanto no âmbito específico da e-Health, quanto naquele mais abrangente da inovação tecnológica em saúde. Após avaliar os principais eixos da estratégia pública de promoção da telemedicina, realçamos a necessidade de uma visão crítica que acompanhe a difusão dos serviços à distância na prática médica, a fim de evitar repercussões negativas, entre as quais o aumento da tendência de privatização dos serviços de saúde e o agravamento das desigualdades, com o risco inerente de criar um sistema de cuidados de saúde “a duas velocidades”.
Since the very emergence of the information technologies in healthcare, a major concern has been raised about the potential of remote services to undermine the intimacy, immediacy and humanity intrinsic to conventional, face-to-face... more
Since the very emergence of the information technologies in healthcare, a major concern has been raised about the potential of remote services to undermine the intimacy, immediacy and humanity intrinsic to conventional, face-to-face medical practice. By contrast, notable literature reports the benefits of information technology–mediated services and their potential to improve efficiency and economic convenience of healthcare systems. This article aims to shed light on this ambivalence by retracing the evolution of doctor–patient interaction in relation to the main technological advancements in healthcare, and in particular, to services mediated by information technologies. Consequently, the reduction of cues and clues associated with the use of these services is framed into the reductionism of the biomedical paradigm, which provides a key to interpret the nature, scope and features of this process of technological innovation, along with its potential and limits.
Abstract Telemedicine is revolutionising conventional healthcare thanks to countless technological devices that allow patients to remotely access a huge range of care services. In the coming years, the spread of telemedicine will arguably... more
Abstract Telemedicine is revolutionising conventional healthcare thanks to countless technological devices that allow patients to remotely access a huge range of care services. In the coming years, the spread of telemedicine will arguably redesign the geography of EU healthcare, with main repercussions on the organisation of the Member States’ health systems and the extent of health protection in the EU. Given the current lack of an EU regulatory framework for telemedicine, this analysis aims to explore the most relevant acts issued in the field of (conventional) healthcare in order to assess their suitability for telemedicine services. In the conclusion, the need for an adequate regulatory framework of telemedicine in the EU will be discussed, in order to sustain its spread in daily practice and to guide patients and healthcare professionals towards a safe use of these innovative services.
Introdução: A reflexão sobre o caráter “socialmente mediado” dos dispositivos tecnológicos é um tema clássico dos Science and Technology Studies. Objetivo: Avaliar o caracter socialmente engajado do projeto Telessaúde Brasil Redes... more
Introdução: A reflexão sobre o caráter “socialmente mediado” dos dispositivos tecnológicos é um tema clássico dos Science and Technology Studies. Objetivo: Avaliar o caracter socialmente engajado do projeto Telessaúde Brasil Redes implantado no Brasil. Método: Uma oportunidade favorável para conciliar a perspectiva dos STS com uma visão mais ampla no âmbito da investigação sobre as formas de deslocação territorial dos processos de cuidado em saúde é o caso do Telessaúde Brasil Redes. Resultados: As suas características estreitam a relação entre o design da rede e as finalidades do SUS, oferecendo elementos úteis a uma leitura teórico-conceitual da estrutura do serviço implantado. Em contraposição ao padrão da telemedicina o serviço de Telessaúde Redes Brasil avança além do clássico esquema da “mediação social” dos artefatos tecnológicos, tendo como objetivo o de ampliar o acesso aos serviços de cuidado em saúde garantidos sistema público de saúde, fator que democratiza e reduz desig...
Over the last two decades, a public rationale for the implementation of telehealth has emerged at the interplay of specialised literature and political orientations. Despite the lack of consistent findings on the magnitude of its... more
Over the last two decades, a public rationale for the implementation of telehealth has emerged at the interplay of specialised literature and political orientations. Despite the lack of consistent findings on the magnitude of its benefits, telehealth is nowadays presented as a worthy solution both for patients and healthcare institutions. Far from denying the potential advantages of telehealth, the main objective of this work is to provide a critical assessment on the spread of the remote services as a vector of positive transformation of contemporary health systems. For pursuing this objective, the EU agenda for the promotion of telehealth will be retraced, and the main evidences alleged to sustain the implementation of remote care services will be assessed. Furthermore, it will be evaluated the attempt made by the European Commission to establish an ethical framework for guiding the use of telehealth in daily practice, and a roadmap of the most relevant legal and ethical issues po...
1. Introduzione. - 2. L'impulso dell'Unione europea per la definizione di criteri di valutazione dei servizi di telemedicina. - 3. II contesto nazionale tra iI fermento delle sperimentazioni e I'assenza di un quadro normativo... more
1. Introduzione. - 2. L'impulso dell'Unione europea per la definizione di criteri di valutazione dei servizi di telemedicina. - 3. II contesto nazionale tra iI fermento delle sperimentazioni e I'assenza di un quadro normativo di riferimento. - 3.1. L'emanazione delle prime linee di indirizzo sulla telemedicina: verso una nuova consapevolezza? - 4. La progressiva emersione di un regime giuridico ad hoc. - 4.1. Cenni in materia di responsabllita professionale in telemedicina. - 5. Conclusioni: i limiti derivanti dall'applicazione delle categorie giuridiche esistenti al fenomeno della telemedicina.
Gli incontri della clinica
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Bioethics in Action Seminar series III
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Bioethics in Action Seminar series III - Bioethics and Capitalism
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NEW MODELS OF CARE AT DISTANCE: TOWARDS A "RIGHT TO TELEHEALTH"? ABSTRACT: European and national institutions increasingly rely on remote health care services to deal with main challenges arisen from demographic change and... more
NEW MODELS OF CARE AT DISTANCE: TOWARDS A "RIGHT TO TELEHEALTH"? ABSTRACT: European and national institutions increasingly rely on remote health care services to deal with main challenges arisen from demographic change and epidemiological transition in industrialized countries. The appearance of a new conception of care based on home-interventions and reduced access to emergence hospital is moreover encouraged by the severe economic constraints of the public health systems. In National context, although the recent approval of the first guidelines in the field, still remains some questions that need to be considered for the purpose of a coherent development of these services. Finally, it is addressed a suggestion arisen in the literature about a possible new dimension of health protection in the constitutional order, in the form of a "right to telehealth". KEYWORDS: right to healthcare; health service; telehealth; ICT; healthcare at distance SOMMARIO: 1. Introduzi...
Contemporary healthcare systems are going through the digital turn, i.e., the progressive incorporation of information and communication technologies to improve the quality and increase the efficacy of healthcare. Despite the flourishing... more
Contemporary healthcare systems are going through the digital turn, i.e., the progressive incorporation of information and communication technologies to improve the quality and increase the efficacy of healthcare. Despite the flourishing of research in this field, just a small number of studies have shed light on the most relevant legal issues posed by the implementation of digital services in healthcare. This literature shows a predilection for some issues among which data protection, confidentiality, licensure, and liability. What is missing is a more comprehensive reflection that may help to assess the overall impact of digitalisation on the right to health, ranging from the emergence of new rights to the reconfiguration of existing ones. This chapter is an attempt to contribute to the aforementioned reflection, which is deemed fundamental in order to protect disadvantaged groups, and to ensure effectiveness of both emerging and existing entitlements conventionally considered as part of an individual’s right to health

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An international and trans-disciplinary "Bioethics in Action Seminar series" by the RUEBES, L'altro diritto
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Breaking up with the mainstream of telemedicine development, the case of Brazilian Telessaúde goes beyond the classic scheme of the social shaping of technological artefacts, showing a more profound implication of the system in pursuing... more
Breaking up with the mainstream of telemedicine development, the case of Brazilian Telessaúde goes beyond the classic scheme of the social shaping of technological artefacts, showing a more profound implication of the system in pursuing objectives of inequalities reduction in healthcare services accessibility. According to the Brazilian public health system strategies of “Permanent Education” and “Humanization”, Telessaúde network remains “on the background” of the medical ecology, thus respecting the sense of the local social relations.
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La ricchezza dei contributi raccolti in questo volume restituisce il largo consenso e l’apprezzamento duraturo che Lorenzo d’Avack ha costruito attraverso la sua riflessione, i suoi scritti e la sua capacità di mediazione al servizio di... more
La ricchezza dei contributi raccolti in questo volume restituisce il largo
consenso e l’apprezzamento duraturo che Lorenzo d’Avack ha costruito
attraverso la sua riflessione, i suoi scritti e la sua capacità di mediazione al
servizio di un’istituzione come il Comitato Nazionale per la Bioetica che,
con il tempo, è divenuta sempre più un punto di riferimento anche per
il confronto intellettuale. Oltre che un onore e un piacere, dedicare un
volume di scritti a Lorenzo d’Avack è, dunque, un’occasione per offrire un
compendio dei temi e dei problemi che la bioetica e il biodiritto hanno
affrontato negli ultimi decenni.
Se al centro vi è il rapporto complesso tra scienza, vita e diritto, le sue
declinazioni spaziano tra temi diversi: dalle possibilità connesse alle tecniche
di procreazione assistita per quanto riguarda il momento iniziale della vita;
ai dilemmi sulle scelte di fine vita posti dal suicidio medicalmente assistito;
per andare oltre la vita con i trapianti; fino al problema di ridefinire le
priorità dell’umano sollevato dall’intelligenza artificiale, così come dalle
emergenze sanitarie e ambientali. A parlarne, in dialogo con Lorenzo
d’Avack, molte voci che si sono confrontate con lui durante la sua lunga,
e tuttora in corso, esperienza al Comitato Nazionale per la Bioetica. Non
solo filosofi del diritto, giuristi provenienti da diverse discipline, bioeticisti
e umanisti con diverse sensibilità, ma anche medici, clinici, esperti di
neuroscienze e così via.
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Il tema delle migrazioni è centrale per il dibattito pubblico contemporaneo, al punto da determinare l’agenda politica di molti Paesi europei, e non solo. Anche a livello teorico, infatti, il confronto rivela una particolare vivacità,... more
Il tema delle migrazioni è centrale per il dibattito pubblico contemporaneo, al punto da determinare l’agenda politica di molti Paesi europei, e non solo. Anche a livello teorico, infatti, il confronto rivela una particolare vivacità, tanto che se si volge lo sguardo al panorama internazionale, è facile avvedersi di come, negli anni, sia andato progressivamente delineandosi un ambito di ricerca autonomo, che ha preso il nome di "Migration Studies". Eppure, al suo interno, la soggettività delle persone migranti con disabilità soffre ancora di un'invisibilità ontologica, epistemologica e pratica. Adottando una prospettiva interdisciplinare, il volume si propone di riflettere "al contro" la condizione delle persone migranti con disabilità, sì da consentire la tematizzazione della loro soggettività e, dunque, la loro visibilità, al fine di promuovere una più compiuta tutela dei loro diritti fondamentali ed umani.
Quest’opera è percorsa da un interrogativo fondamentale: perché la telemedicina? Ovvero, quali sono le ragioni (effettive) per cui pazienti e professionisti sanitari dovrebbero adottare quest’innovativa forma di cura? Qual è l’entità dei... more
Quest’opera è percorsa da un interrogativo fondamentale: perché la telemedicina? Ovvero, quali sono le ragioni (effettive) per cui pazienti e professionisti sanitari dovrebbero adottare quest’innovativa forma di cura? Qual è l’entità dei benefici correlati all’utilizzo di questi servizi? Quali sono, per contro, i rischi che si celano dietro alla loro diffusione? Quest’analisi si pone pertanto come un contributo alla migliore comprensione delle ripercussioni concrete che l’adozione della telemedicina è in grado di indurre su alcuni fra i temi maggiormente
rilevanti per la riflessione di bioetica, come l’accessibilità,
la qualità, e la convenienza delle innovative prestazioni a distanza.
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