Papers by Federico Nicoli
Journal of Anesthesia, Analgesia and Critical Care, Sep 14, 2022
Background: The current organizational structure of the Italian healthcare system does not includ... more Background: The current organizational structure of the Italian healthcare system does not include the institutionalization of clinical ethics services. To describe the need for structured clinical ethics consultation services for ICU staff members in the intensive care unit (ICU), a monocentric observational survey study was performed utilizing a paper-based questionnaire. Results: A total of 73 healthcare professionals (HCPs) responded out of a team of 84 people (87%). The results showed that the need for ethics consultation in the ICU is urgent, the institutionalization of the clinical ethics service is perceived as useful and should be a priority, and the issues on which the HCPs would like ethics consultation to focus are various and belong to "end of life" topics. Conclusions: HCPs believe that the clinical ethicist should become an integral part of ICU healthcare teams, offering consultations similar to the other specialistic consultations carried out in hospitals.
Medicina nei secoli, 2017
The article presents a clinical case of euthanasia occurring at the end of the Nineteenth century... more The article presents a clinical case of euthanasia occurring at the end of the Nineteenth century. Was there an undisputed or conditioned acceptance of euthanasic practices? We will present a short contribution to the historical debate about euthanasia: our reflections take origin from the reading of the autobiographical narrative by Axel Munthe, the Story of San Michele, a masterpiece by the great Swedish physician and writer. His pages describe a nineteenth-century clinical case of euthanasia, forgotted or eluded by the medical history and by bioethical reflections: although not described in scientific literature, this pages are well known by contemporary narrative and literature specialists. Key words : Euthanasia - Pain - Cruelty - Compassionate death
Journal of Anesthesia, Analgesia and Critical Care
BackgroundThe current organizational structure of the Italian healthcare system does not include ... more BackgroundThe current organizational structure of the Italian healthcare system does not include the institutionalization of clinical ethics services.To describe the need for structured clinical ethics consultation services for ICU staff members in the intensive care unit (ICU), a monocentric observational survey study was performed utilizing a paper-based questionnaire.ResultsA total of 73 healthcare professionals (HCPs) responded out of a team of 84 people (87%). The results showed that the need for ethics consultation in the ICU is urgent, the institutionalization of the clinical ethics service is perceived as useful and should be a priority, and the issues on which the HCPs would like ethics consultation to focus are various and belong to “end of life” topics.ConclusionsHCPs believe that the clinical ethicist should become an integral part of ICU healthcare teams, offering consultations similar to the other specialistic consultations carried out in hospitals.
Theoretical Medicine and Bioethics, Oct 1, 2018
Journal of Clinical Ethics, Mar 1, 2023
Transplantation Proceedings, 2019
The possibility to determine death based on cardiocirculatory criteria in controlled cases, namel... more The possibility to determine death based on cardiocirculatory criteria in controlled cases, namely when there is a request to withhold treatmentdor, more frequently, withdraw itdspecifically recalls the recent Italian law on advance treatment directives and leaves the following question unanswered: Under what conditions is the patient's request legally and ethically acceptable? We present three ethical proportionality criteria for supporting physicians' decision-making facing patients' requests of treatment withdrawal, namely: 1. irreversible pathology with an ominous and worsening prognosis; 2. within an evaluation considering both clinical data and the patient's history; and 3. facing burdens that are no longer bearable. We finally argue that reflection over controlled donor may be a model for giving medicine the chance to responsibly deal with broader end-of-life issues.
E.S. Zanetti1-3, G.B. Guerrini3 4, D. Chiesa5, D. Bellandi6, C. Bertelli7, C. Carabellese8, S. Di... more E.S. Zanetti1-3, G.B. Guerrini3 4, D. Chiesa5, D. Bellandi6, C. Bertelli7, C. Carabellese8, S. Di Meo9, P. Lora Aprile10, G.F. Massarelli11, F. Nicoli12 13, P. Ponton14, S. Sperotto9, G. Zaninetta13 15, F. Lonati2 University of Rome “Tor Vergata”, Rome, Italy; APRiRE Network; Italian Society of Gerontology and Geriatrics; Brescia Solidale Foundation, Brescia, Italy; Habilita Care & Research Hospital, Sarnico, Italy; Fondazione Istituto Ospedaliero di Sospiro Onlus, Sospiro Italy; Associazione Nazionale Tumori, Italy; Clinical Institute Città di Brescia, San Donato Group, Italy; Fondazione Casa di Dio, Brescia, Italy, Extrahospital Geriatric Association, Italy; Territorial Healthcare Agency Spedali Civili Brescia, Italy; Italian College of General Practitioners and Primary Care, Florence, Italy; Association “On the Other Side: Doctors, Nurses, Operators and Patients Together”; Department of Biotechnology and Life Sciences, Center for Clinical Ethics, University of Insubria, Varese, Italy; Domus Salutis Clinic, Teresa Camplani Foundation, Brescia, Italy; Agency for health care N.3 “Alto Friuli Collinare Medio Friuli” Gemona del Friuli, Italy; Italian Palliative Care Society
Journal of Palliative Medicine, Aug 1, 2021
Background: The contemporary scientific literature documents a lack of attention toward the act o... more Background: The contemporary scientific literature documents a lack of attention toward the act of consoling put into practice by health care professionals (HCPs) in hospice services. Objective: To describe the act of consoling and its meaning for hospice-employed HCPs. Design: A multicenter observational survey study was performed through a paper-based questionnaire. Subjects: The study was sent to the directors of 10 hospices in Northern Italy and distributed to 232 HCPs. Results: A total of 218 HCPs responded (94%). The results showed that most HCPs consider the practice of consoling to be essential to their profession, but they also underscored the extreme complexity of the process. Conclusion: The act of consoling is not simply a professional duty defined in contractual clauses. Rather, it is a set of specific communicative practices and skills required of HCPs.
Introduction to Medical Humanities, 2022
Transplant Infectious Disease
The debate on the opportunity to use organs from donors testing positive for Severe Acute Respira... more The debate on the opportunity to use organs from donors testing positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in recipients with naïve resolved or active COVID-19 is ongoing. We aim to present the ethical analyses underlying the decision to perform liver transplantation (LT) in selected patients with resolved or active COVID-19 in Italy. We used Jonsen, Siegler, and Winslade's Four-Boxes casuistic method, addressing the four topics considered as constitutive of the essential structure of single clinical cases for their ethical analysis (medical indications, patient preferences, quality of life, and contextual features) to enable decision-making on a case-by-case basis. Based on these topics, we elucidate the meaning and balance among the principles of biomedical ethics. Clinical ethics judgment based on the relation between the risk of acquiring SARS-CoV-2 along with its potentially negative effects and the expected benefits of transplant lead to consider LT as clinically appropriate. Shared decision-making allows the integration of clinical options with the patient's subjective preferences and considerations, enabling a valid informed consent specifically tailored to the patients' individual circumstances. The inclusion of carefully selected SARS-CoV-2 positive donors represents an opportunity to offer lifesaving LT
La Clinica terapeutica, 2019
BACKGROUND Life-saving technologies have completely changed the normal conception of medical trea... more BACKGROUND Life-saving technologies have completely changed the normal conception of medical treatments. Left Ventricular Assist Devices (LVAD) can prolong survival for patients who are not candidates for heart transplantation. In order to analyze the pre-implantation phase, which involves a shared-decision making process before activation of the device, attention should be paid to the criterion of "proportionality" in order to properly assess the risks and benefits of implantation. AIM The aim of our analysis is to provide an useful tool for the assessment of LVAD proportionality during the physicians' decision making. METHODS The method of the "four boxes", developed by Jonsen et al, was chosen to analyze the notion of proportionality and the other main ethical issues regarding LVAD activation in adult patients. RESULTS Medical issues are not the sole factors, which influence the choice of implantation by patients. Indeed, patient preferences, his/her quali...
Frontiers in Neuroscience, 2018
for Gait Training in Spinal Cord Injured people: clinical analysis and ethical Dilemmas, 2017 Jun... more for Gait Training in Spinal Cord Injured people: clinical analysis and ethical Dilemmas, 2017 June 21-23 Tourin; and at the 31th European Conference on Philosophy of Medicine and Health Care (ESPMH), Exoskeleton for gait training in spinal cord injuried people: Should I respond to the budget or to the person?, Belgrade, Serbia 16-19 agosto 2017. A full version of this paper was accepted as chapter of the book "Advance in Service and Industrial Robotics" (eds. C.
Theoretical Medicine and Bioethics, 2018
Medicine, Health Care and Philosophy, 2019
The aim of this paper is to analyze an Intensive Care Unit case that required ethics consultation... more The aim of this paper is to analyze an Intensive Care Unit case that required ethics consultation at a University Hospital in Northern Italy. After the case was resolved, a retrospective ethical analysis was performed by four clinical ethicists who work in different healthcare contexts (Italy, the United States, and Switzerland). Each ethicist used a different method to analyze the case; the four general approaches provide insight into how these ethicists conduct ethics consultations at their respective hospitals. Concluding remarks examine the similarities and differences among the various approaches and offer a reflection concerning the possibility of a shared resolution to the case. The authors' efforts to come to a tentative consensus may serve as an example for professionals working in medical contexts that reflect an increasing pluralism of values. This article aims to respond to some of these concerns by illustrating how different methods in clinical ethics would be used when considering a real case. The goal is not to establish the best model (if there is one) on a theoretical level, but to learn from actual practice in order to see if there are common elements in the different methods, and to validate their pertinence to clinical ethics consultation.
Transplantation Proceedings, 2018
The possibility to determine death based on cardiocirculatory criteria in controlled cases, namel... more The possibility to determine death based on cardiocirculatory criteria in controlled cases, namely when there is a request to withhold treatmentdor, more frequently, withdraw itdspecifically recalls the recent Italian law on advance treatment directives and leaves the following question unanswered: Under what conditions is the patient's request legally and ethically acceptable? We present three ethical proportionality criteria for supporting physicians' decision-making facing patients' requests of treatment withdrawal, namely: 1. irreversible pathology with an ominous and worsening prognosis; 2. within an evaluation considering both clinical data and the patient's history; and 3. facing burdens that are no longer bearable. We finally argue that reflection over controlled donor may be a model for giving medicine the chance to responsibly deal with broader end-of-life issues.
Clinical Ethics, 2016
The Italian debate about the role of clinical ethics and ethics consultation has brought about th... more The Italian debate about the role of clinical ethics and ethics consultation has brought about the need to create a working group of Healthcare Ethics Consultation. The group began to take shape and to be organized in 2010; its activities are largely directed to share experiences, to analyze this field and to develop a professional profile of the clinical ethicist recognized throughout the nation. The working group of Clinical Ethics and Healthcare Ethics Consultation was born from some meetings and the group started to draft a Document about Clinical Ethics Consultation in Healthcare in Rome (June 2013). The Document was approved in Trento at the Kessler Foundation (October 2013) and undersigned by more than 200 people. The newborn document was called ''The Document of Trento'': it is the first Italian document regarding clinical ethics consultation.
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Papers by Federico Nicoli