Transmanubrial osteomuscolar sparing approach for T1-T2 thoracic disc herniation.

Herniated thoracic disks are rare entities and their surgical treatment comprises 0.15% to 4% of all disk operations. Surgical approaches have included pediculectomy, costotransversectomy, lateral extracavitary, transthoracic thoracotomy, and thoracoscopy. The authors present a transmanubrial osteomuscular sparing approach for the treatment of T1-T2 thoracic disc herniation that is likely to be the only one described in the literature for this disease so far.

Preemptive kidney transplantation: an ethical challenge for organ allocation policies.

Preemptive transplants are advisable in advanced stages of kidney disease. The clinical advantages of preemptive transplantation over dialysis are evident. Nevertheless, preemptive transplantations raise ethical concerns, particularly regarding the allocation of medical resources. The present article proposes some criteria for organ allocation policies regarding preemptive transplantations: criteria regarding medical benefit and justice are absolutely essential when addressing the issue of organ allocation, but other ethical values should also be taken into account. The "principle of double effect" offers useful pointers.

Organ Allocation Policies 10 Years After UNESCO's Universal Declaration on Bioethics and Human Rights.

BACKGROUND: October 19, 2015, marked the 10th anniversary of the adoption by the General Conference of the United Nations Educational, Scientific and Cultural Organisation (UNESCO) of the "Universal Declaration on Bioethics and Human Rights," which was signed by representatives of the 191 member states of the conference. The declaration is of major importance: it was the first legally binding document approved by a global organization to address the whole range of subjects covered by bioethics. RESULTS: Among the principles laid down in the declaration, those most relevant for the allocation of organs are benefit and harm (Article 4), equality, justice and equity (Article 10), nondiscrimination and nonstigmatization (Article 11), solidarity and cooperation (Article 13), social responsibility and health (including access to quality health care; Article 14), and sharing of benefits (Article 15). CONCLUSIONS: Policies concerning the allocation of organs cannot disregard the principles affirmed in the Declaration.

On akrasia and the "prevention paradox".

The term akrasia describes the behaviour of persons who knowingly and consciously act against their better judgement and is exemplified by various unhealthy lifestyle choices. Prevention should aim to provide guidance in the choice of lifestyle. While at the individual level this is best directed towards those who are at high risk, at a general population level it is preferable to target the higher numbers of individuals at low risk rather than the fewer high-risk subjects. This is the so-called "prevention paradox". From an ethical viewpoint it is important, when planning measures to maximise the benefits for the community, not to neglect individual subjects: the common good is created by promoting and making the most of the good of the individual.

Ethical approaches to triage in public health emergencies.

General concepts and about medical disasters, public health and triage are outlined. Ethical values at stake are summarized. A special attention is given to conflicts between protection of individual interests (typical of clinical ethics) and collective interests (typical of public health and triage). Hippocratic ethics is compared to utilitarian ethics and to perspectives that emphasize the principle of justice. Three attitudes are suggested: protection of human dignity, precaution, solidarity. A personalistic perspective is suggested to deepen solidarity as a pillar both of clinical and public health ethics.