[Medical overuse, defensive medicine and new reform of professional mistake].

Reflecting on the inappropriateness (medical overuse) and on defensive medicine, the Authors wonder whether the new Italian reform of professional guilt, desired at all institutional levels, will actually contain the high economic costs produced by these large and widespread phenomena. After having characterized the medical overuse and the defensive medicine indicating the common traits and main differences, the reflection is conducted by exploring the many scientific evidence that does not document any causal link between the decriminalization of professional conduct and the containment of the costs produced by the prescriptive inappropriateness. They conclude by stating that, for their containment, a third reform of professional liability will not be helpful. Instead, it must focus on other issues, mainly addressing the excessive reliance on judicial recourse. It should provide for mandatory out-of-court conciliatory mechanisms and clarifying the protective umbrella of the doctor's non-criminality.

[Communication of the diagnosis of dementia: legal aspects and (also) emerging ethical problems.] / La comunicazione della diagnosi di demenza: aspetti giuridici e problematiche etiche (anche) emergenti.

In this paper, in a broad perspective, the problematic issues posed in clinical practice by the communication of the diagnosis of dementia are addressed. After discussing the legal determinants of the right of every person to know the truth, it was explored the ethical questions posed by the communication of unfavourable news highlighting that the scientific discussion has mainly focused on the communication of the diagnosis of neoplastic pathology. Then focus on the Spikes system adapted to the dementia of which the merits and defects are discussed before suggesting its expansion with the necessary adaptations.

[Is there really something wrong with the formalization processes of the anticipated will? Insist on DATs or (finally) promote advance care planning (ACP)?]

The author analyzes the possible paths for the formalization of the anticipated will regarding the care provided for by law no. 219/2017, identifying them in the advance treatment provisions (DAT) and in the shared care planning (advance care planning) of which he examines the merits and related defects. He proposes to invest better and more in shared care planning, indicating the advantages and opportunities that derive from its gradual formation within the care relationship, while signaling the need to proceed promptly with the appointment of the trustee, provided in an optional form by the law. He then addresses the role exercised by this representative figure which is to assist the care team throughout the disease trajectory and not only when it is necessary to honor the wishes and preferences expressed by the person when he was in a position to do so, and he does it criticizing the choice made by the legislator who indicated it in full possession of the ability to understand and want.

Artificial intelligence and digital medicine for integrated home care services in Italy: Opportunities and limits.

Home healthcare in the Italian health system has proven to be an essential factor in adequately responding to the health needs of an increasingly aging population. The opportunities offered by digitization and new technologies, such as artificial intelligence (AI) and robotics, are a lever for making home care services more effective and efficient on the one hand, and on the other for improving remote patient monitoring. Telemedicine devices have enormous potential for telemonitoring and telerehabilitation of patients suffering from chronic disabling diseases; in particular, AI systems can now provide very useful managerial and decision-making support in numerous clinical areas. AI combined with digitalization, could also allow for the remote monitoring of patients' health conditions. In this paper authors describe some digital and healthcare tools or system of AI, such as the Connected Care model, the Home Care Premium (HCP) project, The Resilia App and some professional service robotics. In this context, to optimize potential and concrete healthcare improvements, some limits need to be overcome: gaps in health information systems and digital tools at all levels of the Italian National Health Service, the slow dissemination of the computerized medical record, issues of digital literacy, the high cost of devices, the poor protection of data privacy. The danger of over-reliance on such systems should also be examined. Therefore the legal systems of the various countries, including Italy, should indicate clear decision-making paths for the patient.

[Liability in medical-assisted suicide].

Summarizing the contents of the Italian Constitutional Court's judgment n. 242/2019 on the non-liability in medical-assisted suicide, the author looks at how the new scenarios thus opened might undermine the safety and dignity of the most fragile and vulnerable people. He voices his concerns on the shifting relationship between doctors and patients and on the delegitimization of medical ethics that must instead continue to illuminate, with its guiding principles, professional behavior.

[Limit landscapes in the era of technicality].

In the era of technicality, man seems to have lost the sense and true dimension of the limit: it has thus become something to be annihilated and a point that needs to move further and further not only for human curiosity but also because of profit economic development that governs globalized progress. In this scenario, the Author reflects on the most authentic sense of the limit and tries to defend it because our gender identity is bound to be limited.

[The dangers and drifts of health McDonaldization]. / That is the question (ripensare i fondamentali della relazione di cura per arginare i pericoli e le derive della McDonaldizzazione della salute).

The author reflects on the healthcare crisis, starting from globalization and liquid-modern society, with its systemic contradictions. The health care system is influenced by McDonald's success and its philosophy: efficiency, productivity, cost reduction, procedural standardization and control. This article underlines the deficiencies and manipulations in the health care system. The profit-oriented economic model is successful due to lack of attention to product quality from the globalised and hyper-consumerist society. Italian legislation has regulated the standardization in healthcare procedure, aiming at cost reduction of defensive medicine. It has been underlined that it defines actions, nevertheless human activity is mainly realized through language, gesture and creation. A new anthropological model is proposed, based on commitment and distributive justice.

[The ethics of principles and ethics of responsibility]. / L'etica dei principi e l'etica della responsabilità.

In his brief comment, the author speculates if ethics in health-care relationship it still has a practical sense.The essay points out the difference between principles ethics and ethics of responsibility, supporting the latter and try to highlight its constitutive dimensions.

[Deep continuous palliative sedation in the Opinion adopted by the Italian National Bioethics Committee (Deep palliative sedation)]. / La sedazione palliativa profonda continua nel Parere approvato dal Comitato nazionale per la bioetica italiano il 29 gennaio 2016 (sedazione palliativa profonda).

The Author examines the recent opinion delivered by the Italian National Committee for Bioethics on deep palliative sedation. In particular, it examines its strengths and ample shade that show its ideology, once again, in contrast with the right of every human being to die with dignity.

[The refusal and on the suspension (but, perhaps, not even on the beginning) hemodialysis replacement]. / Sul rifiuto e sulla sospensione (ma, forse, anche sul non inizio) del trattamento emodialitico sostitutivo.

The possibilities offered by scientific progress and technology are, more and more pressing questions about the limits of care:not in the perspective indicated by the policies of cost containment as a promotional support of the defense of fundamental rights of the human person. The Author explores the circumstances in which we must ask yourself some questions before or discontinuation of dialysis replacement. Discusses the scientific evidence and the recommendations contained in international documents, formulating a draft operational perspective advance care planning with 10 statements from which to draft a consensus document professional Italian.

[The mercy in the health care relationship]. / La misericordia nella relazione della cura.

In this article, the author discusses the topic of mercy, trying to focus on the ethical-practical aspects in the health care relationship. The limits of the medical paternalism and of the health care model based on the person's autonomy are discussed in order to propose mercy as the new dimension of the health care alliance.