Recent advances in our understanding of the nature of suffering and its different dimensions have exposed certain deficits in the current definition of suffering. These shortcomings have impacted negatively on the appropriate formulation of precise treatment objectives for each dimension of suffering within the overall framework of the goals of medicine. Existential suffering offers a clear example where the lack of a universally accepted definition has led to confusion regarding what should constitute appropriate relief for this particular dimension of suffering. In this thought piece, we propose a redefinition of suffering based on three elements: first, suffering refers to a specific state of a person (the essence of suffering); second, this state is characterised by a specific psychosomatic anguish reaction (the manifestation of suffering) and third, this reaction is in response to a perceived threat to the integrity of the person (the cause of suffering). The proposed definition allows for an important and clear distinction to be made between the primary and symptomatic relief of suffering and the role of medicine in each form of relief. The terms of the proposed definition and the distinction between primary and symptomatic relief provide useful tools for further research regarding the different dimensions of suffering and its relief.
The concept of medical futility first appeared at the end of the 1980s, was developed throughout the 1990s, and now is widely cited in medical literature and clinical practice to justify refraining from or limiting the use of life-sustaining therapies. The definition of medical futility, however, is not very clear or universally accepted. In this article, we examine the strengths and limitations of a particular concept of medical futility, based exclusively on clinical considerations, that enables the physician to make unilateral decisions about whether to withhold, withdraw, or continue treatment without being required to consult the patient or his family. To respect the patient’s spiritual, philosophical, and ethical values, several significant ethical issues need to be narrowly defined, and the concept of medical futility must be rarely invoked to justify such unilateral decisions.
The Editors 1 state that "unsafe abortion is a leading cause of maternal death [in Argentina]". With all due respect, this statement does not fit the facts. In 2016, the last year for which statistics are available, 245 maternal deaths occurred in Argentina. 2 Direct obstetric causes of maternal mortality accounted for 135 deaths, indirect obstetric causes accounted for 67 deaths, and pregnancy ending in abortion accounted for 43 deaths. This last shown. The Argentinian population has elected to afford greater protection to the fetus in utero; one cannot hold this against them. We need to address the real dangers to women's health, the first of which is poverty, and not pursue illusory foes such as the Catholic Church. This involves, in part, resisting the distraction of playing agent provocateur with tendentious titles. We must focus on reducing poverty's chokehold on women's lives if we want to see an improvement in women's health, rather than on political and religious squabbling and one-upmanship.I declare no competing interests.
La questione sull’obbligo di impiegare o di non impiegare un mezzo terapeutico, era tradizionalmente risolta definendo obbligatori i mezzi che si consideravano ordinari, e invece non obbligatori quelli che si consideravano straordinari. Dopo le critiche ricevute da questo tentativo di risposta si è provato a risolvere diversamente la questione suddividendo le opzioni terapeutiche in proporzionate e sproporzionate. In questo articolo si tenta di mostrare come le due distinzioni non siano equivalenti e come, anche se necessarie, non siano sufficienti per il buon agire medico. Si deve pertanto sempre ricorrere alla prudenza terapeutica per fornire ad ogni paziente la migliore opzione medica personalizzata.
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