WMJ 05 2011 - World Medical Association

National and Regional news
DENMARK
to give an adequate response to the ethical
dilemmas resulting not from an illness but
from the very same patient even if often
occurring unawares. In any case, we cannot
forget that sickness, just as with any coin,
has two inseparable faces: the pathology
and the way in which the individual patient
reacts in a situation of vulnerability, pain
and dependence.
Certainly, a methodology of analyzing clinical
cases offers the advantage of a greater
certainty in the attempt to bring order to
the multiplicity of relevant elements within
an ethically complex situation and to render
objective the assessment of the concrete decision
that arises. At any rate, it is good to
remember that the “certainty” offered by the
methodology of an ethical analysis of the
clinical case remains a “morale” certainty,
a certainty which provides and takes into
consideration the real possibility of making
a mistake.
An exclusive trust in methodology causes a
rigidity in the subsequent action according
to a pre-established pattern which isn’t able
to take into consideration the total human
capacity to act. Reality doesn’t always adequate
itself to the model, simply because
no model elaborated by the human mind
can exhaust reality, especially when we base
this reality on the human being in all its
simplicity and complexity. On the other
hand, the same clinical medicine teaches
us how the models and the mechanisms
learned in the university classrooms rarely
work as a direct rule for the cure of illness
in real patients.
One possible solution to the limits of a
clinical ethic, intended only as a decisional
procedure, is to remember that the “ethical”
understanding which the doctor has to acquire
in order to arrive at a clinical behavior
which is truly virtuous isn’t only that offered
by the content and the methods of ethical
reasoning, but also that which comes from
an understanding of the individual patient
acquired thanks to clinical experience. The
conceptual information which we possess
regarding a given pathology and its evolution
(medical data, rules and ethical references
etc.), as it has been said, constitute a
necessary understanding, but this is not sufficient.
They are, again, only theoretical ways
of understanding which don’t yet grasp the
variety and dynamic, full of nuances and
sometimes unpredictable, of the existential
dimension of real life. For a doctor, therefore,
knowing the clinical situation necessarily
demands an experience involving that
individual sick person, so that if a clinical
decision is taken, for example, considering
only the laboratory parameters, diagnostic
reports and ethical advice, without ever
“meeting” the patient, in no way could this
be called an appropriate ethical behavior.
From this perspective, we know well that,
for the doctor, it is important to develop
a relationship with the way, perhaps even
emotional, in which the patient perceives
their condition. The doctor who is moved
by a true interest and by a real compassion
as it regards his patient, is able to penetrate
his suffering and to recognize the specific
traits of the patient’s living this illness, to
discern the human and existential needs
which the patient doesn’t always manifest.
In the opposite case, if the doctor disregards
or ignores the value and the individual dignity
of his patient, it will be hard for him
to listen (the doctor becomes deaf ) and to
assume the necessary empathic attitude in
order to obtain that kind of understanding.
Showing interest and friendship constitute
an indispensable attitude in the clinical encounter.
We could conclude, then, affirming that
within the clinical ethics of the XXI century,
if we avoid confusing model and reality,
along with making a decisional procedure
absolute, a methodology of ethical analysis
in clinical cases could constitute a useful,
even though necessary help in the face of
more complex clinical cases. Nevertheless,
today, non-negligible contributions to clinical
ethics come from narrative medicine,
from the ethics of healing and, in general,
from the ethics of virtue, perspectives which
are mostly open to an ethics of relationship
and which can effectively integrate the indispensible
ethical analysis of the clinical
decision.
Prof. Ignacio Carrasco De Paula M.D. Ph.D.
Emeritus Professor of Bioethics
and Clinical Ethics,
Gemelli Medical School, Rome
Dependency on Sponsorships and Relations
to the Pharmaceutical Industry:
Experiences from Denmark
the collaboration between doctors and
the pharmaceutical industry. This has
been done per agreement with the industry
which in turn also profited from a responsible
way of conducting business in
terms of improving their image. The goal
has been to minimise the interdependency
between doctors and the pharmaceutical
industry.
For many years, the Danish Medical Association
has been preoccupied with the
question of creating clear guidelines for
With regard to the collaboration with
pharmaceutical industry there is Danish
legislation compelling doctors to inform
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