Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. Mr. H is a ninety-year-old patient with end-stage kidney disease that is no longer (...) manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy). In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient’s daily life, can limit side effects and “dialysis shock”. An individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient’s choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients. (shrink)

Many of the earliest books, particularly those dating back to the 1900s and before, are now extremely scarce and increasingly expensive. We are republishing these classic works in affordable, high quality, modern editions, using the original text and artwork.

Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and (...) some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of “reverse” informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles to the donor and recipient parties. (shrink)

Paula Modersohn-Becker, widely considered to have been one of the most important independent Expressionist painters of the early twentieth century, was thirty-one years old when she gave birth to her first child. Following the then-common practice of putting women to bed rest for two-four weeks after delivery, she died of massive pulmonary embolism when she was first allowed to stand, eighteen days after giving birth. Paula had foreseen her death at a young age and was apprehensive about her pregnancy, yet (...) she painted herself as pregnant in her best known self-portrait, thus underlining the importance of the pregnancy in her life. In the light of knowledge available at the time, the authors present a brief discussion of the life and death of Paula Modersohn-Becker as a reflection on the potential dangers of blindly following conventional wisdom in the medical profession. (shrink)

[1. Without special title] -- [2]. Anastatica.

Tra gli intellettuali italiani della seconda metà del Novecento, Norberto Bobbio ha giocato un ruolo di grande importanza. Girolamo Cotroneo è intervenuto, spesso in maniera polemica per discutere le posizioni assunte da Bobbio di fronte ai problemi più pressanti del dibattito politico. Ad ognuno degli interventi Bobbio ha replicato con una lettera privata all’autore. Quegli articoli e le lettere di Bobbio sono contenute ora in questo volume che costituisce un prezioso documento per una maggiore conoscenza di taluni aspetti del (...) dibattito politico italiano di un passato recente. (shrink)

To provide a possible interpretation of the passive attitude often exhibited by pupils in the context of school trips, the article does not follow the path of moralistic judgement, but starts from the essence of the teaching profession, which consists in showing the world to the students. The article adopts the thesis of the presence, in many school trips, of an excessive cognitive load and affirms the need to devote the same attention to teaching in these learning contexts as in (...) class work. Graduality is proposed as the key to a learning experience based on a motivation that arises from the discovery of reality. (shrink)

Jean Hamburger is considered the founder of the concept of medical intensive care and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world, in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix Balzac and the Cino del Duca (...) prize, awarded, among others, to Jorge Luis Borges and Konrad Lorenz.Here we would like to offer a selected reading of a “golden” book, “Conseils aux étudiants en medicine de mon service”, the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options. The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice. (shrink)

1. Introduzione Perché, tra tutto ciò “che è”, scegliere di studiare proprio il denaro? Essenzialmente per due motivi. Anzitutto, col denaro abbiamo a che fare tutti i giorni, si tratta quindi di un ente che ha un ruolo rilevante nella vita dell’uomo contemporaneo, di più, direi che oggi esso abbia un ruolo centrale negli interessi degli uomini, pensiamo solo a quanti lo usano come criterio di scelta nella propria vita. Tuttavia, e qui arriviamo al secondo motivo, il denaro nella sua (...) struttur... (shrink)

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The article proposes two anthropological movements as guidelines for an education in democratic citizenship more capable of overcoming reductionisms and trivializations: a return to oneself, suggested by Hannah Arendt and a movement towards others, suggested by Edgar Morin. The text also takes the opportunity to formulate a reflection on the relevance of the global educational challenge of compulsory schooling for the construction of a more sensitive and open humanity.

Scopo del saggio è confrontare alcune tra le principali visiones della letteratura occidentale – tra cui la Visio Pauli e la Commedia – e le diverse redazioni della tradizione islamica dell’ascensione celeste e viaggio oltremondano del profeta Muhammad, nel tentativo di stabilire se le affinità, tematiche e strutturali, osservabili tra i due gruppi di testi siano frutto di semplice poligenesi o vadano piuttosto spiegate con rapporti di effettiva intertestualità.Tra le visiones, la tradizione mirajica e la Commedia si instaura dunque un (...) dialogo a tre voci, o di sinfonia, i cui temi principali si arricchiscono e si richiamano a vicenda. Dante, primo comparatista, è in grado di reinventare, armonizzandoli, elementi strutturali e tematici provenienti sia dalle visiones latine che dalla tradizione islamica del Isra’ wa’ l Mi‘râj.The purpose of this essay is to make a confrontation between the main important visiones of the Occidental Literature – also the Visio Pauli and the Dante’s Commedia – anche the various redactions of the Islamic Isra’ wa-l mi’râj. The confrontation is in order to establish if the remarked affinities are just due to polygenesis or rather caused by concrete intertestuality.Between the visiones, the mirajic tradition and the Commedia we are in front of a three voices dialogue: it’s like a symphony, in which the themes enriches themselves and, at least, the arrive to Dante for being harmonized. Dante is the first comparatist. (shrink)

The article begins with an analysis of the learning process, described as a transition from a condition of “not knowing ” to a condition of “knowing something more”. Referring to John Dewey’s theory, it underlines the need, on the part of the teacher, to understand the specific condition of the learner, which is closely related to the uncomfortable posture of learning, in order to make possible a truly meaningful pathway. To foster this experience, the author proposes, in conclusion, two thoughts: (...) the first is focused on the competence to proactively and interactively regulate the lessons, the second on a “principle of excess” which constantly places the teacher in the position of “giving”. (shrink)

SummaryThe problem of converting the Amerindian world to Catholicism was given a radically new solution, both at a theoretical and a missionary level, by the Jesuit Acosta: since American societies were of a completely different nature to Mediterranean ones, the preaching of the Gospel, too, had to be different from the classical approach. He gave a new definition to both preaching and American societies, especially the latter's religion and social organisation. Acosta's approach to American sauvagerie was pioneering; he conceptualised ideas (...) that had never been thought of before. There existed societies which were neither barbarous nor political (like the empires of Incan Peru and Aztec Mexico), which nonetheless had social organisation. With regard to their religious life, Acosta maintained that cult and belief without faith was not a sign of atheism, but of an early form of religion. These two reassessments gave rise to a new image of the savage society, which attained enormous success, even outside the missionary world. Fitting the theological structure into the secularised theories of radical enlightenment, both Locke and Hume had recourse to the ethnologic aspects which Acosta had set out. (shrink)

Benedetto Croce was the author of the most important and original theory of history in the 20th century. His theory was that of ‘absolute historicism’, and this necessarily entailed an acute critique of inherited ideas about the Enlightenment. This article studies both Croce's theoretical analysis of Enlightenment and his historical analysis of the Neapolitan Enlightenment. Croce's interest in the Enlightenment had political as well as philosophical roots. All over Europe in the 1920s and 1930s historical and theoretical research was occurring (...) into in the Age of Enlightenment. The broad goal of such research was to bring forth a new concept of reason, which would have purchase in the contemporary debate about rationalism and irrationalism. This debate, which flourished in the era of totalitarian regimes, raised a series of further questions: What was culture? What was the task of culture in the fight against political irrationalism? What was the relationship between culture and the growth of public opinion? With respect to the latter relationship an important role was played by intellectuals, as evinced by the works of Benda, Max Weber and Croce himself. The genealogy of the modern intelligentsia led again to Enlightenment. In the third part of the article Croce's position on this issue is discussed in the light of his historical researches on Enlightenment by reference to his correspondence with two young historians, Delio Cantimori and Franco Venturi. (shrink)

ABSTRACT This article outlines the concept of the early modern idea of religion through the notion of sacrifice, from Socinus on through Grotius and Spinoza to Diderot’s Encyclopedia. It is generally held that the philosophical representation of religion of the seventeenth century ‘set the stage’ for later Enlightenment philosophers. My argument runs in a different direction. I intend to show that the Enlightenment philosophers’ concept of religious history stemmed not only from the philosophical tradition, but also from their knowledge of (...) antiquarianism. In order to understand the genealogy of the Enlightenment idea of religion it is essential to acknowledge its roots in the antiquarian history of religions of the seventeenth century when a new idea of religious belief emerged with practice of sacrifice at its core. Grotius and the antiquarians inquired into whether religion was a universal phenomenon, what were its categories – such as belief and sacrifice – and the truth and falsehood of these. Diderot considered this history of sacrifice and ceremonies as the fundamental ‘deed’ of the religious experience, which he analysed employing both the philosophical and the historical perspectives through the category of fetishism. (shrink)

v. 1. Compendium logicae. Apologeticus de ratione poeticae artis. Trattato contra li astrologi -- v. 2. Compendium philosophiae naturalis, Compendium philosophiae moralis.