Pietro Refolo

Nursing is characterized by ethical complexity, emotional intensity, and relational asymmetry. While bioethics is often included in nursing curricula, it is frequently taught in a fragmented or purely normative manner, leaving students insufficiently prepared to interpret and inhabit the moral dimensions of care. To describe a three-year educational pathway in Medical Humanities, philosophical anthropology, and bioethics developed for pediatric nursing students at the University of Genoa – Istituto Giannina Gaslini, and to explore the ethical themes articulated by students. The structure of the program, which integrated philosophical anthropology, ethics of care and vulnerability, narrative practices, and dialogical pedagogy, was outlined. A thematic analysis was conducted on students’ written reflections which were presented at a public conference at the end of the program. Students’ reflections reveal the emergence of a coherent ethical sensibility structured around key themes: embodied care, vulnerability as a shared human condition, relational presence, the moral significance of everyday clinical gestures, and the integration of technology within caring relationships. The educational experience fostered reflective depth, interpretive sensitivity, and an understanding of ethics as lived moral practice rather than abstract rule application. An integrated, humanistic approach to bioethics education can meaningfully contribute to the formation of pediatric nurses capable of ethical presence, moral judgment, and relational responsibility. Students can be helped to cultivate an ethically attuned professional identity responsive to vulnerability and care.

The systematic integration of ethical and humanistic dimensions into medical education in Italy has progressively strengthened since the late 1990s. However, no studies currently provide an up-to-date and comprehensive mapping of the teaching of bioethics within Italian Medical Degree Programs (MDPs). To provide a complete and systematic overview of bioethics courses included in the MDPs offered by Italian universities. Using the official list of Italian universities published by the Ministry of Universities and Research, a manual review of the institutional websites of all universities offering MDPs – whether taught in Italian or English – was conducted. Only mandatory courses containing at least one of the following keywords in their title were included: bioetica, etica, morale (Italian) or bioethics, ethics, moral (English). Elective courses were excluded. A subsequent manual search of publicly available online sources was carried out to verify the consistency between each course instructor’s academic degree and the Scientific-Disciplinary Sector (SSD) of the course. The reference academic year was 2025–2026. A substantial portion of the examined curricula (~ 71%) included courses in ethics or bioethics. With the exception of three atypical cases, these courses were predominantly assigned to two medical SSDs – Legal Medicine and History of Medicine – while a smaller share (~ 18%) was assigned to Moral Philosophy. An overall consistency of approximately 78% was observed between the SSD and the academic degree of the instructors. In light of the distinction introduced by the “Gelmini reform” between bibliometric and non-bibliometric sectors, 81% of bioethics courses are placed within bibliometric areas. This placement effectively locates bioethics within the scientific domain of knowledge, raising questions about the implications of such classification for the identity and development of a discipline that is inherently interdisciplinary.

End-of-life (EoL) decisions represent some of the most ethically complex and emotionally charged aspects of healthcare. Understanding the attitudes of physicians, nurses, and the public toward EoL decisions is crucial for aligning care provided with the personal values and preferences of patients. To explore the attitudes of physicians, nurses, and the general public toward EoL decisions, including the withdrawal or withholding of life-sustaining treatments, euthanasia, physician-assisted suicide (PAS), palliative sedation, and advance care planning (ACP) within European countries. An umbrella review was conducted, covering the period from January 2010 to June 2024. The search strategy included Medline, CINAHL, and PsycINFO, supplemented by manual searches of reference lists of all included studies to identify additional relevant studies. The search identified 587 papers, 11 of which were included in the synthesis. Of these, six addressed euthanasia and PAS, three focused on ACP, one on the withdrawal of life-sustaining treatments, and one on palliative sedation. In Europe, the general public expressed the highest level of support for EoL practices such as euthanasia and PAS, followed by nurses, while physicians often held a more cautious perspective. For withdrawal of treatment, palliative sedation, and ACP, a critical recurring theme was the need to improve communication between patients and healthcare professionals. The divergence underscores the intricate complexity of navigating ethical, cultural, and professional considerations in EoL care. Effective communication serves as a cornerstone for respecting patient autonomy and ensuring that healthcare decisions align with individual values, goals and preferences.

Background In Italy, clinical ethics is not well institutionalized. On February 7, 2023, the Italian Ministry of Health published four long-awaited decrees regarding the reorganization of ethics committees. Aim: The aim of this article is twofold: firstly, we aim to briefly summarize the development of clinical ethics in Italy from a legislative point of view; secondly, we aim to examine how Italian regions are implementing the part of the new decrees on the organization of ethics committees that concerns clinical ethics. Methods: As for the first aim, we conducted a critical interpretive review (CIR). The search was restricted to the opinions offered by the Italian National Bioethics Committee (CNB) and to the major Italian legislative decrees on the topic. Regarding the second aim, we conducted an online search through Regional Official Bulletins of each Italian region. Results: Our analysis showed that despite the recommendations from the CNB to differentiate Research Ethics Committees (RECs) and Clinical Ethics Committees (CECs), over the years legislative attention has mainly focused on RECs and pharmacological matters. The new decrees allow regions to be flexible in organizing their activities. However, it emerged that only four regions (Veneto, Friuli-Venezia Giulia, Puglia, Emilia-Romagna) have split the roles, while all the other regions have entrusted both roles to a single committee. Conclusion: The risk for Italy is to take a step backward in the development of clinical ethics. Possible solutions could be either making Local Ethics Committees (CELs) mandatory or institutionalizing Ethics Consultation services (ECSs).

La contribución recorre el debate sobre el tema de la ética y la colocación de los recursos en ámbito sanitario en los últimos sesenta años de publicaciones de la Revista Medicina e Morale. Apelando a algunas fuentes documentales que certifican la inserción de esta temática entre los objetos de indagación de la disciplina bioética, sigue una breve reseña de los contenidos de todos los escritos de la Revista en la materia, una discusión de los elementos que la contra distinguen y la indicación de las perspectivas de publicación deseables.The article deals with the debate on ethics and resource allocation in health care over the past sixty years of the Journal Medicina e Morale publications. The reference to some documental sources certifying the inclusion of this issue among the objects of investigation of bioethics discipline is followed by a brief overview of the contents of all text of the Journal on the subject, a discussion of the elements that mark them and the indication of the prospects of publication that are desirable

In the field of health technology assessment, there are several approaches that can be used for ethical analysis. However, there is a scarcity of literature that critically evaluates and compares the strength and weaknesses of these approaches when they are applied in practice. In this paper, we analyse the applicability of some selected approaches for addressing ethical issues in HTA in the field of complex health interventions. Complex health interventions have been the focus of methodological attention in HTA. However, the potential methodological challenges for ethical analysis are as yet unknown.Six of the most frequently described and applied ethical approaches in HTA were critically assessed against a set of five characteristics of complex health interventions: multiple and changing perspectives, indeterminate phenomena, uncertain causality, unpredictable outcomes, and ethical complexity. The assessments are based on literature and the authors’ experiences of developing, applying and assessing the approaches.The Interactive, participatory HTA approach is by its nature and flexibility, applicable across most complexity characteristics. Wide Reflective Equilibrium is also flexible and its openness to different perspectives makes it better suited for complex health interventions than more rigid conventional approaches, such as Principlism and Casuistry. Approaches developed for HTA purposes are fairly applicable for complex health interventions, which one could expect because they include various ethical perspectives, such as the HTA Core Model® and the Socratic approach.This study shows how the applicability for addressing ethical issues in HTA of complex health interventions differs between the selected ethical approaches. Knowledge about these differences may be helpful when choosing and applying an approach for ethical analyses in HTA. We believe that the study contributes to increasing awareness and interest of the ethical aspects of complex health interventions in general

“HTA is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, health policies that are patient focused, and seek to achieve best value” (EUnetHTA 2007). Even though the assessment of ethical aspects of a health technology is listed as one of the objectives of a HTA process, in practice, the integration of these dimensions into reports remains limited. The article is focused on four points: 1. the HTA concept; 2. the difficult HTA-ethics relationship; 3. the ethical issues in HTA; 4. the methods for integrating ethical analysis into HTA