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Ethics in the Service of the Sick

Reflections and Experiences of Life at the San Raf

Author(s): Charles Vella

ISBN13: 9781847301666

ISBN10: 1847301665

Publisher: Veritas

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  • We need to learn from the patient, we need to listen to them, because from the classroom – as Charles G. Vella calls it – of the bedside, we glean an ethical lesson of inestimable value.The patient can help us become more human, and see the truth of our humanity.


    The patient may render us more humane while we accompany and care for him, always keeping in mind that despite his weakness and helplessness he remains, nevertheless, a person. And following this path, which Charles G. Vella can speak of with authority by the fact of his internationally recognised expertise and long experience with the sick, we discover that the simple communicative acts of listening, caressing, smiling, stopping by, Staying close to and giving time to the sick, may, in time, become therapeutic for ourselves.

     - Enzo Bianchi

  • Charles Vella

    Charles G. Vella was born in Malta in 1928. Between 1948 and 1955 he studied Philosophy and Theology at the Pontifical Gregorian University and the Venerable English College. In 1962 he trained in Communications with the BBC in London and took charge of the running of Maltese Radio and Television stations, a post he held until 1975. In 1986 he was asked to take over responsibility for the Public Relations Office of the Milan San Raffaele Hospital’s Scientific Institute. Since 1988 he has been a member of the Milan European Oncological Institute’s Ethical Committee (IEO).

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    This is a beautifully written book that invites its readers to reflect more deeply upon the health care system and those who work within it. Drawing from his own personal experiences of health care as both a patient and a chaplain, Charles Vella gives a deeply humane and mature account of how our health care system should function. Readers get to the heart of the issues very quickly with Vellas examples of how the doctor and patient relationship should be understood and embodied. At all times, he brings his theological reflections into the equation thereby facilitating a very real and sincere style of writing. The suffering Christ emerges as a central motif, as the author explains how bedside ethics can be viewed through the lens of the Christian story. In each and every patients experience, there is an occasion for doctors and all health care professionals to deepen their own self-knowledge; gain greater insight into the lives of suffering patients; and acquire a mature and humble understanding of their own vocation as carers.


    Vella lists the essential characteristics which doctors must have. These include faithfulness; benevolence; humility; self knowledge; trust; confidentiality; patience; understanding (at both medical and personal levels); a sense of humour; awareness of the uniqueness of each and every situa­tion as well as the ability to listen. Listening is emphasised throughout the work, as the author maintains that all professionals should have the ability to talk less and to listen more. Thus he argues that `all depends [...] on a doctors decision to be at a patients disposal at all times. He must always be prepared to listen (p. 73).


    But Vellas counsel does not stop with health care professionals; he also offers guidelines for the Chaplaincy team. The word team is significant here because Vella believes that the task of spiritual healing, of counsel, and of administering the sacraments is one which should take place in groups. Further, Vella points out that the Chaplains role should be made clear in the hospital so that meetings do not clash with ward rounds or family visits. The need for confidentiality, care and professionalism of the highest order are emphasised by the author, as he seeks to reinstate the Chaplains role in hospitals as one of crucial importance for those of faith and indeed for those who experience a conversion whilst in hospital. Vella argues that elitist attitudes about which roles are most significant in hospitals need to be challenged, and that Chaplains should also be remembered when heads of hospitals are giving praise and showing appreciation for other health care professionals. He explains that post Vatican H vision of `participation founded on the common priesthood of the people could bring about a more just understanding of what care for the sick and dying entails (p. 87).


    The final chapters focus upon more controversial issues facing the families of the sick and dying as well as their carers and doctors. Of particular interest is the discussion in chapter 10 about `living wills. The author emphasises the fact that frequently there exists a misunderstanding about how the Catholic Church interprets a `living will. He explains that one is not obliged to keep a person alive by `extraordinary means (p. 146). Vellas explanation of the Catholic position on such matters is clear though it lacks depth and seems to avoid getting into any difficult discussion of how a patient might interpret `extraordinary means. There is no mention of mental health and how this might impact on the patients ability to make a living will. In addition, the discussion on euthanasia does not engage with the difficult issues that face the sick and dying.


    The final chapter of Vellas work examines HIV/AIDS patients and the care they receive in the San Raffaelo Hospital in Milan. Drawing upon Timothy Radcliffes phrase `the body of Christ has AIDS, the author explains how the faith community should respond in solidarity to the AIDS epidemic which is rife amongst African and Asian populations. The eradication of myths and fears concerning AIDS comes out strongly in this final chapter, but there is no mention of how Catholic teachings might need to be changed or reinterpreted in order to begin the process of healing and AIDS prevention. The use of condoms is not mentioned, and there is no real engagement with the work of theologians who write from a different perspective than the one adopted by Vella.


    Notwithstanding such criticisms, this book deserves to be read widely. The wealth of stories and real experiences that are recounted throughout the work make it real, compelling and relevant to the issues facing health care professionals and patients in the modern world. The main message of the book may be summed up in the words of Enda McDonagh speak­ing at Kevin Kellys festschrift: when it comes to ethics, we must see ourselves as `guests of God, and hosts to one another. Each of us, therefore, has a responsibility to engage with the health care profession at every level so that when we are faced with tough decisions we will be able to act with integrity and an informed conscience.


    - Ann Marie Mealey, The Furrow, Nov 2010


    Before my mother died six years ago she spent some respite time in a nursing home. When she was admitted to the nursing home, which was a lovely place to look at, my sister and I were asked by a nurse what medications, if any, my mother was allergic to. We explained in detail all the tablets my mother must not have.

    When we visited my mother every day she appeared to be heavily sedated and one night a nurse phoned to tell us that my mother had been given the forbidden medication (sleeping tablets) by mistake and had got two very bad falls. She had to be admitted to hospital from which she never came out and died three months later. Clearly she had not received the proper care she deserved.

    I mention this personal story to introduce Monsignor Charles G Vella and his wonderful book, Ethics in the Service of the Sick. This inspirational book is the result of working for many years with the sick at the San Raffaele Hospital, Milan. He feels that hospitals can often be inhuman and frightening places where the unfortunate patient is sometimes seen as just a number devoid of human dignity and rights.

    He writes: "Human values, strengthened by a fervent belief in spiritual values, allow carers to share in each patients sufferings and hope for survival. Patients long to be treated with love and compassion. The Capuchin Saint Pio of Pietrelcina often urged doctors who worked in the Home for the Relief of Suffering to give a great dose of love together with their medicine. The ability to treat the sick not only with medication, but also with love is only possible if carers believe in spiritual values."

    Charles Vella quotes Carl Rogers quite a lot to the effect that the treatment must be centred on the sick individual. Rogers insists that we must look into our own hearts and develop compassion and sensitivity and learn to know ourselves before we can really care for others. In other words, nurses and doctors must essentially be people of deep compassion and concern.

    The author quotes from a speech of Pope a- John Paul II to Catholic doctors: "The humanisation of medicine is a proclamation of human dignity, respect for the body, for the spirit and the culture of each patient. In concrete terms, none of you re can limit yourselves to being doctors who cure only the body but must care for the person as a whole and, even more than that, must foster relationships with each of your patients in order to make a valuable contribution to their well-being."

    Monsignor Vella says: "I simply wish to emphasise that I was called to the San Raffaele to `teach and heal by Providence. It was from the San Raffaele foundations philosophy that I learned that each patient is, before all else, a human being and that every person is Jesus Deus Patiens (Christ, the suffering God)".I found this a deeply moving and encouraging book and it should be compulsory reading for every nurse, doctor and carer.

    - Anthony Redmond, The Irish Catholic, July 9th 2009

    Those of us who visit hospitals on a frequent basis are only too well aware that the vocation of healing is being severely tested at every level in our healthcare system at present. Despite the efforts of many dedicated people in the health service insufficient or misapplied resources, stifling bureaucracy and the diminishing regard for the individual patient as a child of God but rather as a client or customer all add to the unease which many of us now feel at the prospect of hospital care for ourselves or those that we love.

    For those reasons and more a new publication entitled Ethics: In the Service of the Sick by Charles Vella, who at 81 has a lifetime of experience in hospital care, brings an invaluable perspective to the ongoing discussion about the treatment of the sick. Guided by the teaching of Carl Rogers, Charles Vella advocates that all treatment should be centred round the sick individual. This may sound like a statement of the blindingly obvious yet anyone who has spent any length of time in a hospital or nursing home can testify how frequently the individual patients needs slips down the agenda.

    He also emphasises the crucial role of the family and the wider community in the process of healing. Over the eleven chapters of Ethics the author blends personal anecdotes, biblical reflection and numerous medical, philosophical and spiritual resources into a narrative that should enlighten and guide all who are concerned with the welfare of sick people. He does not avoid the difficult personal and ethical dilemmas faced by those with terminal illness as well as the tensions between the purely secular and Christian Catholic ethics and offers many practical examples of both from his own experience which provide ample food for reflection. Included are appendices in the form of a living will which a person may sign before undergoing management of a serious illness as well as exhaustive lists of saints for illnesses of all kinds as well as patrons of medical professionals.

    Monsignor Vella puts forward a truly holistic approach to patient care which deserves to be carefully reflected upon and fully embraced by the Irish medical profession at this particular moment in our history of patient care.

    - Fr Paul Clayton-Lea Clogherhead, Co Louth, Intercom, January 2010


    Two friends and neighbours travelled to Dublin to visit a terminally ill farmer from Tipperary, a county famed throughout Ireland for the prowess of its hurling team. After giving him the local news, they assured him that he would regain full health within a few months and be with them the following summer to celebrate Tipperary thrashing Cork in the Munster Hurling Final. The patient nodded and the visitors left. A young, newly appointed chaplain to the hospital overheard the final exchange and approached the bedside when the others had gone. The patient murmured, I suppose they had to say that, Father. I hope they feel better now! You know and they know that I wont see any more hurling games.
    That little scene encapsulates the unreality, the pretence that often surrounds our relationship with the seriously ill. The image of that resigned nod has never faded from my memory, for I was the young chaplain recently assigned to St Annes Cancer Hospital in Dublin. There were many lessons to be learned in the classroom of the bedside in St Annes. How I wish I had had a book like this one by Charles Vella as my vade mecum then!
    As Fr Vella found when sent to visit a young woman who was near death in Chicago, I too was often confronted by the woeful inadequacy of my preparation for working in a chaplaincy role with sick people, with their families and carers. The training we received as student priests for dealing with the ill was limited to the rubrics of administering the sacrament of Extreme Unction. Thankfully, welcome advances have been made since then in the formation and training of pastoral care professionals in our hospitals and nursing homes.
    As national health services become ever more bureaucratic and the notion of a vocation to healing sinks under the weight of economic imperatives, there is all the more reason to recall the Judaeo-Christian vision of the child of God in each patient. Fr Vella echoes James Schall SJ: the essence of civilization, ethics and dignity (of man) is that all life ... deserves to be lived.
    To be lived! Charles Vella, in his own life story, embodies the words of Christ: I have come so that they may have life and have it to the full (Jn 10: 10). My first encounter with this dynamic Maltese priest happened in Dar-es-Salaam in 1974 at an international congress on the family organised jointly by the Christian Family Movement and the World Council of Churches. Fr Vella was the driving force behind the two-week event which drew couples in their hundreds from many Christian denominations and all parts of the globe. The objectives were two-fold: to highlight before the world the importance of the family in society, and to gain insights from the community and family values underlying the political theory then in practice in Tanzania under the inspired leadership of President Julius Nyerere.
    My involvement was in producing a television documentary on this unique congress, subsequently broadcast in various countries. It was Charles Vella who invited us to come to Dar, to film the proceedings, interview the experts, and bring the message of the essential role of the family unit to a wider audience.
    It was this deep concern for the recognition and well-being of families around the world that led to his long association with the sick, with the San Raffaele Hospital in Milan as his base. But Fr Vella is not a man to confine his work to one particular medical institution. Through his membership of European healthcare committees and his contributions to a variety of medical and ethical journals, he has become a respected advocate of a holistic approach to healthcare. For him, a sick man or woman is not just the patient in bed number twelve, or the kidney in the end cubicle, but a person made in the image and likeness of God, deserving of not only the best medical attention, but the care and love of a family and community.
    This book, the fruit of Fr Vellas ministry at personal, national and international levels, will provide valuable insights not only for professional healthcare workers, but for all who are in contact with the sick, either at home or in hospital. Its narrative style removes it from the realm of weighty academic study and makes the riches within accessible to all. Read, learn and enjoy!

    Former Editor of Religious Programmes RT?ë
    Pastoral Care Facilitator RT?ë
    February 2009


    This book sets out to give a humane face to ethics, that of the patient both as a person and as an image and likeness of God , imago Dei.
    These pages have grown out of my experiences at the bedside of patients , what is called bedside ethics; they are reflections on the many ethical questions posed by patients, doctors and nurses, particularly those which have come up over my twenty years of service within the San Raffaele Hospital in Milan, which I have always loved and will continue to love.
    Since the founding of the Cana Movement in Malta in 1954 for the preparation of couples for marriage, pastoral work with and counselling of families, I have continued to work closely with families in various countries. My interest in this area brought me to Italy, at the invitation of the Commission for the Family of the Italian Bishops Conference, at that time presided over by the late bishop Monsignor Pietro Fiorelli di Prato.
    I have been greatly inspired and helped in my mission by Carl Rogers, the noted humanist-existentialist American psychologist, one of the first to expound the concept of person-centred therapy, which to me meant that putting the well-being and the rights of a patient and his or her family before every other consideration is imperative.
    In these pages I have attempted to give everyday ethics a humane face using a narrative style which I hope is not only easily comprehensible but also stimulating.
    On the other hand, in expounding ethical principles and facts, I hope to encourage and stimulate not only a critical conscience aimed at denouncing the many negative practices which ought to be banished from the treatment of patients, but also a new prospect of life open to hope.
    Making recourse to biblical, theological and magisterial references, I hope to throw light on the holistic treatment and care of the sick in order that the helping relationship (Rogers) may be in accordance with the evangelical logic of receiving with compassion, of giving, of caring for others.
    It is no coincidence that this work is centred on the realities of the San Raffaele, Scientific University Institute of Treatment and Research, since it is in this temple of medicine and suffering that I have exercised my ministry of management, always in the role of priestly-doctor. This by no means suggests that the San Raffaele is an ethical oasis, or that it is the only hospital which treats patients humanely, for the humanisation of medical care is nowadays widespread. I simply wish to emphasise that I was called to the San Raffaele to teach and heal by Providence. It was from the San Raffaele Foundations philosophy that I learned that each patient is, before all else, a human being and that every sick person is Jesus, Deus Patiens (Christ, the suffering God).
    With all my heart I thank all who work at the San Raffaele, from its president down to the workers, for all the benefit I have received through my long years of experience here which now gives me the grace of being able to cast the net wide. I also wish to thank Brigid Garrone for her professional help, Richard Muscat, former Maltese Ambassador to Ireland, and my long-time friend, Dermod McCarthy, for writing the foreword to this book (which puts me in mind of my many other Irish friends: Jo Dunne, Des Forrestal, William Fitzgerald, Eamon Casey and a host of others). I thank you all.




    To introduce our subject, I shall quote a letter to the editor of the Corriere della Sera, which featured as the Story of the Day on 24 June 2005 and elicited a response from Giangiacomo Schiavi, a regular columnist with the paper. Increasingly, the printed media and TV give space to the publication of the negative experiences and the disillusionment caused by the poor quality of care given in hospitals and clinics to members of the public. The writer of this letter, therefore, is not a voice in the wilderness, but I shall quote it in its entirety because it indicates a typical example of the malfunction of the health services. The Italian word is malasanit?á, a word which has entered the Italian language in daily use, even if it is sometimes misused. The title, spread over five columns of print, screamed: HOSPITALS: WHEN THE PATIENT IS MERELY A NUMBER. This is what the letter said:

    I went to a hospital in Milan to care for my ailing father and found the attitude of doctors and nurses to be cold and distant. What really struck me was the psychological degradation of the sick. It was like going back in time to the immediate post-war period, where, like lottery numbers, patients were identified and called by the numbers assigned to their beds. Doctors and nurses would come in and call out: Whos number 12? A few days later my father was brutally given the cold facts about his condition with no thought to the psychological effects of such bad news. This does not foster good doctorpatient relations. Is it not a fact that medical treatments have a greater chance of success when the patient is willing to collaborate with his carers?

    The letter speaks for itself, and Schiavi replied to it in a very correct and humane manner. When patients become mere numbers, something is missing from the bedside manner of carers: it is a sense of ethics, the lack of which is to blame for the socalled malfunction of the health services. If a patient becomes a number it is because a certain deep sensitivity is missing in the attitude of care-givers, which results in a malfunctioning of interpersonal relationships.
    Hospital wards are not populated by numbers, but by men and women of different ages, nationalities and creeds, who have been hospitalised because they are ill. Very often, their suffering is augmented by the humiliation of being thought of as a number on a bed, totally divested of their human dignity: they become mere objects, and are often treated as such, without consideration or courtesy.
    The greatest humiliation for patients is that, being thought of as a number, they are deprived of their dignity. Nobody should be treated in such a way. All individuals have the right of respect to their human dignity, whether they are patients in a luxurious private hospital or in a public ward. Even more degrading is the inhumane treatment of psychiatric patients by certain members of staff in mental institutions, as has been amply shown in a number of appalling cases. The same holds for aged members of society who are not self-sufficient, are incontinent or unable to feed themselves, who throw tantrums and shout or cry loudly in their rage and frustration. God loves every person, but these are his favourite children: why then do not those who work among them have the least spark of love, compassion or respect for their vulnerable brethren?
    As was stated in Schiavis reply to the published letter, it used to be common, in the past, to hear doctors, nurses and other hospital staff call out instructions of the type: An intravenous drip for number 8; a lozenge for number 17, as though calling out numbers in a bingo hall. Added to this, each of these numbers were subjected to being addressed in an overly familiar manner to which they had no choice but submit, whether they were asking for information about their condition or attempting to safeguard their dignity.
    Merely the necessity of having to undergo a stay in hospital is traumatic enough for patients, especially those suffering serious illness. I have witnessed the fear, uncertainty and doubt of patients of all ages being admitted into hospital, both before and during my ministry at the San Raffaele. They are often psychologically at rock bottom, as may be seen by the pallor of their faces, and at times, the odd tear. Being referred to by number on their arrival in the ward adds to their suffering.
    I remember once accompanying a woman to a luxury clinic where she was received in a very professional manner, but on finding herself alone in her hotel-like room, she felt that she had just been shut into a fridge. Even though she was not assigned a number and was always addressed as Madam, the atmosphere of the place was cold and unwelcoming. It is not the papered walls nor the aesthetically pleasing building and furnishings that constitute a hospital worthy of the name, it is the people who work there: the head of surgery, the nurses, the nursing aides and so on down to the domestics. These may create a welcoming atmosphere which puts patients at their ease, calms them down and fosters their trust.
    It is human warmth towards the patient which renders a tangible ethical sense in human relations. In my experience, and doubtlessly that of many patients, there are many doctors and other health workers whose attitudes show a real ethical conscience.
    As a matter of fact, as a priest myself, I have observed that there is a sizeable number of good samaritans within the ranks of the health services, who are dedicated to their profession in the same way as a priest lives his vocation. I remember an elderly military gentleman who walked through the hospital ward proudly wearing his war medals and telling anyone who would listen the stories of how he had won each of them. He was never called Number 20 but always The General and this made him happy. To him, the hospital was home and the staff were his friends. For months towards the end of his life he battled the illness that afflicted him, and to the very end he was referred to and addressed as The General. He died like a true general.


    The well-known human existentialist psychologist Carl Rogers was among the first to develop the concept of person-centred therapy, which involves the ethical imperative of giving priority to the wellbeing and the good of every person, sick or healthy, without discrimination. The individual is of absolute value, and must be considered objectively in his totality and unity a creature of God, made in his image and likeness. Treatment and cure must therefore be holistic, that is, caring for the person in both body and spirit.
    All hospital and medical staff, including administrative staff, must always act in the best interests of the patient. Unhappily there are times when budgetary exigencies make profits and expenses more important to the hospital industry (a most unfortunate term) than the well-being of each patient.
    According to Professor Edmond Pellegrino, who for many years directed the Kennedy Institute for Ethics at Georgetown University in Washington DC, the term medical good refers both to the effects of medical procedure on the illness that is being treated and to the benefits that may be achieved by the application of medical knowledge: prevention, cure, quality of and prolongation of life. The medical benefits can vary. For example, the use of an oxygen mask may lead to a complete recovery, but it can also cause a patient to have a panic attack; for such reasons it is necessary to weigh the pros and cons of any treatment. Pellegrino notes that the usual procedure is to weigh the medical benefits against the effect on the individual patient and act accordingly.
    Values such as freedom, rights, rationality, awareness, the right to take decisions regarding treatment and the ability to choose are associated with the well-being of the patient. When patients are thought of as numbers, their well-being is relegated to second place, because the ethic of human-centred medical treatment is missing.
    In this day and age, the human person and human life are considered of little worth , this is evident if one notices the ease with which people are murdered, wars are declared. As stated in Pope John Paul IIs encyclical Dominum et vivificantem: Despite the dizzyingly rapid technoscientific progress, despite the great achievements and the goals reached, mankind is threatened, humanity is threatened. In this same document the Pope writes about the picture of death and the culture of death which is being composed in our times.
    To change this it is necessary to make a great improvement in the treatment and care of the sick, putting them first, making them protagonists , far from treating them as anonymous numbers , in hospitals worthy of human beings, thus rendering their confinement in hospital a humane experience. Such change involves a revolution in health policy and hospital management: it necessitates viewing the patient as a citizen with full rights, deserving of respect because he or she is a person who is suffering and should be treated, no matter the cost.
    In some countries, as in Great Britain, where the health service has been partially privatised, hospitals sometimes refuse treatment or surgical procedure, even those as necessary as organ transplants, because their budget cannot cope with the expenses involved. One such example involved a girl who was refused treatment by a number of hospitals that lacked the funds to cover the costs, and was eventually allowed into a hospital and given treatment when an anonymous benefactor offered to make good for all the expense needed. This is a classical example of utilitarian ethics, in which the cost of treatment is considered more important than the needs of the patient. Rogers philosophy on the human person is not ascetic, neutral, political or beaurocratic, but is based on human and moral values whereby the individual person is the agent and protagonist.


    What deeply dehumanises the patient-doctor relationship is the long time one must wait before being admitted into hospital or being operated on. This is a common reality in many EU countries; unfortunately Italy holds the record for longest waiting times. According to the Active Citizenship Network (European Active Citizenship Network , Patients Tribunal), in the majority of cases the waiting lists in Italy are longer than those in nine other European countries. This causes psychological distress to patients and undermines their quality of life.
    This situation exists in other countries, but the waiting times are shorter, with a few exceptions. When the wait is too long, the patient is often forced to make an appointment with a hospital that has comparatively shorter waiting lists, for example one in the north of Italy rather than in the south, or even in different countries altogether, where some procedures are carried out using more modern methods. I know many patients who have done this, among them some doctors: for hip replacements one travels to the UK; for liver transplants to Berlin or Brussels; for knee operations to Lyons; for neurosurgery to Innsbruck; and for oncological treatment to Paris. There have been a number of court rulings confirming the right of European citizens to be treated in European countries other than their own; and the European Court of Justice has ruled that patients should be reimbursed for treatment, travelling and lodging expenses in cases where waiting lists in their country of origin were judged to be too long.
    It is unacceptable that, as often happens, hospitals should suggest that patients seek expensive private treatment in order to avoid a long wait. Such a proposal may be acceptable to patients covered by medical insurance, but is not practicable for the vast majority, many of whom often require urgent treatment but are forced to wait months, to the detriment of their health which may consequently deteriorate beyond a state where their condition is curable. This goes against all ethical principles and denies the citizen the right to benefit from public health services within a reasonable time frame.
    Since April 2004 mutual healthcare cooperation agreements between EU countries gives EU citizens the right to free treatment anywhere within the EU, but this only holds true in cases where highly specialised treatment is unavailable in Italy, or specific treatments are unavailable at the time they are needed, or are available but unsuited to the specific needs of particular patients. It is then also necessary to acquire the endorsement of the regional authority for such treatment.
    On the other hand, it must be stated that health welfare regulations are generous with the over-65s, low-income families, the unemployed, the chronically ill and children under the age of six, while millions of Italians are exempt from prescription or other medical charges. It has been calculated that there are between 22 and 23 million Italians (40 per cent) who do not pay for visits to a specialist, analysis and diagnosis of illnesses. This number is further raised to 34 million by those entitled to free medicinals. Only eight regions are left where patients must pay a ticket (Ôé¼10 to Ôé¼20) for medical services or medicinals.
    This situation leaves much to be desired from the point of view of justice, equality and honesty. It is necessary to move on, as other countries have done, from a welfare state to a caring society; that is, a society that is not satisfied with a state that acts as parent.


    The above negative aspects are often characteristic of health services administration. If you go to the local health clinic to get a form filled in by the doctor on duty entitling you to medical examination or analysis, you wait your turn for some hours, despite being sixth in the queue. Then you go to a hospital to make an appointment for the examination, and if you make sure to arrive early in the morning, you will find that you are tenth in line. The receptionist or clerk behind the little window treats you very impersonally. After some days, if you are lucky and line up at 7 a.m., you are twentieth in the queue.
    The situation becomes worse when, having been entered into the computerised system as a number, the patient is made to wait for a number of months before being admitted into hospital or being operated upon. In such a situation, the sound of the phone ringing raises the hopes of the patient that this will be a call from the hospital. It takes the intervention of the heavenly saints to be admitted into hospital or be given an ultrasound scan or x-ray in a short time. Some patients die before their turn to be operated on comes around.
    White Coats and Pyjamas: The Doctors Part in the Italian Health Services Disaster by Dr Paolo Cornaglia Ferraris provoked lively and contrasting reactions, bringing about confrontation between doctors and patients. In a second book, entitled Pyjamas and White Coats: Changes in the Italian Health Services, the author analyses in a more systematic way the changes taking place in the Italian health services since Minister Bindis reforms. Treating the sick is defined as a dignified and noble profession, and a number of practical proposals are put forward, which aim at humanising medical practice. In order to ensure that patients no longer continue to be treated as objects, but are seen as equal stakeholders in their own recovery the author insists on the need to take into account the patients background and life in the devising of the treatment programme and insists that one should never arrogate to oneself the right to make choices which may be contrary to the wishes of the patient. This means building a relationship of trust which allows the patient to come to an informed consent in his/her treatment, in other words to share in the choices made by the doctor.
    Fortunately there are hospitals in Italy which h ave gone way beyond this advice in the way patients are treated. Thanks to new technology, the professionalism of the doctors and the support of administrators, many problems of hospital management have been resolved and the patient today is no longer merely a number, but a person who enjoys a citizens rights to a health service based on an ethic of justice, equality and transparency.
    All hospital workers are called to give of their very best to the sick person: one should never bear an attitude of charity or pity towards the sick, but has an obligation to provide the most humane, scientifically correct surroundings in the same way as one would provide a golden tabernacle for Christ.
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