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About this book

This book offers an overview of the main questions arising when biomedical decision-making intersects ethical decision-making. It reports on two ethical decision-making methodologies, one addressing the patients, the other physicians. It shows how patients’ autonomous choices can be empowered by increasing awareness of ethical deliberation, and at the same time it supports healthcare professionals in developing an ethical sensitivity, which they can apply in their daily practice.

The book highlights the importance and relevance of practicing bioethics in the age of personalized medicine. It presents concrete cases studies dealing with cancer and genetic diseases, where difficult decisions need to be made by all the parties involved: patients, physicians and families. Decisions concern not only diagnostic procedures and treatments, but also moral values, religious beliefs and ways of seeing life and death, thus adding further layers of complexity to biomedical decision-making. This book, which is strongly rooted in the philosophical tradition, features non-directive counseling and patient-centeredness. It provides a concise yet comprehensive and practice-oriented guide to decision-making in modern healthcare.

Table of Contents




Ethics Consultation Services: The Scenario

This chapter aims to provide a review of the state of the art of the ethical consultation services. In particular, we present a map of the most important traditions, discussing the different conceptions and the different roles they give to the counsellors. Then, we show the place of our ethical counselling methodology within this scenario.
Alma Linkeviciute, Virginia Sanchini

Ethical Counselling for Patients

In this chapter, we propose a methodology of Ethical Counselling addressed to patients and/or to their relatives. We show to what extent this is strongly grounded in a robust philosophical tradition: the Aristotelian practical philosophy. It is emphasised that such a methodology has been thought in order to help patients to make an aware ethical choice after having analysed what we call their Personal Philosophy, that is, their more or less systematic set of personal values, ideas and religious beliefs.
Giovanni Boniolo, Virginia Sanchini

Ethical Counselling for Physicians

In this chapter, we propose a methodology of Ethical Counselling addressed to the physician and/or the medical team. The aim of this second methodology is to help clinicians to have a more complete picture of the moral issues raised by the clinical case they encounter in their daily practice. We show that this methodology is philosophically grounded upon the way Medieval philosophers structured their argumentations.
Giovanni Boniolo, Virginia Sanchini

Nocebo and the Patient–Physician Communication

This chapter tackles one of the most delicate issues of the Ethical Counselling: communication. Communication is the central skill required for a proper patient–clinician relationship, but it is also vital whenever a service of ethical counselling is implemented. We do not dwell upon how it should be made. Differently, we discuss its neurocognitive counterpart. That is, we show how a wrong way of informing patients about their clinical situation or about the ethical dilemma they are facing could induce dangerous nocebo effects.
Luana Colloca, Yvonne Nestoriuc

Reasons and Emotions

This chapter outlines the importance of reasons-giving in, and for, Ethical Counselling. By reason-giving, we refer to that particular dialogical process whereby an agent comes to identify, articulate and appraise the various moral reasons structuring an ethical dilemma. In particular, within this chapter, we describe (i) the role of emotions with respect to reason-giving; (ii) why we should rely on reason-giving; (iii) how reason-giving enables to make explicit patients’ Personal Philosophy; and (iv) why reason-giving is always an open-ended process.
Marco Annoni

The Centrality of Probability

This chapter deals with a topic whose importance is too often ignored with respect to Ethical Counselling: probability. Probability, indeed, is at the core of many ethical decisions encountered in the age of molecular medicine, as in the case, for example, of carrier tests or predictive and presymptomatic tests, or whenever survival rates are at issue. Thus, understanding correctly the probabilistic information is extremely important and crucial and an ethical counsellor cannot be unprovided with such knowledge.
Giovanni Boniolo, David Teira Serrano

Ethical Issues


Genetic Testing and Reproductive Choices

This chapter aims to offer an introduction for the management of the ethically controversial issues arising from the relationships between reproductive choices and genetic testing. In particular, three main ethical issues recurrent within this debate are presented and analysed. First of all, it is shown that reproductive choices can be different number choices, meaning that the reproductive decision will change the number of individuals eventually born, or same number choices, meaning that the reproductive decision will not change the number of individuals eventually born. Secondly, considerations pertaining to the quality of life and welfare of the future children are introduced as having a pivotal role in the assessment of controversial reproductive issues. Finally, the principle of procreative beneficence is presented.
Paolo Maugeri

The ‘Right-not-to-Know’

This chapter deals with the ethical controversies related to the so-called right-not-to-know in biomedicine. By problematizing the substantive conflicts at the basis of patient’s decision to waive some health-related information, the chapter provides a normative map for instructing the practice of Ethical Counselling in the face of these claims. In particular, it is argued that both self-regarding and other-regarding considerations in the exercise of the right-not-to-know may ground or dismiss its ethical and legal legitimacy and may prove fundamental aspects of ethical counselling processes.
Luca Chiapperino

Incidental Findings

Various medical tests are routinely performed in medical practice to establish or confirm a diagnosis and prescribe the right treatment. In some cases, the results of a medical test can reveal a previously undiagnosed condition, which is not related to the current medical condition and the original purpose of the test. Such results, called incidental findings, have sparked a significant debate on whether all of them should be reported back to the patients. In this chapter, we present the debate on the implications and management of incidental findings in the clinic, to offer a heuristic for reaching an ethically desirable outcome on a case-by-case basis.
Maria Damjanovicova


This chapter tackles ethical issues surrounding fertility preservation in cancer patients by offering an overview of the main ethical problems which might arise in patients. Main arguments supporting and rejecting the fertility preservation practice are presented including fertility preservation for young children, reproductive decisions faced by cancer survivors and cancer treatment during pregnancy. Moreover, it also shows that decisions to preserve fertility might require further decisions in the future about the use of cryopreserved gametes.
Alma Linkeviciute, Fedro Alessandro Peccatori


Screenings appear to be one of the most promising approaches to tackle cancer based on the assumption that prevention and proactive management of risky lesions is the best strategy to reduce fatalities from invasive cancers. However, the opportunity of early detection implies the possibility of unwanted potentially harmful outcomes, such as false-positive results and overdiagnosis. We argue that the balance between possible benefits and harms has to be established by patients deciding whether to undergo screening. Moreover, we propose Ethical Counselling as a tool for positively coping with these questions.
Giulia Ferretti


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