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Background and aim of the work: Few know that Lombroso was also involved in epidemiological research. In particular, Lombroso’s scientific reflections on Medical Geography were addressed to the theme of climate influences and meteorological conditions on human conduct. The authors analyze the scientific production and the works of Lombroso devoted to medical geography. Discussion: Lombroso carried out accurate epidemiological investigations using the statistical method with great modernity, combining health data with geographical and climatic data to demonstrate the relationship between man, the environment and health in a social vision of preventive and curative medicine. Conclusions: The theory of Cosmotellurism in Lombroso’s work is not only a source of unquestionable interest in the History of Medicine. The heritage of Medical Geography within the pre-bacteriological medical culture can continue with its teachings to correctly address the clinician’s thinking even in the current historical context in which endemic and epidemic pathologies re-emerge in various parts of the world. (www.actabiomedica.it)

Background and aim: The social role of the minor, as indeed that of the physician, has changed markedly. This transformation has given rise to new patterns and responsibilities in the management of healthcare procedures that involve minors. Discussion: According to international legislation, in the clinical setting, as in other areas of social life, minors have the right to be heard and to have their opinions taken into consideration as an increasingly determining factor, in accordance with their age and degree of maturity and discernment. The authors describe the right to information and the decision-making process when the patient is a minor and underline the role of the parties involved (physicians, parents, under-age patient, judge) in various circumstances. Specifically, the paper analyzes the ethical and legal issues relating to the entitlement to decisions concerning the medical treatment of children and assesses the importance that Italian law attaches to the will of minors in the healthcare choices that affect them. Conclusions: Healthcare workers are called upon to face new challenges in order to ensure that healthcare services are able to safeguard the interests of minors while, at the same time, respecting their will. How to evaluate children’s competence to consent and how to balance the autonomy of parents and minors are crucial questions which the law courts in the various countries are increasingly being asked to address. These issues require close collaboration among various figures (parents, doctors, psychologists, judges) and imply the ethical need to undergo continuous training. (www.actabiomedica.it)

The access to sex-reassignment surgery is based on the existence of an unequivocal dyscrasia between the morphological sex and the objective evidence that emerges from in-depth analysis of the individual's personality. In Italy, such type of surgical intervention is subject to the authorization of a judge.Authors examine the recent Italian Constitutional judgement which has addressed the right to change legal sex status without the need for sex-reassignment surgery.The Italian approach is in line with scientific evidence that the physical and mental well-being of an individual does not always require the surgical rectification of primary sexual features. Thus, sex reassignment surgery is not to be considered mandatory; rather, it should be aimed at ensuring the transsexual individual's stable psychological and physical good. From an ethical point of view, the Court's decision is very important, since it does not subordinate such fundamental rights as gender identity, healthcare and equality to prior, highly invasive surgery.The authors point out that critical issues and obstacles to the full implementation of the right to gender identity remain, in that this right is still subject to the authorization of a judge. This approach does not seem to be in line with the recent World Health Organization (WHO) decision to remove the "gender incongruity" from the list of mental and behavioural disorders (as it is in the current International Classification of Diseases-10, so far), to decrease the stigma surrounding such a condition.Gender identity, Sex reassignment, Surgery, Stigma, Transsexualism, Transgender.L’accesso alla chirurgia di riassegnazione del sesso si basa sull’esistenza di una discrasia inequivocabile tra il sesso morfologico e l’evidenza oggettiva che emerge da un’analisi approfondita della personalità dell’individuo. L’effettuazione di questo intervento chirurgico richiede, in Italia, una preventiva autorizzazione del Giudice.Gli Autori esaminano la recente pronuncia della Corte Costituzionale italiana che esclude la necessità dell’intervento chirurgico quale gravosa condicio sine qua non della rettificazione del sesso.La decisione è in sintonia con le risultanze della letteratura scientifica secondo cui il benessere psico-fisico della persona transessuale non sempre necessita di un adeguamento chirurgico dei caratteri sessuali primari. L’accesso all’intervento chirurgico non risulta affatto obbligatorio, ma esclusivamente funzionale alla eventuale necessità di assicurare al soggetto transessuale uno stabile equilibrio psicofisico. Sotto il profilo etico la decisione assume una forte significatività escludendo la possibilità di subordinare i fondamentali diritti all’identità di genere, alla tutela della salute e all’uguaglianza a preventivi trattamenti chirurgici altamente invasivi.Gli Autori, nonostante la rilevanza di questo pronunciamento, rilevano persistenti criticità e pregiudizi nella piena attuazione del diritto all’identità di genere sottoposto a una procedura autorizzativa giudiziale che sembra collidere con la recente rimozione della transessualità dalla categoria dei disordini mentali dell’International Classification of Diseases (ICD) da parte dell’Organizzazione mondiale della Sanità e con la necessità di una normativa mite, capace di superare rigide e prestabilite categorie omologanti.

Background and aim: This study aims at validating a questionnaire on physicians’ knowledge and perception of deontological and ethical rules that guide the medical profession, in a major Italian Province. Methods: We designed an on-line survey questionnaire. Participants (N=200) were asked to fill in information regarding their demographic features and knowledge of the deontological code. Results: Concerning the preliminary data, the median total score on knowledge of the deontological code was 0.50. A significant difference in the total score was observed among education groups. Specifically, the median total score among subjects with a specialist qualification was significantly lower than among those with only a medical degree. Conclusions: The tested instrument and methodology appear to be efficacious and reliable. Our preliminary data indicate that knowledge of the rules concerning medical deontology and the related principles of medical ethics seems to be very limited. Therefore, the authors plan to implement a second phase of the study, which will consist of the questionnaire’ distribution to a broader and more representative sample. (www.actabiomedica.it)

The Italian Parliament has recently approved the Law n. 219/2017 concerning "Rules on informed consent and advance directives". The manuscript points out the main key points of the new law, in order to clarify the role of the advance directives and to provide clear operational guidelines for healthcare personnel. Taking into consideration the Italian deontological and juridical context, along with the main jurisprudential judgements, the law has been analysed. The Authors discussed the new rules and the bioethical issues also in relation to the provisions stated by the Convention on Human Rights and Biomedicine (Convention of Oviedo). The new law deals with relevant issues that were confined to jurisprudential rulings so far, such as the informed consent, the withdrawal/withholding of medical treatment (including artificial nutrition and hydration), the content of medical information, including the modalities, the medical responsibility and, finally, the value of advance directives. In the Authors' opinion this law provides essential rules to expressly strengthen the patients' autonomy, eliminating the juridical uncertainty on many central issues (such us, for example, the refusal of life-sustainment treatments) that have been the subject of contradictory judgments ruled by the Italian Courts. Nevertheless, advance directives should be regarded as a dynamic tools of relationship between physicians and assisted person and, thus, as an essential integrant part of the advance care planning. The education of health professionals and citizens about end of life issues is the basis for the successful implementation of this legislation.

Background and aim: Medical deontology is increasingly important, owing to the interests and rights which the medical profession involves. This paper focuses on the relationships of the Italian Code of Medical Deontology (CMD) with both the ethical and legal dimensions, in order to clarify the role of medical ethics within the medical profession, society and the overall system of the sources of law. Methods: The authors analyze the CMD from an ethical perspective and through the new doctrinal guidelines and current trends in the Italian law courts. Results: From an ethical point of view, moral philosophical analysis scarcely seems to address professional medical ethics. Nonetheless, the CMD needs to undergo careful ethical analysis. From a legal perspective, the Italian CMD contains provisions which do not have an official legal nature. However, they are directly binding for medical practitioners, and therefore could be understood as a supplement to the general rules of the legal system. Conclusions: At an ethical level, rigorous debate on the CMD is indispensable, in order to update its specific principles and to make it a real moral normative document. At a legislative level, there is a possible contradiction between a legal system that does not take into account the CMD, but which then attributes significant importance to the violation of its rules. (www.actabiomedica.it)

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