Carlo Flamigni – Ethical Rules

I think about discipline as obedience to ethical rule, and I think about ethical rule as what influences our conscience. It is clear that the infection of consciousness can be of all types, and there are also the propagators. But there can also be a vaccination, which even prevents that you end up in this negative contagion.
The ethical rule is what makes us understand what is good and what is bad in what we have done and in what we are about to do. So somehow makes us understand what should be our best behavior… sometimes we understand it, sometimes we do it, some other times we don’t… but it exists. And it exists in both our relationship with the social world (in which we are immersed) and in relationship with the job we do.

So maybe my primary problem with discipline is this: what is my relationship with my job, what is the moral rule that should guide the job of a doctor, what is the model of moral medicine that should inspire us. The medicine had no moral rules for a long time, then it had extremely complicated models during its early times. For a certain period of time doctors didn’t exist, there were sorcerers, mediums, mostly because the disease was a divine damnation, sent for punishment, for envy… There were at least surgeons, yes, because the wound of the arrow was inflicted from a man and then a man could cure it.
And then it came the secular medicine, it actually has arrived pretty soon… there were nomad doctors who travelled around, even Omero mention them, while bringing their knowledge, which was acquired through instinct, through observation of nature. And then it came a rather more serious secular medicine that has been able to establish rules that enabled us to never feel uncomfortable with the progress which the new knowledge required, because medicine has made it clear to the people, right away, to be in the making, to be a difficult discipline, long to learn and constantly changing because knowledge over time continuously improve.

There has been a model of “paternalistic” medicine in which the patient was professing, the professional was the patient, because he professed obedience. The doctor took care of him, but he had to swear obedience, without ever protesting on what the doctor required him to do – asked him to do to let’s say – but actually required him to do. The paternalistic medicine long lasted over the centuries, and it has been replaced by very unpleasant models of medicine, I will mention the two most popular, one of which is very popular in the USA but also widely popular in here. It’s the contractual medicine: two people – one of them knows a lot, the other does not know anything at all – which also makes the contract not really fair, right? So “I will pay you, you give me this…”, this kind is also minimalist, it often leads to Courthouse, from a moral point of view it’s the worst thing there can be.
Bringing the doctor in default to the Court, has led to another model of medicine, very popular in Italy, which is the medicine… we can call it defensive: “There are dangerous things, which could lead me to the Court, I know they are useful, but I forget them so I do not risk to go to the Court”. It is widespread all over, for instance, there are places in Italy where 60% of childbirth are caesarean sections, well that is defensive medicine, and I could make many others examples of this.

There is a medicine with a model more… how can I say… fair and morally acceptable. I think so, there is a very beautiful medicine that is based on the ethics of care. It is based, among other things… let’s start by saying that Care (Cura) is a goddess, I think very few knows that, and Hyginus in his Liber fabularum, tells the story of this goddess that passing a river, she takes some clay and creates a model of man which she loves. Then she calls it Jupiter, Jupiter breathes life in him, the model starts to move, they fight, then Earth arrives and says “Why are you arguing?”, “We want to give to this a name but we both have different names for him”, and Earth says “Well, I am also concerned, the clay you used has been taken from me”. Later intervenes Saturn, the aggressive master of the Gods that says: “But I will do it, we will call him Humus, from Earth”, therefore Man (Uomo). And then I can also determine what will happen to him. The breath of Jupiter was short, soon he will stop moving, and he will return to earth, except his soul, which will return to Jupiter. But you, Care, you will love for him during all his life”. This is the ethics of care. Take care of people, caring for people. We are children of the cure, a generous cure, based on what should be the fundamental quality of man: compassion, and the ability to suffer with others, to understand the suffering of others.

I believe that this model of care is one that leads to heroism, to the person who sacrifices himself for others, that is better to forget.

Then there is a model to which we can all refer and that teachers should teach to those who want to start this profession, which is the model of small virtue ethics. Because we all have in ourselves little virtues. The ability to understand, the desire to listen, the ability to understand what it means to hear “Doctor, I am putting myself in your hands”, the responsibility that comes within. If I understand what is real responsibility I don’t watch television tonight, I study.

Just think that in Europe, the first interruption that the doctor makes at the patient who tells his story takes place after only 25 seconds, it’s ridiculous. There is carelessness, there is lack of interest, there’s pomposity. Instead, small virtues should start by a fundamental principle: to recognize that today the fundamental right of every citizen is to decide for himself. So the meeting that the doctor has with the patient has just this fundamental reason: to pass the necessary knowledge in order to make him able to decide for himself.

This said, I believe that this is a fundamental discipline, but I also think that the teaching of this discipline should not only be a concern of schools in which they teach medicine, it should be more widespread; especially if it’s true that consciousness is formed by contagion, this contagion should come, for instance, from bioethics, and who teaches bioethics should play a key role in the education of children, and make them grow in accordance with rules of fair, acceptable and morally beautiful discipline.


Born in Forlì February 4, 1933.
He was graduated in Medicine at the University of Bologna in July 1959 with top grade; then he was graduated as a specialist in Obstetrics and Gynecology in 1963 also with top grade.
He was lecturer in Obstetrics and Gynecology since 1964. From 1972 to 1980 he was Professor of Gynaecological Endocrinology at the Faculty of Medicine, University of Bologna. He was director of the Department of Reproductive Pathophysiology from 1975 to 1994, and he was director of Obstetrics and Gynaecology of the University of Bologna from November 1994 to December 2001. From 1980 to 2004 he was first professor of Endocrinology Gynecology and then of Gynecology and Obstetrics at the University of Bologna.
It is concerned with the issues related to bioethics, and he has become a member of its National Committee. He was president of the Italian Society of Fertility and Sterility. He is member of UAAR (Union of Rationalist Atheists and Agnostics), he was appointed honorary chairman.
He is honorary president of the Italian Association for Demographic Education (AIED). He is an honorary member of the Consult of Bioethics.
He collaborates with several scientific journals, and he was the author of a thousand scientific papers as well as many books, mostly related to issues concerning women’s health and medical and bioethical aspects related to reproduction and artificial insemination.
As a writer, he is the author of many short stories, detective stories and children’s books. In 2011 he won the Serantini literary prize for his “A quiet country of Romagna”. In his personal website he collects his writings mainly devoted to ethical and biomedical issues.
It is part of the editorial board of several scientific journals.

• 26 January 2015

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