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Medical Humanities is an untranslatable and often misconstrued term, born – along with Bioethics – in the United States in the 60s, in the context of what is known as the “contemporary crisis in medicine”. It encompasses the idea of offering cultural and cognitive tools to health practitioners allowing them to establish a better, “more human”, and trusting relationship with the patients and their illness. The effort of “re-humanizing” medical education and practice emphasizes the concepts of human vulnerability, individual autonomy, empathy, and responsibility for the other as part of the basic identity of human beings. This is a need of the last decades that, drawing from a long and rich history, has tried to express the various experiences of illness, suffering, and care through painting, sculpture, and literatureTo give an idea of how complex and fascinating are both the subjects of Medical Humanities and their history, this publication collects some of the lectures presented at the Summer Course organized in September 2014 by the Fondazione Lanza, Center of Advanced Studies in Ethics and Bioethics in Padova since 1989, in collaboration with the Chair of History of Medicine at University of Padova and the Chair of Medical History and Ethics at the University of Marmara of Istanbul. The main purpose of this book is to emphasize the Italian tradition and the value of the cultural heritage of Padua.
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Luciana Caenazzo Lucia Mariani Renzo Pegoraro
First edition: June 2015
First digital edition: July 2016
ISBN 978 88 6787 518 4
“Coop. Libraria Editrice Università di Padova”
via G. Belzoni 118/3, Padova (t. +39 049 8753496), Italy
© 2015 Fondazione Lanza, Padova
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No part of this book may be translated or copied in whole or in part without written permission of the authors, except for brief excerpts in connection with reviews or scholarly analysis.
In copertina: dettaglio dalla pala Sant’Antonio da Padova e il miracolo del cuore dell’avaro del Damini (Accreditamento: fototeca del gruppo di Medicina Umanistica del Dipartimento di Scienze Cardiache, Toraciche e Vascolari dell’Università degli Studi di Padova) (http://medhum.med.nyu.edu/).
A Course on Medical Humanities in Padua
Luciana Caenazzo, Lucia Mariani, Renzo Pegoraro
Introduction to the Medical Humanities
Anne Hudson Jones
Mediterranean Perspectives and Bioethics
Medical History in Italy: the University of Padua Medical School
Fabio Zampieri, Alberto Zanatta
Medical Issues in Italian Frescoes
A narrative shift for Clinical Bioethics. The role of Cinema
Paolo M. Cattorini
A Course on Medical Humanities in Padua
Luciana Caenazzo1, Lucia Mariani2, Renzo Pegoraro3
Medical Humanities is an untranslatable and often misconstrued term, born in the United States in the 60s, along with Bioethics, in the context of what is known as the “contemporary crisis in medicine”. It encompasses the idea of offering, cultural and cognitive tools to health practitioners allowing them to establish a better, “more human”, and trusting relationship with the patients and their illness. The effort of “re-humanizing” medical education and practice emphasizes the concepts of human vulnerability, individual autonomy, empathy, and responsibility for the other as part of the basic identity of human beings.
As described in the New York University School of Medicine website, the term «Medical Humanities» concerns the relationship between humanities (literature, philosophy, ethics, history and religion), social sciences (anthropology, psychology, sociology), arts (literature, painting, sculpture, theater and cinema), and medicine. Humanities and arts provide important information about the human condition, its sufferings, and our responsibility towards each other. Jointly, they offer a historical perspective on medical practice. The focus on literature and arts aims at developing and consolidating skills, such as observation, analysis, empathy, and self-examination which are essential in medical care. Social sciences help us to understand how bioscience and medicine move within different social and cultural contexts and how culture interacts with the individual’s experience of illness and the ways in which medicine is practiced.
At a time when medicine demonstrates an increasing and almost exclusive reliance on scientific and technological progress, it is necessary to restore and promote the important relationship that always existed between medicine and the arts. It is crucial that medical schools teach future physicians how to deal with suffering. A medical curriculum, based uniquely on sciences, doesn’t prepare students to deal with real persons, and persons with real problems.
To face present and future medical issues, it is essential to regain the relationship, lost and neglected over the last centuries, that exists between the human condition and spirituality, between charity and suffering, between life and death. Reading medicine from the perspective of social sciences gives health professionals an advantage to establish that substantial, and not just formal, therapeutic alliance that allows them to really identify, case by case, the most appropriate therapeutic choices.
Scientific and technological progress, social changes, the increasing levels of competence achieved by many patients, and a stronger perception of their role in the process of diagnosis and treatment require a new profile for both the physician and the health professional. What it is needed is a new, or ‘older’, kind of doctor able to root and cultivate his scientific expertise on the dimension of service as traditionally ascribed to his profession.
Why a Course on Medical Humanities?
The Fondazione Lanza – Center of Advanced Studies in Ethics and Bioethics in Padova – in collaboration with some professors of the University of Padova and the Chair of Medical Humanities at the University of Marmara of Istanbul, organized the first English edition of the Summer Course in “Medical Humanities - Italian Perspectives”, held in Padua from Sunday 7 to Friday, September 12, 2014.
The recently concluded course proposed an integrated and interdisciplinary approach to analyze and interpret the human experience of illness, disability, health care, and medical intervention in order to try to take health care practice back to its original purpose: ‘to be amedicine for the person’.
Italian and international experts in painting, sculpture, literature, cinema, forensic science, psychiatry, bioethics, and history of medicine offered their qualified observations, proposing a ‘humanistic’ reflection on illness, medicine, the role of physicians and nurses. All contributions were intended to overcome a reductive conception of treatment practices that explain illness only according to bio-molecular reactions. The humanities have always offered a fundamental contribution to the aspiration of gaining a more complete picture of illness, improving medical care and our assistance to the sick. Instead of finding a clinical explanation, the humanities offer a deeper understanding of the human side of illness, both personal and social, encouraging a greater empathic understanding of self, the other, and the overall therapeutic process.
Why in Padua?
As described by Henry Sigerist, medical historian, Padua is the birthplace of modern medicine. Here, Giovanni Battista De Monte (1489-1551), teaching for the first time at the patient’s bedside, developed clinical medicine; Andreas Vesalius (1514-1564) taught anatomy at the students of the University of Padua; William Harvey developed here his first insights on blood circulation; and Gabriele Falloppio (1523-1562) discovered the uterine tubes. In Padua, Hieronymus Fabrici d’Acquapendente (1533-1619) and Giovanni Battista Morgagni (1682-1771) wrote their masterpieces of pathological anatomy. Workplace Medicine also saw its beginnings in Padua thanks to Bernardino Ramazzini (1633-1714). Most notably, at the same university, Galileo Galilei taught for 18 years, developing his scientific method.
Concurrently, as William Shakespeare wrote in his play The Taming of the Shrew, Padua was also the “nursery of Arts”. From the fourteenth through the sixteenth century, the city expressed an impressive and extraordinary artistic culture thanks to artists such as Giotto, Donatello and Titian, among others.
Finally, Padua, city of St. Anthony, is a place with a long tradition of a strong religious feeling oriented towards charity and where medicine, arts, and religion have always found an extraordinary synthesis. For these reasons, the history of the city is closely tied to the history of its monuments and its hospitals, the first of which, the Saint Francis Hospital, was established in 1414.
In order to clarify the ethical values represented by the arts in the field of medicine, the Fondazione Lanza’s course was structured with morning lectures followed by afternoon visits to important artistic and historical sites of the city (School of Charity, Scrovegni Chapel with Giotto’s frescoes, the Ancient Building of the University, Botanical Garden, Palazzo della Ragione, the Baptistery, Caffè Pedrocchi). To this was added a full day in Venice with lectures on Tintoretto and “The Spirit of Glass” (Murano glasses) and visits (Chiesa della Salute, Scuola Grande di San Rocco, Church of Saint Pantaleon).
To give an idea of how complex and fascinating are both the subjects of Medical Humanities and their history – following the phases of their introduction in Medical schools in the United States and in Europe – this publication collects some of the lectures presented at the Course starting from Anne Hudson’s overview (University of Galveston, USA) on the development of contemporary Medical Humanities during the past four decades in the United States and the remarkable international expansion of interest in Europe, especially in the United Kingdom and Switzerland. In her article, Anna Borovecki (University of Zagreb, Croatia) analyses the path of Bioethics in the countries of the Mediterranean basin, while Fabio Zampieri and Alberto Zanatta (University of Padua, Italy) draw a profile of the history of medicine in Italy through the achievements of some famous scholars who worked at the Medical School of Padua University.
To reopen the dialogue between medicine, ethics, and the humanities, Paolo Cattorini (University of Insubria, Italy) proposes a narrative approach emphasizing the role of cinema as an educational tool to test the general theories and deepen the moral awareness of individuals, particularly health care professionals. Sefik Görkey (University of Marmara, Turkey) offers a tracking shot of beautiful Italian frescoes, religious and secular, analyzed from the medical point of view. Some religious scenes, first of all the “miraculous healings” of Jesus and the Saints, offer us enormous information on different diseases and their symptoms, that can be realistic or totally imaginative. Through the centuries, frescoes portrayed patients’ illnesses, the body language of patients and caregivers, the role of doctors, the quality of health care, and the methods of treatment. Through these illustrations, young medical students, physicians, and health practitioners can initiate a personal reflective itinerary on the theme of pain and suffering. They can learn through the patient’s subjectivity to recognize the fundamental questions of life and death, right or wrong, good or evil, and find empathy as the guiding star of their profession of service.
1 Professor of Legal Medicine, University of Padua.
2PhD. in Humanities, Fondazione Lanza, Padua.
3 Bioethicist, Scientific Director, Fondazione Lanza, Padova.
Introduction to the Medical Humanities
Anne Hudson Jones1
Historical Overview of the Emergence and Development of Contemporary Medical Humanities Programs
The interdisciplinary area of study now known as medical humanities began during the tumultuous decade of the 1960s in the United States, emerging out of concerns about the “dehumanization” of patients as medicine became increasingly more scientific and technological. The early leaders of the movement were hospital chaplains and ministers in medical education. They focused on “rehumanizing” medical education and practice by putting humanities courses into the medical curriculum. In 1965, they established the Committee on Medical Education and Theology (CMET). In the next decade, several other important educational initiatives followed: In 1967, when the new Penn State College of Medicine opened its doors at the Hershey Medical Center in Hershey, Pennsylvania, the Department of Humanities was one of the founding departments. In 1969, the Society for Health and Human Values (SHHV) incorporated out of the CMET. (Twenty-six years later, in 1995, the SHHV merged with two other organizations – the American Association of Bioethics (AAB) and the Society for Bioethics Consultation (SBC) – to form the American Society of Bioethics and Humanities (ASBH), currently the largest and most prominent professional organization of medical humanities in the United States. In 1969, the Hastings Center was established in Hastings-on-Hudson, New York, as “a nonpartisan research institute dedicated to bioethics and the public interest”).
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