La rivisitazione della casistica e il suo ruolo nell'etica clinica.

The object of our research is based on a fundamental question: whether it is possible to offer, in current bioethical debate, a further Foundation of clinical ethics starting from the retrieval, through serious and in-depth study, of the characteristics and the method proposed by the casuistry by Albert R. Jonsen. The interest in the study of casuistry emerged during the drafting of the text “Fino a quando? La sospensione dei trattamenti sanitari” ("Until when? The suspension of medical treatment"), co-written with Mario Picozzi and Vanna Consolandi and published by San Paolo Publishing House in 2012. During the work, it became necessary to structure the text by following a methodology that deals with the presentation of the case through a "many voices" clinical reading, since offering a clinical, ethical and, where appropriate, also a “dialoguing” (i.e. involving the main protagonists of the therapeutic scene, like doctor, patient, family members) analysis. This in order to make it possible all the problems concerning the considered individual case, the assets/moral values at stake, the socio-cultural context of reference, the network of relationships woven by the involved characters and with which the latter should be confronted within the context of clinical practice to emerge. The result of this methodological approach, which cannot leave aside a careful examination of the real clinical-existential situation of the single case, has stimulated research and critical reflection about the basis, i.e. the philosophical-theological-historicalsociocultural roots establishing the theoretical assumptions of casuistic theory development (understood as a model of ethical reasoning methodology for the analysis of moral issues in the context of medical ethics), in order to analyze objectively its peculiar structure and its role, with specific reference to its application in clinical ethics. It was therefore chosen to articulate the research work by examining in depth the theoretical path of the main Author and proponent of casuistry, Albert R. Jonsen, retracing, through his works, the key moments of the origin and development of casuistic model he proposed as a method of analysis of cases applicable in clinical medical ethics. To trace the lines of this analysis, we preferred to propose an interpretation of the reconstruction of the structure of casuistic model that does not simply draw a chronological and historical frame; on the contrary, a search for "topics" was preferred, focusing on factors that led Jonsen, in his own studies and work, to rediscover the need to define and "codify" the structure and how to use that approach to ethical reasoning, as he himself gives evidence through his main publications: The Birth of Bioethics, The Abuse of Casuistry, A History of Moral Reasoning and Clinical Ethics. The analysis of his books – that starting from the survey of historical-cultural-philosophical context led Jonsen to the discovery of the casuistic method - leads us to examine the role of case studies within the traditional ethics and its direct application to the resolution of cases of clinical ethics. Then we focused on the analysis of the main criticisms and reworkings of Jonsen casuistry by latter international authors; in our view, the question is whether it is sufficient that casuistry, as model of ethical and clinical reasoning, has simply the value of method, as it seems considering Jonsen, whose use is therefore always possible, beyond and regardless of the adopted content reference system. Therefore, the following question is if it makes sense and it is possible a neutral method for ethical analysis applied to such a delicate dimension as the clinical one, or if by choosing this method however involves the endorsement of a certain theoretical background. Consequently, we try to propose an alternative to this essential critical element identified in the perspective of Jonsen, though maintaining and supporting the value of certain methodological issues identified by Jonsen himself as positive, such as attention to the concreteness and the completeness in the analysis of clinical and ethical real situation, which outlines the features of a theoretical reference system based on anthropology and ultimately on metaphysics personalist Catholic reference. The appropriately revisited and supported casuistic method, therefore, can be defined synthetic because it appears effective to legitimate the fragile and flexible link between the contributions given by individual disciplines and practical case, offering the chance to build a "proportionate reading" of the assets at stake within the situation determined by the concrete case, allowing a proper evaluation aimed to outline a high profile healthcare, which is not only desirable, but possible.