Course Description
Emergency medicine faces complex clinical situations on a daily basis, often at the boundary between life-saving intervention and therapeutic obstinacy. In this context, the principle of proportionality of care represents an essential ethical and clinical guide for ensuring treatments that are appropriate, respectful of patient dignity, and consistent with their conditions and wishes.
This course was created to train future specialists in the practical application of this principle, with particular reference to critical care settings, where therapeutic decisions must be timely, well-considered and shared.
Proportionality of care means that every medical intervention must be evaluated based on the balance between expected benefits and risks, discomfort or suffering caused. It is not ethically acceptable to continue treatments that do not improve quality of life or offer no possibility of recovery. Discontinuing disproportionate therapies does not equate to stopping care, but rather transitioning to a palliative pathway, focused on relieving suffering and accompanying the patient.
The course also explores the ethical and legal aspects that govern such choices, such as Italian Law 219/2017 on informed consent and advance directives (DAT), and the Code of Medical Ethics. Particular attention is devoted to effective communication with patients and family members, considered as part of the care process, and to clinical documentation, which must clearly reflect the decision-making process.
Another pillar of the training programme is the multidisciplinary approach, involving physicians, nurses, psychologists, bioethicists and, where necessary, religious consultants. Shared evaluation helps avoid isolated decisions and ensures person-centred care. The course provides tools for identifying patients for whom to evaluate proportionality of care (e.g. patients with end-stage organ failure, poor prognosis, irreversible brain conditions) and for applying decision-making strategies such as the time-limited, skill-limited and event-limited approach.
In summary, this course aims to provide trainees with the theoretical and practical tools to competently and sensitively face end-of-life clinical decisions, promoting a model of care that is scientifically grounded, ethically sustainable and humanely respectful.
Program
Module 1 - September 16, 2026
- 16:00 - 17:00 Proportionality in patient dignity - Benedetta Saponaro
- 17:00 - 18:00 Ethics of care and advance directives: primum non nocere - Alessandro Dell'Erba
Module 2 - September 22, 2026
- 16:00 - 17:00 Frailty and palliative care in critical settings - Filomena Puntillo
- 17:00 - 18:00 The frail patient and palliative care challenges in the Emergency Department - Rosa Melodia
Module 3 - September 28, 2026
- 15:00 - 16:00 Proportionality across different patients: who, when and why - Marco V. Ranieri
- 16:00 - 17:00 How and which strategies to use - Sebastiano Cicco
Participation
Participation is free. To register, use the Zoom registration link.