# accanimento terapeutico



## infinite sadness

How do you say "accanimento terapeutico".
Therapeutical fury?


----------



## Siberia

Therapeutic persistence


----------



## Trionfale

I think you might find "extraordinary lifesaving measures" used more commonly in the medical/philosophical literature on the issue.  The point is to indicate in the translation the "extraordinary" nature of the interventions.


----------



## ElaineG

Trionfale said:


> I think you might find "extraordinary lifesaving measures" used more commonly in the medical/philosophical literature on the issue. The point is to indicate in the translation the "extraordinary" nature of the interventions.


 
Actually, I'm not crazy about "lifesaving measures" because that gives a different spin than the Italian does -- the point during the Welby case was that _accanimento terapeutico_ was used by opponents of what was happening to him to describe what they saw as invasive and basically hostile (_accanimento_) therapies. 

I found this definition in the Italian Wiki article:





> Dunque, accanimento terapeutico vuole significare _perserveranza rabbiosa e crudele_ nel trattamento di una malattia che non guarisce e che sta conducendo a morte.


 
(Emphasis added). Obviously, this is a polemical definition -- but the term seems to me to be intentionally polemical in Italian, and I haven't come up with an English phrase that captures that.

Lifesaving measures has something of positive "sfumatura" in English.

I'm glad this question was posted though, because I've thought about it posting it before as I haven't come up with a suitable way of expressing it in English.

I'm going to keep thinking about it, but I'd love to hear other ideas.

P.S.  On Proz, I found "therapeutic obstinancy" which captures the mood a bit, but probably isn't that used in English, as well as "heroic measures", which again sounds too positive to me.


----------



## Siberia

ElaineG said:


> Actually, I'm not crazy about "lifesaving measures" because that gives a different spin than the Italian does -- the point during the Welby case was that _accanimento terapeutico_ was used by opponents of what was happening to him to describe what they saw as invasive and basically hostile (_accanimento_) therapies.
> 
> I found this definition in the Italian Wiki article:
> 
> (Emphasis added). Obviously, this is a polemical definition -- but the term seems to me to be intentionally polemical in Italian, and I haven't come up with an English phrase that captures that.
> 
> Lifesaving measures has something of positive "sfumatura" in English.
> 
> I'm glad this question was posted though, because I've thought about it posting it before as I haven't come up with a suitable way of expressing it in English.
> 
> I'm going to keep thinking about it, but I'd love to hear other ideas.
> 
> P.S. On Proz, I found "therapeutic obstinancy" which captures the mood a bit, but probably isn't that used in English, as well as "heroic measures", which again sounds too positive to me.


 
I agree.  In Italian it definitely has a negative aura that "lifesaving measures" does not have.


----------



## TimLA

One that jumps to mind is "therapeutic futility" which implies treatment that will have little or no benefit.
Here's a list a few of a few the general concepts (including those mentioned here) from "nice" to "obnoxious".

Palliative
Heroic measures
Lifesaving measures
Extrordinary lifesaving measures
Therapeutic persistence (rare, and sounds a bit funny)
Therapeutic obstinancy (rare, sounds a bit funny)
Therapeutic futility
Disproportionate therapy
Overtreatment
Blantant overtreatment
Inappropriate overtreatment

If I were forced to translate the phrase, I'd probably choose one of the last five in the list.

N.B. - I had an off-line discussion with another member regarding "accanimento terapeutico" and the "testamento biologico" debate now occuring in Italy. It's interesting to hear the various perspectives in a different language and culture.


----------



## _forumuser_

Or you could replace the noun phrase with something like:

to stubbornly insist on curing


----------



## Nicholas the Italian

TimLA said:


> ...
> Inappropriate overtreatment *<==*


As a minimum, IMHO.
"Unnecessary overtreatment" would render the meaning better, I think.
"Useless overtreatment" even better.
(No idea about how they do sound for a native.)


----------



## Victoria32

Nicholas the Italian said:


> As a minimum, IMHO.
> "Unnecessary overtreatment" would render the meaning better, I think.
> "Useless overtreatment" even better.
> (No idea about how they do sound for a native.)


It is overtreatment as a word, that doesn't quite sit right with me.. it seems a peculiar coinage... 

Given that you accept overtreatment (and I am trying to think of one word that encapsulates that meaning, give me a minute), unnecessary is fine as a modifier, and so is useless, although I think unnecessary is better, unless you are certain that such treatment _will_ prove useless in a particular case...

No, I have given it some thought, and I can't think of any one word that would go - but I have thought of a phrase that can convey the meaning wanted here - 'over-zealous treatment... 
Vicky


----------



## MünchnerFax

As I read you are rather focusing on the "useless" direction, let me explain the Italian phrase a little bit more.

The patient suffers an advanced deathly disease and may die in a very short time if he weren't treated. Therefore, that treatment is in fact (from a medical point of view) useful, because it prolongs the life of the patient.
The point in the Italian phrase is the following: is it worth or even moral to keep a patient alive for years using machines or medicines (in Italian, _accanirsi su di lui_, -> _accanimento terapeutico_), provided that most of his functions are compromised and he can't have a "normal" life? For instance, several of these patients are in coma at a terminal state, and are only kept alive by machines. _Accanimento terapeutico_ is to keep them in that state rather than let them die.

Do the English expressions you all have mentioned convey this?


----------



## Victoria32

MünchnerFax said:


> As I read you are rather focusing on the "useless" direction, let me explain the Italian phrase a little bit more.
> 
> The patient suffers an advanced deathly disease and may die in a very short time if he weren't treated. Therefore, that treatment is in fact (from a medical point of view) useful, because it prolongs the life of the patient.
> The point in the Italian phrase is the following: is it worth or even moral to keep a patient alive for years using machines or medicines (in Italian, _accanirsi su di lui_, -> _accanimento terapeutico_), provided that most of his functions are compromised and he can't have a "normal" life? For instance, several of these patients are in coma at a terminal state, and are only kept alive by machines. _Accanimento terapeutico_ is to keep them in that state rather than let them die.
> 
> Do the English expressions you all have mentioned convey this?


A term that comes to my mind is: "heroic measures", which does convey the idea of (ultimate) futility... There is as far as I know, no moral obligation to treat someone if the treatment isn't ultimately life-saving...but that isn't the topic of the thread...

Vicky


----------



## Siberia

Victoria32 said:


> A term that comes to my mind is: "heroic measures", which does convey the idea of (ultimate) futility... There is as far as I know, no moral obligation to treat someone if the treatment isn't ultimately life-saving...but that isn't the topic of the thread...
> 
> Vicky


 

Yes, Vicky.  But it sounds too positive for the Italian expression.  There is nothing "heroic" about "accanimento".
Sib


----------



## TimLA

MünchnerFax said:


> As I read you are rather focusing on the "useless" direction, let me explain the Italian phrase a little bit more.
> 
> The patient suffers an advanced deathly disease and may die in a very short time if he weren't treated. Therefore, that treatment is in fact (from a medical point of view) useful, because it prolongs the life of the patient.
> The point in the Italian phrase is the following: is it worth or even moral to keep a patient alive for years using machines or medicines (in Italian, _accanirsi su di lui_, -> _accanimento terapeutico_), provided that most of his functions are compromised and he can't have a "normal" life? For instance, several of these patients are in coma at a terminal state, and are only kept alive by machines. _Accanimento terapeutico_ is to keep them in that state rather than let them die.
> 
> Do the English expressions you all have mentioned convey this?


 
The English expressions I wrote convey a sense, from "acceptable" to "useless" therapies. But now I'm confused. From some of the prior comments the implication was that "accanimento terpeutico" should be interpreted as very negative. Perhaps to clarify, let me give a series of examples, and then ask you which ones meet the criteria.

1. A 20 year old professional soccer player has gangrene of the leg and they recommend an amputation. He has the amputation, and spends the rest of his life depressed because he cannot play soccer.

2. A 30 year old has heart failure and ultimately receives a heart transplant. She is kept on a ventilator for one month after the heart transplant, kept in the hospital for one year, and after another one year, returns to a near-normal lifestyle.

3. A 50 year old woman has breast cancer, has a lumpectomy, but because of positive nodes, undergoes chemotherapy and radiation therapy, and loses her hair. She must wear a wig for the rest of her life and must be on pills every day which make her very tired.

4. A 60 year old woman has metastatic breast cancer, and a decision is made to do a bone-marrow transplant in an attempt to help her. There are no data to support the use of a bone marrow transplant in this case.

5. A 40 year old has a fast heart rhythm, faints and develops brain damage. The patient is kept in the hospital for a month and recovers completely.

6. A 40 year old has a fast heart rhythm, faints and develops brain damage. The damage is permanent, and the only thing the patient can do is move their eyes. They are on a ventilator for years.

7. A 60 year old has a chronic nerve disease where he can barely move, other than his right hand. He cannot talk. He is on a portable ventilator and has to be attended by someone 24/7, but "gets around" in an electric wheelchair.

8. An 80 year old has heart failure and does not qualify for a heart transplant. She is taking many medications, some of which make her very tired. Because she is so tired, she stays at home all the time.

9. An 80 year old has a heart attack and is not doing well in the hospital. The patient refuses to sign a living will and wants everything done. The patient stops breathing, and is put on a ventilator for a month. Eventually he recovers and goes home feeling reasonably well.

From the Italian perspective, which of these is _*accanimento terapeutico*_?


----------



## gabrigabri

TimLA said:


> The English expressions I wrote convey a sense, from "acceptable" to "useless" therapies. But now I'm confused. From some of the prior comments the implication was that "accanimento terpeutico" should be interpreted as very negative. Perhaps to clarify, let me give a series of examples, and then ask you which ones meet the criteria.
> 
> 1. A 20 year old professional soccer player has gangrene of the leg and they recommend an amputation. He has the amputation, and spends the rest of his life depressed because he cannot play soccer.
> 
> 2. A 30 year old has heart failure and ultimately receives a heart transplant. She is kept on a ventilator for one month after the heart transplant, kept in the hospital for one year, and after another one year, returns to a near-normal lifestyle.
> 
> 3. A 50 year old woman has breast cancer, has a lumpectomy, but because of positive nodes, undergoes chemotherapy and radiation therapy, and loses her hair. She must wear a wig for the rest of her life and must be on pills every day which make her very tired.
> 
> 4. A 60 year old woman has metastatic breast cancer, and a decision is made to do a bone-marrow transplant in an attempt to help her. There are no data to support the use of a bone marrow transplant in this case.
> 
> 5. A 40 year old has a fast heart rhythm, faints and develops brain damage. The patient is kept in the hospital for a month and recovers completely.
> 
> 6. A 40 year old has a fast heart rhythm, faints and develops brain damage. The damage is permanent, and the only thing the patient can do is move their eyes. They are on a ventilator for years.
> 
> 7. A 60 year old has a chronic nerve disease where he can barely move, other than his right hand. He cannot talk. He is on a portable ventilator and has to be attended by someone 24/7, but "gets around" in an electric wheelchair.
> 
> 8. An 80 year old has heart failure and does not qualify for a heart transplant. She is taking many medications, some of which make her very tired. Because she is so tired, she stays at home all the time.
> 
> 9. An 80 year old has a heart attack and is not doing well in the hospital. The patient refuses to sign a living will and wants everything done. The patient stops breathing, and is put on a ventilator for a month. Eventually he recovers and goes home feeling reasonably well.
> 
> From the Italian perspective, which of these is _*accanimento terapeutico*_?


 
I don't think it depends on the age; I think it is when someone has no chances to heal but despite that doctors still try to do something. 
This word makes me think about a patient who is treated like a "toy": he gets all kind of medicines just to test if some of them works. It is playing against the nature, trying to do something impossible, making the rest of the patient's life worse than it already is.

With an example (it's not so easy!): A person (30 years old???) has an accident. He goes in coma and remains in coma for 20 years. During these years he has heart and lung problems: he becomes a new heart and artificial help to breathe. Doctors try everything to heal him, but he won't have a normal life ever again.


----------



## Nicholas the Italian

TimLA said:


> From some of the prior comments the implication was that "accanimento terpeutico" should be interpreted as very negative.


"Accanimento terapeutico" is a no-no. It is plainly forbidden by Italian law (or at least medical ethics). It gives the idea that "I don't give a thing about the patient, my only aim is to make him/her live longer, doesn't matter how longer, doesn't matter how well".



> From the Italian perspective, which of these is _*accanimento terapeutico*_?


None. Let me make another example (in Italian, sorry).

Un uomo ha una malattia cerebrale degenerativa (oppure, semplicemente, ha 120 anni e sta morendo di vecchiaia). È incurabile. Quando arriva allo stadio terminale viene ricoverato in ospedale. Quando non riesce più a nutrirsi da solo viene attaccato a una flebo. Quando non riesce più a respirare autonomamente viene attaccato a un respiratore. Quando il suo cuore inizia a non funzionare più viene defibrillato, ancora, e ancora, e ancora, e ancora, fino a quando l'EEG non diventa piatto. A quel punto viene dichiarato morto e staccato dalle macchine.
Risultati ottenuti:
- allungare la vita del paziente di N ore/giorni/settimane;
- procurargli una sofferenza atroce e assolutamente inutile.
*Questo* è accanimento terapeutico nella sua accezione *standard*.

Ora, si sta cercando di far passare per "accanimento terapeutico" anche il caso Welby; ma lì il paziente era vivo, vegeto, cosciente, comunicante. L'unica cosa è che non era consenziente, ossia voleva l'interruzione delle cure; ma ciò non toglie che si trattasse di eutanasia.
L'accanimento terapeutico è illegale: bisogna sospendere le cure.
L'eutanasia (purtroppo) è illegale: finché il paziente è in grado di vivere in modo semi-autonomo *deve* essere supportato, anche se contro la sua volontà, e anche se è comunque destinato alla morte entro breve.

Edit: 





> but he won't have a normal life ever again


I want to be more precise: not "he won't have a *normal* life", "he won't have *a* life", a human life at least, a life that he's aware of. He might have the life of a vegetable, at best. Period, full stop, new line.


----------



## MünchnerFax

Before answering, let me clarify the idea of _accanimento terapeutico_ is strongly biased by personal opinions and feelings. What I personally believe is an useless overtreatment may be perceived as life-saving necessity by someone else. If things were plain and simple, we wouldn't debate so rudely in Italy about this.

Thus, I think any situation may be defined as _accanimento terapeutico_ only from a subjective, personal point of view. The recent Welby case actually pivoted around this: a person whose clinical situation was very similar to Tim's case no. 6 had been kept alive by a ventilator for years. He himself perceived it as _accanimento terapeutico_ and repeatedly asked to turn the ventilator off.

In general, _accanimento terapeutico_ indicates:
1) a permanent disease such that the patient can't recover, but only be kept in his actual clinical condition by means of medicines or machineries. His condition will become worse and worse with ageing, and eventually a "natural" death occurs (I've put "natural" in quotes because the patient would have died naturally several years before, if he hadn't been treated all this time);
2) the treated person and/or his relatives feel this forced life prolongment is useless; they are no longer capable, or are no longer willing to carry on the abnormal life they have to because of the disease. The consequence of this is stating the treatment as _accanimento terapeutico_ and demanding its discontinuation.


----------



## Nicholas the Italian

From both gabrigabri and MunchnerFax examples, I fell something is missing. If we want to stick to the standard meaning of "accanimento terapeutico":
- if you are in coma for N years, and during this period suffer of several failures, for which you undergo different treatments, but there is actually some (reasonable) chance for you to recuperate, this is *not* accanimento terapeutico;
- if you have some kind of illness which will lead you to death, as long as you are conscious and living some kind of life, whatever treatment you undergo, even when useless, is *not* accanimento terapeutico.
If you are in irreversible coma, and kept to (biological) life by machines, that's accanimento terapeutico.
If you're going to die, you're in your very last days of life, you've lost consciousness, nonetheless doctors keeps treating you in order to give you another few hours or days of (biological) life, that's accanimento terapeutico.

In any other case medical treatment is in order; its contrary is euthanasia.
Now, someone wants to extend the concept of "accanimento terapeutico" to avoid the word "euthanasia", which is an ugly word in a catholic country. (I read somewhere that now the majority of people is pro-euthanasia. But that's OT.)
But I want to point out, Muncher, that "accanimento terapeutico" is not under debate: it is a medical, clinical, pragmatical, ethical, moral no-no situation. The limits of "accanimento terapeutico", they are now under discussion.

[PS: any correction to the English text would be welcome, that was pretty tough.]


----------



## gabrigabri

Nicholas the Italian said:


> From both gabrigabri and MunchnerFax examples I fell something is missing. If we want to stick to the standard meaning of "accanimento terapeutico":
> - if you are in coma for N years, and during this period suffers of several failures, for which you undergo different treatments, but there is actually some (reasonable) chance for you to recuperate, this is *not* accanimento terapeutico;
> - if you have some kind of illness which will lead you to death, as long as you are conscious and living some kind of life, whatever treatment you undergo, even if useless, is *not* accanimento terapeutico.
> If you are in irreversible coma, and kept to (biological) life by machines, that's accanimento terapeutico.
> If you're going to die, you're in your very last days of life, you've lost consciousness, nonetheless doctors keeps treating you in order to give you another few hours or days of (biological) life, that's accanimento terapeutico.
> 
> In any other case medical treatment is in order. Its contrary is euthanasia. Now, someone wants to extend the concept of "accanimento terapeutico" to avoid the word "euthanasia", which is an ugly word in a catholic country. (I read somewhere that now the majority of people is pro-euthanasia. But that's OT.)
> But I want to point out that, Muncher, "accanimento terapeutico" is not under debate: it is a medical, clinical, pragmatical, ethical, moral no-no situation. The limits of "accanimento terapeutico", they are now under discussion.



Sì, mi sono espresso un po' male. Questo mio ipotetico uomo va in coma, ma non si risveglierà più! E nel corso del tempo le sue condizioni peggiorano, diventa quindi un "vegetale".
Ovviamente ogni considerazione è personale, visto che è un termine relativamente nuovo; inoltre proprio su un argomento come questo ci sono pareri troppo discordanti!


----------



## TimLA

Perfetto! Perfetto! Perfetto!
Che bella discussione, e credo che capisca meglio.
Quindi voterei per "Therapeutic futility".
Secondo me, l'unico caso di accanimento terapeutico nella mia lista sarebbe il numero sei.

Un punto minore: numero sette è Stephen Hawking. 

Grazie mille a tutti quanti!


----------



## Nicholas the Italian

TimLA said:


> Perfetto! Perfetto! Perfetto!
> Che bella discussione, e credo *di capire* meglio.


"Bella" non è l'aggettivo che userei...  magari interessante, istruttiva...



> Secondo me, l'unico caso di accanimento terapeutico nella mia lista sarebbe il numero sei.





> 6. A 40 year old has a fast heart rhythm, faints and develops brain damage. The damage is permanent, and the only thing the patient can do is move their eyes. They are on a ventilator for years. [= forever?]


Se muove gli occhi, vuol dire che è in qualche modo cosciente (o potrebbe esserlo)? In questo caso non è accanimento terapeutico. Se si tratta solo di spasmi involontari, e per il resto è come una pianta, allora lo è.



Nicholas the Italian said:


> If you are in irreversible coma, and kept to (biological) life by machines, that's accanimento terapeutico.


Ripensandoci, posso correggermi?
Prima, durante e dopo il "caso Welby" si è parlato del "caso Eliana(?)", una ragazza in coma irreversibile da qualcosa come 19 anni.
Anche in quel caso i genitori e parenti parlano di accanimento terapeutico, ma tecnicamente non credo lo sia. Infatti la ragazza è semplicemente *assistita* dalle macchine, ma non subisce interventi attivi particolari.
Se ora il suo cuore si fermasse, e i medici intervenissero per rianimarla, allora, forse, sarebbe accanimento.

Lasciar morire una persona senza intervenire, perché totalmente inutile, è sospensione legittima delle cure (contrario dell'accanimento terapeutico).
Lasciar morire una persona cessando le cure (es. staccandola dalle macchine) è, al momento attuale, considerato eutanasia (passiva).
*Far* morire una persona (es. somministrandole una tonnellata di morfina) che è a uno stato terminale ma ancora in vita, è eutanasia attiva.
Far morire una persona che è depressa, ma a parte questo non in pericolo di vita, è omicidio del consenziente (forma particolare di omicidio volontario, punita con 6-15 anni).

L'eutanasia passiva è al limite del non-accanimento terapeutico (ossia si può considerare legittimo, oppure omissione di soccorso - che, nel caso del personale medico, diventa omicidio colposo), l'eutanasia attiva è al limite dell'omicidio del consenziente. I confini, quelli sono il problema.


----------



## TimLA

Nicholas the Italian said:


> From both gabrigabri and MunchnerFax's examples, I feel something is missing, if we want to stick to the standard meaning of "accanimento terapeutico":
> - if you are in coma for N years, and during this period suffer from several complications, for which you undergo different treatments but there is actually some (reasonable) chance for you to recuperate, this is *not* accanimento terapeutico;
> - if you have some kind of illness which will lead to your death, as long as you are conscious and living some kind of life, whatever treatment you undergo, even when useless, is *not* accanimento terapeutico.
> If you are in irreversible coma, and kept alive by machines, that's accanimento terapeutico.
> If you're going to die, you're in your very last days of life, you've lost consciousness, nonetheless doctors keeps treating you in order to give you another few hours or days of life, that's accanimento terapeutico.
> 
> In any other case medical treatment is in order; its contrary is euthanasia.
> Now, someone wants to extend the concept of "accanimento terapeutico" to avoid the word "euthanasia", which is an ugly word in a catholic country. (I read somewhere that now the majority of people is pro-euthanasia. But that's OT.)
> But I want to point out, Muncher, that "accanimento terapeutico" is not under debate: it is a medical, clinical, pragmatical, ethical, and moral no-no. The limits of "accanimento terapeutico" are now under discussion.


 
Bravo!
Hai chiesto, quindi...niente importante...


----------



## Nicholas the Italian

TimLA said:


> Bravo!
> Hai chiesto, quindi...niente di importante...


Grazie!


----------



## ElaineG

TimLA said:


> Perfetto! Perfetto! Perfetto!
> Che bella discussione, e credo che capisca meglio.
> Quindi voterei per "Therapeutic futility".
> Secondo me, l'unico caso di accanimento terapeutico nella mia lista sarebbe il numero sei.
> 
> Grazie mille a tutti quanti!


 
Non penso che "futility" abbia tutte le qualità negative di "accanimento".  

Forse, "futilely aggressive treatment"?


----------



## TimLA

ElaineG said:


> Non penso che "futility" abbia tutte le qualità negative di "accanimento".
> 
> Forse, "futilely aggressive treatment"?


 
At this level of translation, I think anything very negative is reasonable.
From an AE medical perspective, therapeutic futility is...drumroll please...useless.


----------



## Nicholas the Italian

TimLA said:


> From an AE medical perspective, therapeutic futility is...drumroll please...useless.


Yes but "accanimento terapeutico" is not only useless, it is plainly cruel.
Otherwise we'd rather call it "spreco di denaro pubblico" 



> Forse, "futilely aggressive treatment"?


Non so, "trattamento inutilmente aggressivo" non mi sembra neanche lontanamente simile ad "accanimento".
Voto per "unneeded death-procrastinating treatment", anche se non ho idea di come suoni in inglese!


----------



## ElaineG

Well maybe then, "futile and cruel treatment."


----------



## Nicholas the Italian

ElaineG said:


> Well maybe then, "futile and cruel treatment."


*This* expresses the idea.
It is just not politically correct.
Oh well...


----------



## _forumuser_

How about:

(futilely) obstinate treatment.


----------



## Trionfale

I've found all of the options - since I first suggested "extraordinary lifesaving treatment" - very interesting as they all underscore the complicated cultural nuances involved.  This is one of the more challenging aspects of translation, no?  Many of the translations suggested end up 'glossing' or 'interpreting' the moral/ethical/philosophical difficulty in rendering 'accanimento' in English in the given context (medical rather than social - bullying, mobbing, mugging, or whatever.)  The many posts relating to the entire end-of-life issue in Italy are right on the mark, however this places a serious question before us, as translators.  How much should we interpret or judge the cultural meanings implied in linguistic choices?  
So, what about using the term most commonly used in English in these context as I proposed and providing a translator's footnote which explains the cultural nuances.  I often find this the only viable option.


----------



## hsWhite

sono passati qualche mese ma comunque voglio aggiungere una linea. Sto lavorando su una traduzione di un articolo che parla del caso welby. Leggendo gli articoli del New York Times ho trovato che loro usano la frase 'unwanted medical treatment' per accanimento terapeutico. Trovo che sia 'soft' ma lascia un accenno della connotazione negativa che si trova nell'italiano.
L'ho trovato nel articolo del 22 dicembre 2006 New York Times Online.


Ho trovato un'altra fonte da considerare. L'art. 14 del codice deontologico medico legge '' il medico deve astenersi dall' *ostinazione in trattamenti*, da cui non si possa fondatamente attendere un beneficio per la salute del paziente...''

Questa frase sostiene il punto di vista che si potrebbe tradurre *''obstinancy in treatment'' or ''obstinant treatment''*


----------



## Shumeyosalt

The word you're looking for has got to be "overtreatment". The following are extracts from the   _Wolters-Kluwer Health OvidSP_ bibliographic database which is widely acknowledged as nothing less than of the best online medical database currently available and has been the paradigm as far as electronic bibliographic research for academics goes since its release back in mid 90's: 

"_A new culture of negotiated medical constraint needs both doctor and patient as partners ready to learn how to walk the narrow ridge between *overtreatment* and just individual choice._"

_"[...] Conversations with nursing and medical providers caring for the frail elderly within an intensive care unit often reveal feelings of concern for *overtreatment* of patients when hope for improvement has diminished.[...]"
_


> _For the whole article, follow link.
> Tutto l'articolo leggibile qui.
> _


So, yeah, it seems a more than likely translation, however someone else might've stumbled upon a different adaptation of the meaning in which case I'd be grateful if he could provide some sort of feedback.


----------



## hasso_wr.qaz

*C*iao sapete se esiste un'espressione ideomatica per dire "accanimento terapeutico"?
*G*razie in anticipo


----------



## prf55

Any objections to 'the forcible and prolongued administration of medical treatment' as a solution for 'accanimento terapeutico'? I found an old forum thread but wasn't totally convinced by the solutions proposed. In my offering, the adjectives could be changed perhaps. 'Forcible' could be removed and another adjective added before 'medical treatment' - though I don't like the sound of 'futile'!


I arrived by putting the name 'Piergiorgio Welby' into Google and specifying only pages from the UK. This led to a BBC online news article where I found the following piece of text:

".......The case hinges on whether Mr Welby is being forcibly administered life-sustaining medical treatment - which is against Italy's constitution. ...."


----------



## AlabamaBoy

Maybe "involuntary, aggressive and sustained life saving medical measures"


Meriam Webster: *involuntary* *1* *:* done contrary to or without choice, as in involuntarily committed or [URL="http://www.google.com/search?q=involuntary+life+saving&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-USfficial&client=firefox-a"]involuntarily treated
[/URL]


----------



## prf55

What about 'life-sustaining' rather than 'life saving'? And 'involuntary' would really be wrong (it's a synonym for 'unintentional'!!).


----------



## King Crimson

prf55 said:


> Any objections to 'the forcible and prolongued administration of medical treatment' as a solution for 'accanimento terapeutico'? I found an old forum thread but wasn't totally convinced by the solutions proposed. In my offering, the adjectives could be changed perhaps. 'Forcible' could be removed and another adjective added before 'medical treatment' - though I don't like the sound of 'futile'!
> 
> 
> I arrived by putting the name 'Piergiorgio Welby' into Google and specifying only pages from the UK. This led to a BBC online news article where I found the following piece of text:
> 
> ".......The case hinges on whether Mr Welby is being forcibly administered life-sustaining medical treatment - which is against Italy's constitution. ...."


 
What about using using "forced" rather than "forcible"; could this better convey the idea of an unwanted (from the patient) treatment, or does "forcible" work better in the context?

"Overtreatment", though correct from a medical viewpoint, in my opinion has a more neutral nuance and doesn't render the meaning that "accanimento terapeutico" has in Italian.


----------



## WordsWordWords

Hello everyone, 

I would like to add (better late than never!) this: http://it.wikipedia.org/wiki/Accanimento_terapeutico, where, by clicking on the left for the English version, you have the term "futile medical care" which I did not find in this thread but since I needed an English medical equivalent (this is, after all, a medical term!) I dug elsewhere on the internet a bit more and that's what I found, regardless of where one sits with the ideological implications/results/opinions.... I needed this term in English to use in the translation of the following phrase:

"la promozione di strategie che mirino a evitare l’accanimento terapeutico" 

This is the fourth item in a list of measures in a set of hospital guidelines, so I really needed to find something medically appropriate, the true equivalent in English. What I have (for now!) is:

Implementing strategies which aim to avoid futile medical care. 

I wouldn't mind the input of others of you who might have found anything significantly different though at this point I think this is the correct term...


----------



## london calling

Hello Words.  In the UK it's known as _futile care or futile treatment_.


----------



## WordsWordWords

Hi London -- thanks for the input! I think "futile care" works the best   Even within the link I indicated they shortened it to this from the longer "futile _medical_ care" (which actually sounds kind of redundant the more I think about it) Thanks again!


----------



## candel

aggressive/invasive intervention...therapy


----------



## angelrocks

HI everybody,

very, very late, but it may be useful to someone else. The term used in medical literature is therapeutic obstinacy

*Therapeutic obstinacy*. Is the initiation or continuation of medical actions that have no other aim but to prolong the patient's life when the patient is facing irreversible death. To insist on prolonging merely biological human life at all costs is a serious assault on a person's dignity (from What is Therapeutic obstinacy - Meaning and definition - Pallipedia).

As for *overtreatment* it's not at all the same thing. Overtreatment is just a treatment that is too much for the specific case. I'll give you an example: a woman has breast cancer. The standard treatment is lumpectomy but the surgeon performs a mastectomy (for whatever reason) That's overtreatment, but it's not useless, obstinate, cruel (and all the other proposed definer) treatment.


----------



## Paulfromitaly

angelrocks said:


> very, very late, but it may be useful to someone else. *The term used in medical literature is therapeutic obstinacy*


Not true.
The most used term seems to be "Futile care" (at least in BrE), as native speakers have already pointed out. It doesn't seem to be the only one, but it's mentioned also in dicitionaries.
futile care
Cambridge suggests *aggressive treatment*


TimLA said:


> Therapeutic obstinancy (rare, sounds a bit funny)





ElaineG said:


> P.S. On Proz, I found "therapeutic obstinancy" which captures the mood a bit, but probably isn't that used in English


----------



## angelrocks

I've been reading some literature on the subject lately and both terms (therapeutic obstinacy  and futile care) are used. To me, but this is just an impression based on the articles I've been reading, it looks like therapeutic obstinacy is used in a very negative sense. I mean, when the writer is condemning the practice, which may or may not be true in Italian.


----------



## Mary Beth

Hopelessly late, but did someone take a look at the WR dictionary under "accanimento"? There is  dysthanasia, which is the term for futile or useless treatment which does not benefit a terminal patient.  Maybe too scientific, but according to the context it could work.


----------



## london calling

In un contesto scientifico per gli addetti, si. Noialtri dovremmo ricorrere ad un dizionario...


----------



## Benzene

_Ho trovato il termine "relentless therapy". Può funzionare come traduzione di "accanimento terapeutico"?

Grazie.

Bye,
*Benzene*_


----------



## mcrasnich

Paulfromitaly said:


> Not true.
> The most used term seems to be "Futile care" (at least in BrE), as native speakers have already pointed out. It doesn't seem to be the only one, but it's mentioned also in dicitionaries.
> futile care
> Cambridge suggests *aggressive treatment*


Non so se questo è il forum giusto, ma sarebbe possibile aggiornare in questo senso la voce del dizionario It-Eng accanimento - Dizionario italiano-inglese WordReference 
Anch'io sono d'accordo che la traduzione più vicina sia Futile Care o Futile Treatment. Futile (Medical) Care è il titolo della pagina wiki inglese corrispondente ad Accanimento Terapeutico, come ricordato sopra; ricercando insieme le due frasi "futile care" e "right to die" si hanno 45.700 hits, cercando "futile treatment" e "right to die" addirittura 123.000, e leggendo il contenuto degli articoli mi sembra ci si riferisca proprio all'argomento di cui si parla. 
PS Aggressive treatment è in realtà generico, se usato da solo e non nel contesto end-of-life.


----------



## london calling

Benzene said:


> _Ho trovato il termine "relentless therapy". Può funzionare come traduzione di "accanimento terapeutico"?
> 
> Grazie.
> 
> Bye,
> *Benzene*_


Ci fornisci il link, Benzene? Non l'ho mai sentito (ma non vuol dire nulla) e vorrei leggerlo 'in context' . 😊


----------



## Benzene

london calling said:


> Ci fornisci il link, Benzene? Non l'ho mai sentito (ma non vuol dire nulla) e vorrei leggerlo 'in context' . 😊


_Ecco qui: Ethics of Hospitality
Bye,
*Benzene*_


----------



## london calling

Benzene said:


> _Ecco qui: Ethics of Hospitality
> Bye,
> *Benzene*_


The author, Daniel Innerarity, is Spanish. That may explain it.


----------



## Mary49

london calling said:


> The author, Daniel Innerarity, is Spanish. That may explain it.


But the book (written in Spanish, not in English) was translated by Stephen Williams (English) and Serge Champeau (French philosopher).


----------

