Sostenibilità e rischio sistemico

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risk management, sostenibilit

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Sostenibilit e rischio sistemicoCaveant consules ne quid res publica detrimenti caperet

Pier Paolo Dal Monte, MD Bologna, Italy

Board member Associazione Italiana di Bioetica ChirurgicaBoard member Eurasian Colorectal Technologies AssociationMember Bioethic Commission, Italian Colorectal Surgery SocietyAssociazione Medicina Fondata sulla Persona

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Considerate la vostra semenza: fatti non foste a viver come bruti,

ma per seguir virtute e canoscenzaDante, Inferno, XXVII, 118-120

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Come conosciamo(cosa conosciamo, cosa crediamo di conoscere, cosa non

conosciamo)

EpistemologiaDal Greco Epi- Histomai: stare sopra

I principi che guidano la nostra conoscenza

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Dallindoeuropeo -Dha: ci che stbilito and Sva-: s

Sanscrito: Svadha: ci che stabilito per se stessi, la via personale, fato, destino

La disciplina che concerne il retto comportamento

Dal greco Ethos: uso, costume, comportamento

Etica

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Etica medicaLo scopo principale della pratica medica, nella storia, stato sempre definito in termini di benefici per i pazienti

Epistemologia medicaLa conoscenza pi appropriata (metodi) per perseguire

il beneficio per il singono paziente

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Sostenibilit significa che un sistema dovrebbe soddisfare i bisogni del presente senza compromettere la possibilit

di soddisfare i bisogni del futuro

Sostenibilit

Brundtland, G.H. (ed.), (1987). Our Common Future: The World Commission on Environment and Development

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Sostenibilit

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Sistemi complessi

OlarchiaLa stabilit degli oloni di alto livello basata sulla stabilit

degli oloni di livello inferiore. A propria volta gli oloni di livello inferiore dipendono per la propria stabilit

strutturale dagli oloni di livello superiore

Un sistema adattativo complesso (olarchia) composto da diversi sotto-sistemi (oloni) che sono definiti dalle

modalit di con le quali interagiamo con il con il sistema (visione del mondo)

Rosen, R., (1977), Complexity as a system property, Int. J. Gen. Syst., 3, 227232

The Crash of Reductionism against the Complexity of Reality 5

context in which the scientist is operating. The possibility of multiple nonequivalent perceptions of thesame situation is one of the typical characteristics of complexity, and it is further elaborated in thefollowing section.

1.1.2 Looking at Nonequivalent Useful Pictures of a Person, Which One Is Right?

Before moving to the second example, this section discusses in more detail the impossibility of obtainingthe right picture of a given situation when dealing with complex systems organized in a nestedhierarchy. In this section I want to make the point that it is literally impossible to get the right pictureof a given complex system. Even when talking of real pictures (those printed on a paper or shown ona monitor), the complexity of the reality entails the unavoidable existence of multiple identities that, tobe represented, require the parallel use of nonequivalent pictures.

Imagine that we are requested to pick up a visiting scientist at the airport. We are given the name Dr. X but we do not know her or his face. The most obvious additional input needed to perform ourtask is a picture of Dr. X. Now imagine that we ask for a picture and what we get in the mail is thepicture given in Figure 1.2a with a note saying: Please find enclosed the picture of Dr. X that yourequested. Such a picture is completely useless for our task, even though we cannot say that such apicture does not contain relevant information about Dr. X. This picture makes it possible to study howDr. X digests nutrients to keep him or her alive. Therefore, this picture (which has been taken from anexperimental nutrition lab in my institute) reflects a very important option available to us for looking athuman beings. It should be considered a crucial piece of information to study human sustainability.

Getting back to our story, we ask for another picture of Dr. X, this time a picture taken at a largerscale. In response to our request we get another picture, that shown in Figure 1.2c, with a note saying:Fulfilling your request, please find enclosed a larger-scale picture of Dr. X, who is the one indicatedby the arrow. Also in this case, even if we cannot use this picture at the airport, this picture tells us

FIGURE 1.2 Nonequivalent views of the same person. (Photos by Andrea Ghiselli.)

a. b.

c. d.

The Crash of Reductionism against the Complexity of Reality 5

context in which the scientist is operating. The possibility of multiple nonequivalent perceptions of thesame situation is one of the typical characteristics of complexity, and it is further elaborated in thefollowing section.

1.1.2 Looking at Nonequivalent Useful Pictures of a Person, Which One Is Right?

Before moving to the second example, this section discusses in more detail the impossibility of obtainingthe right picture of a given situation when dealing with complex systems organized in a nestedhierarchy. In this section I want to make the point that it is literally impossible to get the right pictureof a given complex system. Even when talking of real pictures (those printed on a paper or shown ona monitor), the complexity of the reality entails the unavoidable existence of multiple identities that, tobe represented, require the parallel use of nonequivalent pictures.

Imagine that we are requested to pick up a visiting scientist at the airport. We are given the name Dr. X but we do not know her or his face. The most obvious additional input needed to perform ourtask is a picture of Dr. X. Now imagine that we ask for a picture and what we get in the mail is thepicture given in Figure 1.2a with a note saying: Please find enclosed the picture of Dr. X that yourequested. Such a picture is completely useless for our task, even though we cannot say that such apicture does not contain relevant information about Dr. X. This picture makes it possible to study howDr. X digests nutrients to keep him or her alive. Therefore, this picture (which has been taken from anexperimental nutrition lab in my institute) reflects a very important option available to us for looking athuman beings. It should be considered a crucial piece of information to study human sustainability.

Getting back to our story, we ask for another picture of Dr. X, this time a picture taken at a largerscale. In response to our request we get another picture, that shown in Figure 1.2c, with a note saying:Fulfilling your request, please find enclosed a larger-scale picture of Dr. X, who is the one indicatedby the arrow. Also in this case, even if we cannot use this picture at the airport, this picture tells us

FIGURE 1.2 Nonequivalent views of the same person. (Photos by Andrea Ghiselli.)

a. b.

c. d.

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Sistemi complessi

Contesto semantico: BiofisicoSociale

Economico

Contesto olarchico:Mondo

Area geopoliticaNazioneDistretti

Realt localiOspedaleRepartoIndividuo

Contesto spazio-temporale

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Cause di morte di un individuo

Orizzonte temporale Causa Contesto Azione

Brevissimo Arresto cardiaco terminale RianimazioneCome

Procedure rianimatorie

Breve Neoplasia polmonare OspedaleCome > perchCure (chirurgia,

oncologia)

lungo Forte fumatore Tecnico-PoliticoPerch > come

Prevenzione, politiche sanitarie

Molto lungo Tutti gli uomini devono morire

Filosofico Epistemologico

Economico

PerchDiscussione teorica sul concetto di sostenibilit

Contesto spazio-temporale: i domini descrittivi non-equivalenti

Tabella adattata da: M. Giampietro, Multi-scale integrated analysis of agro-ecosystem, CRC Press 2004

ComeCome

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I modelli descrittivi hanno valore temporaneo Anche quando validati in occasioni precedenti non sono necessariamente appropriati per predire futuri scenari.

Dobbiamo essere pronti ad aggiornare continuamente le identit che noi attribuiamo al sistema

Nessuna una singola descrizione pu esseresoddisfacente, neutrale e obiettiva per definire le propriet

significative di un sistema adattativo complesso

Le traiettorie evolutive di un sistema adattativo complesso hanno una scala spazio-temporale pi ampia di quella dei singoli osservatori

S. Salthe, Development and evolution: complexity and change in biology, MIT Press, Cambridge, MA 1993

Modelli predittivi nei sistemi complessi

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Il concetto di rischio utile quando si affrontano problemi 1) Facilmente classificabili

2) Facilmente misurabili

Incertezza: Situazione nella quale non possiile formulare una predizione

attendibile su eventi futuri (probabilistica)

Rischio, incertezza e ignoranza

Rischio:Situazione in cui possibile assegnare una distribuzione di

probabilit ad un assieme di possibili eventi futuri

Le informazioni derivanti dalla precedente esperienza possono essere solo parzialmente utili

Knight, F.H., (1964), Risk, Uncertainty and Profit, A.M. Kelley, New York.Rosen, R. (1985), Anticipatory Systems: Philosophical, Mathematical and Methodological Foundations,, New York

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1) Indeterminatezza

I problemi sono classificabili ma non interamen