[Healthcare at a crossroads: ethical decisions or collapse].

In 1948, Aneurin Bevan launched the UK's National Health Service (NHS), emphasizing health as a right. Inspired by this, Italy created its NHS in 1978, based on universality and equity. Despite efforts focusing on clinical efficacy and economic efficiency, Italy's NHS faces a crisis: uncontrolled public spending, rising private costs, neglect of prevention, staff shortages, long wait times and regional disparities in care. Inefficiencies include overuse of ineffective treatments, underuse of effective ones, high costs, and conflicts of interest. Aging, chronic diseases, and lifestyle issues also impact healthcare use. Medical and managerial criteria alone can't justify healthcare choices, as they don't address how resources should be distributed across sectors or prioritize patient groups. Donald Berwick advocates for an ethical approach focused on justice, prioritizing care quality, fairness, transparency, and compassion. Daniel Callahan and others call for a cultural revolution in medicine, advocating a "limited" healthcare role, moving away from individualism, and fostering a realistic understanding of health. Without ethical principles, healthcare reform may fail.