What is medical ethics. Deontology and medical ethics History and traditions of medical ethics

Ethics, medical ethics, biomedical ethics: definition of the concept, history of the issue

The term "ethics" was proposed by the Greek encyclopedic philosopher Aristotle (from the Greek ethos - habit, morality, custom) and it means the doctrine of moral, moral norms and rules of behavior that determine the relationship between people in the family, society, everyday life and labor activity... Medical ethics is a set of requirements (principles, rules and norms) for the professional activity (behavior) of a doctor (medical worker) and for his moral qualities. The basics medical ethics formed in ancient times. They were most clearly expressed in the writings of Hippocrates (IV century BC). Even then, the circle of eternal problems of medical ethics was determined: the relationship between the doctor and society, the doctor and the patient, the doctor and the patient's relatives, the doctors themselves, medical secrecy, euthanasia (“I will not give anyone the lethal means I ask for”), medical errors, etc. .d.

Deontology, medical deontology. Historical stages in the development of medical ethics

Deontology is a section of general ethics, which examines the specific criteria of duty, moral requirements in the performance of professional duties. The concept of deontology became widespread after the publication in 1789 of the book by the English philosopher I. Bentham "Deontology as a science of morality." This work stated: "The foundation of deontology is the principle of benefit ... which means that a certain act is good or bad, worthy or unworthy, deserving or not deserving of approval, depending on its tendency to increase or decrease the amount of public benefit." Medical deontology examines and substantiates the principles of behavior of doctors in their practical and scientific activities... In essence, the concept of medical deontology is close (for most authors is identical) to the concept of medical ethics. This, in particular, is noted in a large medical encyclopedia: "What is now the subject of medical deontology, at the end of the 19th century was called medical ethics."

Thus, it can be stated: classical (Hippocratic) medical ethics (deontology) defines the system of traditional moral and ethical requirements for both the professional activity of a doctor (medical worker) and his moral qualities. hippocrates ethics medical deontology

The term “bioethics” was introduced by the American biologist W.R. Potter, who published in 1969 the book “Bioethics - a bridge to the future”. In it, he designated bioethics as a combination of biological knowledge and human values, understanding it as “the science of survival and improving living conditions”, as a discipline “determining the degree of responsibility of those who make decisions about choosing a treatment method and applying scientific knowledge in practice” ... This definition has not been settled, and the range of its meaning is interpreted very broadly. From our point of view, we can take as a basis the definition proposed by the Strasbourg Symposium on Bioethics (1990), according to which bioethics, being a complex field of knowledge, studies moral, legal and social problems that arise with the development of medicine and biology. In many foreign publications, along with the term “bioethics”, it is widely used, in essence, its synonym “biomedical”, “biomedical ethics”.

The formation of bioethics as a new field of knowledge (a new scientific discipline) was primarily due to the unprecedented progress of medicine associated with the scientific and technological revolution that began in the 60s. The widespread introduction into practice of the latest, on the verge of fantasy, technologies has brought to life a complex of moral, ethical and legal problems, the solution of which within the framework of traditional medical ethics turned out to be very difficult, and sometimes impossible, and these problems concerned all periods of a person's life - from conception to death. It is well known, for example, what acute moral conflicts arise in connection with in vitro reproduction, surrogate motherhood, and determination of the sex of the unborn child. No less dramatic is the situation when one has to answer the question: shouldn't the treatment of a patient who has been in a stable vegetative (unconscious) state for several months (or even years) be stopped? It should also be noted the severity of ethical problems arising with the development of transplantation (the problem of donation, death, commercial use of organs and tissues).

The leading reason for the development of bioethics was also the movement for democratic rights, mass distribution and approval in the public consciousness of the population western countries liberal-democratic ideas about individual rights and freedoms, about the primacy of human rights, in the context of which they could not but receive a new understanding and the patient's rights as their integral and most important part. In the ethics of Hippocrates, liberal interpretations of the patient's rights simply did not exist. At the same time, provisions that were traditionally considered the prerogative of doctors began to be attributed to the rights of the patient. As a result of these tendencies, the traditional paternalistic scheme of relations between the doctor and the patient is being replaced by a model based on the recognition of the principles of self-determination, patient autonomy, on the model of an informational and deliberative nature. For example, from the duties of the physician to inform the patient about the proposed method of medical intervention, the patient's right to information and choice (up to refusal) of the method of treatment arose.

In addition to these two fundamental reasons, mention should be made of such factors contributing to the formation and development of bioethics, such as:

- the need for control (ethical, legal, public) over research activities in many areas of medicine, because this activity affects the fundamental values \u200b\u200bof society and man;
- the growing role of biomedical law (a number of problems can no longer be settled by traditional ethical norms, this requires legal control);
- the need for ethical and legal regulation of experimental research on animals and humans, the scope of which is growing exponentially, and, accordingly, the solution of the most important problem - minimizing risk, suffering and pain for subjects, protecting their interests;
- medicalization as a two-pronged process: the phenomenon of an extraordinary rise in the value of health and the hugely increased role of medical science and practice in modern society;
- growing attention to the problem of implementing the principle of social justice in the health care system (especially in the context of insurance medicine, commercialization of medical services) and social assistance (issues of allocation of increasingly limited resources);
- the growing importance of moral pluralism in resolving those bioethical situations when people involved are forced to take responsibility for setting the limits of their own existence, deliberately transcending the boundaries of their own religious, ethnic, political, racial and sexual identity
- the globalization of bioethical problems, the presence and solution of which affects the interests of all mankind (it is no coincidence that the collective search for moral solutions in the field of medicine leads World organization health care - WHO, and more recently the World Medical Association - WMA).

Analysis of literary sources, which to one degree or another touch upon the relationship (relationship) between traditional medical ethics and bioethics, allows, in our opinion, to reflect the essence of the problem in the following three provisions.

First. Most authors discussing the problem of the genesis of bioethics do not doubt that it goes back centuries, to the Hippocratic oath that traditional medical ethics is the natural historical predecessor of bioethics.

Second. There is - many foreign authors insist on this - a broader interpretation of bioethics. It includes a number of axiological problems related to the health care system and the relationship between humans and animals and plants. In other words, there are a number of fundamental differences between the two subjects under discussion, which we have tried to summarize in the table.

Third. Many authors specifically focus on the close, essential connection between the ethics of Hippocrates and bioethics. A number of scientists (here, first of all, it is necessary to point out the publications of A.Ya. Ivanyushkin) substantiate the point of view that “according to the origin and content of their problems, bioethics remains a part of professional medical ethics” (emphasized by us - authors) and that “bioethics can be defined as such a level of subject medical ethics, which reflects the new moral problems of medicine and applied biology of the era of the scientific and technological revolution ”. In essence, if we proceed from the point of view presented above, then we can postulate the following (we will not hide, close to us, the authors) position. The first part is a classic traditional ethics, which is based on the commandments (dogmas), the letter and the spirit of the Hippocratic oath, and its content is actually exhausted by “two problems: the behavior of medical personnel and the internal corporate responsibilities of doctors in relation to each other.” The second part - bioethics (biomedical) in its essence (as we have already mentioned) is saturated with social content, goes beyond medicine, and in the applied sense it tries to solve purely specific problems of a moral and legal nature that arise in modern clinical practice, due to the use of the latest technologies, affecting the holy of holies - the beginning and end of life.

Based on the above, it seems to us that modern medical ethics, its main content and purpose on the present stage development of society (patient rights) and medicine (latest technologies) could be designated by the term "medical bioethics". However, this proposal is not original. It seems to be in the air. So, the head of the department of philosophy of the Krasnoyarsk Medical Academy L.A. Shevyrnogova aptly noted: "Our colleagues from medicine quite consciously and seriously reduce bioethics to medical bioethics." We are far from such a straightforward substitution of one concept for another. But taking into account the fact that bioethics is engaged in the philosophical understanding of a number of fundamental medical problems (a), has undoubted applied significance for clinical medicine (b), it solves, albeit from other fundamentally new positions, the central problem of medical professional ethics (deontology) of any era - the problem of the relationship between a doctor and a patient (c), we believe that the separation from it (in it) of a special medical unit under the name of “medical bioethics” looks quite correct (analogies with genetics and medical genetics, demography and medical demography, etc. are appropriate here .).

Thus, by medical bioethics we mean an object that arose at the junction of traditional medical ethics and bioethics, and we define it as the professional ethics of a doctor (physician) at the present stage of development of society and medicine.

It is quite obvious that the content of medical bioethics as a teaching subject should rest on three pillars: on the foundations of philosophical, traditional medical, and biomedical ethics. The complexity of the question is different. How to avoid eclecticism, mechanical mixing of the three named disciplines? How to be able to prove (show, convince) that, on the one hand, he replaced the ethics of Hippocrates, without losing (preserving) at the same time its eternal values, and on the other hand, he embodied (absorbed) the achievements of liberal philosophical thought, the idea of \u200b\u200bhuman rights?

The content of the subject of medical bioethics could be conditioned by the following goal: analysis of ethical dilemmas caused by modern development medicine, biology and society and the development of the ability and skills to make vital decisions based on a humanistic worldview. In order to achieve this goal, from our point of view, it is necessary to solve the following tasks:

The subject should be divided into general (propaedeutic) and special (private, clinical) parts.

In general, teaching should begin with a philosophical foundation - ethics. This is necessary for a number of reasons:

1) ethics makes it possible to comprehend the meaning of moral values \u200b\u200b(good, duty, justice, etc.) as the main pivot of universal human values \u200b\u200b(life, health, etc.);
2) the philosophical foundations of morality make it possible to understand the genesis, evolution and patterns of development of professional ethics in the context of dynamics and changes in society from the point of view of value priorities;
3) and, finally, without getting acquainted with ethical theories, their embodiment both in the past and in the present, it will be difficult to form a “bioethical worldview”.

In the general section of teaching medical bioethics, it is proposed to study the following issues: 1) bioethics as social institution, social movement and worldview; 2) medical bioethics as a field of knowledge; 3) the philosophical foundations of medical bioethics: a) bioethics - the ethics of life, or a moral attitude towards living things; b) humanism, utilitarianism, deontologism as theoretical foundations of medical bioethics; c) the principle of moral autonomy of the individual; d) justice as a moral ideal; 4) ethical dilemmas of value dominants: a) health and illness in the system of value dominants modern man; b) life and death as the basis of human existence and problems of self-identification, the meaning of life; 5) moral pluralism in a multicultural society and problems of bioethical consent.

As a connecting link between the first and second parts of the subject, a topic is proposed in which the ethical norms of classical medical ethics will be considered from a historical and epistemological point of view, where a special place will be taken by the contribution of representatives of domestic medicine to the formation of the humanistic orientation of medical deontology.

3. The special (clinical) part, in our opinion, should include an analysis of the following problems: modern models of the relationship between a doctor and a patient in the light of bioethical realities; experiments on humans; abortion, contraception, sterilization; new reproductive technologies; transplantation of systems and organs; genetics, genetic screening and genetic engineering; suicide and refusal of patients from treatment for vital indications; euthanasia (active and passive) and its alternatives; psychiatry and the rights of the mentally ill; AIDS and ethical aspects social adaptation; analyzing equity concepts and defining health policies. The clinical part also involves the study of medical and ethical standards, mastering the documentation of the WHO, the Military Medical Academy, as well as Russian legislation.

To develop a certain ability and skills in applying decisions of a medico-ethical nature, the basis of practical knowledge should be clinical and ethical analyzes (analysis of incidents).

The Russian philosopher PD Tishchenko, reflecting on the phenomenon of bioethics, emphasized: “If our society has a future, it cannot do without bioethics. This provision is intended to convince the reader that the development of modern Russian society in line with democracy will not become real without both bioethical movement and thinking and education. It fully applies to Russian medicine - health care in general and medical education in particular. The latter can be designated as nonsense if the study of bioethical problems and issues does not occupy (will not occupy) a worthy place in its system. In our opinion, this problem can be successfully solved by teaching medical bioethics and organizing the corresponding departments (courses).

Medical bioethics as a science and subject of teaching at a medical university will combine into a single harmonious whole the achievements of the world, including the famous Russian early 20th century, philosophical, ethical thought (a), the tradition of classical (Hippocrates) and national medical ethics (b), the study of modern, social, legal and ethical consequences of using the latest biomedical technologies (c). This will fill in the system of medical education, on the one hand, part of the existing vacuum of humanitarian (ideological) content, and on the other, full-fledged teaching of the professional ethics of a doctor will begin to be carried out, which meets the realities of today's development of society and medicine.

Department of Public Health and Health Care

N.P. PETROVA

HISTORY OF MEDICAL ETHICS.

MEDICAL EMBLEMATICS

Teaching aid on the history of medicine for 1st year medical students of the medical and diagnostic faculty, specializing in "Medical and diagnostic business"

Reviewer:

Candidate of Medical Sciences, Associate Professor of the Department of Social and Humanitarian Sciences of the Educational Institution "Gomel State Medical University"

M.E. Abramenko

Petrova N.P.

P Medical ethics. Medical emblems: Textbook on the history of medicine for 1st year medical students of the medical diagnostic faculty, specializing in "Medical diagnostic business" / NP Petrova - Gomel: Educational institution "Gomel State Medical University". 2010 .-- p.

It is intended for holding seminars at the Department of Public Health and Healthcare in order to gain knowledge, skills and abilities in the history of medicine on the topic: “History of medicine ethics. Medical emblem ". Corresponds to the curriculum and standard curriculum for the discipline "History of Medicine", approved by the Ministry of Health of the Republic of Belarus.

"Gomel State

medical University ", 2010

INTRODUCTION

"Treat every day, help every hour, comfort every minute."

Medical proverb

Professional medical practice testifies to the fact that the doctor daily solves not only clinical problems, but also faces moral problems in choosing one or another action. To avoid mistakes, the doctor must be able to make the right decision, which requires special moral and ethical knowledge.

Ethics as a science helps us understand our actions and deeds. Just as logic helps to avoid false judgments, so ethics helps to understand the principles by which a particular action is judged as right or wrong.

Knowledge and ability to follow the ethical principles and rules developed by the medical community determines one of the foundations of a doctor's professionalism - his moral culture. There is no doctor who does not recognize the value for the healing process of the moral relationship with the patient. The moral culture of the doctor directly depends the most important factor successful treatment, namely: the patient's trust in the doctor, who always faces the question of how to achieve this trust. Medical ethics reveals that the main condition for its occurrence is the doctor's willingness and ability to subordinate his interests to the interests of the patient. This skill serves, in turn, the main thing - the task of alleviating the suffering of the patient.

HISTORY OF MEDICAL ETHICS

At all times, doctors were treated with respect. After all, people of this profession come to the rescue at the most critical moments of a person's life, from birth to the hour of death.

Since ancient times, the physician has been considered a highly moral person. For example, the inscription on the Temple of Asclepius in the Acropolis reads: "... he, like God, should be the same savior of slaves, poor people, rich people and heirs to the throne and be a brother to everyone, this is what kind of help he should provide." In turn, the patients were also treated in a special way. A striking example of this is the activity of the knightly order of the Hospitallers of St. John in Jerusalem, founded at the end of the 11th century. At the official initiation into this brotherhood, each member of the order took the ancient vow: "The Hospital brothers should serve our masters, the sick, with zeal and devotion, as if they were slaves to their masters."

Doctors have to make decisions about people's lives, health, dignity and rights. Medical care cannot be complete if the most highly professional doctor does not have ethical qualities. Therefore, ethics are the principles of morality and the rules of conduct based on them, i.e. deontology - occupies a special place in medicine.

Ethics -the doctrine of moral norms and rules that determine the relationship of people in the family, society, everyday life and work. The word "ethics" comes from the Greek ethos - custom, disposition. The term "ethics" was proposed by Aristotle (384-322 BC).

Medical ethics - a set of norms of behavior and morality of medical workers.

In professional medical ethics, the principle of humanism should be considered the starting point.

Humanism- This is a view that considers a person as the highest value, protecting his freedom and all-round development. Despite the fact that the term "humanism" itself appears only in the Renaissance, the idea of \u200b\u200bhumanity (philanthropy as a virtue, as a certain moral value) was formed already in the middle of the first millennium BC. e., found in the Bible, in Homer, in ancient Indian, ancient Chinese, ancient Greek philosophical sources of the 6th-4th centuries. BC e. During this historical period, doctors Ancient Greece gave an ethical obligation - the "Oath" of Hippocrates (460-377 BC). The idea of \u200b\u200bhumanity is already embedded in the famous “golden rule of morality”: act towards others as you would like them to act towards you.

In Hippocrates, the idea of \u200b\u200bhumanism has specific expressions: "Whatever house I enter, I will enter there for the benefit of the patient ... I will direct the regime of the sick to their benefit ... refraining from causing any harm and injustice ...". Among the brightest manifestations of the humanism of Hippocrates' ethics are the commandments about medical secrecy and the unconditional value of any human life.

Medical humanism in its original meaning affirms human life as the highest value, defines its protection and assistance as the main social function of medicine, which must fulfill this task, guided by scientific knowledge and professional skill.

The organization in 1981 of the movement "Doctors of the World for the Prevention of Nuclear War" was a confirmation of this truth. In the movement of doctors of the planet against the threat of nuclear war on the broadest historical scale, the moral principle of the commandment of medicine about the value of human life, a commandment that is the true beginning of professional medical ethics was manifested.

Medical ethics requires respect for the suffering of a person, even when it comes to a captured enemy, as reflected in the International Convention of the Red Cross on the treatment of prisoners of war (1929).

It is known from the history of medicine that as early as the 3rd century BC. in the composition of the Indian folk epic "Ayurveda" ("Book of Life"), the questions of the doctor's attitude to the patient and the relationship between doctors were reflected. About the personality of a doctor, it is said here that he should be modest in life and in behavior, not to display his knowledge and not emphasize that others know less than you.

Medical ethics requires concreteness in the relationship between all members of the team, regardless of ranks and titles. The respectful treatment of colleagues, as well as the white color of the medical gown, emphasizes the purity and high meaning of the profession. This principle must be adhered to especially strictly if communication takes place in the presence of the patient. The doctor, in the eyes of the patient, should not question the professionalism of a colleague. The situation with a colleague should be discussed in person and in private.

Doctors should respectfully treat nursing and nursing staff. Modern nurse - a highly qualified worker who knows and knows a lot. She is the first assistant to the doctor, without whom the treatment process is impossible. A respectful relationship with nurses, especially a young professional, allows you to learn a lot and avoid a lot of mistakes.

1. Equality and fairness.

2. Good and good.

3. Professional duty.

4. Responsibility.

5. Honor, dignity, conscience.

Equality and fairness.

Medical ethics requires seeing in the patient, first of all, the patient, establishing a certain equality of all people in the face of illness and death. The moral sense of people is especially sensitive to the inequality in the distribution of "medical services" in society.

None of the doctors have the right to forget that in a hospital and in a polyclinic (dispensary) they always deal with a mass of patients, a significant part of the work with each of whom (treatment of each) is carried out in front of others. Each physician takes the first ethical examination in front of his patients on the subject of "equality". Reception of one of the patients bypassing the queue (without medical indications) is a multiple moral evil: a manifestation of disrespect for many people at the same time, disregard for the condition of patients, cynical, causing demonstration of immoral behavior by doctors.

At the same time, medical ethics cannot ignore issues related to "patient ethics". The patient's position will be ethical when he will treat with understanding any case of just unequal attention that the doctor pays to some patients due to the natural differences in the course of their diseases.

Blago and good.

In medical practice, first of all, attention should be paid to such manifestations of good as life and health. Improvement of the patient's condition, accidental coincidence of the circumstances contributing to the success of treatment, ignorance of a significant part of patients about the prognosis of their disease - all this is good. Good (like evil) is the most general moral concept. Even when a person's actions are not crowned, due to some external circumstances, with practical success, the moral choice made correctly by him alone allows us to say about this person that he did not change himself as a person, since he strove to do good.

The benefit of the patient is the priority goal of the doctor's professional activity. In medical practice, the patient in a certain sense personifies the category of "good", and the doctor (physician) - the category of "good".

In the patient's view, an exemplary doctor is a person of duty, for whom helping the patient is not only job dutybut a truly moral act. A true doctor will always overcome selfish or selfish temptations that can make it difficult for him to fulfill his medical duty. This is evidenced by the immortal lines of the "Hippocratic Oath": "Whatever house I enter, I will enter there for the benefit of the patient, being far from everything intentional, unrighteous and destructive ...".

Fidelity to professional duty requires both wisdom and a kind of moral fortitude, moral hardening. In this case, speaking of wisdom, we mean the degree of development, maturity of the doctor's mind, his awareness of the collective moral and ethical experience of colleagues, and most importantly, the ability to draw reasonable conclusions not only from his own successes, but also from mistakes. Moral steadfastness should be understood as the acquisition by a doctor of a kind of moral and ethical experience in overcoming various kinds of temptations.

Category "responsibility". Responsibility is a specific measure of duty. It is generally accepted that the responsibility of physicians in their case is enormous. Individuals sometimes have a hypertrophied idea of \u200b\u200bthe responsibility of medical professionals.

Responsibility is undoubtedly the most important moral quality of a physician, it is consciousness, a sense of responsibility that feeds his professionalism as a whole, it is the “growth hormone” of his very personality. The moral energy of the medical professional's professional responsibility is then concentrated in a multitude of specific deontological imperatives, for example, the following: under no circumstances should a promise made to the patient be broken; antipathy, irritation, resentment, haste, impatience, forgetfulness are prohibited to the doctor in relation to the sick.

The concept of professional responsibility in medicine also has a legal meaning.

Concept "Honor" reflects the assessment of the individual by society, as well as the attitude of the individual to this assessment. Do not drop yourself in the eyes of other people, especially your social group, professional environment - the internal legislation of each person. A white coat and a hat, as it were, symbolize the integrity of the honor of medical workers. A medical student should have a sense of professional honor already in the first year. In the professional sense of honor of medical workers, as in a single alloy, there is pride in medical humanism, and the consciousness of the enormous social significance of medical work, and belief in the power of a scientific medical title.

Those who receive the right to heal must work with the responsibility required by the laws and traditions of medicine. Inconsistency with the proper professional level is unacceptable from the point of view of professional honor.

Like any person, self-respect is precious to a doctor. Consciousness professional dignity it is not developed in a medical student immediately, it is the fruit of inner spiritual work, moral self-education.

The professional merit of a doctor collectively characterizes his moral qualities. Independence, independence, freedom of moral decisions are the components of a person's personal dignity. Consciousness and a sense of personal dignity exclude cowardice, flattering, self-deprecation and self-doubt.

The relationship of doctors with patients requires special tact, adherence to a kind of etiquette. The example of older colleagues is of great educational value. The goal of upbringing (and self-education) is to develop consciousness and self-esteem, which ultimately determine the rules of professional etiquette of doctors and nurses.

If dignity is the desire of a person not to enter into discord with himself, then conscience - this is the desire of the individual not to enter into discord with the truth of life

The ethical category of conscience is called upon to play an essential role in solving all the controversial problems generated by medical practice. It is a matter of the doctor's conscience to constantly self-assess his attitude to medicine - to its past and future, to its historical fate.

Historical principles and models of medical ethics.

Medical ethics is very dynamic, therefore, it is necessary to constantly pay close attention to its most diverse aspects. In order to understand what moral, ethical and value-legal principles lie at the basis of modern biomedical ethics, one should at least briefly describe their development in different historical eras.

1. Model of Hippocrates and the principle “do no harm”.

The moral principles of healing were laid down by the "father of medicine" Hippocrates (460-377 BC). They lie at the origins of medical ethics as such. In his famous "Oath", Hippocrates formulated the duties of the doctor to the patient and his fellow craftsmen. One of the most important principles is “do no harm”. The "Oath" says: "I will direct the regime of the sick to their advantage in accordance with my strength and my understanding, refraining from causing any harm and injustice." The principle of “do no harm” focuses on the civic credo of the medical class. The Hippocratic model contains an initial professional guarantee, which is considered as a condition and basis for the recognition of the medical class not only by society as a whole, but also by every person who trusts a doctor, no less than his life.

The norms and principles of a doctor's behavior, defined by Hippocrates, are not just a reflection of specific relationships in a specific historical era. They are filled with content determined by the goals and objectives of healing, regardless of the place and time of their implementation. Due to this, slightly changing, they are observed today, acquiring in one or another ethical document.

An example of a document created on the basis of the “Hippocratic model” is the “Oath of a doctor of the Republic of Belarus”.

Paracelsus' model and principle ("do good") - a model of medical ethics that took shape in the Middle Ages. Its principles were most clearly stated by Paracelsus (1493-1541). In contrast to the Hippocratic model, when the doctor wins the patient's social trust, in the Paracelsian model, paternalism acquires the main importance - the emotional and spiritual contact of the doctor with the patient, on the basis of which the entire treatment process is built.

"The greatest basis of medicine is love."
Paracelsus taught his students: "The strength of a doctor is in his heart ..."; “The most important basis of medicine is love” ;, “the doctor must think about his patient day and night”; "The doctor does not dare to be a hypocrite, tormentor, liar, frivolous, but must be a just person."

3. The deontological model and the principle of "respect of duty".

Compliance of a physician's behavior with certain ethical standards is an essential part of medical ethics. This is its deontological level, or “deontological model”.

The term "deontology" (from the Greek deontos - due) was introduced into Soviet medical science in the 40s of the XX century by Professor N.N. Petrov. He used this term to refer to a real-life area of \u200b\u200bmedical practice - medical ethics.

The deontological model of medical ethics is a set of “proper” rules that correspond to a particular area of \u200b\u200bmedical practice. Surgical deontology is an example of such a model. N.N. Petrov in his work "Questions of surgical deontology" following rules:

“Surgery is for the sick, not the sick for surgery”;

“Do and advise the patient to do only such an operation to which you would agree in the present situation for yourself or for the person closest to you”;

“For peace of mind of patients, visits to the surgeon are necessary on the eve of the operation and several times on the very day of the operation, both before and after”;

“The ideal of major surgery is to work with a truly complete elimination of not only all physical pain, but also all mental excitement of the patient”;

“Informing the patient”, which should include mention of the risk, the possibility of infection, collateral damage.

From the point of view of N.N. Petrov's “informing” should include not so much “adequate information” as the suggestion “that the risk is insignificant in comparison with the probable benefit of the operation”.

The principle of “respect of duty” is central to the deontological model. To “comply with duty” means to fulfill certain requirements. An inappropriate act is one that contradicts the requirements of the medical community, society and his own will and reason. If a person is able to act on the unconditional demand of "duty", then such a person corresponds to his chosen profession, if not, then he must leave this professional community.

4. Bioethics and the principle of “respect for human rights and dignity”.

The rapid development of science and technology in the 20th century has led to the fact that science and, in particular, biology and medicine received colossal opportunities to interfere with the existence of biological objects and humans. This allowed, along with hopes, to express fears associated with the limits of permissible manipulation of biological processes, especially those related to humans.

A combination of factors contributed to the birth of bioethics. First, Nazi medical experiments on concentration camp prisoners heightened concerns about people's vulnerability to medical research. Second, with the rapid progress of medicine, including reproductive health, organ transplantation and genetics, questions have arisen about the purpose and limits of medical technology. Third, the post-war movements for civil rights led to increased attention to the disruption of the balance of power between doctors and patients and to the consequent need to increase the ability of patients to control their decisions about health care.

Therefore, in the 60-70s of the twentieth century, such a form of medical ethics as bioethics was formulated, which begins to consider medicine in the context of human rights.

Bioethics - an interdisciplinary field of knowledge that covers a wide range of philosophical and ethical problems arising from the rapid development of medicine, biological sciences and the use of high technologies in healthcare. The formation and development of bioethics is associated with the process of transformation of traditional ethics in general, medical and biological ethics in particular. They are primarily due to the sharply increasing attention to human rights (in medicine, these are the rights of the patient, the subject, etc.) and the creation of new medical technologies that give rise to many problems that require solution, both from the point of view of law and morality. Are there limits to medical care and what are they in keeping a terminally ill person alive? Is euthanasia permissible? From what point should you count the onset of death? From what moment can an embryo be considered a living being? Is abortion legal? These are just some of the questions that arise before the doctor, as well as before the general public at the current level of development of medical science.

Thus, bioethics is a system of knowledge about the relationship between a doctor and a patient.

The authorship of the term “bioethics” belongs to Van Rensseller Potter, who in 1971 in his book “Bioethics: a bridge to the future” defined this discipline as “the connection of the system of biological knowledge with the knowledge of the system of human values”. He proposed to consider bioethics as a kind of knowledge, the task of which is to indicate exactly how the data of science should be applied to achieve social benefits. His name is associated with a view of bioethics as the science of survival.

The main moral principle of bioethics is the principle of respect for human rights and dignity. Under the influence of this principle, the solution to the "main issue" of medical ethics - the question of the relationship between doctor and patient - changes. Today, the question of the patient's participation in making a medical decision is acute. This is far from being a “secondary” participation, which is taking shape in a number of new models of doctor-patient relationship. Among them - informational, advisory, interpretation. Each of them is a kind of protection of human rights and dignity.

A specific form of resolving possible contradictions in the field of biomedicine is bioethical public organizations (ethical committees).

Ethical committees (commissions) - analytical and advisory bodies of various composition and status, and in some cases also controlling bodies, designed to develop moral rules for the functioning of specific research and medical institutions, as well as to give ethical expertise and recommendations on conflict situations arising in biomedical research and medical practice. The ethics committees are built on an interdisciplinary basis and include, in addition to physicians and biologists, lawyers, psychologists, social workers, medical ethics experts, patients and their representatives, as well as members of the public.
Thus, the theoretical features and moral and ethical principles of each of the listed historical models are real elements of an integral system of professional and ethical knowledge and constitute the value-normative content of modern professional biomedical ethics.

Translate the sentences into English. 1. The production of touch screens for the new smartphone model was entrusted to different manufacturers

V1: Section 2. Models and theories of human behavior in the organization

V1: Section 2. Models and theories of human behavior in the organization. V2: Topic 2.4. Behavior change theories

V2: Topic 2.2. Basic human models in economic theories

MEDICAL ETHICS, a type of professional ethics related to the activities and behavior of representatives of the medical profession. Prof. ethics application general concepts about morality to this or that branch prof. activities. Different authors have different views on the essence and origin of ethical views. While for Kant ethics is a "categorical imperative", the idea of \u200b\u200bduty, which hangs over people like some kind of internal coercive force, in the Marxist understanding, ethics are rules of behavior devoid of absolute categoricality dictated by class interest and class consciousness and changing over the centuries different nations and social groups, depending on economic, class and political conditions. Specific ethical issues, with which the doctor meets, concern three sides of his activity; 1) relationship with b-nym, 2) relationship of doctors with each other and 3) relationship with social. team. Moreover, these three categories of relationships can come into conflict and give rise to intractable ethical problems. If a number of elementary rules of the doctor's behavior (honesty and conscientiousness in the performance of their duties, high demands on their knowledge, skills and work, the inadmissibility of delaying treatment in order to obtain material benefits or advertising for mercenary reasons of unsuitable means) is quite obvious, then the situation with such issues as the use of b-nogo for the needs of honey. teaching or scientific experimentation. Here are the interests of God and G85 collectives can contradict each other, and for the doctor there is a need for their most painless coordination. In the field of relations between doctors, questions arise about the degree of observance of the interests of a comrade in the profession and the boundaries of competition and other conflicts on the basis of prof. honey. activities. In this area, the hex experience of communication of doctors among themselves on prof. the field has developed a well-known unwritten code of ethical rules, violation of which is considered reprehensible in the medical environment (for example, a disapproving opinion about the methods and method of treating a patient by a previous doctor, unjustified refusal to participate in consultation at the patient's bedside, etc.) .d.). But there are times when traditions are pushing for wrong behavior, such as deliberate suppression of mistakes, and sometimes the dishonesty of their comrade out of a falsely understood sense of collegiality (which is especially often the case in forensic examination), abuse of medical advertising, etc. There are also questions about how ethical it is to use state and public lay down. institutions for the treatment of patients, served by private paid honey. practice, about the issuance of certificates (sanitary supervision) and certificates of illness (labor examination, assignment to military service) to patients used in private paid practice (danger of a hidden form of bribe), etc. Here poorly understood rules of medical behavior can contrary to the interests of God and the community. If for capitalist medicine with a predominance in it private practice and with the inviolability of the veil covering medical disciplines and activities for the uninitiated, conflicts in the field of the first two categories of relationships are typical, conflicts that are completely unavoidable under the system of private capitalist medicine, then public medicine is characterized by different ideas about V.E. and other ethical conflicts. Thus, from the point of view of public medicine and the interests of the collective, it should be recognized that the sabotage by German doctors of the work of insurance offices, their organized exclusion of young workers from participating in the work of insurance offices, the prevalence of the principles of corporate interests of the "medical class" over the interests of the collective should be recognized as unethical from the point of view of public medicine and the interests of the collective. The principles of Soviet health care radically improve the tendencies of ethical principles in medicine. State organization of health care, the availability and free of charge medicine, building it on social. bases with expulsion or restriction of private practice, dignity. enlightenment, gradually tearing the veil of mystery from all actions of representatives of the medical class - all this educates the doctor as a conscientious member of the team, establishes a cleaner atmosphere in the relationship between the doctor and the doctor and doctors among themselves and radically destroys the mercantile spirit that continues to dominate in this area in a number of bourgeois countries. The principles of Soviet medicine remove the main stumbling block in the field of veterinary medicine - the question of payment for medical care and advice. On the other hand, a number of other requirements for a doctor arise, the violation of which should be considered unethical in the context of public medicine. This includes, for example, the refusal of unemployed doctors in cities to go to work in the countryside. In addition to such individual private issues, the ethics of the doctor is entirely covered by general requirementspresented by the collective to its member; V. e. cannot be considered as something separate from the general foundations of morality and morality in this social group. Lit .:Kautsky K., Ethics and materialistic understanding of history, M., 1922; MoplA., Medical ethics, St. Petersburg, 1903; Veresaev V., Notes of a doctor, M., 1927. T. Bron.

All professions, depending on the general content and nature of the moral problems generated by them, can be divided into two large groups: firstly, professions where the object of professional activity is a person, and, secondly, professions where a person is not the direct object of such activity. is an. The range of issues that ethics associated with the cervical group of professions is called upon to resolve is more extensive.

Both the first and the second group of professions by the content of their special ethics reflects the attitude of the people of this profession to society as a whole. These relationships are expressed in terms of "professional duty", "professional honor", etc. Topical issues for all professional groups, and therefore, for professional ethics in general, it is also the definition of the moral qualities of the personality of a specialist and the influence of the characteristics of professional activity on his moral development. At the same time, ethics associated with professions for which a person is the direct object of activity is not limited to this. It also includes the question of moral standards covering the behavior of people in their relation to those who are the object of this activity. Medical ethics, in the center of which are the relationship between the doctor and the patient, refers precisely to this type of professional and ethical complexes. Obviously, it is not by chance that it attracts special attention not only of specialists, but of the whole society.

Oddly enough, some researchers and practitioners deny the need for medical ethics. Therefore, consideration of her problems should begin with a critical analysis of their arguments. Back in the 30s, Professor G.I.Dembo wrote that medical ethics is a poor-quality surrogate for medical law and that it should be replaced by it. This point of view is untenable, since the area of \u200b\u200bthe moral is broader than the area of \u200b\u200blaw, what is subject to moral responsibility does not always cause legal responsibility. For example, sometimes a careless or rude word of a doctor brings great harm to the patient, although he is not subject to legal responsibility for this. In some situations, legal control turns out to be impossible, and then only control of conscience remains.

Other arguments are put forward against the necessity of medical ethics. Some argue that since there is a moral code for the builder of communism, there is no need for special moral standards for medical workers. In fact, the existence of a single moral code does not deny the need to concretize the general norms of morality in relation to people of different professions. In the activities of each specialist, these norms should be embodied in a set of specific tasks, the conscientious implementation of which is his professional duty, a matter of his professional honor.

Others explain the need for the existence of medical ethics by the imperfection, low efficiency of modern medicine, they believe that medical ethics is needed now, while medical science and technology are insufficiently developed, while the doctor is forced to heal with his heart, with a sympathetic attitude, and not only using medicines, technology, etc. With the development of medical science and technology, with the growth of success in medical practice, the role of the physician's personality will diminish, and medical ethics will become unnecessary. This view raises the following objections: in addition to the fact that every patient needs and will always need sympathy, participation and encouragement, these factors are themselves curative. They facilitate the course of the disease and accelerate recovery. Therefore, even if you look at the matter only from the point of view of the treatment process, then there is no point in abandoning these factors of treatment, no matter how successful medicine as a whole has achieved. Great Russian doctor

STATE EDUCATIONAL INSTITUTION

HIGHER PROFESSIONAL EDUCATION

CHITA STATE MEDICAL ACADEMY

BIOMEDICAL ETHICS

TEACHING AND METHODOLOGICAL GUIDE

CHITA - 2009

UDC: 614.253 (07)

Avkhodiev G.I., Cat M.L., Belomestnova O.V.

Biomedical ethics: Study guide. - Chita, 2009 .-- 216 p.

The study guide examines the actual moral and ethical problems arising in the field of modern science and health care, which presents material related to the history of the emergence and development of bioethics as a science, its theoretical foundations. Such aspects of bioethics as the dignity of the patient, personal freedom and informed consent, the “right to death”, dilemmas arising in various fields of medicine are analyzed.

The manual is intended for students of medical universities.

Reviewers:

Head of the Department of Pathological Anatomy

professor V.P. Smekalov;

Head of the Department of Histology and Embryology

Chita State Medical Academy,

doctor of Medical Sciences, Professor A.V. Pateyuk.

INTRODUCTION

CHAPTER 1. Origin of ethics. Types of professional

ethics. Medical ethics. A History of Medical Ethics.

CHAPTER 2. Theoretical foundations of biomedical ethics.

Basic ethical theories and principles of biomedical ethics.

CHAPTER 3. Basic rules of biomedical ethics. Rights and

moral obligations of doctors. Patient rights.

CHAPTER 4. Ethical rules the relationship of medical professionals.

CHAPTER 5. Ethical and legal regulation of biomedical research

on humans and animals.

CHAPTER 6. Death and dying. Euthanasia.

Moral problems of transplantation.

CHAPTER 7. Medical interventions in human reproduction.

Moral problems of medical genetics.

CHAPTER 8. Ethics in psychiatry and psychotherapy.

CHAPTER 9. AIDS. Moral and ethical problems.

CHAPTER 10. Moral problems of the distribution of scarce

health resources.

ANNEXES

SITUATION TASKS

BIBLIOGRAPHY

INTRODUCTION

"Hurry to do good!"

F.P. Haaz

Bioethics is a new and very broad field of interdisciplinary scientific research, although, as will be shown, it is not limited to research alone. The term "bioethics" itself arose a little over thirty years ago, however, the problems studied by bioethics are in many ways not new to science. This does not mean that they are removed from the everyday life of an ordinary person and are of interest only to specialists.

The development of biomedical ethics was due to revolutionary achievements in the field of high biomedical technologies, the development of the concept of "brain death" in neurology and resuscitation, fundamental discoveries in transplantology, psychopharmacology, in the field of in vitro fertilization and embryo transfer, molecular biology and medical genetics (gene diagnostics and gene therapy) etc. The ideas of the environmental and human rights movement had a significant impact on the development of bioethics as a specialized theoretical discipline.

Biomedical ethics is an ethically grounded response to the oldest moral problems posed by the progress of medical science and biomedical technologies, adequate to modern social conditions. The fundamental provisions of bioethics (such as, for example, the voluntary informed consent rule) formed the theoretical basis for a new internationally recognized ethical standard in medical practice that has emerged in recent decades, which has found expression in numerous documents of international law, national legislation (including Russian legislation in the field of health ), codes of ethics and declarations of international and national medical associations.

The lack of systematic education of Russian doctors in the field of modern biomedical ethics negatively affects the image of a Russian doctor in the eyes of the international medical community, puts them at a disadvantage in relation to foreign colleagues who are more prepared in this field (for example, when developing joint programs of scientific cooperation). The issue of convertibility of diplomas issued to graduates of Russian medical universities is becoming problematic, hindering the formation of new relations in the domestic health care that more adequately meet modern political and economic conditions.

CHAPTER 1

ORIGIN OF ETHICS. TYPES OF PROFESSIONAL ETHICS. MEDICAL ETHICS. HISTORY OF MEDICAL ETHICS

I. Purpose of the lesson:

1. To master the concepts: ethics, medical ethics, bioethics.

2. Study the history of the development of ethics and the formation of basic principles.

3. To get acquainted with the main ethical documents: "The Convention on Human Rights and Biomedicine", "The Hippocratic Oath", "The Oath of the Russian Doctor".

II. Motivational characteristic:

The problems of medical deontology and medical ethics in recent years have attracted more and more attention of scientists, practitioners, and the general medical community. This is due to many reasons, among which, first of all, the increasing importance of moral, moral, ethical factors in human relations should be mentioned. Complication of the treatment and diagnostic process, the constant introduction of innovations generated by modern science requires the physician to know the ethical norms governing the behavior of the physician and the basic documents containing these norms.

III. Equipment for classes:

2. Tasks on the topic of classes.

3. Texts: “The Convention on Human Rights and Biomedicine”, “The Hippocratic Oath”, “The Oath of the Russian Doctor”.

IV. Test questions to check the initial level of knowledge of students:

1. The first known source of the concept of medical ethics?

a) Bible

b) Book "Ayurveda"

c) "The Hippocratic Oath"

d) "Canon of Medicine"

2. Patron saint of healing in ancient Greek mythology?

a) Asclepius

c) Apollo the Healer

d) Artemis

3. Year of adoption of the "Convention on Human Rights and Biomedicine"?

4. Who owns the words: "The doctor should have the eye of a falcon, the hands of a girl, the wisdom of a snake and the heart of a lion"?

a) Avicenna

b) Plato

c) Paracelsus

d) Aristotle

5. What were the names of private hospitals in ancient Greece?

a) Asklepions

b) Yatreya

c) Hospitals

d) Hospitals

6. In honor of which Russian doctor was the institute in Bombay named?

a) Zabolotny

b) Savenko

c) Samoilovich

d) Khavkin

7. Who coined the term "deontology"?

b) Bentham

8. Classic soviet deontology?

a) Ivanov

b) Petrov

c) Pavlov

d) Mechnikov

9. The main moral idea of \u200b\u200bAvicenna's "Canon"?

a) Pragmatism

b) Humanism

c) Skepticism

d) Stoicism

10. In which document, for the first time in Russia, the punishment of doctors for neglect of their duties was defined?

a) Military regulations

b) Marine charter

c) Zemsky charter

d) City charter

11. Who coined the term bioethics?

a) Potter

b) Freud

c) Percival

d) Kant

Standards of answers: 1-b, 2-a, 3-d, 4-a, 5-b, 6-d, 7-b, 8-b, 9-b, 10-a, 11-a.

The profession of a doctor is one of the most ancient and revered professions on earth. It is an expression of a person's need to help a suffering person. At all times and among all peoples, healing was highly valued. This can also be understood from Homer's statement: "For many warriors there is one skilled healer." Medicine is very closely connected with the fate of a person, with his health and life. Hence, there are special requirements for the moral character of the doctor. They are most fully defined by the concept of humanism. Without humanism, medicine generally loses its meaning, because then its scientific principles come into conflict with the main purpose of medicine - to serve man. Humanism is the ethical foundation of medicine. The question arises, what is ethics. Ethics is a philosophical science, the object of study, which is morality (Aristotle). Morality is a set of norms-prohibitions, ideals, requirements, prescriptions - accepted and shared in a given society. These norms are fixed in his culture and in a fairly stable form is passed from generation to generation. A feature of ethics is the fact that, unlike law, it was formed and developed as a set of unwritten rules. And also ethics is understood as a branch of philosophy not so much studying the nature of man as teaching how he should behave himself.

What is physician ethics? This is the science of the moral values \u200b\u200bof the actions and behavior of a doctor in his field of activity. G.I. Tsaregorodtsev defined medical ethics as follows: “a set of principles of regulation and norms of behavior of physicians, conditioned by the peculiarities of their practical activity….”. Thus, the principles of medical ethics consider the attitude of a doctor not only to a specific patient, but also to people's health in general. With the development of society, the position of a doctor in it also changed, however, regardless of social and social formations, the observance of certain moral and ethical principles in the relationship between a doctor and a patient has always been and remains a prerequisite for successful healing.

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