What is medical ethics. Deontology and Medical Ethics History and Traditions of Medical Ethics

Ethics, medical ethics, biomedical ethics: definition of the concept, background

The term "ethics" was proposed by the Greek philosopher-encyclopedist 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 of people in the family, society, life and labor activity. Medical ethics is a set of requirements (principles, rules and norms) for professional activity(behavior) of a doctor (medical worker) and his moral qualities. Basics medical ethics formed in ancient times. They received the clearest expression in the writings of Hippocrates (4th century BC). Even then, a circle of age-old problems of medical ethics was defined: 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 drug 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 that deals with 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 basis of deontology is the principle of benefit ... this 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 considers and substantiates the principles of behavior of doctors in their practical and scientific activities. Essentially, the concept medical deontology close (for most authors 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 was called medical ethics at the end of the 19th century.”

Thus, we can state that classical (Hippocratic) medical ethics (deontology) defines a system of traditional moral and ethical requirements for both the professional activities 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 the book “Bioethics - a bridge to the future” in 1969. 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 that “determines the degree of responsibility of those who decide on the choice of a method of treatment and on the application of scientific knowledge in practice” . This definition has not settled down, and the spectrum of its meaning is interpreted very broadly. From our point of view, the definition proposed by the Strasbourg Symposium on Bioethics (1990) can be taken as a basis, according to which bioethics, being a complex field of knowledge, studies the moral, legal and social problems that arise with the development of medicine and biology. In many foreign publications, along with the term “bioethics”, in essence, its synonym “biomedetics”, “biomedical ethics” is widely used.

The formation of bioethics as a new field of knowledge (a new scientific discipline) was primarily due to the unprecedented progress in 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 sharp moral conflicts arise in connection with in vitro reproduction, surrogate motherhood, and determining the sex of the unborn child. No less dramatic is the situation when one has to answer the question: should the treatment of a patient who has been in a stable vegetative (unconscious) state for several months (or even years) be stopped? It is impossible not to note the acuteness of the ethical problems that arise with the development of transplantation (the problem of donation, ascertaining death, the 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 the rights of the patient as their integral and most important part could not but receive a new understanding. In the ethics of Hippocrates, liberal interpretations of the rights of the patient simply did not exist. At the same time, the rights of the patient began to include provisions that were traditionally considered the prerogative of doctors. As a result of these trends, there is a change in the traditional paternalistic scheme of relations between a doctor and a patient to a model based on the recognition of the principles of self-determination, patient autonomy, to an informational and deliberative model. For example, from the duty of a 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, one should also mention such factors that contribute to the formation and development of bioethics, such as:

- the need for control (ethical, legal, social) for research activities in many areas of medicine, because this activity affects the fundamental values of 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 experimental studies on animals and people, the scope of which is growing exponentially, and, accordingly, the solution of the most important task - minimizing risk, suffering and pain for the subjects, protecting their interests;
- medicalization as a dual process: the phenomenon of an extraordinary rise in the value of health and the gigantically increased role of medical science and practice in modern society;
- growing attention to the problem of implementing the principle of social justice in the healthcare system (especially in the context of insurance medicine, commercialization medical services) And social assistance(issues of distribution of increasingly limited resources);
- the growing importance of moral pluralism in resolving those bioethical situations when people involved in them are forced to take responsibility for setting the limits of their own existence, deliberately transgressing the boundaries of their own religious, ethnic, political, racial and sexual identity;
- globalization of bioethical problems, the presence and solution of which affects the interests of all mankind (it is by no means accidental that the collective search for moral solutions in the field of medicine is headed by World Organization health - WHO, and more recently the World Medical Association - WMA).

The analysis of literary sources, which to some extent 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 have no doubt that its roots go back centuries, to the Hippocratic oath that traditional medical ethics is a 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 of man to 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, one should point to the publications of A.Ya. Ivanyushkin) substantiate the point of view that “by the origin and content of its problems, bioethics remains part of professional medical ethics” (emphasized by us - author) 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 classical traditional ethics, which is based on commandments (dogmas), the letter and spirit of the Hippocratic oath, and its content actually exhausts “two problems: the behavior of medical personnel and internal corporate duties of doctors towards each other.” The second part - bioethics (biomedetics) in its essence (which we have already mentioned) is saturated with social content, goes beyond medicine, and in the applied plan tries to solve the purely specific tasks 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 foregoing, it seems to us that modern medical ethics, its main content and purpose for present stage development of society (the rights of the patient) and medicine ( the latest technology) could be designated by the term “medical bioethics”. However, this proposal is not original. It's like it's floating in the air. Thus, the head of the Department of Philosophy of the Krasnoyarsk Medical Academy, L.A. Shevyrnogova, aptly remarked: “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 philosophical understanding of a number of fundamental medical problems (a), has an undoubted applied value for clinical medicine (b), solves, albeit from other fundamentally new positions, the central problem of medical science. professional ethics(deontology) of any era - the problem of the relationship between the doctor and the patient (c), we believe that the allocation of a special medical part from it (in it) under the name "medical bioethics" looks quite correct (analogies with genetics and medical genetics, demography and medical demographics, etc.).

Thus, under medical bioethics we understand the subject that arose at the intersection 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 subject of teaching should rest on three pillars: on the foundations of philosophical, traditional medical and biomedical ethics. The complexity of the issue lies elsewhere. 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) its eternal values, and on the other hand, he embodied (absorbed) the achievements of liberal philosophical thought, idea of human rights?

The content of the subject of medical bioethics could be determined by the following goal: analysis of ethical dilemmas caused by modern development medicine, biology and society and the development of the skills and abilities 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 the philosophical foundations - ethics. This is necessary for a number of reasons:

1) ethics makes it possible to comprehend the meaning of moral values (goodness, duty, justice, etc.) as the main core of universal human values (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 in terms of value priorities;
3) and, finally, without familiarity with ethical theories, their implementation 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 supposed to study the following issues: 1) bioethics as social institution, social movement and outlook; 2) medical bioethics as a field of knowledge; 3) philosophical foundations of medical bioethics: a) bioethics - the ethics of life, or a moral attitude towards living things; b) humanism, utilitarianism, deontologism as the 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 the problem of self-identification, the meaning of life; 5) moral pluralism in a multicultural society and problems of bioethical harmony.

As a link between the first and second parts of the subject, a topic is proposed that will consider the ethical norms of classical medical ethics from a historical and epistemological point of view, where a special place will be given to the contribution of representatives of domestic medicine to the development of the humanistic orientation of medical deontology.

3. The special (clinical) part, in our opinion, should include an analysis of the following issues: modern models of the relationship between a doctor and a patient in the light of bioethical realities; human experiments; 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 ethics social adaptation; analysis of the concepts of social justice and the definition of health policy. The clinical part also involves the study of medical and ethical standards, the development of documentation from WHO, VMA, as well as Russian legislation.

To develop a certain skill and ability to apply decisions of a medical and ethical nature, the basis of practical knowledge should be clinical and ethical analyzes (analysis of incidents).

The Russian philosopher P.D.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 a bioethical movement, as well as thinking and education. It fully applies to Russian medicine - to health care in general and to medical education in particular. The latter can be described as nonsense if the study of bioethical problems and issues does not occupy (does not occupy) a worthy place in its system. Successfully solve this task, in our opinion, is possible by teaching medical bioethics and organizing appropriate departments (courses).

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

Department of Public Health and Health

N.P. PETROVA

HISTORY OF MEDICAL ETHICS.

MEDICAL EMBLEM

Educational and methodological manual on the history of medicine for students of medical universities of the 1st year of the Faculty of Medicine and Diagnostics, specialty "Medical Diagnostic Business"

Reviewer:

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

M.E. Abramenko

Petrova N.P.

P Medical ethics. Medical emblematics: A teaching aid on the history of medicine for students of medical universities of the 1st year of the medical diagnostic faculty in the specialty "Medical diagnostic business" / N.P. Petrova - Gomel: Educational Institution "Gomel State Medical University". 2010. - p.

Designed 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, console every minute."

Medical saying

Professional medical practice shows that every day a doctor solves not only clinical problems, but also faces moral problems of 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 to understand our actions and deeds. Just as logic helps to avoid false judgments, so ethics helps to realize the principles by which this or that act is judged as right or wrong.

Knowledge and ability to follow the developed medical community ethical principles and the rules determines one of the foundations of a doctor's professionalism - his moral culture. There is no doctor who would not recognize the importance for the healing process of moral relationships with the patient. The most important factor of successful treatment directly depends on the doctor's moral culture, 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 willingness and ability of the doctor to subordinate his interests to the interests of the patient. This skill, in turn, serves the main thing - the task of alleviating the suffering of the patient.

HISTORY OF MEDICINE 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 dying hour.

Since ancient times, the doctor was considered a person who performs a highly moral deed. For example, the inscription on the temple of Asclepius in the Acropolis reads: "... he, like God, should be the same savior of slaves, the poor, rich people and heirs to the throne and be a brother to everyone, that's what help he should provide." In turn, there was also a special attitude towards the sick. A vivid 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 brought an ancient vow: "The brethren of the Hospital must serve our masters, the sick, with zeal and devotion, as if they were slaves of their masters."

Doctors have to make decisions related to the life, health, dignity and rights of people. 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, life and work. The word "ethics" comes from the Greek ethos- custom, habit. The term "ethics" was proposed by Aristotle (384-322 BC).

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

In professional medical ethics, the principle of humanism should be considered as 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 humanity (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 VI-IV centuries. BC e. During this historical period, physicians Ancient Greece gave an ethical obligation - the "Oath" of Hippocrates (460-377 BC). The idea of humanity 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 humanism has specific expressions: “Whatever house I enter, I will enter there for the benefit of the patient ... I will direct the regimen of patients to their benefit ... refraining from causing any harm and injustice ... ". The clearest manifestations of the humanism of the Hippocratic ethics include 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 to it as the main social function medicine, which must fulfill this task, guided by scientific knowledge and professional skill.

This truth was confirmed by the organization in 1981 of the movement "Physicians of the World for the Prevention of Nuclear War". In the movement of doctors of the planet against the threat of nuclear war on the widest historical scale, the moral principle of the commandment of medicine about the value of human life, the commandment, which is the true beginning of professional medical ethics, manifested itself.

Medical ethics requires respect for the suffering of a person, even when it comes to a captured enemy, which is reflected in the International Convention of the Red Cross on the Treatment of Prisoners of War (1929).

From the history of medicine it is known that as early as the 3rd century BC. The composition of the Indian folk epic "Ayurveda" ("The Book of Life") reflects the relationship of the doctor to the patient and the relationship between doctors. About the personality of a doctor, it is said here that he should be modest in life and behavior, not to show off his knowledge and not to emphasize that others know less than you.

Medical ethics requires specificity in relations between all members of the team, regardless of rank and title. The respectful address to 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 should be discussed with a colleague in person and in private.

Respectfully doctors should treat middle and junior medical staff. modern nurse- A highly skilled worker who knows and can do a lot. She is the first assistant to the doctor, without whom the treatment process is impossible. Respectful relationships with nurses especially young specialist allow you to learn a lot and avoid a lot of mistakes.

1. Equality and justice.

2. Good and good.

3. Professional duty.

4. Responsibility.

5. Honor, dignity, conscience.

Equality and justice.

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 has the right to forget that in the hospital and in the clinic (dispensary) they always deal with a mass of patients, a significant part of the work with each of them (treatment of each) is carried out in front of others. Each physician takes the first ethical exam in front of his patients on the subject of "equality". Taking one of the patients bypassing the queue (without medical evidence) is a multiple moral evil: a manifestation of disrespect for many people at the same time, disregard for the condition of the patients, a cynical, defiant demonstration of immoral behavior by doctors.

At the same time, medical ethics cannot ignore issues related to the “ethics of the patient”. The ethical position of the patient will be when he treats with understanding any case of fair 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 the good as life and health. The improvement of the patient's condition, the coincidence of circumstances conducive to the success of treatment, the ignorance of a significant part of patients regarding the prognosis of their disease - all this is a blessing. Good (like evil) is the most general moral concept. Even when a person’s actions are not crowned with practical success due to some external circumstances, the moral choice made by him correctly makes it possible to say about this person that he did not change himself as a person, as he strove to do good.

The welfare of the patient is the most important 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 view of the patient, an exemplary doctor is a man of duty, for whom helping the patient is not only official duty but a truly moral act. A true physician will always overcome selfish or selfish temptations that may 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 sick, being far from everything intentional, unrighteous and pernicious ...".

Loyalty to professional duty requires both wisdom and a kind of moral stamina, moral toughness. 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 his colleagues, and most importantly, the ability to draw reasonable conclusions not only from his own successes, but also from mistakes. Moral stamina 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". Liability is a concrete measure of duty. It is generally accepted that the responsibility of physicians in their work is enormous. Some people sometimes develop an exaggerated idea of the responsibility of medical workers.

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, this is the “growth hormone” of his very personality. The moral energy of the professional responsibility of a medical worker is then concentrated in a variety of specific deontological imperatives, for example, such: under no circumstances should the promise given to the patient be broken; antipathy, irritation, resentment, haste, impatience, forgetfulness are prohibited in relation to the sick doctor.

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. The white coat and cap, as it were, symbolize the purity 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, lies both pride in medical humanism and consciousness of enormous social significance. medical work, and belief in the power of scientific medical title.

The one who receives the right to heal must work with such responsibility as the laws and traditions of medicine require. Non-compliance with the proper professional level is unacceptable from the point of view of professional honor.

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

The professional dignity 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, flattery, self-humiliation and disbelief in oneself.

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

If dignity is the desire of the individual 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 essential role in solving all the contradictory problems generated by medical practice. A matter of conscience for a doctor is a constant self-assessment of 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, so it is necessary to constantly pay close attention to its various aspects. In order to understand what moral, ethical and value-legal principles underlie modern biomedical ethics, one should at least briefly characterize their development in different historical eras.

1. The Hippocratic model and the “do no harm” principle.

The moral principles of healing were laid 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 obligations of the doctor to the patient and his colleagues in the craft. One of the most important principles is “do no harm”. The "Oath" says: "I will direct the regimen of the sick to their advantage, according to my ability and my understanding, refraining from causing any harm and injustice." The principle “do no harm” focuses the civil creed of the medical class. The Hippocratic model contains the original 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 the doctor, no less - his life.

The norms and principles of the doctor's behavior, defined by Hippocrates, are not just a reflection of specific relationships in a particular historical era. They are filled with content determined by the goals and objectives of healing, regardless of the place and time of their implementation. Because of this, while changing somewhat, 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 the Doctor of the Republic of Belarus”.

Paracelsus' model and principle ("do good") - a model of medical ethics that developed in the Middle Ages. Its principles were most clearly stated by Paracelsus (1493-1541). In contrast to the Hippocratic model, when a doctor wins the patient's social trust, in the Paracelsian model, paternalism is of primary 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 power 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, a torturer, a liar, a frivolous one, but he must be a just person."

3.Deontological model and the principle of "observance of duty".

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

The term "deontology" (from the Greek deontos - due) was introduced into Soviet medical science in the 1940s by Professor N.N. Petrov. He used this term to designate a real-life area of medical practice - medical ethics.

The deontological model of medical ethics is a set of “proper” rules that correspond to a particular area of medical practice. An example of such a model is surgical deontology. N.N. Petrov in his work “Issues of surgical deontology” singled out following rules:

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

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

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

“The ideal of major surgery is to work with the really complete elimination of not only any physical pain, but also any emotional excitement of the patient”;

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

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

The principle of "observance of duty" is the main one for the deontological model. To “observe duty” means to fulfill certain requirements. An improper act is one that is contrary to the demands placed on the doctor by 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 have received tremendous opportunities to interfere in the existence of biological objects and humans. This made it possible, along with hopes, to express concerns related to the limits of permissible manipulation of biological processes, especially those related to people.

A combination of factors contributed to the birth of bioethics. First, the Nazis' medical experiments on concentration camp inmates raised concerns about people's vulnerability in medical research. Second, the rapid advances in medicine, including reproductive health, organ transplantation, and genetics, have raised questions about the purpose and limits of medical technology. Third, post-war movements for civil rights led to increased attention to the imbalance of power between doctors and patients and the resulting need to increase the ability of patients to control their decisions regarding medical care.

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

Bioethics - an interdisciplinary field of knowledge covering a wide range of philosophical and ethical problems arising in connection with the rapid development of medicine, biological sciences and use in health care high technology. Formation and development of bioethics are connected 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 need to be addressed, both from the point of view of law and morality. Are there limits to the provision of medical care and what are they in maintaining the life of a terminally ill person? Is euthanasia allowed? From what moment should the onset of death be counted? At what point can a fetus be considered a living being? Are abortions allowed? These are just some of the questions that confront the doctor, as well as 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 Rensselaer Potter, who in 1971 in his book "Bioethics: a bridge to the future" defined this discipline as "the connection of a system of biological knowledge with the knowledge of a system of human values." He proposed to consider bioethics as a kind of knowledge, the task of which is to indicate exactly how these sciences should be applied to achieve social benefits. His name is associated with the 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 “basic issue” of medical ethics, the question of the relationship between the doctor and the patient, changes. Today, the question of the participation of the patient in making a medical decision is acute. This far from “secondary” participation takes shape in a number of new models of the relationship between the doctor and the patient. Among them - informational, deliberative, interpretive. Each of them is a peculiar form 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 even regulatory bodies, designed to develop moral rules for the functioning of specific research and medical institutions, as well as to provide ethical expertise and recommendations on conflict situations that arise in biomedical research and medical practice. Ethics committees are built on an interdisciplinary basis and include, in addition to physicians and biologists, lawyers, psychologists, social workers, experts in medical ethics, 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 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 an organization

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

V2: Topic 2.2. Basic models of man in economic theories

MEDICAL ETHICS, a type of professional ethics relating to the activities and behavior of representatives of the medical profession. Prof. ethics-application general concepts about morality to one or another branch of prof. activities. Views on the essence and origin of ethical views are different for different authors. While for Kant, ethics is a “categorical imperative”, the idea of duty, which hangs over people, like some kind of internal coercive force, in the Marxist understanding of ethics, rules of conduct devoid of absolute categorization, dictated by class interest and class self-consciousness and changing over the centuries different peoples and social groups, depending on economic, class and political conditions. Specific ethical questions, with which the doctor meets, concern three aspects of his activity; 1) relationships with b-nym, 2) relationships between doctors and 3) relationships with the social. team. At the same time, these three categories of relationships can come into conflict and give rise to ethical problems that are difficult to resolve. If a number of elementary rules of a doctor's behavior (honesty and conscientiousness in the performance of his duties, high demands on his knowledge, skills and work, the inadmissibility of delaying treatment to extract material benefits or advertising unsuitable means for selfish reasons) is completely obvious, then the situation is much more complicated with issues such as the use of b-nogo for the needs of honey. teaching or for scientific experimentation. Here the interests of the b-th and G85 collectives can contradict each other, and for the doctor there is a need for the most painless coordination. In the field of relationships 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 clashes on the basis of prof. honey. activities. In this area, the experience of doctors communicating with each other at prof. the field has developed a well-known unwritten code of ethical rules, the violation of which is considered reprehensible in the medical environment (for example, a disapproving review expressed before b-ny about the methods and methods of treating a patient by a previous doctor, an unreasonable refusal to participate in a consultation at the patient’s bedside, etc. d.). But there are cases when traditions push for wrong behavior, as, for example, for conscious suppression of mistakes, and sometimes dishonesty of one’s comrade out of a falsely understood sense of collegiality (which is especially often the case at forensics), abuse of medical advertising, etc. There are also questions about how ethical it is to use state and public to lay down. institutions for the treatment of b-nyh, served in the order of private paid honey. practice, on issuing certificates (sanitary supervision) and certificates of sickness (labor examination, assignment to military service) to patients used in private paid practice (danger of a hidden form of bribery), etc. Here, poorly understood rules of medical behavior can go contrary to the interests of the b-th and the team. 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 other ideas about V. e are typical for public medicine. and other ethical conflicts. So, from the point of view of public medicine and the interests of the collective, it is unethical to recognize the sabotage by German doctors of the work of insurance funds, the organized prevention of young workers from participating in the work of insurance funds, the predominance of the principles of the corporate interests of the “medical estate” over the interests of the collective. The principles of Soviet health care radically heal the tendencies of ethical principles in medicine. State. organization of health care, accessibility and free medicine, building it on the social. bases with expulsion or restriction of private practice, a dignity. enlightenment, gradually tearing the veil of mystery from all the actions of representatives of the medical class - all this educates the doctor as a conscious 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 V. e. - the question of payment for medical care and advice. On the other hand, there are a number of other requirements for the doctor, the violation of which should be considered an unethical act in the conditions 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 separate private issues, the ethics of the doctor is fully covered general requirements presented by the collective to its member; V. e. cannot be seen as separate from common ground morality and morality in this social group. Lit.: Kautsky K., Ethics and materialistic understanding of history, M., 1922; mople A., 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 is designed to resolve, associated with the church group of professions, is more extensive.

Both the first and the second group of professions reflect the relationship of people in this profession to society as a whole by the content of their special ethics. These relations are expressed in the concepts of "professional duty", "professional honor", etc. Topical issues for all professional groups, and hence for professional ethics in general is also the determination 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, the ethics associated with professions for which the direct object of activity is a person is not limited to this. It also includes the issue of moral norms 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, belongs precisely to this type of professional and ethical complexes. Obviously, it is no coincidence that she attracts Special attention not only professionals, but the whole society.

Strange as it may seem, some researchers and practitioners deny the need for medical ethics. Therefore, consideration of its problems should begin with a critical analysis of their arguments. Back in the 1930s, 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 the moral is wider than the area of the legal, that which is subject to moral responsibility does not always cause legal. 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. Legal control in some situations is impossible, and then only the control of conscience remains.

Other arguments are put forward against the need for the existence of medical ethics. Some argue that since there is a moral code of 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 negate the need to specify the general norms of morality in relation to people. different professions. In the activities of each specialist, these norms should be embodied in a set of specific tasks, conscientious performance 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 not sufficiently developed, while the doctor is forced to treat with his own heart, sympathetic attitude, and not just using medicines, equipment, etc. With the development of medical science and technology, with the growth of the successes of medical practice, the role of the doctor's personality will decrease, medical ethics will become unnecessary. This opinion 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 ease the course of the disease and speed up recovery. Therefore, even if you look at the matter only from the point of view of the healing process, then there is no point in abandoning these factors of treatment, no matter how successful medicine as a whole may be. Great Russian doctor

STATE EDUCATIONAL INSTITUTION

HIGHER PROFESSIONAL EDUCATION

CHITA STATE MEDICAL ACADEMY

BIOMEDICAL ETHICS

EDUCATIONAL AND METHODOLOGICAL AID

CHITA - 2009

UDC: 614.253 (07)

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

Biomedical Ethics: Educational and Methodological Guide. - Chita, 2009. - 216 p.

The teaching aid deals with topical moral and ethical problems that arise in the field of modern science and healthcare, which presents material on 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, individual freedom and informed consent, the “right to die”, dilemmas that arise 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,

MD, Professor A.V. Pateyuk.

INTRODUCTION

CHAPTER 1. The origin of ethics. Types of professional

ethics. Medical ethics. 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 physicians. The rights of patients.

CHAPTER 4. Ethical rules for the relationship of medical workers.

CHAPTER 5. Ethical and legal regulation of biomedical research

on man and animals.

CHAPTER 6. Death and dying. Euthanasia.

Moral problems of transplantology.

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

health resources.

APPS

SITUATIONAL TASKS

BIBLIOGRAPHY

INTRODUCTION

"Hurry to do good!"

F.P. Haas

Bioethics is a new and, moreover, a very wide 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 Everyday life 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 vitro fertilization and embryo transfer, molecular biology and medical genetics (gene diagnostics and gene therapy) and etc. The development of bioethics as a specialized theoretical discipline was significantly influenced by the ideas of the environmental and human rights movements.

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

The lack of systematic education of domestic doctors in the field of modern biomedical ethics has a negative impact on the image of the Russian doctor in the eyes of the international medical community, puts them at a disadvantage in relation to foreign colleagues more trained in this field (for example, when developing joint scientific cooperation programs). The issue of the convertibility of diplomas issued to graduates of Russian medical universities is becoming problematic, preventing the formation of new relations in domestic healthcare 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. The purpose of the lesson:

1. Master the concepts: ethics, medical ethics, bioethics.

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

3. Get acquainted with the main ethical documents: "Convention on Human Rights and Biomedicine", "Hippocratic Oath", "Russian Doctor's Oath".

II. Motivational characteristic:

The problems of medical deontology and medical ethics in recent years have attracted increasing attention of scientists, practitioners, and the general medical community. This is due to many reasons, among which, first of all, the growing importance of moral, moral, ethical factors in human relationships should be mentioned. The complication of the treatment and diagnostic process, the constant introduction of innovations into it, generated by modern science requires physician knowledge ethical standards regulating the behavior of a physician and the main documents containing these norms.

III. Lesson equipment:

2. Tasks on the topic of classes.

3. Texts: "Convention on Human Rights and Biomedicine", "Hippocratic Oath", "Russian Doctor's Oath".

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

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

a) the Bible

b) Ayurveda book

c) The Hippocratic Oath

d) "Canon of Medicine"

2. Patron 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 must 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 private clinics called in Ancient Greece?

a) Asklepion

b) Yatreya

c) Hospitals

d) Hospitals

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

a) swampy

b) Savenko

c) Samoilovich

d) Khavkin

7. Who coined the term "deontology"?

b) Bentham

8. A classic of Soviet deontology?

a) Ivanov

b) Petrov

c) Pavlov

d) Mechnikov

9. The main moral idea of Avicenna's "Canon"?

a) pragmatism

b) Humanism

c) Skepticism

d) Stoicism

10. What document was the first in Russia to determine the punishment of doctors for neglecting their duties?

a) military regulations

b) Maritime charter

c) Zemsky charter

d) City charter

11. Who proposed the term bioethics?

a) Potter

b) Freud

c) Percival

d) Kant

Sample 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 the suffering. At all times and among all peoples, healing was highly valued. This can be understood from the statement of Homer: "Many warriors are worth one skillful healer." Medicine is very closely connected with the fate of a person, with his health and life. This implies 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 goal of medicine - to serve man. Humanism is the ethical basis 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 enshrined in its culture and are passed on from generation to generation in a fairly stable form. A feature of ethics is the fact that, unlike law, it was formed and developed as a set of unwritten rules. Ethics is also understood as a branch of philosophy not so much studying the nature of man as teaching how he should behave.

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

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