M. i. Mudrov is the founder of the tradition of medical ethics in Russia in the first half. Report on the topic of medical ethics in the works The contribution of domestic scientists to the development of medical ethics

Notes

1. Fedorov N.F. and his Voronezh environment (1894-1901): articles, letters, memoirs, chronicles of his stay in Voronezh. Voronezh 1998.; Kotlyarova I.V. Formation and development of museums in the Voronezh region in the regional cultural context (the second half of the 19th - the first third of the 20th centuries): Abstract of the thesis. dis. cand. ist. Sciences. M., 2006.

2. Fedorov N.F. and his Voronezh environment (1894-1901): articles, letters, memoirs, chronicles of his stay in Voronezh. Voronezh, 1998.

3. Fedorov N.F. From the philosophical heritage (Museum and culture). M., 1995.

D. A. Mironov

M. Ya. MUDROV - THE FOUNDER OF THE TRADITION OF MEDICAL ETHICS IN RUSSIA IN THE FIRST HALF

XIXCENTURIES

The founder of Russian therapy M. Ya. Mudrov (1776-1831) was widely known in his time as a famous Moscow doctor. In addition, it is he who has the honor of restoring the medical faculty of Moscow University after a fire and looting in 1812. Through his efforts, a clinical base was created - the Clinical Institute; five times the faculty elected him as its dean.

The first translations into Russian of the works of Hippocrates (“Oath”, “Law”, “Aphorisms”) appeared in print only in 1840. But two decades earlier, the ideas of Hippocrates were popularized at the medical faculty of Moscow University by M. Ya. Mudrov. His area of ​​interest focuses on medical ethics and is entirely based on the ethics of Hippocrates, whose texts he translated and interpreted. No one had shown such an interest in ethical issues in medicine before him.

In his essay “The Word on the Piety and Moral Qualities of the Hippocratic Doctor”, Mudrov raises important questions of ethics, both general and particular. General questions include reflections on the ethical and epistemological relationships in medicine. "Whoever wants to acquire knowledge in Medicine, he must have the following leaders: the ability of nature, learning, a place convenient for learning, education from youth, thoroughness and time." He mentions social role medicine: "It is necessary that the doctor acquire for himself some humanity." In detail and in detail, he illuminates the famous fragment of Hippocrates that the physician-philosopher is like God. “Why should Medicine be combined with wisdom; for a physician who is wise is like God. All that is needed for Wisdom: contempt for wealth, chastity and modesty, moderation in dress, importance, reason, friendliness, cleanliness, short conversation, knowledge of useful things for life and necessary cleansing medicines, removal from superstition, divine dignity. Above all, the light of the knowledge of God should illuminate his soul; for in many infirmities and fits Medicine must reverently turn to God. For doctors yield to the power of God. Medicine has no power of its own. Doctors do a lot, but God prevails even more. Medicine is seen by Mudrov as a science that combines both morality and wisdom, and one is unthinkable without the other. At the same time, wisdom and morality are understood not as the result of teaching, but as an individual experience of self-knowledge by a person of himself in the face of God. “Hippocrates spoke here about moral wisdom, and not about intellectual philosophy, about the wisdom of piety and the fear of God, and not about the sophistication of school nonsense, which, according to him, do not bring any benefit and disappear like ghosts in the light of true wisdom.” Mudrov develops the position of Hippocrates and expands it from a simple wish to a kind of "moral law" of each doctor. Such rules should form a separate code of laws for doctors, they would be imputed to them along with the Hippocratic oath. This is where the conversation about medical ethics comes in.

The position of the Hippocratic ethics on respect for the patient in the mouth of M. Ya. Mudrov sounds like this: “Starting with love for your neighbor, I should inspire you with everything else that stems from one medical virtue, namely, helpfulness, readiness to help at any time, and day and night, friendliness that attracts both the timid and the bold, mercy towards the sensitive and the poor. He also emphasizes the most important qualities for a doctor - a kind attitude towards another person, love and selflessness. “Sometimes treat for nothing at the expense of future gratitude, or, as they say: not from a profit, glory would be good.”

In several places of his “Words on the way to teach and learn practical medicine”, Mudrov speaks of medical secrecy: “Keeping secrets and secrecy in case of reprehensible diseases; silence about seen or heard family disorders ... Curb your tongue, this small but daring ud, for unsimilar verbs and words of slyness. With regard to the approach to hopeless patients, he has several statements that do not coincide with each other. The “Sermon on the piety and moral qualities of the Hippocratic doctor” says: “Much must be hidden from the patient, always enter him with a cheerful, impressive face ..., but not reveal the present state of the disease and its future outcome ...”. In the "Word on the way to teach and learn practical medicine" (where ethical views are predominantly expressed) the following is written: "To promise healing in an incurable disease is a sign either of an ignorant or dishonest doctor." This contradiction reveals a fine line between the doctor's respect for the moral autonomy of the individual and medical secrecy, which affects the interests of intercollegiate relations between doctors. The provisions voiced by Mudrov have acquired great relevance in modern medicine.

M. Ya. Mudrov also pays much attention to the topic of the doctor's attitude to his profession. Among physicians, his aphorism is widespread: “In the art of medicine, there is no doctor who has completed his profession. The aphorism is relevant to this day. In modern terms, it reflects the idea of ​​the need for constant retraining of medical personnel and postgraduate education. The main denominator of successful mastering medical profession, according to Mudrov, is gaining the trust of the patient. “Now you have experienced sickness and know the sick; but know that the patient has tested you and knows what you are. From this you can conclude what patience, prudence and mental tension are needed at the bed of a patient in order to win all his power of attorney and self-love, and this is the most important thing for a doctor.

M. Ya. Mudrov is a translator and consistent popularizer of the ethical doctrine of Hippocrates. His system of ethical ideas is rooted in religious consciousness and involves faith in God. Morality is the result of faith, piety and fear. Since antiquity, the doctor has been endowed by nature and God with special powers to fulfill his mission with dignity. The doctor's morality is the measure of his relationship with God, which the doctor transfers into his work. However, a certain contradiction arises: individual morality in medicine inevitably outgrows itself, since medicine, being in the field of social relationships, needs its own ethical system. With the advent of a broad university medical education in Russia, a problem arises medical ethics for doctors. Mudrov's merit in this issue immeasurable, since it was he who highlighted the problem of the need for medical ethics and formulated a number of its provisions that have not lost their relevance today. Borrowing Hippocratic ethical ideas in the form of moral prescriptions and advice, he expands them to the sphere of society and shows the need to reformulate them into an integral moral doctrine of medicine. Thus, the long tradition of caste doctors is interrupted. With the improvement of the quality of medical education and medical culture in society, medicine "opens up" to society with the problem of finding its own ethical foundations. In the fact of such openness, the features of the developing secularization of public consciousness are seen.

In his reflections, M. Ya. Mudrov touched not only on the issues of medical ethics and deontology in medicine, but also on the problem of the ethical foundations of medicine itself. His statements about medicine are contradictory: he alternately proceeds from the idea of ​​medicine as an art, then as a science. The realities of the first quarter of the 19th century show that medicine can be taught, and it can be an independent science. At the same time, a centuries-old tradition conveys the notion of medicine as an art, and art cannot be morally reduced to specific prescriptions and duty. The appearance of such a gap in ideas about the status of medicine indicates the emergence of a secular attitude in the medical environment - a shift in the vector of the problematic field of medicine from religious to secular. The complex of ethical issues in medicine, raised by M. Ya. Mudrov, laid new ethical foundations for the profession of a doctor.

Notes

Mudrov M.Ya. A word about the piety and moral qualities of the Hippocratic doctor. - M., 1814.

Introduction to bioethics: textbook / Ed. ed. B. G. Yudin. - M., 1998.

A.A. Mikhailova

The behavior of the characters in the cell of the elder Zosima as an indicator of their moral character in the novel by F.M. Dostoevsky "The Brothers Karamazov"

Roman F.M. Dostoevsky's "The Brothers Karamazov" poses a wide range of problems to the reader, most of which affect spiritual and moral issues. Among them is the issue of compliance with ethical standards.

“They don’t go to a strange monastery with their charter,” Fyodor Pavlovich Karamazov recalls at the entrance to the skete a well-known proverb that says that you should accept the rules of the place you visit and respect the traditions of other people. All the companions of Fyodor Pavlovich seem to agree with this wise saying. Knowing themselves about their incontinence, ambiguous relations, and, nevertheless, understanding what kind of respectable person they are going to, the guests of the monastery "all gave their word to behave decently here ...". It turns out that they are going to hide behind a mask of decency. However, older visitors do not stand such a test, their duplicitous behavior is immediately revealed. Fyodor Pavlovich shows ostentatious piety, starting to put large crosses in front of the icons at the skete gates, and at the same time he enters the role of a jester and tries to be sarcastic, trying on his way of thinking to the monks: “So, after all, a loophole to the ladies from the skete has been made.” It is pleasant for the old man Karamazov to smear the chaste way of life of monks with his dirt, so that he himself looks better against this background, or not so disgusting. He is so preoccupied with material well-being that does not see the other, spiritual, side of being, which is the basis of the life of the monastery. Miusov, full of his own dignity, is ashamed of the behavior of his companion and tries to justify himself: "... I'm afraid to go with him to decent people," meanwhile, indignation boils inside him both at the old man Karamazov and at the monks. That is, without realizing it, he also plays the role of an extremely educated, enlightened person.

It is no coincidence that the narrator stops at the scene of the elder's greeting. According to church custom, it is supposed to take a blessing from a clergyman who has a priestly rank, and so do the hieromonks present and the elder himself. What express love and respect for each other. But the first intentional gesture of the secular visitors who entered shows their prejudice against the inhabitants of the monastery. Planning in advance to respect this custom out of elementary politeness, Miusov, at the sight of mutual bows and kisses of the monks, becomes even more annoyed. Judging by himself, he thinks that all this is just hypocritical signs of attention. He immediately changes his mind: he gives only a polite bow, outwardly observing the rules of secular etiquette and at the same time, as if showing his pride and disdain. Fyodor Pavlovich did the same, “this time completely mimicking Miusov like a monkey” - that is, he made a new clownish attack, which could be directed not only against the companion, but also against the monks, whose opinion is not so authoritative for him. Ivan Karamazov “bowed very importantly and politely, but also keeping his hands at his sides” - this gesture speaks of respect, but still abstaining from accepting local norms. Such behavior even embarrassed the young man Kalgatin to the point that he himself forgot to greet the owner of the cell, and Alyosha Karamazov was plunged into shame.

However, the elder did not show the slightest displeasure or resentment, did not force them to comply with the church custom, but he himself went to meet them, also answering the guests with a simple bow.

Chatter, teasing Fyodor Pavlovich, who introduced himself as a jester, and impatient remarks, even Miusov's fury - this scene was extremely disrespectful to the place and the inhabitants of the skete, and therefore caused bewilderment and surprise among the rest of those present. After all, earlier “many of the“ higher ”persons, even of the most learned, moreover, some of the free-thinking even persons who came either out of curiosity or for another reason, entering the cell ... made it their primary duty, every single one, the deepest reverence and delicacy throughout the meeting. Observing the behavior of Fyodor Pavlovich, the elder Zosima correctly remarked: “... Do not be so ashamed of yourself, for everything comes out of this.” And he agreed with this statement: “You ... sort of punched me through and read inside.” Behind the guise of buffoonery, behind this habit of a former hooker, the old man Karamazov hides a sense of shame, a “complex of low value” and, one might add, indignation because he is humiliated, unequal to other members of society. His pride is infringed, and therefore his defensive reaction is to reject himself from this society and slap him in the form of boorish behavior.

Seeing the wisdom, fidelity of the elder’s judgments and being surprised at the serious attention to himself, Fyodor Pavlovich “jumped up and ... quickly kissed the old man on his thin hand.” Such a gesture symbolizes the recognition by this character of the height and superiority of Father Zosima over other people and over himself. However, although Fyodor Pavlovich is strengthening his respect for Father Zosima, even in his presence he does not hesitate to arrange a quarrel and unceremoniously reveal his true state of mind, views, thoughts.

Among the unbelieving visitors to the monastery cell is the middle son of Fyodor Pavlovich Ivan. Educated and socially suave, he behaves with restraint and even humility. Before the elder, he does not try to hide his views, on the contrary, seriously, openly speaks about them, carefully and thoughtfully listens to the words of the elder. It can be concluded that Ivan Fedorovich is a man of high culture, not devoid of a moral sense, with a noble heart. This is confirmed by the elder Zosima: "... thank the Creator for giving you a higher heart ...". Despite the fact that Ivan is an atheist, he accepts his father Zosima as a wise, experienced person. It is no coincidence that Ivan silently stood up and took his blessing, surprising everyone present with this act. This is also a recognition of the intellectual dignity and insight of the elder and a sign of great respect for him.

Dmitry Karamazov is the most open and honest at this family gathering. Although his soul is burdened with vices and passions, it is alien to duplicity. Dmitry treats the elder with deep reverence, seeing in him a special person, close to God. Dmitry is the only one at the entrance asking for blessings from the owner of the cell. His words and actions are sincere, he does not play a role, like Fyodor Pavlovich, does not try to hide contempt, like Miusov. Turning to the elder, Dmitry directly says: "... Reverend Father ... I don't know what to call you ...". The young man refers to his lack of education, apologizing for possible mistreatment, afraid of involuntarily offending the elder. Taking advantage of the fact that Mitya is able to easily succumb to the feeling that has gripped him, Fyodor Pavlovich deliberately infuriates him, and he himself plays the role of an offended father and brings the situation to a scandal. The final gesture - the earthly bow of the elder Dmitry - shocked everyone present. Dmitry ran out of the cell in horror, which means that he realized that the elder foresaw something terrible in his fate. The rest, leaving, out of embarrassment, did not even say goodbye to the owner. Only the hieromonks again came under the blessing. Despite the fact that they, too, were alarmed by this outburst of hostile feelings and vicious inclinations, and also worried about the condition of the sick old man, this did not break their self-control.

The young people present in the cell were respectfully silent almost all the time, their participation in the general conversation was expressed only by internal and facial expressions. So, Alyosha did not interfere in what was happening as a simple novice, but he was either ready to cry and stood with his head bowed, or his heart was beating violently. He worried both for his family and for his beloved elder. Mikhail Rakitin stood motionless, but “attentively peering and listening, although his eyes were lowered. But Alyosha guessed from the lively blush on his cheeks that Rakitin was also excited ... ". Thus, it becomes noticeable that this person is very interested in the conversation and remembers it for some purpose. As it turns out later, behind external modesty and respectfulness, this young man has his disbelief and true aspirations, that is, he is a two-faced person. Throughout the entire meeting, only Kalganov, condemning the inappropriate behavior of the father and son of the Karamazovs, following Father Joseph, dared to utter two words.

The elder patiently, keeping calm, contemplated these stormy scenes of the laity accustomed to live by the passions; just like other sinners who came with a feeling of repentance, he covered them with love. He did not denounce their vices, did not drive them out of their cell due to their immoral behavior, but argued on their topics, answered their questions, spoke in their language.

So, no secular politeness and education helped the guests of Father Zosima - they even, against their will, showed their real moral character. This happened precisely in the monastery walls, where the repentant revelation of secrets is constantly being made and there is a desire for purity, liberation from the sinful inclinations of the soul.

Thus, the elder, as a character with a high level of authority, becomes a kind of indicator in the novel, highlighting the moral state of society. Moreover, regarding the image of this virtuous person, not only human vices are revealed, but also a path is offered that frees from them. However, there was no counter movement towards the elder, the heroes of the novel preferred to remain with their views. Although even under such circumstances, the meeting with the elder left a mark in the hearts of visitors, and his image became for them an example of spiritual and moral height.

Notes

Dostoevsky F.M. Brothers Karamazov: In 2 vols. T. 1. M .: Soviet Russia. 1987. - 352 p.

Lossky N. Dostoevsky and his Christian world outlook. New York: Chekhov Publishing House. 1953. - 408 p.

E.F. Mosin

LEGAL POSITION OF THE CONSTITUTIONAL COURT OF THE RUSSIAN FEDERATION IN THE QUESTION OF TAX LIMITATION OF PROPERTY RIGHTS IN THE LIGHT OF HEGEL'S PHILOSOPHY OF LAW

The Constitutional Court of the Russian Federation, whose interpretation of the Constitution of the Russian Federation is, according to Art. 106 of the Federal Constitutional Law of July 21, 1994 No. 1-FKZ “On the Constitutional Court Russian Federation”, official and binding on all representative, executive and judicial bodies of state power, local governments, institutions, organizations, officials, citizens and their associations, has repeatedly considered the issue of limiting property rights by the constitutional obligation to pay legally established taxes - resolutions of 12/17/1996 No. 20-P, dated October 12, 1998 No. 24-P, dated July 14, 2005 No. 9-P, dated February 28, 2006 No. 2-P, dated March 17, 2009 No. 5-P, etc.

The essence of the legal position of the Constitutional Court of the Russian Federation following from these acts on the issue of tax restriction of property rights is as follows:

taxes are necessary condition the existence of the state and represent a monetary form of alienation of property based on the law in order to ensure the costs of public authority, carried out on the basis of obligation, irrevocable, individual gratuitousness;

The Constitution of the Russian Federation obliges everyone to pay legally established taxes and fees, and this constitutional obligation has a special, namely public law, and not private law (civil law) nature, which is due to the public law nature of the state and state power;

The obligation of taxpayers to pay taxes embodies the public interest of all members of society, and therefore the state has the right and obligation to take measures to regulate tax legal relations in order to protect the rights and legitimate interests of not only taxpayers, but also other members of society;

The right of private property does not belong to those rights that are not subject to restriction under any conditions, however, as the very possibility of introducing federal law restrictions of this right, and their nature are determined by the legislator not arbitrarily, but in accordance with the Constitution of the Russian Federation, according to which the rights and freedoms of a person and citizen can be limited by federal law only to the extent necessary to protect the foundations of the constitutional order, morality , health, rights and legitimate interests of other persons, ensuring the defense of the country and the security of the state;

The Constitution of the Russian Federation provides for a distinction between property that a taxpayer cannot dispose of at its own discretion, since it is subject to a contribution to the budget in the form of a certain amount of money (since otherwise the rights and legally protected interests of other persons, as well as the state, would be violated), and property located in private property, the guarantees of which are provided for in Article 35 of the Constitution of the Russian Federation, therefore, the collection of tax cannot be regarded as an arbitrary deprivation of the owner of his property, because it is a legal seizure of part of the property, arising from a constitutional public law obligation;

Since the collection of taxes is associated with the intervention of the state in the right to property, property rights, freedom entrepreneurial activity and thus - in the sphere of fundamental rights and freedoms, the regulation of tax relations should be carried out in such a way that equal performance of duties by taxpayers is guaranteed and conditions would not be created for violating their constitutional rights, as well as the rights and legitimate interests of other persons;

If, exercising tax control, the tax authorities are guided by goals and motives that are contrary to the current legal order, tax control may turn from necessary tool tax policy as an instrument of suppression of economic independence and initiative, excessive restriction of freedom of enterprise and property rights;

The forced seizure of property in the form of taxes and other payments, carried out in an improper procedure, violates the judicial guarantees for the protection of property rights, enshrined in the Constitution of the Russian Federation.

This position, outlined above using formulations borrowed from the rulings of the Constitutional Court of the Russian Federation, fully corresponds to the spirit and essence of the position taken by Hegel on the issue of tax restriction of the right to private property.

Hegel attached exceptionally great importance to the right to property, pointing out that “in the states of the new time, the provision of property is the axis around which all legislation revolves and with which most of the rights of citizens are somehow related” . At the same time, arguing that “the right to property is a high right, it is sacred”, and that “only in property does a person act as reason”, Hegel stipulated that the right to property “remains very subordinate, it can and must be violated. The state requires the payment of taxes, this requirement boils down to everyone giving away part of their property; in this way, the state deprives the citizens of part of their property ... Law is sacred, but, on the other hand, it is both the existence of freedom and, as a particularity, something that must be subordinated. The state is this subordination of law, subordination of rights to one another, subordination which is itself legal. Therefore, taxes do not violate property rights, and the demand for taxes is not something illegal. The law of the state is above the law individual person on his property and person. And as a problem: "It would be important to ascertain to what extent the right of property should be sacrificed in order to establish a stable form of republic."

Tax nihilism is a common phenomenon in all eras; The era of Hegel and the modern Russian era is no exception in this regard. The position of the Constitutional Court of the Russian Federation on this issue corresponds to the position of Hegel in his “Philosophy of Law”: “... most people consider the requirement to pay taxes as a violation of their features, as something hostile to them, preventing them from achieving their goal; however, however true it may seem to them, the particularity of the goal cannot be satisfied without the universal, and a country in which taxes would not be paid would not be able to distinguish itself by strengthening the particularity.

Drawing attention to the interest of the taxpayer in paying the tax, Hegel, at the same time, pointed out that taxes should not be turned into an instrument for suppressing the economic independence of taxpayers, excessively restricting their property rights: “Taxes, duties, etc., which constitute an obligation for me, they do not return me, but on the other hand I gain the security of my property and an infinite number of other advantages; they constitute my right. What I do is infinitely different, however, in quality from what I receive. If this value becomes unequal, does not remain identical, then a breakdown occurs in the relationship, they become untrue. And he also on this topic: “Everywhere a tax system should be introduced, the tax may seem insignificant: a little from everyone, but everywhere. If it is unreasonably high in any industry, then this industry is left: they drink less wine if high taxes are imposed on it. For everything, you need to find a type of surrogate, otherwise the need begins. But this necessity also turns against itself. The costs of levying taxes become more and more significant, the embarrassment and discontent more and more, because the use of everything is difficult and due to the presence of too many points. Accordingly, “taxes, to which the estates give their consent, should not be considered as a gift presented to the state; they are affirmed for the good of those who affirmed them.”

A more detailed comparison of Hegel's statements on the issue of the tax restriction of property rights with the position of the Constitutional Court of the Russian Federation described above shows that, to the extent that Hegel spoke on this issue, his position is close to modern views on taxation (with the exception of Hegel's clearly inadequate modern view of the role taxes in the social security of the poor: "The best remedy is to leave the poor to their fate and reconcile themselves to the fact that they are beggars").

Notes

Hegel G.W.F. Jena Real Philosophy // Hegel G.W.F. Works of different years. In 2 vols. T. 1. M., 1970.

Hegel G.W.F. Historical studies // Hegel G.W.F. Works of different years. In 2 vols. T. 1. M., 1970.

Hegel G.W.F. Philosophy of law. M., 1990.

Appendix (new sources on the "Philosophy of Law") / Hegel G.W.F. Philosophy of law. M., 1990.

societies. The works of the Tyumen school are not known...

1. "Sterlitamak State Pedagogical Russian Philosophical Society St. Petersburg Association of Philosophers International Association of Historical Psychology named after Professor

   Monograph

   In the first half of 2000 / N.A. Nosov // Bulletin Russianphilosophicalsocieties, 2000, - No. 4. - P. 53 - 54. Nosov, ... on II Russianphilosophical congress (Ekaterinburg, June 7-11, 1999) / N.A. Nosov // Bulletin Russianphilosophicalsocieties. − ...

2. OF THE RUSSIAN ACADEMY OF SCIENCES Main areas of research bibliography

   Document

   Department of Philosophy. Member Russianphilosophicalsocieties, Russian Association of Political Science, ... graduated with honors philosophical Faculty of USU. Member Russianphilosophicalsocieties, Russian political science associations. Protected...

3. Metamorphoses of the ethos of the Russian philosophical community in the XX century Ulyanovsk 2008

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   V.A. Bazhanov Baranets, N.G. B 24 Metamorphoses of ethos Russianphilosophical communities in the XX century: monograph. : at 2 o'clock - ... Russianphilosophical congresses. played an active role in their organization. Russianphilosophicalsociety(I.T. Frolov...

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

Kazan State Medical University

Department of Biomedical and Medical Law with a course in the history of medicine

TEST

in Biomedical Ethics

on the topic: History of medical ethics in Russia

Completed by: 1st year student

Correspondence department of the faculty of the MVSO,

Groups No. 811

Zalaldinova A.R.

Checked by _________________________

Passed (not passed)

Kazan, 2010

Introduction ……………………………………………………………………...
Chapter 1. The origin of professional medical ethics in Russia ……………………………………………………………………………
1. 1. Founder of domestic therapy Mudrov M.Ya. (1776 - 1831)………………………………………………………………………..
1.2. MD Gaaz F.P. (1780-1853)……………………………
1.3. A younger contemporary Pirogov N.I. (1811-1881)………………….
1.4. The leader of clinical medicine Botkin S.P. (1832-1889)………
1.5. An outstanding domestic clinician Zakharyin G.A. ( 1827- 1897) ……………………………………………………………………………..
1.6. Student of S.P. Botkina Manassein V.A. ( 1841-1901)…………………
1.7. Attitude towards medical secrecy and euthanasia Koni A.F. (1844-1927).
1.8. The success of the book by V.V. Veresaev (1867-1945) “Doctor’s Notes”…………...
Chapter 2. Medical ethics in the period of Soviet power …………………
2.1. The first years of Soviet power ………………………………………..
2.2. Problems of medical secrecy …………………………………………
2.3. Denial of medical ethics ……………………………………..
2.4. Rehabilitation of medical ethics ……………………………………
Conclusion …………………………………………………………………..
List of used literature ……………………………………….

Introduction

Relevance The chosen topic is due to the following circumstances. The relevance of studying the history of medical ethics is manifested, firstly, in the need to understand modern medical ethics, based on past experience; secondly, in the ability to foresee the future development of medical ethics in Russia, having clarified historical patterns and found similar situations in the history of the past.

The peculiarity of medical ethics lies in the fact that in it, all norms, principles and assessments are focused on human health, its improvement and preservation, which increases the importance of studying the history of the development of medical ethics.

Medical deontology (from the Greek deontos - due, proper and logos - teaching) is the science of the professional behavior of a medical worker. The term "deontology" itself was coined at the beginning of the 19th century by the English philosopher Jeremy Bentham to refer to the science of professional human behavior.

Central to medical deontology is the problem of the relationship "doctor - patient". These relationships are mainly determined by the "personal qualities of the doctor, his moral principles, personal morality.

Medical deontology studies: the principles of behavior of medical personnel aimed at maximizing the effectiveness of treatment;

problems of exclusion of unfavorable factors in; professional behavior of medical workers; the system of relationships between medical personnel and the patient, as well as within the medical team.

The most outstanding works of the Ancient World, which raise questions of deontology, are: “On the Nature of Life” by the Chinese physician Huang Di Nemjin, “The Science of Life” by the ancient Indian physician Sushruta, “Instructions”, “On the Physician” by Hippocrates, the works of Galen, Celsus, Avicenna .

In the Middle Ages, all science was the servant of theology. The direction of medicine and its teaching were for a long time almost in the hands of the clergy.

With the formation of the Moscow state, the development of the economy and culture of Russia accelerates. In the 16th century, medical care was provided to the population for a fee by folk doctors who had shops selling various healing herbs.

In Russia, before the reign of Boris Godunov, there were no professional doctors even in the troops. And ignorance in the treatment led to sad consequences. The responsibility of the doctor for the unfavorable outcome of treatment was legalized by Peter I in the Naval Charter. Management through colleges, and not through orders, was introduced in Russia by order of Peter I from 1720. Since 1720, the supreme body of medical management was called the Pharmaceutical Office, and it regulated the activities of doctors. In the 19th century, teachers of the Medico-Surgical Academy in St. Petersburg and Moscow University paid great attention to the issues of medical deontology. The largest clinician-therapist of the first third of the XIX century. M.Ya. Mudrov taught doctors to be modest and attentive, to treat patients with love. Mudrov, analyzing the Hippocratic oath, believed that it could be a code of conduct for a Russian doctor. Self-sacrifice, asceticism are characteristic features of Russian physicians. Physician writers such as A.P. Chekhov, M.A. Bulgakov, V.V. Veresaev, N.P. Pavlov, S.P. Botkin wrote about this.

With the development of capitalism, the relationship between the doctor and the patient acquired the character of a sale. In such a society, the situation of the poor was the most difficult, and the possibility of assistance was minimal. The theorist of the American Medical Association of Physicians Dickinson argues that the doctor is basically a small businessman. He sells his services just like any other businessman selling a commodity.

In recent decades, issues of deontology have become the subject of discussion at international medical forums. In 1953, the First International Congress of Physicians was held in Vienna, where the important social significance of medicine was pointed out. By the nature of his profession, the doctor must look after the health of every person with complete impartiality, regardless of gender, creed, and philosophical or political convictions.

With the rapid development of medicine, scientific and technological progress in medical deontology and medical ethics, such sections have been created as:

Elements medical deontology;

· Elements of deontology in the activities of middle and junior medical personnel;

· Deontology and organization of the work of a medical institution;

· Deontology and scientific and technological progress;

Deontology in clinical medicine;

· Deontology and medical documentation;

· Deontology in research work.

Target of this work: to explore the history of medical ethics in Russia.

To achieve this goal, it is necessary to solve the following tasks :

1. Consider the history of the origin of professional medical ethics in Russia;

2. To study the development of medical ethics during the Soviet era.

Chapter 1

medical ethics in Russia

1.1. The founder of domestic therapy Mudrov M.Ya. (1776-1831)

The first translations into Russian of certain works of Hippocrates (“Oath”, “Law”, “Aphorisms”) appeared in Russia in printed form only in 1840. However, several decades earlier, Hippocrates persistently propagated at the medical faculty of Moscow University M.Ya.Mudrov (1776-1831).

The founder of Russian therapy M.Ya. Mudrov was not only a famous Moscow doctor, but also an outstanding figure in Moscow University. M.Ya. Mudrov has the honor of restoring the Faculty of Medicine after a fire and looting of the University in 1812, through his efforts, for the first time in the history of the University, a clinical base (Clinical Institute) was created, the Faculty elected him as its dean five times. In connection with the consecration of the Faculty of Medicine in 1813 and the opening of the Clinical Institute in 1820, M.Ya. , but with the mellifluous lips of Hippocrates ... in order ... to more captivate your mind into obedience and study of the Prince of Physicians and the Father of Medical Science. And further: "This chapter should be read on your knees..."

Medical ethics, according to M.Ya. Mudrov, anticipates all medicine: a statement of the "duties" of doctors and "strong rules that serve as the basis for an active medical art", he begins with ethical instructions. Ethics of Hippocrates respect for the patient in the mouth of M.Ya. Mudrova sounds like this: “Starting with love for your neighbor, I should inspire you with everything else that stems from one medical virtue, namely, helpfulness, readiness to help at any time, day and night, friendliness that attracts both the timid and the brave. , mercy to the sensitive and the poor; ... condescension to the errors of the sick; meek strictness to their disobedience ... ".

Ultimately, the solution of all issues that arise in the relationship between the doctor and the patient, M.Ya. Wise, as it were, reduces to a common denominator - gaining patient confidence“Now you have experienced sickness and know the sick; but know that the patient has tested you and knows what you are. From this you can conclude what patience, prudence and mental exertion are needed at the patient’s bed in order to win all his power of attorney and self-love, and this is the most important thing for a doctor.

In Russia, the development of medical ethics took place, of course, under the influence of those ideas that were in Europe, but with some peculiarities. Translations of certain works of Hippocrates into Russian appeared only in 1840. However, much earlier, Hippocrates was persistently promoted at the medical faculty of Moscow University by M.Ya. Wise (1776-1831).

M.Ya. Mudrov, discussing medical ethics in his work “A word on the method of teaching and learning practical medicine in the beds of the sick,” said: “... keeping secrets and secrecy in case of reprehensible illnesses ... silence about heard and seen family disorders ... cordial acceptance of good advice, from whomever he did not go; convincingly rejecting harmful suggestions and advice; removal from superstitions. M.Ya. Mudrov in his statement emphasizes the elements of philanthropy in the activities of a doctor, believing that disinterestedness should be inherent in choosing this profession. This echoes the ideas about the ethics of the doctor Hippocrates, Avicenna and Paracelsus, i.e. is a kind of fusion of those productive thoughts about the ethics of the doctor that have been promoted in the past.

Medical ethics, according to M.Ya. Mudrov, anticipates all medicine: a statement of the "duties" of doctors and "strong rules that serve as the basis for an active medical art", he begins with ethical instructions.

The position of the Hippocratic ethics on respect for the patient in the mouth of M.Ya. Mudrova sounds like this: “starting with love for your neighbor, I should inspire you with everything else that stems from one medical virtue, namely, helpfulness, readiness to help at any time, day and night, friendliness that attracts both timid and courageous, mercy to the sensitive and the poor; ... condescension to the errors of the sick; short strictness to their disobedience ... your outfit should be like this: that you got up, you are ready. Not only in a waking state, but also in the very sleep of your exhausted body at the bed of a sick person, you are awake in spirit, hear his breathing, listen to his demands, cough, delirium, hiccups; and wake up from your waking sleep."

The younger contemporary M.Ya. Mudrova was N.I. Pirogov (1811-1881). Soon after graduating from Moscow University, N.I. Pirogov begins to work as a professor and head of the Department of Surgery at the University of Tartu. His first year report is of exceptional importance in the context of the history of medical ethics. The report addresses one of the most important issues professional ethics doctor - the problem of medical errors. According to Pirogov, doctors should make the most of their professional mistakes, enriching both their own experience and the overall experience of medicine. He believed that such a moral position could compensate for the "evil of medical errors."

The recognized leader of clinical medicine in Russia was S.P. Botkin (1832-1889), who headed the Department of Therapeutic Clinic at the Military Surgical Academy for almost 30 years, and from 1878 until the end of his life - the Society of Russian Doctors. N.I. Pirogov.

S.P. Botkin in his "Clinical Lectures" touches on various issues of medical ethics. For example, his solution to the problem of informing hopeless patients is given here in the spirit of medical paternalism: “I consider it impermissible for a doctor to express doubts to a patient about the possibility of an unfavorable outcome of the disease ... The best doctor is the one who knows how to inspire the patient with hope; in many cases it is the most effective remedy."

The most prominent place in the history of medical ethics in Russia belongs to V.A. Manassein (1841-1901). He was a student of S.P. Botkin and for 20 years headed the Department of Private Therapy at the St. Petersburg Medical and Surgical Academy. Not only in the medical environment, but also in society as a whole, Manassein waned the title of “knight of medical ethics”, “conscience of the medical class”.

Manassein believed that doctors should be fundamentally opposed to the death penalty and corporal punishment, because otherwise their function would be in irresolvable contradiction with their mission in society, with their professional ethics.

Various manifestations of non-collegiate relations of doctors to each other were subjected to fundamental criticism - the nobility of some professors in relation to their employees; deviations of individual doctors from the ancient custom of their profession - to treat for free; slander against colleagues, sometimes acquiring monstrous forms.

Manassein stood for the absolute preservation of medical secrecy under all circumstances ... "To be silent ... the doctor does not have the right to give out secrets that he learned through his profession, this is a betrayal of the patient ...".

Modern stage historical development ethical teachings was marked by the formation in the second half of the twentieth century of a new doctrine - bioethics.

The term "bioethics" was coined by the American biologist V.R. Potter in 1971. Initially, bioethics was understood as a check on the ethical consistency of all biological sciences. In the future, the meaning of the term began to be associated mainly with clinical medicine. Bioethics is the experience of philosophical, ethical understanding of the so-called problem situations or problems of conflict of interest that have arisen over the past 40 years. We are talking about a complex of problems associated with dying, medical intervention in human reproduction, the admissibility of using modern methods medical genetic control, etc.

Control questions to check the final level of knowledge of students:

1. What does the term deontology mean?

b) gaining social trust of the individual

c) obligations to teachers, colleagues, students

d) a set of "proper" rules

2. The basic principle of Hippocratic ethics:

a) do no harm

b) keep duty

c) do good

3. The main principle of biomedical ethics:

a) respect for human rights and dignity

b) defense of justice

c) helping a person - do not harm him

4. Morality is:

a) a science that studies the psycho-emotional sphere of human life

b) a set of norms, ideals, principles that regulate people's lives, in the form of unwritten rules

c) the science of morality.

5. Professional ethics is:

a) a set of moral norms that determine the attitude of a person to his professional duty

b) a science that studies the rules of relationships in a team

c) rules and principles to improve the quality of work

6. The main reasons for the emergence of bioethics:

a) scientific and technological progress with its positive and negative impacts on people's lives

b) conducting inhumane experiments during the Second World War

c) increasing the requirements for the quality of medical care

7. Professional ethics studies:

a) relationship labor collectives and each specialist separately;

b) moral qualities of the personality of a specialist,

c) relationships within professional teams

d) features of professional education.

8. Bioethics considers the problems of modern medicine:

a) at the level of conflict of interest

b) in terms of disease prevention

c) within the framework of the usefulness or harmfulness of introducing scientific innovations into medical practice

9. Percival was the first to recognize the physician's obligation:

a) not only to patients, but to society as a whole

b) be responsible for the adverse outcome of treatment

c) for the results of ongoing scientific research

10. The basis of medical ethics is:

a) humanism

b) professionalism

c) pragmatism

Sample answers: 1 - d; 2 - a; 3 - a; 4-b; 5 - a; 6 - a; 7 – a, b, c, d; 8 - a; 9 - a; 10 - a.

CHAPTER 2

Theoretical Foundations of Biomedical Ethics. Basic ethical theories and principles of biomedical ethics.

I. The purpose of the lesson:

1. Get acquainted with the history of the emergence and development of the main ethical theories and principles of biomedical ethics.

2. To study the main models of relationships in the doctor-patient system.

3. Familiarize yourself with current trends in biomedical ethics.

II. Motivational characteristic of the topic:

In modern conditions, medicine plays a very important role in the life of society. Therefore, the relationship between medical workers and their patients goes beyond the usual domestic or industrial relations between people. They require knowledge and adherence to the changed principles of ethics of the doctor and the patient, some legal aspects of regulating their relationship, and in order to successfully apply the knowledge gained in practice, you need to know the history of their occurrence.

III. Lesson equipment:

2. Tasks on the topic of classes.

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

1. Is pregnancy a reason why a person cannot be hired?

2. What is the name of the situation when the doctor is obliged to protect the interests of both the patient and the second person?

a) Litigation

b) Investigative work

c) Conflict of interest

a) Paracelsus

b) Epicurus

c) Hippocrates

d) Plato

4. Inventor of the "do good" principle?

a) Pythagoras

b) Aristotle

c) Paracelsus

d) Wise

5. Is the doctor always obliged to act in the interests of the patient?

6. What is the main moral principle of bioethics?

a) Respect for human rights and dignity

b) Winning the social trust of the individual

c) Obligations to teachers, colleagues, students

d) The set of "proper" rules

7. Are there any rules governing informing the patient about his disease?

8. What name is associated with an ethical model built on mercy and love for one's neighbor?

c) Bentham

d) Paracelsus

9. What is informed consent?

a) It is a way to protect the right to choose

b) It is getting complete information

10. About whom C.T. Jung wrote: “In him we see not only the pioneer in the field of chemical drugs, but also in the field of empirical mental treatment.”

c) Bentham

d) Paracelsus

Sample answers: 1-b; 2-in; 3-in; 4-in; 5-a; 6-a; 7-a; 8-d; 9-a; 10th

Bioethics is an important stage in the growth of philosophical knowledge, the formation and development of bioethics is associated with the process of transformation of traditional ethics in general and medical ethics in particular. It is due, first of all, 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 acute problems that require legal and moral regulation.

The development of bioethics in Russia can contribute to the humanization of domestic medicine, the ethical self-awareness of the medical professional community, help to form new ethical regulators for the medical professional community, to realize the moral conflicts and dilemmas that biologists, doctors, and psychiatrists face in their work. The formation of bioethics in our country is different directions. Among them, the main one should be legislative regulation biomedical research and healthcare practice. Especially in areas such as transplantology, determination of the moment of death, the limits of life-sustaining treatment for the terminally ill, the use of new methods of intervention in human reproduction, etc. Important role should play the creation of ethical committees and commissions in research and medical institutions. In the formation of the ethical self-awareness of the medical community, the introduction of bioethics courses in medical educational institutions all levels. And finally, support for research work on bioethics. A lot has been done in 1991-1993. The Russian National Bioethics Committee was created. Within the framework of the Moscow Philosophical Foundation, an association for bioethics has been formed. The law "On protecting the health of citizens of the Russian Federation" was adopted.

unfolding research on bioethical issues. Lawyers, philosophers, and doctors of various specialties are actively involved in the discussion.

The formation of bioethics is due, first of all, to those grandiose changes that have taken place in the technological re-equipment of modern medicine, cardinal changes in medical and clinical practice, which have found their expression in the successes of genetic engineering, organ transplantation, biotechnology, and maintaining the patient's life. All these processes in an unprecedented way exacerbated the moral problems facing the doctor, the relatives of patients, and the medical staff.

Are there limits, and what are they, in keeping a terminally ill person alive? Is euthanasia allowed? When should death be considered? At what point can a fetus be considered a living being? Are abortions allowed? Or is abortion the killing of living beings? These are just some of the questions that arise before the doctor, and before the general public in the conditions of unprecedented technological equipment of modern medicine in developed countries Oh.

First of all, they try to identify bioethics with biomedical ethics, limiting its content to the ethical problems of the doctor-patient relationship. There is also a broader understanding of bioethics, which includes a number of axiological problems. professional activity, a number of social problems related to health systems and, finally, problems related to human relations with animals and plants. Thus, bioethics includes the ethical regulations of the attitude towards animals and the range of problems that previously belonged to environmental ethics. In addition, the term "bioethics" indicates that it focuses on the study of living beings, whether they find their application in therapy or not. In other words, bioethics focuses on the achievements of modern biology in substantiating or resolving moral conflicts that arise in the course of scientific research.

There are a number of research centers for bioethics. Among them, the most famous are the Hastings Center near New York (USA), the Center for Bioethics at the Medical Research Institute of Montreal (Canada), the Center for Bioethics at the University of Toronto (Canada), the Institute for Ethics founded by Kennedy at Georgetown University ( USA). A number of national and international journals are published. In 1978, the publication of the Encyclopedia of Bioethics began. 15 volumes of the international bibliography on bioethics prepared by the Hastings Center (USA) have been published. We can say that this is a very intensively developing research area. In which philosophers, biologists, physicians, theologians from the USA, Canada, France, Germany, Great Britain collaborate. This, unfortunately, cannot be said about Russia. Meanwhile, the crisis of the healthcare system in our country exacerbates ethical and legal problems in medical science and practice, gives rise to conflicts, both in the organization of health care, and in the behavior and consciousness of the individual. The methods of administrative control and regulation, on which the former healthcare system in our country was based, were supplemented by paternalistic norms of deontology, which did not take into account at all, or rather, completely ignored the value orientations of various ethnic and confessional groups that had different attitudes to life and death, to health and illness, to childhood and old age. The development of bioethics in Russia can help our society adapt to the new system of insurance medicine, will allow developing value orientations of the individual that would correspond to human rights, the life and dignity of citizens, and the fundamental humanistic values ​​of mankind. The development of bioethics in our country involves understanding the traditions that existed in ethical thought in Russia, analyzing them philosophical foundations and the horizons that they open up in a person's new relationship to life.

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Outlining briefly the history of medical ethics in Russia, first of all, it should be said about M. Ya. Mudrov - the first third of the 19th century. Permanent dean of the medical faculty of Moscow University. He was re-elected 5 times, the translator of Hippocrates - Mudrov told students about his works: "This chapter must be read on your knees!" Mudrov's ethical instructions first concern the way of life of doctors: cleanliness, neatness of clothes, housing, special requirements for their speech and what is in modern nursing called "body language". Further, Mudrov speaks of the necessary moral qualities of a physician: “... readiness to help at any time, day and night, ... selflessness, condescension to the errors of the sick, ... polite importance with the highest: talking only about what is necessary and useful, ... gaiety without laughter and jokes in the happy course of the disease; keeping secrets and secrecy in case of reprehensible diseases; silence about seen or heard family disorders, ... cordial acceptance of good advice, ... removal from superstition ... ". Here is how Mudrov solves the issue of informing terminally ill patients: “To promise healing in an incurable disease is a sign of either an ignorant or dishonest doctor.” Finally, let us cite Mudrov’s words about the calling of a physician: “Whoever does not want to follow this difficult path, who does not want to carry this title with diligence until the end of his days, who is not called to it, but fell into it, having stumbled, leave these sacred places in advance and return home." Almost fifty years of life in Russia, the medical and social activities of the German physician devout Catholic Friedrich Joseph Haas (first half of the 19th century) is a true example of moral genius in human history. He liked to say: "I am a Christian first, and then a doctor." He is widely known for his motto: "Hurry to do good!". In 1994, Moscow Catholics raised the issue of official canonization by the Roman Catholic Church of "Saint Doctor Fyodor Petrovich," as he was called in Russia. The main lesson of medical ethics left to us by Dr. Haas, who for a quarter of a century was the chief physician of Moscow prisons: prisoners also have the right to humane treatment and quality medical care. In 1982, the UN General Assembly officially approved the "Principles of Medical Ethics", which made such an approach to prisoners a norm of international law.

As you know, the formation of an independent nursing profession took place in the 19th century, and Russia, along with Great Britain, played a leading role here. In 1822, X. Opel publishes the “Guidelines and Rules on how to go after the sick, in favor of everyone involved in this business, and especially for compassionate widows who have dedicated themselves to this title”, in which he defines the mission of nursing: “Without proper walking and the most skillful physician can do little, or even none, in the restoration of health or the aversion of death ... the one who walks is a performer or only a necessary tool, on whose fidelity and accuracy much depends on the success of healing ... ". A special page in the history of Russian medicine is the movement of sisters of mercy that arose during the Crimean War (1853-1856). N.I. Pirogov wrote about sister of mercy E.M. Bakunina: “She became an example of patience and tireless work for all the sisters of the community. Her whole personality breathed truth. Complete harmony reigned between her feelings and her actions. She was exactly an ingot of everything sublime. But the words of I.S. Turgenev about Baroness Y. Vrevskaya, who died of typhus during the Russian-Turkish war (1877-1878): “Such strength, such a thirst for sacrifice. Helping those in need of help ... she did not see another happiness. And all, blazing with the fire of unquenchable faith, gave herself to the service of others.

For the last two decades of the 19th century, the Vrach newspaper, created by V.A. Manassein whom contemporaries called "the knight of medical ethics." Manassein was a principled unmercenary, he created a kind of "mutual assistance fund" for physicians, each doctor sent 1 ruble annually to the editorial office of the "Doctor" - the famous "Manasein ruble". The Vrach newspaper discussed issues of medical ethics that are still relevant today: the ethical standards of experimental medical research, especially on dying prisoners; exposure of "shameless deceptive medical advertising"; the incompatibility of the mission of medicine with its participation in the death penalty; deviations of individual doctors from the ancient custom - to treat colleagues for free, etc. Particularly characteristic is Manassein's view of a medical secret, which, from his point of view, should not be disclosed under any circumstances as a secret of confession. A different position was defended in Russia in those years by the largest lawyer A.F. Koni: medical secrecy, like lawyer, commercial, etc., is a mandatory secret, but in special cases, for example, when investigating crimes, exceptions should be made for it.

At the very beginning of the 20th century, “Notes of a Doctor” by V.V. Veresaev was first printed - a work whose significance for medical students cannot be overestimated. Here we find in an artistic and journalistic form the captured experience of the soul of a young man, step by step entering the world of medicine. Among the many topics of this book that are relevant to this day, we note the following: methods and criteria for the quality of training specialists in medicine; prestige and authority of medicine; professional medical errors; moral and ethical aspects of autopsies; the "price" of experimental medical research on humans, etc.

SEMINAR № 8. HISTORY OF MEDICAL ETHICS IN RUSSIA
Seminar plan:

1. Formation of medical ethics in Russia XIX v.

2. Medical ethics in the USSR

4. Medical ethics in modern Russia

Topics of reports:

1. Ethical views of N.I. Pirogov

2. Problems of medical ethics in V.A. Manassein

3. Physician ethics in Soviet healthcare

4. The main biomedical problems of modern Russian healthcare

The main concepts of the topic (write out definitions in a notebook):

mercy, euthanasia, etiquette, philanthropy, altruism, authoritarianism, totalitarianism, medical experiment.

Explanatory note to seminar No. 8.

1. 
   Formation of medical ethics in Russia in the 19th century.

The first translations into Russian of individual works of Hippocrates (“Oath”, “Law”, “Aphorisms”) appeared in print only in 1840. However, several decades earlier, Hippocrates was persistently promoted at the medical faculty of Moscow University by M.Ya. Wise (1776-1831).

Medical ethics, according to M.Ya. Mudrov, anticipates all medicine: a statement of the "duties" of doctors and "strong rules that serve as the basis for an active medical art", he begins with ethical instructions. The position of the Hippocratic ethics on respect for the patient in the mouth of M.Ya. Mudrova sounds like this: “Starting with love for your neighbor, I should inspire you with everything else that stems from one medical virtue, namely, helpfulness, readiness to help at any time, day and night, friendliness that attracts both the timid and the brave , mercy to the sensitive and the poor; ... condescension to the errors of the sick; meek severity to their disobedience ... Your outfit should be like this: when you get up, you are ready. Not only in a waking state, but also in the very sleep of your exhausted body at the bed of a sick person, you are awake in spirit, hear his breath, listen to his demands, moaning, coughing, delirium, hiccups; and wake up from your waking sleep."

M Ya. Mudrov emphasizes the elements of philanthropy in the professional activities of a doctor, believing that one who chooses this profession should be characterized by disinterestedness. The corresponding place in the book of Hippocrates "Instructions" in the translation of M.Ya. Mudrova sounds like this: "...Sometimes treat for nothing at the expense of future gratitude, or, as they say: not from profit, glory would be good ..."

In several places of his "Words on the way to teach and learn practical medicine" M.Ya. Mudrov speaks of medical secrecy: silence about seen or heard family disorders ... Curb your tongue, this small but daring ud, for unsimilar verbs and words of slyness.

The attitude towards hopelessly dying patients is considered by M.Ya. Mudrova in different aspects. The theme of the dying patient is part of his clinical and theoretical ideas: “We see four types of diseases: some are curable, others are incurable; some are useful for maintaining general health, others threaten health and life. Diagnosis of an incurable disease, determination of a fatal prognosis, when such a case occurs to a doctor, is also the doctor’s professional duty: “Be ready to answer the most difficult questions with which his relatives are waiting for you in another room, questions: about the outcome of the disease, about imminent danger , or impending death. Relatives of the patient need this, "so that in the event of an impending danger, they gradually prepare and think about their future lot." And the correct prediction saves the doctor from "family reproaches" and always helps to strengthen his authority.

Regarding informing doomed patients, M.Ya. Mudrova has conflicting recommendations. The “Sermon on the Piety and Moral Qualities of the Hippocratic Doctor” says: “Much must be hidden from the patient, always enter him with a cheerful, impressive face ... but do not reveal the present state of the disease and its future outcome ...”. In the “Word on the Way to Teach and Learn Practical Medicine...” (mainly containing the author’s own medical-theoretical and ethical judgments), we read: “Promising a cure in an incurable disease is a sign either of an ignorant or dishonest doctor.” This contradiction fixes one of the ethical dilemmas (of particular relevance in modern medicine): respect for the moral autonomy of the individual (including the right of any patient to information), on the one hand, and the humane nature of respect (of the doctor, those around him) to the fear of death in the soul of almost everyone person, on the other. In the very general view at M.Ya. Mudrova has an idea of ​​palliative care for hopeless patients: "Relief of an incurable disease and continuation of the patient's life." Ultimately, the solution of all issues that arise in the relationship between the doctor and the patient, M.Ya. but know that the patient has tested you and knows what you are. From this you can conclude what patience, prudence and mental exertion are needed at the bedside of a patient in order to win all his power of attorney and love for himself, and this is the most important thing for a doctor.

In his ethical instructions, M.Ya.Mudrov pays much attention to the topic of the doctor's attitude to his profession. The well-known aphorism of M.Ya.Mudrov - “In the art of medicine there is no doctor who has completed his science” contains both the idea of ​​continuous professional education of medical specialists and the problem of their postgraduate training, fully realized only in the future.

A true doctor cannot be a mediocre doctor: “... a mediocre doctor is more harmful than useful. The sick, left to nature, will recover, and those used by you will die. And from here follows his advice to the student, if he is not ready to comprehend a huge array of medical knowledge, to master the most difficult secrets of medical art: “Who does not want to go to perfection in this difficult way, who not called to it, but fell into it stumbled, leave these sacred places in advance and return home.

Discussing the issues of intercollegiate relations of doctors, M.Ya. Mudrov says that every honest doctor in case of professional difficulties will turn to a fellow doctor for help, and a smart and benevolent doctor will not vilify his colleagues out of envy.

Directly following Hippocrates, M.Ya. Mudrov says about his teachers: “For good advice and wise instructions to the doctors Frez, Zybelin, Keresturius, Skiadan, Politkovsky, Minderer, and I bring here worthy incense.”

In a certain sense, the whole life and especially the death of M.Ya.Mudrov "has the dignity of an ethical argument" (as A.A.Guseinov said about the life of the most famous doctor of the 20th century A.Schweitzer). M.Ya.Mudrov died in the summer of 1831 during a cholera epidemic. He became infected after many months of work, treating cholera patients and organizing measures to combat the epidemic, first in the Volga region, and then in St. Petersburg. The inscription on his tombstone, in particular, reads: “Under this stone is buried the body of Matvey Yakovlevich Mudrov ... who ended his earthly career after a long-term service to humanity on the Christian feat of giving help to those infected with cholera in St. Petersburg and fallen victim of his zeal from it.”

The brightest page in the history of Russian medicine is the medical and social activities of F.P. Haaz (1780-1853), known for his aphorism: “Hurry to do good!” A young German doctor, doctor of medicine Friedrich Josef Haas arrived in Russia as a family doctor to Princess Repnina in 1806, then he went with the Russian army from Moscow to Paris as a military doctor, returned to Moscow, where in 1825-1826. was appointed stadt-physicus (chief physician) of Moscow, and from 1829 until his death in 1853 he was secretary of the Prison Guardianship Committee and chief physician of Moscow prisons.

The half-century medical activity of Haaz in Russia, who is used to being called Fedor Petrovich here, earned him the fame of the “holy doctor”. F.P. Haaz gained his legendary fame thanks to his selfless work in the Committee for the Guardianship of Prisons. This wonderful doctor, who willingly treated the nobility, gave all his strength to the most disadvantaged - exiles, convicts, etc.; in the conditions of the then socio-political organization and the then state of the medical services in Russia, he sought to protect the special rights of prisoners to protection, protection of their health and medical care; through his efforts, the “Police Hospital” was built for sick vagrants and prisoners (at the end of the century it was given the name of Alexander III, but in Moscow everyone called it Gaazovsky); everywhere he tirelessly introduced the arrangement of bathrooms and separate retreats (toilets) for men and women; ten years lasted his struggle with the Ministry of Internal Affairs for the abolition of the so-called "rod" (the exiles walking along the stage were chained in pairs to a long iron stick - alternating men and women); he designed lightweight shackles, conducting an experiment on himself - is it possible, being shackled on the legs and arms, to walk 5-6 miles, etc. etc.

It should be emphasized that the activities of F.P. Haase was carried out several decades before the emergence in 1859-1863. International Red Cross Movement, which set the task of helping all the wounded during the hostilities - regardless of citizenship, nationality, etc. And even more so F.P. Haas anticipated the adoption of many modern documents of international law, prohibiting any form of cruel, inhuman treatment of people and, in particular, emphasizing the role of doctors and medical personnel in this.

Let us give at least a few examples based on documents characterizing the highest level of medical ethics of F.P. Haaz. In the autumn of 1830, an epidemic of cholera began in Moscow (the same one that took the life of M.Ya. Mudrov): “The first cholera patient was brought to the hospital ... Here, colleagues,” said Haaz, “our first patient ... Hello, my dear , we will treat you, and with God's help you will be healthy. Leaning towards the patient, who was trembling with chills and convulsions, he kissed him.

In addition to the therapeutic optimism so needed by the doctor, in addition to instilling in the patient the faith in recovery that is so necessary, there is another important point here: the duty of the doctor is to fight panic moods, overcome the horror and phobias before the epidemic in the mass of the population.

One more example. In 1891, Professor Novitsky told about an incident he had witnessed in his youth. It was an 11-year-old peasant girl whose face was affected by the so-called "water cancer" (which destroyed half of the face along with the skeleton of the nose and one eye within 4-5 days). Destroyed, dead tissue spread such a stench that not only medical staff, but the mother could not stay in the ward for any length of time. “One Fedor Petrovich, who was brought by me to a sick girl, stayed with her for more than three hours in a row and then, sitting on her bed, hugged her, kissing and blessing. Such visits were repeated in the following days, and on the third - the girl died ... ". In the context of medical ethics proper, attention should be paid to the religious origins of F.P. Haaz's worldview: "I am first of all a Christian, and then a doctor." From our point of view, the peculiarity of the spiritual structure of the personality of F.P. Haaz was that for him, as it were, there was no phenomenon of doubling morality - a gap existing in any society between the moral ideal (due) and real mores (existing). F.P. Haaz did not leave works on medical ethics, but his very life is the personification of medical duty.

The younger contemporary of M.Ya.Mudrov and F.P.Gaaz was N.I.Pirogov (1811-1881). Soon after graduating from Moscow University, namely in 1836, N.I. Pirogov began to work as a professor and head of the surgical clinic at Derpt (Tartu) University. His report for the first year of work in Dorpat is extremely important in the context of the history of medical ethics. The report deals with one of the most acute problems of professional ethics of a doctor - the problem of medical errors. In the preface to the first issue of the Annals surgical department clinic of the Imperial Derpt University "(1837) N.I. Pirogov writes:" I considered ... my sacred duty to tell readers frankly about my medical activity and its results, since every conscientious person, especially a teacher, must have a kind of inner need make your mistakes public as soon as possible in order to warn other people who are less knowledgeable from them.

Before entering the ancient anatomical theaters, even today you can read the aphorism "Here the dead teach the living." The attitude of N.I. Pirogov to medical errors encourages us to deepen the meaning of this maxim in the moral and ethical sense. Yes, medical errors are bad. But the one who stops at the pessimistic and apathetic statement "medical errors are inevitable" is in a position of ethical surrender, which is immoral and unworthy of the title of a doctor. According to N.I. Pirogov's "Annals", physicians should extract the most instructive from their professional mistakes, enriching both their own experience and the total experience of medicine. N.I. Pirogov believed that such a moral position could compensate (redeem) "the evil of medical mistakes."

It is significant that as an epigraph to the Annals, the author quotes from Rousseau's Confessions. "Annals" by N.I. Pirogov is also a confession. However, what for Rousseau was the spiritual feat of the philosopher, N.I. Pirogov makes professional ethical standard doctor. That is, in N.I. Pirogov, the atonement for the “evil of medical errors” is supplemented by one more condition - merciless self-criticism, absolute honesty with oneself. It turns out that we are talking about following the moral norm, which requires a spiritual feat from a doctor. I.P. Pavlov wrote about the very fact of the publication of the Annals by N.I. Pirogov: “Such merciless, frank criticism of oneself and one’s activities is hardly found anywhere else in the medical literature. And this is a great merit! As a doctor next to a patient who puts fate in your hands, and in front of a student whom you teach in mind is almost always overwhelming, but, however, an obligatory task - you have one salvation, one dignity - this is truth, one undisguised truth.

In the light of trends in the development of medical ethics at the end of the 20th century. it is necessary to pay attention to the ethical content of the principles of "sorting" the wounded, proposed by N.I. Pirogov during the Crimean War of 1853 - 1856. Recalling in 1876 the origin and organization of the movement of Russian sisters of mercy, N.I. Pirogov, in particular, says that assistance to the wounded in the besieged Sevastopol was carried out in such a way that all of them, upon admission, “were sorted by type and degree of illness” into: 1) requiring urgent operations; 2) lightly wounded, receiving medical care and immediately transported to hospitals for aftercare; 3) in need of operations, which, however, can be performed in a day or even later; 4) hopelessly ill and dying, whose help (“last care and dying consolations”) was carried out only by the sisters of mercy and the priest. We find here an anticipation of the ideas of modern medical ethics - the refusal of extraordinary therapy (passive euthanasia) with a fatal prognosis and the right of a hopelessly ill patient to die with dignity.

The approach of N.I. Pirogov to the problem of medical errors has become a kind of ethical standard for his students and followers. Let's give two examples. A well-known professor of obstetrics and gynecology (head of the department of the St. Petersburg Medical and Surgical Academy) A.Ya. Krassovsky operated on a young woman with a giant ovarian cyst. The patient died 40 hours after the operation. At the autopsy, it turned out that the doctor left a sponge swab in the abdominal cavity. A.Ya. Krassovsky described this case in detail in the popular medical journal Medical Bulletin (No. 1, 1870), methodically discussing the following questions: “1. When and how did the sponge enter the abdominal cavity? 2. Have proper precautions been taken to ensure that all sponges are removed from the abdomen in time? 3. To what extent could the sponge be the cause of the unfortunate outcome of the operation? 4. What measures should be taken to avoid similar cases in the future? In conclusion, the doctor-scientist recommends counting the sponges before and after the start of the operation, as well as supplying them with long ribbons. In 1886, not only the medical community, but also the media discussed the suicide of S.P. Kolomnin, a surgeon professor at the St. Petersburg Military Medical Academy. He operated on a woman for a rectal ulcer. After anesthesia with a cocaine solution in the form of an enema 4 times 6 grains (1.5 grams), the surgeon performed scraping of the ulcer, followed by cauterization. 45 minutes after the operation, the patient's condition deteriorated sharply, urgent therapeutic measures (including tracheotomy) had no effect, and the patient died 3 hours after the operation. An autopsy confirmed the version of cocaine poisoning. Even before the operation, S.P. Kolomnin's colleague Professor Sushchinsky expressed the opinion that the maximum dose of cocaine in this case should be 2 grains. Professor S.P. Kolomnin based himself on literature data, according to which the dose of cocaine used for two years in European clinics ranged from 6 to 80 and even up to 96 grains. S.P. Kolomnin (together with his assistant) spent several evenings analyzing the relevant scientific literature. S.P. Botkin, to whom S.P. Kolomnin came these days for advice, bringing with him piles of medical books and journals, later said that anyone could make a mistake in this case. However, the situation was aggravated by the fact that at the very beginning S.P. Kolomnin incorrectly diagnosed tuberculosis, and the patient actually had syphilis, that is, she was not indicated for surgery at all. Responding to the entreaties of his comrades not to attach special importance to this case, S. P. Kolomnin said: "I have a conscience, I am my own judge." 5 days after the operation, he shot himself. His act had a huge public outcry. Many memoirs about him were published, depicting the image of a doctor with high professionalism, crystal honest and noble.

S.P. Botkin (1832-1889) was the recognized leader of clinical medicine in Russia. N.I. Pirogov. S.P. Botkin is a participant in two wars: in the Crimean War, he worked under the leadership of N.I. Pirogov, in the Russian-Turkish war of 1877-1878. participated as a life physician at the royal headquarters. His "Letters from Bulgaria" (to his wife) is an interesting and important historical document. In one of the letters to S.P. Botkin, noting “the good moral level at which our doctors stood in this campaign,” further writes: “Practitioners who are in the public eye influence it not so much with their sermons as with their lives.” In his "Clinical Lectures" (1885-1890) S.P. Botkin touches on various issues of medical ethics. For example, his solution to the problem of informing hopeless patients is given here in the spirit of orthodox medical paternalism: “I consider it impermissible for a doctor to express doubts to a patient about the possibility of an unfavorable outcome of the disease ... The best doctor is the one who knows how to inspire the patient with hope: in many cases this is the most effective medicine ".

Another outstanding domestic clinician of the last third of the 19th century. There was G.A. Zakharyin (1827-1897), who for more than 30 years headed the faculty therapeutic clinic of Moscow University. There were legends about G.A. Zakharyin, a doctor and diagnostician. G.A. Zakharyin treated L.N. Tolstoy and his family, while friendly relations were established between the doctor and his patient. The clinical method of G.A. Zakharyin, in which exceptional attention was paid to the collection of anamnesis, medical observation, an individual, and not a stereotyped approach to the patient, always necessarily included a psychotherapeutic element. One of the biographers of the famous doctor N.F. Golubov notes that he spent 1.5 - 2 or more hours on unraveling complex cases. In the context of medical ethics, the medical activity of G.A. Zakharyin is of interest in at least two respects. First, the patients' trust in him was reverse side his enormous medical authority, that dignity of the individual, which contemporaries note in all his actions. Every day he visited the clinic (changing this habit only in recent years) - not excluding the holidays. He told his assistants: there are no breaks in the suffering of the patient. It is noteworthy that once, while consulting a patient with a young doctor, G.A. Zakharyin did not agree with the attending physician and canceled all his appointments. Observing, however, the course of the disease, the professor was convinced that he was wrong and admitted the mistake to the relatives of the patient, expressing his readiness to explain in writing in connection with this with the attending physician. Secondly, ethical contradictions are instructive (sometimes reaching a state of acute social conflict), which took place in the medical activities of G.A. Zakharyin. It is known that, as a renowned clinician, Zakharyin was invited to treat Emperor Alexander III, who suffered from a severe kidney disease. In the last months of his life, the emperor was in the Crimea under the supervision of Zakharyin and Dr. Leiden, invited from Berlin. For psychotherapeutic reasons, life doctors had to compose bulletins encouraging the patient, who until last day read these reports in the Russian and foreign press. After the death of the emperor, court circles began to say that Zakharyin made gross mistakes and treated the patient incorrectly, and rumors spread among the people that he even poisoned the emperor. Zakharyin was forced to give a public explanation of what medical appointments were made to the late emperor. In general, about the attitude towards seriously ill patients, Zakharyin said: “For the very success of treatment, the doctor must encourage the patient, reassure him with recovery, or at least, depending on the occasion, improve his health, pointing out those good aspects of the patient’s condition, which the latter does not appreciate in his gloomy mood. ... "Zakharyin's conflict with the doctor Boev had a great resonance in the medical environment. Relatively recently, Boev, who began to practice, brought his patient to Zakharyin for a consultation. The professor, making sure that in this case the attending physician did not provide the patient with qualified medical care, advised the latter to turn to another doctor - a well-known specialist. After that, 70 Moscow doctors signed a letter published in the medical press, qualifying Zakharyin's act as non-collegiate. It seems that both sides were right here in their own way, and therefore it would be more correct to resolve this conflict by compromise.

The most serious accusations were brought against Zakharyin in the last period of his life - in connection with his private practice. The professional revolutionary S.I. Mitskevich, who studied at the medical faculty of Moscow University in the early 90s, recalling his professors, in particular, emphasizes that by that time Zakharyin had a large fortune acquired by medical practice. "The acquisitive methods of the Zakharyintsy" (also referring to his assistants) were criticized in the general and medical press. In 1896, a year before his death, G.A. Zakharyin was forced to resign.

1. 
   Medical ethics in the USSR.

The new regime that opened the Soviet period national history, came to power on the crest of a severe and destructive world war for Russia, and he immediately faced serious problems. Destruction and famine in conditions of low sanitary culture of the population provoked powerful epidemics of cholera, typhoid and smallpox, so that the first steps of the government in the field of health were of an emergency nature. In particular, measures were taken to coordinate the activities of disparate and significantly weakened health services, which led to their rigid centralization. In July 1918, the People's Commissariat of Health was established Russian Republic- the world's first nationwide ministry of health. Under the leadership of the first Soviet Commissar of Health N.A. Semashko(1874-1949), a doctor who was personally close to Lenin, all areas of the government, one way or another responsible for providing medical care, were united. In subsequent years, however, autonomous from the commissariat, but centralized health care structures were gradually recreated. railway transport, in the army, in special services, etc.

The measures of the new government provoked sharp criticism from the doctors who were members of the Pirogov Society, who believed that the introduction of free healthcare by the Soviet government would deprive doctors of the independence and initiative they had won during the zemstvo reforms. The regime, however, was not inclined to put up with criticism and opposition, as well as with the existence of any organized opposition in general. First, in opposition to the Pirogov Society, the All-Russian Federation of Medical Workers (Medsantrud) was created, and in 1922 the society was completely liquidated. However, Medsantrud, as he sought to preserve the remnants of democratic self-government among medical workers, incurred the disfavor of the authorities. So, one of the organizers of the Soviet health care, Deputy People's Commissar of Health Z.P. Solovyov(1876-1928) in 1923 wrote: “What kind of public is this and what kind of public can we talk about in the conditions of the Soviet state? There shouldn't be two answers to this question. Our community is work in all fields of Soviet life on the basis of the initiative of the revolutionary class, the bearer of the proletarian dictatorship - the proletariat and its ally, the poor and middle peasants. ... We do not think of any other public, except for the proletarian one, in the field of our construction. And only the doctor who refuses to oppose this public to some of his own “democratic”, medical, will be able to find his way into this social environment, will be able to deploy his forces in this environment and apply his knowledge and special competence; only such a doctor has the right to call himself a public doctor now. The regime thus defined the social role of the doctor in a fundamentally new way. The doctor was conceived as a representative of a hostile, bourgeois class, who has to be tolerated as a specialist, but who is allowed to work only under the strict control of the proletariat. In fact, however, this control was exercised by a government official. Hence, the discussions about medical errors, which at times became extremely acute, behind which many were inclined to see only the malicious intent of the class enemy. Hence the repeated waves of repressions against doctors who were accused of poisoning and killing both the population and the highest party and government officials. Meanwhile, the revolution and civil war led to a sharp reduction in the number of doctors in the country. According to some reports, about eight thousand doctors emigrated from Russia in the first years after the revolution. Many doctors died of starvation and disease. This forced the authorities to engage in accelerated training of doctors, which was carried out by peculiar methods. Even those who did not receive a secondary education and who sometimes could neither read nor write began to be admitted to medical institutes; final exams were abolished; a system of brigade training was introduced, in which the knowledge of a group of students was assessed by questioning one of them - it was assumed that stronger students would help weaker ones. Such measures made it possible to quickly increase the number of doctors, although, inevitably, at the cost of a sharp decline in professional standards.

In general, such an emphasis on collectivism was not accidental. Medicine, like everything else, is viewed from a class point of view; at the same time, individualistic bourgeois medicine is opposed to collectivist proletarian medicine. The purpose of the new medicine is understood as follows: “The preservation of the living forces of the proletariat and the construction of socialism, of course, should be the main compass for us when raising the question of the tasks of our modern medicine” (Z.P. Solovyov). In accordance with this, Soloviev believed, the entire practice of medicine should also be rethought: “A characteristic feature of the modern clinic is that it has developed and exists to this day as a strictly individualistic discipline. In this regard, the structure of modern capitalist society lays its hand on medicine, both in the field of theory and especially in the field of practice. The individualistic demand for the service of an individual, and not of a human collective, creates the corresponding methods of thinking and practice.

The above statements of one of the leaders of Soviet medicine at the stage of its formation are highly indicative as an example of the denial of the self-worth of the human personality, characteristic of Bolshevism, relegating a person to the role of a cog in the production system, unconditional subordination of his social expediency. Considerations of class expediency directly determined the very views of the Bolsheviks in the field of morality and ethics. Here is a typical example: “The vaunted theoretician of petty-bourgeois morality, Emmanuel Kant, once put forward a moral demand: never look at another person as a means to an end, but always as an end in itself ... One can imagine how far the proletariat would have gone in its struggle, if guided by this, and not quite the opposite demand in their class interests. ... The highest wisdom of the proletarian struggle is not that everyone pokes around inside their own personality and declaims about its rights, but that everyone knows how selflessly, almost spontaneously, without phrases and unnecessary gestures, without demanding anything personally for himself, to pour all their energy and enthusiasm into the general stream and break through to the goal with their class, perhaps falling first along the road, ”wrote the philosopher E.A. Preobrazhensky.

With regard to the systematic development of medical ethics that would be consistent with the ideological guidelines of the new regime and new system health care, then such a task - perhaps, fortunately - was not set. To the extent that the social role of the doctor was considered not so much independent as purely official, the very posing of the question of some kind of special ethics of the doctor lost its meaning. Nevertheless, some problems that have a clearly expressed moral and ethical sound became the subject of discussion, sometimes very fierce, (for example, the problems of abortion, medical secrecy, medical error).

In the 1920s, heated discussions revolved around the problem medical secrecy. People's Commissar of Health N.A. Semashko proclaimed "a firm course towards the destruction of medical secrecy", which was understood as a relic of bourgeois medicine. This position was substantiated by the fact that the only meaning of maintaining medical secrecy is to protect the patient from a negative attitude towards him from others; if everyone understands that illness is not a disgrace, but a misfortune, then medical secrecy will become unnecessary. It was assumed, however, that the complete abolition of medical secrecy would occur when this idea was accepted by the entire population. Until then, the need to preserve medical secrecy was associated with the fear that refusing it would become an obstacle to accessing a doctor. And although N.A. Semashko in 1945, being no longer the People's Commissar, but a doctor, began to speak out in defense of medical secrecy, his former views turned out to be influential for a long time, so that until now medical workers often do not understand the meaning of the requirement of confidentiality. Only in 1970 was this requirement enshrined in law.

In general, medical or, as they preferred to say then, medical ethics was understood as the justification and approval of corporate-estate morality, alien to the class interests of the proletariat. A rather widespread point of view was that all Soviet people, regardless of gender and profession, are guided by the uniform moral norms of communist morality, and the existence of any specific norms of professional morality will limit the operation of general norms. As far as medical education is concerned, there was no systematic course in medical ethics either in pre-revolutionary Russia or under the new regime. Moreover, after the revolution, the adoption by novice doctors of the “Faculty Promise” of the Russian doctor was abolished - a version of the “Hippocratic Oath” adapted to the then conditions, the adoption of which was mandatory from the beginning of the 20th century. Humanitarian training of students was reduced mainly to the study of the course of Marxism-Leninism. Against this backdrop of the denial of eternal moral values ​​characteristic of Bolshevism, however, the previous tradition of medical ethics continued to be reproduced.

Among those who received a medical education, quite a few were inspired by the ideal of disinterested and selfless service, which goes back to the moral principles of zemstvo medicine; The profession of a doctor attracted people of an intellectual orientation also by the fact that in the field of their activity there was still no particularly strict ideological control. The norms and values ​​of medical ethics were transmitted through the channels informal communication, during the daily contacts of professors with students and experienced doctors - with beginners.

Since the late 1920s and early 1930s, the ruling regime has been consolidating. The beginnings of administrative-bureaucratic planning and management penetrated into all pores of public life and became dominant. Health care is also becoming planned - the number of doctors of various specialties, and the number of hospital beds, hospitals and polyclinics in the city and countryside, topics of medical research, development of sanatorium treatment, etc.

Planning involves quantitative estimates and measurements, and from this point of view, Soviet medicine has achieved impressive results: the number of doctors has long ago exceeded a million, and there are about half as many patients per doctor as in the United States. For a long time, indicators of a more qualitative nature also improved: many infectious diseases were practically eliminated, infant mortality significantly decreased, and average life expectancy was growing. According to these and some other indicators, the country has approached the level of the most developed countries or has become equal to it. Thanks to this, the experience of the Soviet organization of health care attracted and still attracts many in the West, and especially in developing countries. During the Soviet period, health policy has always been seen as subordinate to economic policy. Thus, when the Communist Party put forward the industrialization of the country as a priority, the central task of the health care system was declared to be the improvement of medical care for workers in industrial centers, especially miners and metallurgists (1929).

The resulting health care system, which has remained relatively stable for many decades, was in many ways unprecedented. The doctor became a civil servant, whose activities were regulated by many departmental instructions and largely reduced to reporting, reflecting how he carried out these instructions. In relation to the higher medical (and party) bureaucracy, he had almost no rights; any manifestation of personal initiative was dangerous. As for the patient's social role, it was characterized by a paradoxical combination of two mutually exclusive attitudes. On the one hand, paternalism, which had previously dominated throughout society, and not just in health care, became even stronger, to the point that both the person himself and his entourage saw in health a kind of state, and therefore, nobody's property that can be squander irresponsibly. On the other hand, however, health was perceived as the highest value, and so high that it would be simply indecent to look for any material equivalent to it. In value terms, this corresponds to such moral categories as “selflessness”, “sacrifice”, etc. - these properties must be shown by those who are fighting for the preservation of health, and especially not claiming a high level of remuneration for their labor. Both installations, by the way, coincided in that they made it possible to be content with modest financing of health care, as long as the reproduction of the labor force was ensured.

In 1939, the renowned surgeon-oncologist N.N. Petrov(1876 - 1964) publishes an article "Issues of Surgical Deontology" in the journal "Bulletin of Surgery", and in 1945 - a small book with the same title. These publications were, in fact, the first steps in rehabilitation of medical ethics. It is characteristic that N.N. Petrov justified the use of the term "medical deontology" by the fact that the concept of "medical ethics" is narrower - it refers only to corporate morality, reflecting the scientific career and service career interests of doctors. Now it is difficult to say whether this was a deliberate ploy to circumvent ideological taboos, or whether such a choice was completely sincere; what is important is that the problematics of medical ethics, even if understood only in the aspect of the doctor's duty, was legitimized. It is also indicative that such an attempt was made by a doctor who had received training and formed as a person even before 1917. A wide discussion of the problems of deontology began much later, in the middle and late 60s, in an atmosphere of some democratization of the regime, when writings on deontology began to appear. this topic is the work of many physicians and philosophers. The holding in 1969 in Moscow of the first All-Union Conference on Problems of Medical Deontology played a significant role. Shortly after it, in 1971, the text of the “Doctor’s Oath” was approved by the highest state leadership. Soviet Union". The “oath” was to be taken by all graduates of medical institutes starting independent professional activities. The text of the "Oath", however, spoke more about responsibility to the people and the Soviet state than to the patient. At the same time, the teaching of medical deontology was introduced into the curricula of medical institutes. However, there was no single course in deontology - deontological topics were scattered among the courses of individual medical specialties.

After 1971, the flow of deontological literature increased dramatically. As for its content, it, unfortunately, often came down to criticism of "inhumane Western medicine", statements about the undeniable moral superiority of Soviet "free" medicine and the Soviet disinterested doctor, moralizing and moralizing reasoning. It was also common to contact specific situations, for example, from the personal practice of the author; at the same time, however, really difficult situations that do not allow an unambiguous moral choice were carefully avoided. In addition to the fact that this literature at least indicated the presence of moral and ethical problems in medicine, its interesting feature was the ever-increasing appeal to the moral authority of Russian pre-revolutionary medicine over time and the desire to present Soviet medicine as a direct and continuous continuation of the best traditions of the past. The revival of interest in medical deontology coincided with the period when signs of a crisis in Soviet medicine began to be more and more clearly revealed.

The appeal to deontology, therefore, was to some extent dictated by the desire to mobilize the previously ignored moral factor in the face of growing crisis phenomena. However, this attempt itself, to the extent that it appealed only to the values ​​of a glorious, but irrevocably gone past, could not be successful. Nevertheless, it should be noted that the discussion of the problems of medical deontology has become one of the prerequisites for the emergence and strengthening of interest in bioethics in our country.

1. 
   Medicine in conditions of authoritarianism and totalitarianism.

Essential features of totalitarianism are revealed when comparing it with an authoritarian regime. One-party membership cannot serve as a sufficient criterion, since it also occurs under authoritarianism. The essence of the differences is primarily in the relations between the state and society. If under authoritarianism a certain autonomy of society in relation to the state is preserved, then under totalitarianism it is ignored and rejected. The state strives for global dominance over all spheres of public life. Pluralism is being eliminated from socio-political life. Social-class barriers are forcibly demonstrated. The government claims to represent a certain general “superinterest” of the population, in which social group, class, ethnic, professional and regional interests disappear and become depersonalized. The total alienation of the individual from power is affirmed.

Consequently, totalitarianism forcibly removes problems: civil society - the state, the people - political power. The state completely identifies itself with society, depriving it of its social functions of self-regulation and self-development. Hence the features of the organization of the totalitarian system of state power:

Global centralization of public power headed by a dictator;

Domination of repressive apparatuses;

Abolition of representative bodies of power;

The monopoly of the ruling party and the integration of it and all other socio-political organizations directly into the system of state power.

“The legitimation of power is based on direct violence, state ideology and personal commitment of citizens to the leader, political leader (charisma). Truth and individual freedom are virtually non-existent. Very important sign totalitarianism is its social base and the specificity of the ruling elites due to it. According to many researchers of Marxist and other orientations, totalitarian regimes arise on the basis of the antagonism of the middle classes and even the broad masses in relation to the previously dominant oligarchy.

The leader is the center of the totalitarian system. His actual position is sacralized. He is declared the most wise, infallible, just, tirelessly thinking about the welfare of the people. Any critical attitude towards him is suppressed. Usually charismatic individuals are nominated for this role.

In accordance with the installations of totalitarian regimes, all citizens were called upon to express support for the official state ideology, to spend time studying it. Dissent and the release of scientific thought of the official ideology were persecuted.

A special role in a totalitarian regime is played by its political party. Only one party has lifelong status as the ruling party, acts either in the singular, or “leads” a bloc of parties or other political forces, the existence of which is allowed by the regime. Such a party, as a rule, is created before the emergence of the regime itself and plays a decisive role in its establishment - by the fact that one day it comes to power. At the same time, her coming to power does not necessarily take place by violent means. The ruling party is declared the leading force of society, its attitudes are regarded as sacred dogmas. Competing ideas about the social reorganization of society are declared anti-people, aimed at undermining the foundations of society, at inciting social hostility. The ruling party takes over the reins government controlled: there is a merging of the party and state apparatuses. As a result, it becomes a mass phenomenon to simultaneously occupy a party and state position, and where this does not happen, state officials direct instructions of persons holding party posts are carried out.

1. 
   Medical ethics in modern Russia.

Authoritarianism (from Latin auctoritas - power) is a system of power characteristic of anti-democratic political regimes. Depending on the combination of methods of government, it can vary from a moderately authoritarian regime with the formal preservation of the attributes of democracy to a classic fascist dictatorship. The extreme form of authoritarianism is totalitarianism 1 . By their own characteristic features it occupies, as it were, an intermediate position between totalitarianism and democracy. It has in common with totalitarianism the usually autocratic, not limited by laws, nature of power, with democracy - the presence of autonomous public spheres not regulated by the state, especially the economy and private life, and the preservation of elements of civil society. In general, an authoritarian political system has the following features:

Autocracy (autocracy) or a small number of power holders. They can be one person (monarch, tyrant) or a group of people (military junta, oligarchic group, etc.)

Unlimited power, its non-control of citizens. At the same time, the government can rule with the help of laws, but it accepts them at its own discretion. “The people in such regimes are actually removed from the formation of state power and control over its activities.”

Reliance (real or potential) on strength. An authoritarian regime may not resort to mass repression and be popular among the general population. However, he has sufficient power to, if necessary, at his own discretion, use force and force citizens into obedience.

Monopolization of power and politics, prevention of political opposition and competition. The certain political and institutional monotony inherent in this regime is not always the result of legislative prohibitions and opposition from the authorities. Often it is explained by the unpreparedness of society for the creation of political organizations, the lack of a need for this among the population, as it was, for example, for many centuries in monarchical states. Under authoritarianism, the existence of a limited number of parties, trade unions and other organizations close in spirit is possible, but subject to their control by the authorities.

Rejection of total control over society, non-intervention or limited intervention in non-political spheres and, above all, in the economy. The government deals mainly with issues of its own security, public order, defense, foreign policy, although it can also influence the development strategy, carry out a fairly active social policy without destroying the mechanisms of market self-regulation.

Recruitment of the political elite through co-optation, appointment from above, rather than competitive electoral struggle.

The general civilizational prerequisites for bioethical knowledge were fully manifested in Russia in the early 1990s. However, this does not mean that biomedical technologies began to be mastered in Russia only by that time. On the contrary, it is Russia that has the "palm tree" for the creation of most of them. In 1926, S. S. Bryukhonenko creates the world's first heart-lung machine; in 1926 the world's first Institute of Blood Transfusion was opened; in 1931 Yu.Yu. Voronoi performs kidney allotransplantation in the clinic; 1937 - the date of the world's first experiment on the implantation of an artificial heart. V.P. Demikhov, who directed this experiment, studied and trained Christian Bernard. In 1920, Russia became the first country in the world to remove all legal restrictions on artificial termination of pregnancy. In the 1920s, Russian scientists of the school of A. S. Serebrovsky conducted a series of fundamental experiments for the development of genetics, which proved the complex structure of the gene. In 1925, at the VI Congress of the All-Union Society of Gynecologists and Obstetricians in Tashkent, Dr. A. A. Shorokhova reported 88 artificial insemination operations with 33 positive results. Work in all areas of modern medical technologies was carried out in the former USSR constantly and successfully. But in the 1960s and 1970s, when experimental medicine entered practice and when bioethics emerged in the United States, bioethics in Russia did not and could not be formed. One of the reasons for this is the assessment of science in the state ideology of the USSR. Socialism was interpreted as "a society based on science in its development." “We are talking about “scientific”, about “scientific rationality” as one of the leading principles of socialist culture, which was expressed in the spread of the scientific style of thinking, in the scientific character of socialist ideology, the dominance of the scientific worldview and the atheistic character of culture.” Science in the state ideology was evaluated not only as "the direct productive force of society", that is, in terms of production and economic parameters. From a "directly productive force" it was transformed into the immediate and highest "human-forming" value of culture. “Science under socialism becomes a means of transforming not only the material and technical base social production but also society as a whole. At the same time, despite the prevailing ideological principles, a different attitude to the problem of the relationship between science and culture, science and morality began to form among specialists. I. T. Frolov, one of the first Soviet philosophers, precisely in connection with the achievements in biomedicine, raised the question “not only about the value of scientific truth, but also about its price, and the “reference point” here is a person, his good.” In 1995, the manuscripts of the Russian methodologist of science M. K. Petrov were published, who in the 60s substantiated the idea that “science, according to the canon, is blind to the human, does not see and is not able to see the human, even if you wanted to." A.P. Ogurtsov in the study "History of natural science, ideals of scientific character and values ​​of culture" shows that the expansion of the socio-cultural context of the study of science leads to the problem of social recognition and socialization scientific discoveries . Such an approach to the problems of scientific knowledge meant a transition in Russian philosophy from the standard scientistic “image of science” to the realization of the existence of a wide range of axiological and ethical problems of science that were non-standard for the Soviet scientistic ideology. Democratization in Russia, which affected worldview culture, has become the main prerequisite for the very intensive development of bioethical knowledge in the country. In recent years, the social matrix as a formal condition for the deployment and existence of knowledge has been filled in at the scientific and organizational, educational and educational, publishing, and theoretical levels. The scientific-organizational level corresponds to the existence of special structural units in the organizational system of science in Russia. These are, first of all, the “Bioethics” sector at the Institute of Man of the Russian Academy of Sciences, the Russian National Committee on Bioethics under the Presidium of the Russian Academy of Sciences, the Department of Bioethics at the Research Institute of Social Hygiene, Economics and Health Management named after. N. A. Semashko, Laboratory “Axiology of Cognition and Ethics of Science” of the Institute of Philosophy of the Russian Academy of Sciences. The educational level is represented by the discipline "bioethics", which has become an obligatory element of the humanitarian training of a doctor in medical universities in Russia in accordance with the State Educational Standard of 2000. This was initiated by the Educational and Methodological Conference on Humanitarian Education in Higher Medical and Pharmaceutical Educational Institutions of the Russian Federation, which took place in 1995 in St. Petersburg and decided to recommend the introduction of biomedical ethics as an independent course in the system of humanitarian training of senior students. In 1995, at the Institute for Retraining and Advanced Training of Teachers of the Humanities and Social Sciences at Moscow State University. M. V. Lomonosov, a program for training teachers in the specialty "Biomedical Ethics" was created and the experience of teaching bioethics at Moscow State University was analyzed. M. V. Lomonosov (philosophical, psychological faculties), at the Russian State Medical University, at the Moscow Medical Academy. I. M. Sechenov, in the MMSI im. N. A. Semashko and other medical universities of the country. Kazan State Medical University (head of department professor V.Yu. Albitsky) and Russian State Medical University (head of department professor I.V. Siluyanova) became the first Russian universities where departments of biomedical ethics were created. The publishing level is represented by the magazine "Chelovek" (chief editor B. G. Yudin), "Medical Law and Ethics" (chief editor I. S. Mylnikova). Listed Forms reproduce the structural and organizational modes of existence of bioethical knowledge in Russia, which are, in principle, standard for any knowledge in any country. But it is at the theoretical level that it is possible to raise the question not only about the features of bioethics as a form of knowledge, but also about the specifics of Russian bioethics. Bioethics is a way of understanding important situations related to health and illness, life and death of a person, and the search for worthy moral ways out of them in the context of the coexistence of alternative possible solutions. The logic of search and decision-making is primarily determined by the values ​​widespread in society and supported by traditions. Are there any in Russia? In recent years, Russia has experienced a unique state. Through the greatest spiritual and ideological devastation, the sprouts of understanding that we have the richest cultural heritage break through. The deep existentiality, vitality of the principles of Christian morality, their determination to “resistance to death” prompts us to “learn tradition” again, to see in it not an inert, alien, distant education, but “the primary reality of man” 58. The fullness of the cultural and historical reality of Russia is unthinkable without taking into account religious and moral traditions of Orthodoxy. At the same time, the way to determine the features of these traditions lies through comparative analysis approaches to the problems of bioethics in Catholicism and Protestantism

Literature:

Main:

1. 
   Lopatin P.V. Bioethics: textbook. - M.: GEOTAR-Media, 2009. - 272 p.
2. 
   Khrustalev Yu.M. From ethics to bioethics. - Rostov-on-Don: Phoenix, 2010. - 446 p.
3. 
   Siluyanova I.V. Guide to the ethical and legal foundations of medical activity: textbook. settlement - M., 2008. - 238 p.

Additional:

1. 
   Lopatin P.V. Bioethics: workbook. - M.: GEOTAR-Media, 2008. - 272 p.
2. 
   Siluyanova I.V. Bioethics in Russia: values ​​and laws. - M.: Grant, 2001. - 192 p.
3. 
   Wilms J. R. Guide to medical ethics: textbook. settlement - M.: GEOTAR-Media, 2006. - 128 p.
4. 
   Campbell A. Medical ethics / ed. Yu.M. Lopukhin. - M.: GEOTAR-Media, 2005. - 400 p.
5. 
   Campbell A. Medical ethics / ed. Yu.M. Lopukhin. - M.: GEOTAR-Media, 2007. - 400 p.

1 Malko A.V. Political and legal life of Russia: topical issues: Tutorial. - M., 2000 p. 128

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