M. i. mudrov is the founder of the tradition of medical ethics in russia in the first half. Report on the topic of issues of medical ethics in the writings Contribution of domestic scientists to the development of medical ethics
Notes
1. Fedorov N.F. and his Voronezh entourage (1894-1901): articles, letters, memoirs, chronicles of his stay in Voronezh. Voronezh 1998 .; I. V. Kotlyarova Formation and development of museums in the Voronezh region in a regional cultural context (second half of the 19th - first third of the 20th centuries): Author's abstract. 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. Y. MUDROV - FOUNDER OF THE TRADITION OF MEDICAL ETHICS IN RUSSIA IN THE FIRST HALF
XIX CENTURY
The founder of domestic therapy M. Ya. Mudrov (1776-1831) was widely known at one time as a famous Moscow doctor. In addition, it was he who was honored to restore the Faculty of Medicine of Moscow University after a fire and looting in 1812. Through his efforts, a clinical base was created - the Clinical Institute; the faculty elected him five times as its dean.
The first translations into Russian of the works of Hippocrates ("The Oath", "Law", "Aphorisms") appeared in print only in 1840. But two decades earlier, Hippocrates' ideas were popularized at the medical faculty of Moscow University by M. Ya. Mudrov. His area of \u200b\u200binterest focuses on medical ethics and is entirely based on the ethics of Hippocrates, whose texts he translated and interpreted. In such a volume, no one had shown interest in ethical issues in medicine before him.
In his essay "A Word on the piety and moral qualities of the Hippocratic physician" Mudrov raises important issues of ethics, both general and specific. General questions include reflections on ethical and epistemological relationships in medicine. “Whoever wants to acquire knowledge in Medicine 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 for the doctor to acquire some humanity for himself." He covers in detail and in detail the famous fragment of Hippocrates that the doctor-philosopher is like God. “Why Medicine should be combined with wisdom; for a wise doctor is like God. Everything that is needed for Wisdom: contempt of wealth, chastity and modesty, moderation in dress, importance, reason, friendliness, cleanliness, a short conversation, knowledge of useful things for life and necessary cleansing drugs, removal from superstition, divine dignity. Most importantly, the light of theology of God should illuminate his soul; for in many infirmities and seizures Medicine must address God with reverence. For doctors give in to the power of God. Medicine has no powers of its own. Doctors do a lot, but more than God prevails. " Mudrov sees medicine 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 a result of teaching, but as an individual experience of a person's self-knowledge of himself in the face of God. "Hippocrates spoke here about moral wisdom, and not about mental philosophy, about the wisdom of piety and fear of God, and not about the wisdom of school ravings, 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 every doctor. Such rules should constitute a separate set of laws for doctors, they would be imputed to them along with the Hippocratic Oath. This is how the conversation about medical ethics begins.
The position of Hippocrates' ethics on respect for the patient in the mouth of M. Ya. Mudrov sounds like this: “Starting with love for your neighbor, I should have inspired you with everything else arising from one medical virtue, namely, helpfulness, willingness to help at any time, and day and night, friendliness that attracts both timid and courageous, mercy to 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 heal for nothing at the expense of future gratitude, or, as they say: not out of profit, it would be good."
In several passages of his "Word on the Way to Teach and Study Practical Medicine" Mudrov says about medical secrecy: "Keeping secrets and secrecy in cases of reprehensible diseases; silence about seen or heard family riots ... Your language, this small, but daring oud, curb the words inappropriate and the words of guile. " With regard to the approach to hopeless patients, he has several statements that do not coincide with each other. The "Word on the piety and moral qualities of the Hippocratic doctor" says: "Much should be hidden from the patient, always come to him with a cheerful, impressive face ... but not reveal the present state of the disease and the future outcome ...". In the "Word on the Way to Teach and Study Practical Medicine" (where ethical views are mainly expressed) it is written the following: "Promising healing in an incurable disease is a sign of either an ignorant or dishonest doctor." This contradiction reveals a fine line between the respect on the part of the doctor for the moral autonomy of the individual and medical secrecy, which affects the interests of intercollegial relations between doctors. The provisions voiced by Mudrov have acquired great relevance in modern medicine.
Also, M. Ya. Mudrov 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 finished his profession. The aphorism is relevant to this day. In modern terms, it reflects the idea of \u200b\u200bthe need for constant retraining of medical personnel and postgraduate education. The main denominator of successful mastering of the medical profession, according to Mudrov, is the gaining of the patient's trust. “Now you have experienced illness and know the patient; but know that the sick person has tested you and knows what you are. From this you can conclude what patience, prudence and tension of mind are needed at the patient's bed in order to win all his trust and self-love, and this is most important for the doctor. "
M. Ya. Mudrov is a translator and consistent popularizer of the ethical doctrine of Hippocrates. His system of ethical representations is rooted in religious consciousness and implies 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 matter is immeasurable, since it was he who highlighted the problem of the need for medical ethics and formulated a number of its provisions, which 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 the caste of 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 ethical foundations. The fact of such openness is seen as features of the developing secularization of public consciousness.
In his reflections, M. Ya. Mudrov touched upon not only the issues of medical ethics and deontology in medicine, but also the problem of the ethical foundations of medicine itself. His statements about medicine are contradictory: he alternately proceeds from the idea of \u200b\u200bmedicine, either as an art or 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, the centuries-old tradition conveys the idea of \u200b\u200bmedicine as an art, and art cannot be reduced in moral terms to specific prescriptions and duty. The emergence of such a gap in the concept of the status of medicine testifies to 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 problems of medicine, raised by M. Ya. Mudrov, laid new ethical foundations for the profession of a doctor.
Notes
Mudrov M. Ya. A word about piety and moral qualities of the Hippocratic physician. - M., 1814.
Introduction to bioethics: a tutorial / Otv. ed. B.G. Yudin. - M., 1998.
A.A. Mikhailova
The behavior of the characters in Elder Zosima's cell as an indicator of their moral character in F.M. Dostoevsky's "The Brothers Karamazov"
Roman F.M. Dostoevsky's The Brothers Karamazov presents the reader with a wide range of problems, most of which touch on spiritual and moral issues. Among them is the issue of compliance with ethical standards.
“They don’t go to someone else’s monastery with their own charter,” recalls at the entrance to the skete Fyodor Pavlovich Karamazov a well-known proverb that says that one should accept the rules of a visited place and respect the traditions of other people. All Fyodor Pavlovich's companions seem to agree with this wise saying. Knowing themselves about their intemperance, ambiguous relations and, nevertheless, understanding which 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 pass such a test, their two-faced 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 enters the role of a jester and tries to sneer, trying on his way of thinking to the monks: "So, there is still a loophole to the ladies from the skete." Old man Karamazov is pleased to smear the chaste lifestyle of monks with his mud, so that he himself may look better against this background, or not so disgusting. He is so absorbed in worries about material well-being that he does not see the other, spiritual, side of being, which is the basis of the life of the monastery. Full of his own dignity, Miusov is ashamed of his companion's behavior and tries to justify himself: “… I'm afraid to go to decent people with him,” and meanwhile inside him resentment boils at both old Karamazov and the monks. That is, without realizing it, he also plays the role of an extremely educated, enlightened person.
It is no accident that the narrator stops at the stage of greeting the elder. According to church custom, it is necessary to take a blessing from a clergyman who has a priestly rank, and this is what the hieromonks present and the elder himself do. Than express love and respect for each other. But the first deliberate gesture of the secular visitors entering shows their prejudice against the inhabitants of the monastery. Planning in advance to respect this custom out of elementary politeness, Miusov becomes even more annoyed at the sight of mutual bows and kissing of the monks. Judging by himself, he thinks that all these are 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 it were, showing his pride and disdain. Fyodor Pavlovich did the same, "this time, like a monkey, completely mimicking Miusov" - that is, he made a new buffoonish 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 the seams" - this gesture speaks of respect, but still about refraining from accepting the local norms. This behavior even embarrassed the young man Kalgatin to the point that he himself forgot to greet the owner of the cell, and Alyosha Karamazov plunged into shame.
However, the elder did not show the slightest displeasure or resentment, did not force the church custom to be fulfilled, but he himself went forward, responding to the guests with a simple bow.
The chatter, teasing of Fyodor Pavlovich, who had introduced himself as a jester, and impatient remarks, even the fury of Miusov - this scene was highly disrespectful to the place and inhabitants of the skete, and therefore caused bewilderment and surprise among the rest of those present. Indeed, earlier “many of the“ higher ”even persons and even of the most learned, moreover, some of the freethinking even persons who came either out of curiosity or for some other reason, entering the cell ... put themselves in their first duty, every single one, the deepest respect and delicacy at all times of the date. " Observing the behavior of Fyodor Pavlovich, Elder Zosima correctly remarked: "... Do not be so ashamed of yourself, for from this only everything comes out." And he agreed with this statement: "You ... kind of poked me through and read inside me." Behind the guise of buffoonery, behind this habit of a former adherent, old man Karamazov hides a feeling of shame, a "complex of inferiority" 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 face in the form of boorish behavior.
Seeing the wisdom, faithfulness of the elder's judgments, and being surprised at the serious attention to himself, Fyodor Pavlovich "jumped up and ... quickly kissed the elder 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 strengthens his respect for Father Zosima, he does not hesitate to arrange a quarrel in his presence and unceremoniously reveal his true state of mind, views, thoughts.
Among the non-believers visitors to the monastery cell and the middle son of Fyodor Pavlovich Ivan. Educated and secularly courteous, he behaves with restraint and even humility. In front of the elder, he does not try to hide his views, on the contrary, seriously, speaks openly about them, attentively 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 moral feeling, with a noble heart. Elder Zosima confirms this: "... thank the Creator for giving you a higher heart ...". Despite the fact that Ivan is an atheist, he accepts Father Zosima as a wise, experienced person. It is no coincidence that Ivan stood up silently and took his blessing, surprising everyone present with this act. This is also a recognition of the elder's intellectual dignity and insight and a sign of great respect for him.
Dmitry Karamazov is the most open and honest at this family gathering. Although his soul is weighed down by vices and passions, it is alien to duplicity. Dmitry treats the elder with deep respect, seeing in him a special person, close to God. Dmitry is the only one at the entrance asks for blessing 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. Addressing the elder, Dmitry directly says: "... the reverend father ... I do not know what to call you ...". The young man refers to his lack of education, apologizing for possible mishandling, fearing unwittingly offending the elder. Taking advantage of the fact that Mitya is able to easily succumb to the feeling that gripped him, Fyodor Pavlovich deliberately pisses him off, and he himself plays the role of an offended father and brings the situation to a scandal. The final gesture - the Elder Dmitry's bow to earth - shocked everyone present. Dmitry ran out of his cell in horror - it 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 approached the blessing. Despite the fact that they, too, were alarmed by this outpouring of hostile feelings and vicious inclinations, and also worried about the condition of the sick elder, this did not disturb 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 inner and facial expressions. So, Alyosha did not interfere with what was happening as a simple novice, but he was ready to cry and stood with his head bowed, then his heart beat violently. He worried both for his family and for his beloved old man. Mikhail Rakitin stood motionless, but “peering attentively and listening attentively, although with downcast eyes. But from the lively blush on his cheeks Alyosha guessed that Rakitin was also excited ... ". Thus, it becomes noticeable that this person is very interested in the conversation and remembers it for some reason. As it turns out later, behind the external modesty and reverence, this young man is his unbelief and true aspirations, that is, he is a two-faced man. During the entire meeting, only Kalganov, condemning the inappropriate behavior of the father and son of the Karamazovs, dared to utter two words after Father Joseph.
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 cells for their immoral behavior, but reasoned on their topics, answered their questions, spoke their language.
So, no amount of secular politeness and education helped the guests of Father Zosima - they even showed their real moral character against their will. This happened precisely within the monastery walls, where the penitential revelation of secrets is constantly being performed and there is a striving for purity, liberation from the sinful inclinations of the soul.
Thus, the elder, as a character with a high level of authority, becomes in the novel a kind of indicator that highlights the moral state of society. Moreover, regarding the image of this virtuous person, not only human vices are revealed, but also a path is proposed that frees them from them. However, there was no counter movement to 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 on the hearts of visitors, and his image became for them an example of spiritual and moral height.
Notes
Dostoevsky F.M. The Brothers Karamazov: In 2 volumes. T. 1. M .: Soviet Russia. 1987 .-- 352 p.
Lossky N. Dostoevsky and his Christian worldview. New York: Publishing House named after Chekhov. 1953 .-- 408 p.
E.F. Mosin
LEGAL POSITION OF THE CONSTITUTIONAL COURT OF THE RUSSIAN FEDERATION IN THE QUESTION OF TAX RESTRICTIONS OF THE PROPERTY RIGHT IN THE LIGHT OF THE GEGEL 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 of the Russian Federation", official and mandatory for all representative, executive and judicial bodies of state power, local government bodies, institutions, organizations, officials, citizens and their associations, repeatedly considered the issue of limiting the right to property by the constitutional obligation to pay legally established taxes - Resolutions of December 17, 1996 No. 20-P, of October 12, 1998 No. 24-P, of July 14, 2005 No. 9-P, of February 28, 2006 No. 2-P, dated 17.03.2009 No. 5-P and others.
The essence of the legal position of the Constitutional Court of the Russian Federation on the issue of tax restriction of property rights, which follows from these acts, is as follows:
Taxes are a prerequisite for the existence of the state and represent a legal form of property alienation in order to ensure the costs of public authorities, carried out on the basis of obligation, irrevocability, 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) character, which is due to the public law nature of the state and state power;
The public interest of all members of society is embodied in the duty of taxpayers to pay taxes, and therefore the state has the right and is obliged 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 to private property does not belong to such rights that are not subject to restriction under any circumstances, however, both the very possibility of imposing restrictions on this right by federal law 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 a person and a citizen may be limited by federal law only to the extent necessary in order to protect the foundations of the constitutional order, morality, health, rights and legitimate interests of others, to ensure the country's defense and state security;
The Constitution of the Russian Federation provides for the differentiation of property that the taxpayer cannot dispose of at his 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 by 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 into property rights, property rights, freedom business activities 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 are not created for violating their constitutional rights, as well as the rights and legitimate interests of others;
If, in exercising tax control, the tax authorities are guided by goals and motives that contradict the current legal order, tax control can turn from a necessary instrument of tax policy into an instrument to suppress economic independence and initiative, excessive restriction of freedom of entrepreneurship and property rights;
Forced seizure of property in the form of tax and other payments, carried out in an improper procedure, violates judicial guarantees for the protection of property rights enshrined in the Constitution of the Russian Federation.
This position, set out above with the use of formulations borrowed from the decisions 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 restrictions on the right to private property.
Hegel attached exceptionally great importance to the property right, pointing out that "in the states of modern times, securing property is the axis around which all legislation revolves and with which most of the rights of citizens are in one way or another correlated." 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 should be violated. The state requires the payment of taxes, this requirement boils down to the fact that everyone should give part of their property; thus, the state deprives citizens of part of their property ... Right is sacred, but, on the other hand, it is also the present existence of freedom and, as a feature, something that must be subordinated. The state is this subordination of law, subordination of rights to each other, subordination, which is itself legal. Therefore, taxes do not violate property rights, and the demand for taxes is not something illegal. The right of the state is higher than the right of an individual to his property and personality. " And as a problem: "It would be important to establish to what extent the right to property should be sacrificed for the sake of establishing a stable form of the republic."
Tax nihilism is common in all ages; the era of Hegel and the modern Russian one 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 demand to pay taxes as a violation of their peculiarities, as something hostile to them, preventing the implementation of their goals; however, no matter how true it may seem to them, the specificity of the goal cannot be satisfied without the universal, and a country in which taxes would not be paid would not be able to differ and enhance the specificity.
Drawing attention to the interest of the taxpayer in paying the tax, Hegel, at the same time, pointed out that taxes should not turn into an instrument for suppressing the economic independence of taxpayers, excessive restriction of their property rights: “Taxes, duties, etc., which constitute a duty 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 its quality from what I get. If this value becomes unequal, does not remain identical, then a breakdown arises in the relationship, they become untrue. " And he also on this topic: “Everywhere tax systems should be introduced, the tax may seem insignificant: a little from everyone, but everywhere. If it is prohibitively large in any industry, then this industry is abandoned: they drink less wine if high taxes are imposed on it. For everything, you need to find a kind of surrogate, otherwise the need begins. But this necessity also turns against itself. The costs of collecting taxes are becoming more significant, the difficulties and discontent are more and more, since the use of everything is difficult and associated with the presence of too many points. Accordingly, “the taxes to which the estates give their consent should not be regarded 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 tax limitation of property rights with the above-described position of the Constitutional Court of the Russian Federation 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 view of the role of taxes in the social security of the poor: “The best way is to leave the poor to their lot and to come to terms with the fact that they are beggars”).
Notes
"Sterlitamak State Pedagogical Russian Philosophical Society St. Petersburg Association of Philosophers International Association of Historical Psychology named after Professor
MonographIn the first half of 2000 / N.A. Nosov // Bulletin Russianphilosophicalsociety, 2000, - No. 4. - P. 53 - 54. Nosov, ... on II Russianphilosophical Congress (Yekaterinburg, June 7-11, 1999) / N.A. Nosov // Bulletin Russianphilosophicalsociety. − ...
RUSSIAN ACADEMY OF SCIENCES Main directions of research bibliography
DocumentDepartment of Philosophy. Member Russianphilosophicalsociety, Russian Political Science Association, ... graduated with honors philosophical Faculty of USU. Member Russianphilosophicalsociety, Russian associations of political science. Protected ...
Metamorphoses of the ethos of the Russian philosophical community in the XX century Ulyanovsk 2008
BookV.A. Bazhanov Baranets, N.G. B 24 Metamorphoses of ethos russianphilosophical communities in the XX century: monograph. : at 2 o'clock - ... Russianphilosophical congresses. An active role in their organization was played by Russianphilosophicalsociety (I.T. Frolov ...
Hegel G.V. F. Jena real philosophy // Hegel G.V.F. Works of different years. In 2 volumes. T. 1.M., 1970.
Hegel G.V. F. Historical studies // Hegel G.V.F. Works of different years. In 2 volumes. T. 1.M., 1970.
Hegel G.V. F. Philosophy of Law. M., 1990.
Appendix (new sources on "Philosophy of Law") / Hegel G.V.F. Philosophy of Law. M., 1990.
society... The works of the Tyumen school are not known ...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
on biomedical ethics
on the topic: History of medical ethics in Russia
Completed: 1st year student
Correspondence department of the faculty of MSSO,
Groups No. 811
Zalaldinova A.R.
Checked _________________________
Passed (not credited)
Kazan, 2010
| Introduction ………………………………………………………………… ... | |
| Chapter 1. The origin of professional medical ethics in Russia ……………………………………………………………………… ... | |
| 1. 1. The founder of domestic therapy Mudrov M.Ya. (1776 - 1831) …………………………………………………………………… .. | |
| 1.2. Ph.D. Gaaz F.P. (1780-1853) …………………………… | |
| 1.3. The younger contemporary Pirogov N.I. (1811-1881) …………………. | |
| 1.4. The leader of clinical medicine S.P. Botkin (1832-1889) ……… | |
| 1.5. Outstanding Russian clinician G.A. Zakharyin ( 1827- 1897) …………………………………………………………………………….. | |
| 1.6. A student of S.P. Botkina Manassein V.A. ( 1841-1901)………………… | |
| 1.7. Attitude to medical secrecy and euthanasia Koni A.F. (1844-1927). | |
| 1.8. The success of the book by V.V. Veresaev (1867-1945) "Notes of a Doctor" ... ... ... ... ... | |
| Chapter 2. Medical ethics in the period of Soviet power ………………… | |
| 2.1. The first years of Soviet power ……………………………………… .. | |
| 2.2. Medical confidentiality problems ………………………………………… | |
| 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, relying on past experience; secondly, in the ability to foresee the future development of medical ethics in Russia, having understood the historical patterns and finding 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 - doctrine) - the science of the professional behavior of a medical worker. The term "deontology" itself was introduced into everyday life at the beginning of the 19th century by the English philosopher Jeremiah Bentham - to denote 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: principles of behavior of medical personnel aimed at maximizing the effectiveness of treatment;
problems of excluding unfavorable factors; professional behavior of healthcare professionals; the system of relationships between medical personnel and patients, as well as within the medical team.
The most outstanding works of the Ancient World, in which questions of deontology are raised, are: "On the nature of life" by the Chinese doctor Huang Di Nemtsin, "The Science of Life" by the ancient Indian doctor Sushruta, "Instructions", "On the Doctor" by Hippocrates, the works of Galen, Celsus, Avicenna ...
In the Middle Ages, all science was the servant of theology. The administration and teaching of medicine 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 accelerated. In the 16th century, medical assistance was rendered to the population by folk doctors who had shops selling various medicinal herbs for a fee.
In Russia, before the reign of Boris Godunov, even the troops did not have professional doctors. And ignorance in the treatment led to sad consequences. The responsibility of the doctor for an unfavorable outcome of treatment was legalized by Peter I in the Maritime Regulations. Management through the collegia, and not through orders in Russia, was introduced by order of Peter I in 1720. The highest body of medical management was called the Pharmaceutical Chancellery since 1720, and it regulated the activities of doctors. In the 19th century, teachers of the Medical-Surgical Academy in St. Petersburg and Moscow University paid great attention to the issues of medical deontology. The largest clinical therapist of the first third of the 19th 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 and selfless devotion are characteristic features of Russian doctors. Writers-doctors, 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 doctor and patient acquired the character of a sale and purchase. In such a society, the position of the poor was the most difficult, and the opportunity for help was minimal. Dickinson, the theorist of the American Medical Association of Physicians, argues that the doctor is mainly a small businessman. He sells his services in the same way as any other commodity businessman.
In recent decades, issues of deontology have become the subject of discussion at international medical forums. In 1953, the I 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 physician must take care of the health of everyone with complete impartiality, regardless of gender, religion, or philosophical or political conviction.
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 work of a medical institution;
· Deontology and scientific and technical progress;
· Deontology in clinical medicine;
· Deontology and medical documentation;
· Deontology in research work.
goal 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 period.
Chapter 1. The origin of the professional
medical ethics in russia
1.1. The founder of domestic therapy Mudrov M.Ya. (1776-1831)
The first translations into Russian of individual works of Hippocrates ("The Oath", "Law", "Aphorisms") appeared in Russia in printed form only in 1840. However, several decades earlier, Hippocrates persistently promoted at the Medical Faculty of Moscow University M.Ya.Mudrov (1776-1831).
The founder of domestic therapy M. Ya. Mudrov was not only a famous Moscow doctor, but also an outstanding figure at Moscow University. M.Ya. Mudrov was honored to restore the Faculty of Medicine after the fire and plundering of the university in 1812, his efforts for the first time in the history of the university created a clinical base (Clinical Institute), five times the faculty elected him as its dean. In connection with the consecration of the Faculty of Medicine in 1813 and the opening of the Clinical Institute in 1820, M.Ya. Mudrov made solemn speeches, the content of which is primarily devoted to the presentation and interpretation of the ethics of Hippocrates: “... I will speak to you not in my own language. , but with the honey-flowing lips of Hippocrates ... in order ... to more captivate your mind into obedience and study of the Prince of Physicians and the Father of Medicine. " And further: "This chapter should be read on your knees ..."
Medical ethics, according to M.Ya. Mudrov, precedes all medicine: the 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 Hippocrates ethics about respect for the patient in the mouth of M. Ya. Mudrova sounds like this: “Beginning with love for your neighbor, I should inspire you with everything else arising from one medical virtue, namely, helpfulness, willingness 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 patients; meek severity to their disobedience ... ".
Ultimately, the solution of all issues arising in the relationship between a doctor and a patient, M.Ya. Mudrov, as it were, reduces to a common denominator - gaining the patient's trust: “Now you have experienced illness and know the patient; but know that the sick person has tested you and knows what you are. From this you can conclude what patience, prudence and mental tension are needed at the patient's bed in order to win all his trust and self-love, and this is most important 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 individual works of Hippocrates into Russian appeared only in 1840. However, much earlier, Hippocrates persistently promoted at the medical faculty of Moscow University M.Ya. Mudrov (1776-1831).
M. Ya. Mudrov, speaking about medical ethics in his work "A Word about the Way to Teach and Study Practical Medicine in the Bed of the Sick," he said: he did not go; convincing rejection of harmful offers and advice; removal from superstition. " M. Ya. Mudrov, in his statement, emphasizes the elements of philanthropy in the activity of a doctor, believing that selflessness should be inherent in those who choose this profession. This echoes the ideas about the ethics of the physician Hippocrates, Avicenna and Paracelsus, i.e. is a kind of fusion of those productive thoughts about the ethics of the doctor that were promoted in the past.
Medical ethics, according to M.Ya. Mudrov, precedes all medicine: the 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 ethics of Hippocrates on respect for the patient in the mouth of M.Ya. Mudrova sounds like this: “starting with love for your neighbor, I should instill in you everything else arising from one medical virtue, namely, helpfulness, readiness to help at any time, day and night, friendliness, which attracts both timid and courageous, mercy to the sensitive and the poor; ... condescension to the errors of the sick; short severity to their disobedience ... your outfit should be as follows: as you stand up, you are ready. Not only in the waking state, but also in the very sleep of your exhausted body, at the sick bed, you stay awake in spirit, hear his breath, listen to his demands, cough, delirium, hiccups; and wake up from your waking sleep. "
The younger contemporary of M.Ya. Mudrova was N.I. Pirogov (1811-1881). Soon after graduating from Moscow University, N.I. Pirogov starts working as a professor and head of the department of the surgical clinic of the University of Tartu. His first year report is extremely important in the context of the history of medical ethics. The report examines one of the most important problems of professional ethics of a 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 cumulative experience of medicine. He believed that such a moral position could make up 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 Physicians named after V.I. N.I. Pirogov.
S.P. Botkin in his "Clinical Lectures" touches upon 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 who knows how to inspire a patient with hope; in many cases this 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-Surgical Academy. Not only in the medical environment, but also in society as a whole, Manassein dreamed of the title of "knight of medical ethics", "the conscience of the medical class."
Manassein believed that doctors should be principled opponents of the death penalty and corporal punishment, because otherwise their function would be in an insoluble contradiction with their mission in society, with their professional ethics.
Various manifestations of non-collegial relations of doctors to each other were subjected to fundamental criticism - the lordship 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 taking monstrous forms.
Manassein stood for the absolute preservation of medical secrets under all circumstances ... "To be silent ... a doctor has no right to give out secrets that he learned thanks to his profession, this is a betrayal in relation to a patient ...".
Modern stagethe historical development of ethical teachings was marked by the formation in the second half of the twentieth century of a new doctrine - bioethics.
The term "bioethics" was introduced into circulation by the American biologist V.R. Potter in 1971. Originally, bioethics was understood as a test of 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 of medical genetic control, etc.
Control questions to test the final level of students' knowledge:
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 Hippocrates' ethics:
a) "do no harm"
b) "keep your duty"
c) "do good"
3. The basic principle of biomedical ethics:
a) respect for human rights and dignity
b) protection 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 governing 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 a person's attitude to his professional duty
b) 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 inhuman experiments during the Second World War
c) increasing requirements for the quality of medical care
7. Professional ethics studies:
a) relations between labor collectives and each specialist separately;
b) the 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) from the point of view of disease prevention
c) within the framework of the usefulness or harmfulness of the introduction of scientific innovations into medical practice
9. Percival was the first to recognize the doctor's obligation:
a) not only to patients, but also to society as a whole
b) be responsible for the unfavorable outcome of treatment
c) for the results of ongoing scientific research
10. The basis of medical ethics is:
a) humanism
b) professionalism
c) pragmatism
Standards of answers: 1 - g; 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. Purpose of the lesson:
1. To get acquainted with the history of the emergence and development of the main ethical theories and principles of biomedical ethics.
2. To study the basic models of relationships in the doctor-patient system.
3. To get acquainted with current trends in biomedical ethics.
II. Motivational characteristics of the topic:
In modern conditions, medicine plays a very important role in the life of society. Therefore, the relationship between healthcare professionals and their patients goes beyond the usual household or industrial relations between people. They require knowledge and adherence to the changed principles of ethics of a doctor and a 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. Equipment for classes:
2. Tasks on the topic of classes.
IV. Test 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 a situation when a 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. The inventor of the “do good!” Principle?
a) Pythagoras
b) Aristotle
c) Paracelsus
d) Mudrov
5. Is the physician obligated to always act in the best interest of the patient?
6. What is the basic moral principle of bioethics?
a) Respect for human rights and dignity
b) Winning social trust of the individual
c) Obligations to teachers, colleagues, students
d) A set of "proper" rules
7. Are there any rules governing informing the patient about his illness?
8.What name is the ethical model based on charity and love for one's neighbor associated with?
c) Bentham
d) Paracelsus
9. What is informed consent?
a) This is a way to protect the right to choose
b) This is getting complete information
10. About whom KT Jung wrote: "In him we see not only a founder in the field of creating chemical drugs, but also in the field of empirical mental treatment."
c) Bentham
d) Paracelsus
Standards of answers: 1-b; 2-in; 3-in; 4-in; 5-a; 6-a; 7-a; 8-d; 9-a; 10-d.
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, which 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 professional community of doctors, help to form new ethical regulators in front of the professional community of doctors, to realize the moral conflicts and dilemmas that biologists, doctors, psychiatrists face in their work. The development of bioethics in our country is going in different directions. Among them, the main one should be the legislative regulation of biomedical research and health care practice. Especially in areas such as transplantation, determination of the moment of death, the limits of life-sustaining treatment of hopelessly ill patients, 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. Finally, support for bioethics research work. Much has been done in 1991-1993. The Russian National Bioethics Committee was created. An association for bioethics was formed within the framework of the Moscow Philosophical Foundation. The law “On health protection of citizens of the Russian Federation” was adopted.
Research work on the problems of bioethics is being developed. Lawyers, philosophers, and physicians of various specialties are actively involved in the discussion.
The formation of bioethics is primarily due to those tremendous changes that have occurred in the technological re-equipment of modern medicine, cardinal shifts in medical and clinical practice, which have found their expression in the success of genetic engineering, organ transplantation, biotechnology, and maintaining the patient's life. All these processes have unprecedentedly exacerbated the moral problems facing the doctor, the relatives of patients, and the medical staff.
Are there limits, and what are they in maintaining the life of a terminally ill person? Is euthanasia permissible? From what moment should the onset of death be considered? From what moment can an embryo be considered a living being? Is abortion legal? Or is abortion the killing of living beings? These are just a few of the questions that confront the doctor and the general public in the context of the unprecedented technological equipment of modern medicine in developed countries.
First of all, attempts are made to equate 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 associated with health systems and, finally, problems related to human attitudes towards animals and plants. Thus, bioethics includes ethical regulations for attitudes 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 things, regardless of whether they find their application in therapy or not. In other words, bioethics focuses on the achievements of modern biology in justifying or solving moral conflicts that arise in the course of scientific research.
There are a number of bioethics research centers. Among them, the best known are the Hastings Center near New York (USA), the Center for Bioethics at the Montreal Medical Research Institute (Canada), the Center for Bioethics at the University of Toronto (Canada), the Kennedy Institute for Ethics at Georgetown University ( USA). A number of national and international journals are published. In 1978, the publication of the "Encyclopedia of Bioethics" was started. 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 in the health care 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 previous 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, who had different attitudes towards life and death, towards health. and diseases, to childhood and old age. The development of bioethics in Russia can help our society to adapt to the new system of insurance medicine, will help develop personal value orientations that would correspond to human rights, the life and dignity of citizens, and the fundamental humanistic values \u200b\u200bof mankind. The development of bioethics in our country presupposes an understanding of the traditions that existed in ethical thought in Russia, an analysis of their philosophical foundations and the horizons that they open up in the new relationship of a person to life.
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Biomedical ethics
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Briefly describing 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 should be read on your knees!" Mudrov's ethical instructions first relate to the lifestyle of doctors: cleanliness, neatness of clothes, home, special requirements for their speech and what is called "body language" in modern nursing. Further, Mudrov speaks about the necessary moral qualities of a physician: “... willingness to help at any time, day and night, ... disinterestedness, condescension to the errors of patients, ... polite importance with the higher: talking only about the necessary and useful, ... gaiety without laughter and jokes with a happy course of the disease; keeping secrets and secrecy in cases of reprehensible diseases; silence about seen or heard family disturbances, ... warm acceptance of good advice, ... removal from superstition ... ". Here is how Mudrov resolves the issue of informing incurable patients: "Promising 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 arduous path, who does not want to carry this title with diligence until the end of his days, who is not called to it, but has fallen, having fallen into trouble, 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 of a devout Catholic Friedrich Joseph Haas (first half of the 19th century) are 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 the 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 high-quality medical care. In 1982, the UN General Assembly formally approved the Principles of Medical Ethics, which made this 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 here, along with Great Britain, Russia played a leading role. In 1822 H. Opel publishes "Guidelines and rules for how to go after the sick, for the benefit of everyone who is engaged in this business, and especially for compassionate widows, who have dedicated themselves especially to this title", in which he defines the mission of nursing: "Without proper walking and looking after the sick and the most skilful doctor can do little, or even none, in restoring health or disgusting death ... the walker is the executor or the only necessary tool, on whose fidelity and accuracy the success of healing depends a lot ... ". A special page in the history of Russian medicine is the movement of sisters of mercy, which arose during the Crimean War (1853-1856). NIPirogov wrote about the 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 the truth. Complete harmony reigned between her feelings and her actions. She was exactly the ingot of everything sublime. " But the words of I.S. Turgenev about Baroness Y. Vrevskaya, who died from typhus during the Russian-Turkish war (1877-1878): “Such a force, such a thirst for sacrifice. Helping those in need ... she saw no other happiness. And all, blazing with the fire of inextinguishable faith, was given over to the service of others. "
The last two decades of the 19th century, the newspaper "Doctor", created by V.A. Manassein whom his contemporaries called "the knight of medical ethics." Manassein was a principled unmercenary, he created a kind of "mutual aid fund" for physicians, each doctor sent 1 ruble annually to the editorial office of "Doctor" - the famous "Manassein ruble". The Vrach newspaper discussed issues of medical ethics that are relevant today: 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. Especially 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 prominent lawyer A.F. Koni: medical secrets, like attorney's, commercial, etc., are mandatory secrets, but in special cases, for example, when investigating crimes, exceptions should be made for it.
At the very beginning of the 20th century, VV Veresaev's "Notes of a Doctor" was first published - a work whose significance for medical students cannot be overestimated. Here we find in artistic and journalistic form the experience of the soul of a young man, step by step, entering the world of medicine. Among the many relevant topics in this book to this day, we note the following: methods and quality criteria for training specialists in medicine; the prestige and authority of medicine; professional medical errors; moral and ethical aspects of autopsies; The "price" of experimental medical research in humans, and so on.
SEMINAR No. 8. HISTORY OF MEDICAL ETHICS IN RUSSIASeminar lesson plan:
1. Formation of medical ethics in Russia XIX in.
2. Medical ethics in the USSR
4. Medical ethics in modern Russia
Presentation topics:
1. Ethical views of N.I. Pirogov
2. Problems of medical ethics in journalism V.А. Manassein
3. Ethics of a doctor in Soviet health care
4. The main biomedical problems of modern Russian healthcare
Basic concepts of the topic (write out definitions in a notebook):
mercy, euthanasia, etiquette, philanthropy, altruism, authoritarianism, totalitarianism, medical experiment.
Explanatory note for the seminar No. 8.
Formation of medical ethics in Russia in the 19th century.
Medical ethics, according to M.Ya. Mudrov, precedes all medicine: the 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 ethics of Hippocrates on respect for the patient in the mouth of M.Ya. Mudrova sounds like this: “Beginning with love for your neighbor, I should inspire you with everything else arising from one medical virtue, namely, helpfulness, willingness 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 patients; meek severity to their disobedience ... Your outfit should be as follows: as you stand up, you are ready. Not only in the waking state, but in the very sleep of your exhausted body, at the sick bed, you stay awake in spirit, hear its breath, listen to its demands, groaning, coughing, delirium, hiccups; and rise from your waking sleep. "
M Ya. Mudrov emphasizes the elements of philanthropy in the professional activity of a doctor, believing that disinterestedness should be inherent in those who choose this profession. The corresponding place in the book of Hippocrates "Instructions" in M.Ya. Mudrova sounds like this: "... Sometimes heal for free at the expense of future gratitude, or, as they say: not out of profit, the glory would be good ..."
In several passages of his "Word on the Way to Teach and Study Practical Medicine" M.Ya. Mudrov says about medical secrecy: "Keeping secrets and secrecy in cases of reprehensible diseases; silence about seen or heard family riots ... Your language, this small but impudent oud, curb the words inappropriate and the words of guile. "
The attitude towards hopeless dying patients is considered by M.Ya. Mudrova in various aspects. The theme of the dying patient is part of his clinical and theoretical concepts: “We see four kinds 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 a doctor encounters such a case is also a doctor's professional duty: “Be ready to answer the most difficult questions, with which your relatives expect you in another room, to questions: about the outcome of the disease, about imminent danger , or about the impending death. " The loved ones of the patient need this, "so that in the impending danger they gradually prepare and think about their future lot." A correct prediction saves a doctor from "family reproaches" and always helps to strengthen his authority.
Regarding informing doomed patients, M.Ya. Mudrova has conflicting recommendations. The "Word on the piety and moral qualities of the Hippocratic physician" says: "Much must be hidden from the patient, always come to him with a cheerful, impressive face ... but not reveal the present state of the disease and the future outcome ...". In "The Word on the Way to Teach and Study Practical Medicine ..." (mainly containing the author's own medical-theoretical and ethical judgments), we read: "Promising healing in an incurable disease is a sign of either an ignorant or dishonest doctor." In this contradiction, one of the ethical dilemmas (of particular relevance in modern medicine) is fixed: 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, others) for the fear of death in the soul of almost everyone person, on the other. In the very general view M.Ya. Mudrov has an idea of \u200b\u200bpalliative care for hopeless patients: "Easing an incurable disease and continuing the patient's life." Ultimately, the solution of all issues arising in the relationship between the doctor and the patient, M.Ya. Mudrov, as it were, reduces to a common denominator - winning the patient's trust: “Now you have experienced the disease and know the patient; but know that the sick person has tested you and knows what you are. From this you can conclude what patience, prudence and mental tension are needed at the patient's bed in order to win all his trust and self-love, and this is most important for a doctor. "
M.Ya. Mudrov pays much attention in his ethical instructions to the topic of the doctor's attitude to his profession. The well-known aphorism of M.Ya. Mudrov - "There is no doctor who graduated from his science in the medical art" contains both the idea of \u200b\u200bcontinuous professional education of medical specialists, and the problem of their postgraduate training, which is 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 who are 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 the medical art: “Who does not want to go to perfection in this difficult way, who does not want he was not called to it, but fell into it, having fallen asleep, he should leave these sacred places in advance and return home. "
Discussing the issues of intercollegial relations of doctors, M.Ya. Mudrov says that any honest doctor in case of professional difficulty will turn to a fellow doctor for help, and an intelligent and benevolent doctor will not vilify colleagues out of envy.
Directly following Hippocrates, M.Ya. Mudrov says about his teachers: "For good advice and wise instructions to doctors Frez, Zybelin, Keresturia, Skiadan, Politkovsky, Minderer, and here I bring worthy incense."
In a sense, the whole life and especially the death of M.Ya. Mudrov “has the merit of an ethical argument” (as A.A. Huseynov said about the life of the most famous doctor of the 20th century A.Shveitser). 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 finished his earthly career after long-term service to mankind in the Christian feat of giving aid to those infected with cholera in St. Petersburg and who fell victim to his zeal."
The brightest page in the history of Russian medicine is represented by the medical and social activities of F.P. Gaaz (1780-1853), known for his aphorism: "Hurry to do good!" A young German doctor, Doctor of Medicine Friedrich Josef Haas arrived in Russia as the family doctor of Princess Repnina in 1806, then he went as a military doctor with the Russian army from Moscow to Paris, 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 Committee for the Guardianship of Prisons and the chief physician of Moscow prisons.
Haas's half-century medical activity in Russia, whom they used to call Fyodor Petrovich here, earned him the fame of a "holy doctor." F.P. Gaaz gained his legendary fame thanks to his selfless activities in the Committee for the Guardianship of Prisons. This wonderful doctor, at whom the nobility willingly received treatment, devoted all his strength to the most disadvantaged - exiles, convicts, etc .; in the conditions of the then socio-political organization and in the then state of medical services in Russia, he strove 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 named after Alexander III, but in Moscow everyone called it Gaazovskaya); everywhere he tirelessly introduced the arrangement of bathrooms and separate retreats (toilets) for men and women; for ten years his struggle with the Ministry of Internal Affairs for the abolition of the so-called "rod" lasted (the exiles walking through the stage were chained in pairs to a long iron stick - alternately men and women); he constructed lightweight shackles, conducting an experiment on himself - is it possible, being shackled on the legs and arms, to walk 5-6 versts, etc. etc.
It should be emphasized that the activities of F.P. Haase was carried out several decades before its appearance in 1859-1863. International movement of the Red Cross, which has set the task of helping all those wounded during hostilities - regardless of citizenship, nationality, etc. And even more so F.P. Gaaz anticipated the adoption of many modern documents of international law, prohibiting any form of cruel, inhuman treatment of people and in particular highlighting the role of doctors and medical personnel in this.
Let us cite at least a few examples based on documents characterizing the highest level of medical ethics of F.P. Gaaz. In the fall of 1830, an epidemic of cholera began in Moscow (the very one that took the life of M.Ya. Mudrov): “The first cholera was brought to the hospital ... Here, colleagues,” said Gaaz, “our first patient ... Hello, dear , we will treat you, and you will be healthy with God's help. Leaning over to the patient trembling with chills and convulsions, he kissed him. "
In addition to the therapeutic optimism so necessary for the doctor, in addition to instilling the faith in recovery so necessary to the patient, there is one more important point: the doctor's duty is to combat panic, to 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 struck by the so-called "aquatic cancer" (within 4-5 days it destroyed half of the face, along with the skeleton of the nose and one eye). The destroyed, dead tissue spread such a stench that not only the medical staff, but also the mother could not stay in the ward for any length of time. “Fyodor Petrovich alone, whom I brought 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 her. Such visits were repeated on the following days, and on the third - the girl died ... ”. In the context of medical ethics proper, one should pay attention to the religious origins of FP Gaaz'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 F.P. Gaaz's personality was that for him, as it were, there was no phenomenon of the doubling of morality - the gap existing in any society between the moral ideal (due) and real mores (existing). F.P. Gaaz did not leave works on medical ethics, but his very life is the personification of a 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 the University of Dorpat (Tartu). His account of his first year in Dorpat is extremely important in the context of the history of medical ethics. The report examines one of the most pressing problems of professional ethics of a doctor - the problem of medical errors. In the preface to the first issue of "Annals of the surgical department of the clinic of the Imperial Dorpat University" (1837), N.I. Pirogov writes: "I considered it ... my sacred duty to tell the readers frankly about my medical practice and its results, since every conscientious person, especially a teacher, should have a kind of inner need to publicize his mistakes as soon as possible in order to warn other people less knowledgeable from them. "
Before entering the ancient anatomical theaters, you can still read the aphorism "Here the dead teach the living." The attitude of N.I. Pirogov to medical errors prompts us to deepen the meaning of this maxim in moral and ethical terms. Yes, medical errors are evil. But those who stop at the pessimistic and apathetic statement “medical mistakes are inevitable” are in the position of ethical surrender, which is immoral and unworthy of being called a doctor. According to the "Annals" of NI Pirogov, doctors should extract the maximum of instructive from their professional mistakes, enriching both their own experience and the cumulative experience of medicine. NI 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 NI Pirogov is also a confession. However, what for Rousseau was a spiritual feat of the philosopher, N.I. Pirogov makes professional ethical norm doctor. That is, in NI Pirogov, the redemption of the "evil of medical errors" is supplemented by one more condition - merciless self-criticism, absolute honesty before oneself. It turns out that we are talking about following a moral norm, which requires a spiritual achievement from a doctor. IP Pavlov wrote about the very fact of NI Pirogov's publication of the Annals: “Such a merciless, frank criticism of himself and of his 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 into your hands, and in front of a student whom you teach in view of an almost always unbearable, but, nevertheless, obligatory task - you have one salvation, one merit - this is truth, one blatant truth.
In the light of trends in the development of medical ethics at the end of the XX century. it is necessary to pay attention to the ethical content of the principles of "sorting" of the wounded, proposed by NI Pirogov during the Crimean War of 1853-1856. Recalling in 1876 about the origin and organization of the movement of Russian sisters of mercy, N.I. Pirogov, in particular, says that the help to the wounded in besieged Sevastopol was carried out in such a way that all of them upon admission were "sorted by the nature and degree of illness" on: 1) requiring urgent operations; 2) lightly wounded, receiving medical care and immediately transported to hospitals for follow-up treatment; 3) in need of operations, which, however, can be performed every other day or even later; 4) the hopelessly sick and dying, whose help ("last care and dying comforts") was provided only by the sisters of mercy and the priest. We find here an anticipation of the ideas of modern medical ethics - the rejection of extraordinary therapy (passive euthanasia) in case of a fatal prognosis and the right of the hopelessly ill patient to die with dignity.
N.I. Pirogov's approach to the problem of medical errors became a kind of ethical standard for his students and followers. Here are two examples. A well-known professor of obstetrics and gynecology (head of the department of the St. Petersburg Medical-Surgical Academy) A.Ya. Krassovsky operated on a young woman with a giant ovarian cyst. The patient died 40 hours after the operation. The autopsy revealed that the doctor had left a sponge tampon 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 issues: “1. When and how did the sponge get into the abdominal cavity? 2. Have proper precautions been taken to ensure that all sponges are removed from the abdominal cavity 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 professor of surgeon at the Petersburg Military Medical Academy. He operated on a woman for a rectal ulcer. After anesthesia with a solution of cocaine in the form of an enema 4 times, 6 grains (1.5 grams), the surgeon produced curettage of the ulcer, followed by cauterization. 45 minutes after the operation, the patient's condition deteriorated sharply, urgent medical 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, a colleague of S.P. Kolomnin, Professor Sushchinsky, expressed the opinion that the maximum dose of cocaine in this case should be 2 grains. Professor S.P. Kolomnin based on literature data, according to which the dose of cocaine used for two years in European clinics ranged from 6 to 80 and even 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 to consult these days, bringing piles of medical books and journals with him, later said that everyone could be mistaken in this case. However, the situation was aggravated by the fact that at the very beginning S.P. Kolomnin made the wrong diagnosis, suggesting tuberculosis, and the patient actually had syphilis, that is, the operation was not indicated for her at all. Responding to the persuasions of his comrades not to attach particular 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 response. Many memoirs of him have been published, portraying the image of a doctor of high professionalism, crystal honest and noble.
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 Physicians named after V.I. 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 physician at the tsarist 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," then writes: "Doctors-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), SP Botkin touches upon 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 ... ".
Another outstanding Russian clinician of the last third of the XIX 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. GA Zakharyin treated Leo Tolstoy and his family, while friendly relations were established between the doctor and his patient. The clinical method of G.A. Zakharyin, in which exclusive attention was paid to the collection of anamnesis, medical observation, an individual, rather than a stereotyped, approach to the patient, necessarily always included a psychotherapeutic element. One of the biographers of the famous doctor N.F. Golubov notes that he spent 1.5 - 2 hours or more 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. Firstly, the trust of patients in him was the reverse side of his enormous medical authority, the dignity of the individual, which contemporaries note in all his actions. He visited the clinic every day (having changed this habit only in recent years) - not excluding holidays. He told his assistants: there are no interruptions 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 became convinced that he was wrong and confessed to the mistake in front of the patient's relatives, expressing his readiness to explain in writing in this regard with the attending physician. Secondly, ethical contradictions (sometimes reaching a state of acute social conflict) that took place in the medical work of G.A. Zakharyin are instructive. It is known that, as a renowned clinician, Zakharyin was invited to treat Emperor Alexander III, who suffered from severe kidney disease. In the last months of his life, the emperor was in Crimea under the supervision of Zakharyin and Dr. Leiden, invited from Berlin. For psychotherapeutic considerations, the physicians had to compose bulletins encouraging the patient, who until the last day read these messages in the Russian and foreign press. After the death of the emperor, they began to say in court circles that Zakharyin made gross mistakes and incorrectly treated the patient, and rumors spread among the people that he had 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 the patient 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, in his gloomy mood, does not appreciate ... "The conflict between Zakharyin and the doctor Boev had a great resonance in the medical environment. Boev, who had recently begun to practice, brought his patient to Zakharyin's 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 consult 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-collegial. It seems that both sides were right here in their own way, and therefore it would be more correct to resolve this conflict in a compromise.
The most serious charges were brought against Zakharyin in the last period of his life - in connection with his private practice. 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 Zakharyans" (also meant his assistants) were criticized in the general and medical press. In 1896, a year before his death, G.A. Zakharyin was forced to resign.
Medical ethics in the USSR.
The measures of the new government drew sharp criticism from doctors who were part of the Pirogov society, who believed that the introduction of free health care by the Soviet government would deprive doctors of the independence and initiative they won during the zemstvo reforms. The regime, however, was not inclined to put up with criticism and opposition, as well as the existence of any kind of 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, since he sought to preserve the remnants of democratic self-government among medical workers, brought upon himself the disfavor of the authorities. So, one of the organizers of Soviet health care, deputy people's commissar of health Z.P. Soloviev(1876-1928) wrote in 1923: “What kind of public is this and what kind of public can we talk about under the conditions of the Soviet state? There shouldn't be two answers to this question. Our public is work in all areas 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 peasantry. ... We do not think of any other public, except for the proletarian, in the field of our construction. And only the doctor who refuses to oppose this society with some of his own "democratic", medical, will be able to find a 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. " Thus, the regime defined the social role of the doctor in a significantly new way. The doctor was conceived of as a representative of a hostile, bourgeois class who had to be tolerated as a specialist, but who was allowed to work only under the strict control of the proletariat. In fact, however, this control was exercised by a government official. Hence - and at times acquired an extremely acute debate about medical errors, behind which many were inclined to see only the malicious intent of the class enemy. Hence - and repeated waves of repressions against doctors, who were accused of poisoning and murdering both the population and the highest party and state officials. Meanwhile, the revolution and civil war led to a sharp decline in the number of doctors in the country. According to some data, in the first years after the revolution, about eight thousand doctors emigrated from Russia. Many doctors died of hunger and disease. This forced the authorities to take up the accelerated training of doctors, which was carried out by peculiar methods. Even those who had not received a secondary education and who sometimes could neither read nor write were admitted to medical institutes; final exams were eliminated; a team training system was introduced, in which the knowledge of a group of students was assessed by interviewing 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, this emphasis on collectivism was not accidental. Medicine, like everything else, is viewed from a class point of view; at the same time, the collectivist proletarian is opposed to the individualistic bourgeois 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 posing the question of the tasks of our modern medicine" (ZP Soloviev). In accordance with this, Soloviev believed, the entire practice of medicine should 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 respect, the structure of modern capitalist society imposes 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 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 intrinsic value of the human personality inherent in Bolshevism, reducing a person to the role of a cog in the production system, and unconditional subordination of his social expediency. The very views of the Bolsheviks in the field of morality and ethics were directly determined by considerations of class expediency. 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 go in its struggle, if he were guided by this, and not quite the opposite, requirement in his class interests. ... The highest wisdom of the proletarian struggle is not that everyone poking around inside his own personality and declaiming about his rights, but that everyone can selflessly, almost spontaneously, without phrases and unnecessary gestures, without demanding anything personally for himself, to pour in all his energy and enthusiasm into a common stream and make his way to the goal with his class, perhaps by falling down the first on the road ”- wrote the philosopher E.A. Preobrazhensky.
As for the systematic development of medical ethics that would correspond to the ideological principles of the new regime and the new health care system, 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 service, the very formulation of the question of some kind of special ethics of the doctor became meaningless. Nevertheless, some problems that have a clearly expressed moral and ethical sound, became the subject of discussions, sometimes very fierce, (for example, 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 secrets," which was understood as a relic of bourgeois medicine. This position was justified by the fact that the only meaning of preserving medical secrecy is to protect the patient from negative attitudes towards him from others; if everyone understands that illness is not a shame, but a misfortune, then medical secrecy will become unnecessary. It was assumed, however, that the complete abolition of medical secrecy will occur when this idea is perceived by the entire population. Until then, the need to preserve medical confidentiality was associated with the fear that rejecting it would become an obstacle to seeking medical attention. And although N.A. Semashko in 1945, being no longer the People's Commissar, but a doctor, began to defend medical secrecy, his previous views proved to be influential for a long time, so that medical workers still often do not understand the meaning of the requirement for confidentiality. Only in 1970 this requirement was enshrined in law.
In general, medical or, as they preferred to say at that time, medical ethics was understood as the justification and assertion of corporate-estate morality, alien to the class interests of the proletariat. The point of view was quite widespread, according to which all Soviet people, regardless of gender and profession, are guided by the same moral norms of communist morality, and the existence of any specific norms of professional morality will limit the operation of general norms. As for medical education, 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 a Russian doctor - a version of the "Hippocratic Oath" adapted to the conditions of that time, the adoption of which had been mandatory since the beginning of the 20th century, was abolished. The humanitarian training of students was mainly reduced to studying the course of Marxism-Leninism. Against this background, the denial of eternal moral values \u200b\u200binherent in Bolshevism, however, the previous tradition of medical ethics continued to be reproduced.
Among those who received medical education, many were inspired by the ideal of disinterested and selfless service, going back to the moral principles of rural medicine; the career of a doctor attracted people of intellectual orientation also by the fact that in the field of their activity there was still not particularly strict ideological control. The norms and values \u200b\u200bof medical ethics were transmitted through the channels informal communication, in the course of everyday contacts of professors with students and experienced doctors - with beginners.
Since the late 1920s and early 1930s, the ruling regime has been consolidating. In all pores of public life, the beginnings of administrative-bureaucratic planning and management penetrated 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 urban and rural areas, the topic of medical research, the development of sanatorium treatment, etc. is planned.
Planning involves quantitative assessments and measurements, and from this point of view, Soviet medicine has achieved impressive results: the number of doctors has long exceeded a million, and there are about half the number of patients per doctor than in the United States. For a rather long time, indicators of a higher quality also improved: many infectious diseases were practically eliminated, infant mortality decreased significantly, and average life expectancy increased. In terms of these and some other indicators, the country approached the level of the most developed countries or became equal to it. Thanks to this, the experience of the Soviet health organization attracted and is attracting many in the West, and especially in developing countries. During the Soviet period, health policy was always viewed as subordinate to economic policy. So, when the Communist Party put forward the task of industrializing the country as a priority, the central task of the health care system was declared to improve 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 unprecedented in many ways. The doctor became a civil servant, whose activities were regulated by many departmental instructions and to a large extent came down to the preparation of reports reflecting how he followed these instructions. In relation to the higher medical (and party) bureaucracy, he was almost without 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, the paternalism that prevailed in the whole of society, and not only in health care, was even more consolidated, to the point that both the person himself and his entourage saw in health a kind of state, and therefore, no one's property, which can be waste 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 her any material equivalent. In terms of value, this corresponds to such moral categories as "selflessness", "sacrifice", etc. - These properties must be shown to those who are fighting for the preservation of health, and not particularly claiming a high level of remuneration for their labor. Both attitudes, incidentally, coincided in that they allowed one to be content with modest financing of health care, as long as the reproduction of the labor force was ensured.
In 1939 the renowned oncologist surgeon N.N. Petrov(1876 - 1964) publishes an article "Questions of Surgical Deontology" in the "Vestnik Kirurgii" journal, and in 1945 - a small book with the same title. These publications were essentially 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 and career and service and career interests of doctors. Now it is difficult to say whether it was a deliberate trick aimed at circumventing ideological taboos, or whether such a choice was quite sincere; what is important is that the problem 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 broad discussion of the problems of deontology began much later, in the mid and late 60s, in an atmosphere of some democratization of the regime, when this topic is the work of many physicians and philosophers. A noticeable role was played by the holding in 1969 in Moscow of the first All-Union conference on the problems of medical deontology. Soon after it, in 1971, the text of the "Oath of a Doctor of the Soviet Union" was approved by the top state leadership. The "oath" was to be taken by all graduates of medical institutes who embark on an independent professional activity. 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 boiled down to criticism of "inhuman Western medicine", statements about the indisputable moral superiority of Soviet "free" medicine and the Soviet selfless doctor, moralizing and moralizing reasoning. The appeal to specific situations, for example, from the personal practice of the author; at the same time, however, the really difficult situations were diligently dealt with, which did not allow for an unambiguous moral choice. In addition to the fact that this literature at least denoted the presence of moral and ethical problems in medicine, its interesting feature was the increasingly intensifying appeals over time to the moral authority of Russian pre-revolutionary medicine 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 a period when the signs of a crisis in Soviet medicine began to appear more and more clearly.
Thus, the appeal to deontology was to some extent dictated by the desire to mobilize a previously ignored moral factor in the face of the growing crisis. However, this attempt itself, to the extent that it appealed only to the values \u200b\u200bof a glorious, but irrevocably gone past, could not be successful. Nevertheless, it should be noted that the discussion of the problems of medical deontology in our country has become one of the prerequisites for the emergence and strengthening of interest in bioethics.
Medicine under conditions of authoritarianism and totalitarianism.
Consequently, totalitarianism forcibly removes the problems: civil society - state, 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 led by a dictator;
The dominance of the repressive apparatus;
Abolition of representative bodies of power;
Monopoly of the ruling party and its integration and all other social and political organizations directly into the system of state power.
“The legitimization of power is based on direct violence, state ideology and the personal commitment of citizens to the leader, political leader (charisma). Truth and personal freedom are virtually absent. A very important feature of totalitarianism is its social base and the resulting specificity of the ruling elites. 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 center of a totalitarian system is the leader. His actual position is sacralized. He is declared the wisest, infallible, just, tirelessly thinking about the welfare of the people. Any critical attitude towards him is suppressed. Usually charismatic personalities are put forward for this role.
In accordance with the principles of totalitarian regimes, all citizens were called upon to express support for the official state ideology, to spend time studying it. Dissent and the exit of scientific thought of the official ideology were persecuted.
Its political party plays a special role under a totalitarian regime. Only one party has a life-long ruling status, acts either in the singular, or “heads” a bloc of parties or other political forces, the existence of which is permitted 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 one day coming to power. Moreover, her coming to power does not necessarily take place by violent measures. The ruling party is declared to be the leading force of society, its principles are regarded as sacred dogmas. Competing ideas about the social reorganization of society are declared anti-national, aimed at undermining the foundations of society, at inciting social enmity. The ruling party seizes the reins of government: the party and state apparatus are merging. As a result, the simultaneous occupation of party and state posts becomes a mass phenomenon, and where this does not happen, state officials follow the direct instructions of persons holding party posts.
Medical ethics in modern Russia.
Autocratism (autocracy) or a small number of power holders. They can be one person (monarch, tyrant) or a group of persons (military junta, oligarchic group, etc.)
Unlimited power, its lack of control over 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 may be popular among the general population. However, he has sufficient power to, if necessary, at his own discretion, use force and force citizens to obey.
Monopolization of power and politics, prevention of political opposition and competition. The certain political and institutional uniformity inherent in this regime is not always the result of legislative prohibitions and opposition from the authorities. Often it is explained by the unwillingness of society to create political organizations, the lack of the population's need for this, as was the case, for example, for many centuries in monarchical states. Under authoritarianism, a limited number of parties, trade unions and other organizations of similar spirit may exist, but subject to their control over the authorities.
Refusal of total control over society, non-interference or limited intervention in non-political spheres and, above all, in the economy. The government is mainly concerned with issues of its own security, public order, defense, foreign policy, although it can also influence the development strategy, conduct a fairly active social policywithout destroying the mechanisms of market self-regulation.
Recruiting the political elite through co-optation, appointment from above, and not through competitive electoral struggle.
The general civilizational prerequisites of bioethical knowledge are fully manifested in Russia in the early 90s. However, this does not mean that biomedical technologies began to be mastered in Russia only by this time. On the contrary, it is Russia that holds the “palm” for the creation of most of them. In 1926, S. S. Bryukhonenko created the world's first heart-lung machine; in 1926, the world's first Blood Transfusion Institute was opened; in 1931 Yu.Yu. Voronoi performs kidney allotransplantation in the clinic; 1937 is the date of the world's first artificial heart implantation experiment. Christian Bernard studied and underwent an internship with V.P.Demikhov, who directed this experiment. In 1920, Russia became the first country in the world in which all legislative restrictions on artificial termination of pregnancy were removed. In the 1920s, Russian scientists of the A.S. Serebrovsky school conducted a series of fundamental experiments for the development of genetics, which proved the complex structure of the gene. In 1925, at the 6th 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 continuously and successfully. But in the 60s and 70s - the years when experimental medicine came into practice and the emergence of bioethics in the United States - bioethics in Russia was not formed 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 nature of socialist ideology, the dominance of the scientific worldview and the atheistic nature of culture." Science in the state ideology was assessed 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 an immediate and supreme "human-forming" value of culture. "Science under socialism is becoming a means of transforming not only the material and technical base of social production, but 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. IT 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 the 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, absolutely incompatible with Soviet ideology, that “science, according to the canon, is blind to the human, does not see and is unable to see the human, even if I wanted to. " A. P. Ogurtsov in his research "History of natural science, ideals of scientific character and cultural values" shows that the expansion of the socio-cultural context of the study of science leads to the problem of social recognition and socialization of scientific discoveries. This approach to the problems of scientific knowledge signified a transition in Russian philosophy from the standard scientistic "image of science" to an awareness of the existence of a wide range of axiological and ethical problems of science that were non-standard for Soviet scientist ideology. Democratization in Russia, which affected the worldview culture, became 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-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 Human Institute of the Russian Academy of Sciences, the Russian National Committee on Bioethics at the Presidium of the Russian Academy of Sciences, the Department of Bioethics at the N.N. N. A. Semashko, Laboratory "Axiology of Cognition and Ethics of Science", Institute of Philosophy, Russian Academy of Sciences. The educational and 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 2000 State Educational Standard. This was initiated by the Educational-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 for senior students. In 1995, at the Institute for Retraining and Advanced Training of Teachers of the Humanities and Social Sciences at Moscow State University. MV Lomonosov, a program for the training of teachers in the specialty "Biomedical Ethics" was created and the experience of teaching bioethics at Moscow State University was analyzed. MV Lomonosov (Philosophy, Psychological Faculties), at the Russian State Medical University, at the Moscow Medical Academy. I.M.Sechenov, at the Moscow Museum of Modern Art. N. A. Semashko and other medical universities of the country. The first Russian universities and universities, in which the departments of biomedical ethics were created, were Kazan State Medical University (head of the department, Professor V. Yu. Albitsky) and the Russian State Medical University (head of the department, Professor I. V. Siluyanova). The publishing level is represented by the magazine "Man" (chief editor B. G. Yudin), "Medical law and ethics" (chief editor I. S. Mylnikova). The listed forms reproduce the structural and organizational ways of bioethical knowledge existence in Russia, which, in principle, are standard for any knowledge in any country. But it is precisely at the theoretical level that the question can be raised 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 comprehending 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 conditions of coexistence of alternative possible solutions. The logic of the search and decision-making is primarily determined by the values \u200b\u200bprevailing in society and the traditions supported. Are there such in Russia? In recent years, Russia has experienced a unique state. Through the greatest spiritual and ideological devastation, the germs of understanding that we have the richest cultural heritage are breaking through. The deep beingness, vitality of the principles of Christian morality, their determinism of “resistance to death” prompts us to “learn from 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 inconceivable without taking into account religious and moral traditions of Orthodoxy. At the same time, the path to determining the features of these traditions lies through a comparative analysis of approaches to the problems of bioethics in Catholicism and Protestantism.
Literature:
Main:
P.V. Lopatin Bioethics: a textbook. - M .: GEOTAR-Media, 2009 .-- 272 p.
Khrustalev Yu.M. From ethics to bioethics. - Rostov n / Don: Phoenix, 2010 .-- 446 p.
Siluyanova I.V. Ethical and Legal Guidelines medical activity: uch. pos. - M., 2008 .-- 238 p.
P.V. Lopatin Bioethics: workbook. - M .: GEOTAR-Media, 2008 .-- 272 p.
Siluyanova I.V. Bioethics in Russia: values \u200b\u200band laws. - M .: Grant, 2001 .-- 192 p.
Williams J. R. Guide to medical ethics: textbook. pos. - M .: GEOTAR-Media, 2006 .-- 128 p.
Campbell A. Medical ethics / ed. Yu.M. Lopukhin. - M .: GEOTAR-Media, 2005 .-- 400 p.
Campbell A. Medical ethics / ed. Yu.M. Lopukhin. - M .: GEOTAR-Media, 2007 .-- 400 p.
1 Malko A.V. Political and legal life in Russia: topical issues: Tutorial... - M., 2000 p. 128
philosophy -\u003e Working curriculum discipline name psychology of communication direction of preparation 080100.62 Economics
philosophy -\u003e Brief content of the topic: Question General characteristics of memory. Memory theories
philosophy -\u003e Approximate questions for credit in the discipline "Psychology"
philosophy -\u003e Questions for credit in the discipline "psychology of communication"
philosophy -\u003e Philosophy test february lf to which direction of the philosophical worldview does the search for primary matter belong?
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