Vol 12, No 1 (2019)

Articles
How can we overcome the crisis of the medical humanities?
Sedova N.N.
Abstract
Medical humanities is a complex of scientific and educational concepts that ensure the integration of medical theory and practice in the context of society. The current crisis of medical humanities is associated with the intensive development of new biotechnologies and a much slower process of developing explanatory hypotheses, normative regulators and social forecasts of their use in practice. This lag could be regarded as natural, if not for the pace of technological progress, by orders of magnitude higher than all previous changes in the technological sphere. The paradox is that the society interested in humanitarian expertise of application of new technologies, at the same time brakes its development. From a philosophical point of view, this is a typical substitution of value - technology becomes self-valuable, and the understanding of what happens as a result of their application, recedes into the background. The most dangerous thing in this situation is the change of approaches to training, which will work with new technologies. Digital medicine requires operational skills, the time for the acquisition of which is "taken" in universities from "non-core" (mainly humanitarian) disciplines. Therefore, every year the trend of dehumanization of medical education is increasing in Russian medical universities. The asset of the annual all-Russian scientific and practical conference "Philosophical problems of biology and medicine" addressed, in connection with the situation, an Open letter to the Ministries, Committees of the State Duma and the All-Russian Popular Front. The letter has already received much more signatures than is required for the consideration of such a document. We publish his full text and our comment below.
Bioethics. 2019;12(1):3-5
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Bioethics of prudence and axiology of recklessness
Strelchenko V.I.
Abstract
Reanimation of long-discredited aspirations of hermetic symbolic philosophy, social Darwinism, eugenics, social hygiene, and now also transhumanism in order to solve the problems of social and individual human existence by technical means of biomedical manipulation of scientific expression of a kind of "obsession" with utopian projects of scientific-technocratic ideologies. However, resisting the threats of anthropological catastrophes and environmental crises is not a molecular genetic or biomedical problem. This is the problem of overcoming social antagonisms (class, ethno-cultural, etc.), revealed in the form of contradictions and conflicts, immanent to the present variety of activities of modern capitalism in nature and society.
Bioethics. 2019;12(1):6-11
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Narrative bioethics in the search of “other” world (on example of the J. Steinbeck’s novel “the grapes of wrath”)
Smirnov K.S.
Abstract
The perspective foreshortening of bioethical discourse known as narrative bioethics is analysed in article. This analysis is realized on example of the novel “The Grapes of wrath” of the outstanding American author John Steinbeck. Deconstruction in its ethical aspect of the discourse of justice is used as method of bioethical reflection. The text of the novel is interpreted as pharmacon, medical remedy, medicine for the human individual soul and for all social organism. The result of the analysis is the principle that “other” world is not at all real socially-cultural place existing somewhere on the Earth. People themselves (Joads’family in the novel) are bringing in themselves this “other” world: world of humanity, good, justice which excludes individualism and aggression. Thus “other” world is the discourse of bioethics as the “science of survival” in the face of inhuman capitalistic system. Given discourse can serve for the basis of the creation of global bioethos as real space of justice and new, bioethical metanarrative which is able to be real alternative to economical discourse of total capital.
Bioethics. 2019;12(1):11-15
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«The rules of the game» in the bioethics institutions
Sidorova T.A.
Abstract
The article reveals the methodological prerequisites for analyzing the institutional aspect of bioethics. Three main interpretations of the concept of "institution" are considered, which highlight a structure, functions and ideational meaning of social forms. The author sees the theoretical substantiation of this triad in the Hegelian forms of the objective spirit. Modern neoinstitutionalism understands the “rules of the game” under the institutions and expands the thesaurus of institutional theory. An attempt was made to apply these concepts to more accurately define the heterogeneous institutional formations in bioethics. Rethinking the assertion that the institutional side of bioethics is represented only by ethical committees.
Bioethics. 2019;12(1):15-19
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Islam, ethics and bioethics
Tabatadze G.S., Golitsyna O.Y.
Abstract
The article discusses the influence of Sharia, as mandatory rules of behavior of Muslims, on ethical and bioethical norms of life. Based on the sources of Islam, the Koran and the Sunnah, rather than their various interpretations, the article deals with a number of problems of medical bioethics. It is noted that, despite the influence of modern biomedical technologies on modern world cultures, their moral and ethical comprehension is the least in Islam. All of these issues are considered solely on the basis of the provisions of the Koran and the Sunnah. From the various ethical positions that contain the Qur'an and the Sunnah, it can be concluded that the physician, as a true Muslim, must demonstrate the qualities prescribed by Islam to the individual. It is shown that discussions in Islamic countries in a number of areas of modern bioethics do not conflict with the sources of Islam. It is concluded that in the Islamic world the norms of medical bioethics are determined by religious beliefs, which are the dominant of all social life.
Bioethics. 2019;12(1):19-24
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Socio-cultural representations of female in biomedicine: transformation vectors
Dondokova B.B.
Abstract
The article describes the sociocultural basis of representation of the feminine in biomedicine. The relevance of the topic is associated with the expansion of medical intervention in human reproduction and the proliferation of assisted reproductive technologies. These tendencies are based on a rather entrenched sociocultural interpretation of the feminine as a passive material principle. The anthropology of the female body is reduced only to its ability to bear children. The transformation of this attitude to the female ability to bear children is reflected in the work “Hospitality of the Matrix” by Irina Aristarkhova. The main vector of transformation is the position of restoring the subjectivity of a woman in her corporal incarnation. The author emphasizes the importance of the diversity of female subjectivity in all the richness of corporal experience.
Bioethics. 2019;12(1):24-26
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Modern transformations of medicine space from medical care to a medical service
Krom I.L., Yerugina M.V., Eremina M.G., Kovalev E.P., Vlasova M.V.
Abstract
According to the authors, transformations in medicine in modern Russia are characterized by the transition to the market of medical services, which is considered as one of the causes of a relative status inflation, a decline in the prestige of the profession of a doctor. The discrepancy in the activity and status of this professional group is a determinant moment. Modern process of institutionalization of medicine is realizing in the change of the status and the marginalization of social-professional groups of the Institute of Medicine. In the opinion of the authors the process of marginalization of doctors is explained by the «concept of status inconsistency» proposed by G. Lensky.
Bioethics. 2019;12(1):27-29
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Spiritual-moral compass of healthcare professionals and patients
Svetlichnaya T.G., Smirnova E.A., Sukhoruchko M.A.
Abstract
The article outlines the results of the research aimed at complementarity of the value-based orientations of healthcare professionals and patients as conditions for shaping partnership relations in medicine. The received data allowed to ascertain the crucial similarity in the worldview beliefs of healthcare professional and patients. Most healthcare professionals (85.4%) and patients (71.7%) apperceive their belonging to the Orthodox ethics and recognise the need to preserve the traditional religious values in Russia (88.5% and 72.1% respectively). In practice, the application of rules of religious morale is admitted by only a negligible number of them - 9.7% of healthcare professionals and 19.5% of patients. The differences in the spiritual-moral compass are only contained in a varying breadth of principal life philosophy and moral values. The revealed unity of spiritual-moral compass of healthcare professionals and patients allows hoping for the successful formation of a new, collaborating model of ethical relations in medicine in the future.
Bioethics. 2019;12(1):30-35
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Particularly vulnerable patients as a category of Bioethics and law
Mokhov A.A.
Abstract
This article is devoted to the analysis of the categories of "vulnerable persons" and "particularly vulnerable patients." International and national ethical and legal acts are analyzed from the standpoint of mentioning certain groups of vulnerable persons. The author proves that certain groups of patients can be classified as the most vulnerable due to: age, presence of certain diseases; the difficult life situation; attracting as trial subjects. The approval and wider use of the phrase “particularly vulnerable patients” is necessary to further clarify the catalog of their rights, as well as to take additional measures to protect them.
Bioethics. 2019;12(1):35-39
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Evtanazia as a form of implementation of human rights to death in the russian federation: ethical and legal aspects
Guryleva M.E., Khamitova G.M.
Abstract
Euthanasia is a procedure for stopping the life of a person experiencing pain and suffering. Attitude towards it depends on cultural, religious, ethical values. In connection with the problems that arise in all continents, the discussion of legal and ethical problems that are relevant to all mankind. The article deals with the problem of euthanasia, as a form of realization of the human right to death. The authors study the problems of population aging, statistics of growth in the number of patients with cancer, severe forms of incurable pathology, accompanied by the suffering of patients, a significant deterioration in their quality of life, and uncontrollable pain syndrome. The authors raise the question of the realization of the patient’s right to a dignified end to life and suggest holding a nationwide discussion on the possibility of resolving euthanasia in our country. The article analyzes the current legislation of the Russian Federation on the problem of a decent death, in particular, the ratio of such regulations as the constitutional right to life and the legislative ban on euthanasia. The authors conclude on the need to develop a special legal act regulating the procedure for conducting this procedure in the Russian Federation. The article contains the principles and conditions for conducting euthanasia, which should be enshrined in law with a positive decision of the issue. The experience of the Netherlands, Switzerland and Germany is given as an example.
Bioethics. 2019;12(1):39-42
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Experience of pedagogical work on implementation of principles of medical deontology at training of students of medical university
Alyoshina N.F., Piterskaya N.V., Starikova I.V., Radyshevskaya T.N.
Abstract
The introduction of the principles of medical ethics in teaching students is carried out by the staff of the Department of Therapeutic Dentistry in practical classes, lectures, during the work of student scientific circles and evening student polyclinics, as well as during extracurricular time in the process of curatorial work of teachers. During practical classes, the teacher pays attention to students not only theoretical knowledge and practical skills, but also deontological principles in relation to the patient: respect, polite treatment, which helps to gain the patient’s trust, to establish good contact, in many respects helping to conduct a successful examination of the patient, to put the right diagnosis and prescribe effective treatment. Solving situational problems reveals the ability of students to generalize results, conduct differential diagnostics with similar diseases, assign additional examination methods, which develops clinical thinking, the ability to tactfully and competently compose questions to identify the patient’s history and complaints, taking into account his emotional state and the results of an objective examination. The purpose of such training is aimed at educating students of a sense of duty and responsibility towards patients and colleagues. The consolidation and deepening of knowledge in deontology is achieved not only by solving situational problems, but also by solving test tasks, working on essays on the proposed topic under the guidance of a teacher, as well as preparing for performances at student scientific and practical conferences and participating in student Olympiads. Interactive teaching methods contribute to the improvement of the quality of training of future specialists, allow learning to interact with each other. With the help of such teaching methods, the formation of cognitive and professional motives, the development of systemic thinking of the future dentist in accordance with the core competencies, takes place.
Bioethics. 2019;12(1):43-45
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Attitude of the population of russia towards the post-mortem organ donation and the sources of information involved in its shaping
Romanov S.V., Abaeva O.P.
Abstract
This study focuses on the need to shape attitude of the Russian people to support the development of the post-mortem organ donation program. The aim of the work was to study the attitude of the population to the post-mortem organ donation and to determine the sources of information involved in its shaping. The study was based on the results of a survey of 250 patients at the federal medical center where organ transplant operations are performed. The analysis demonstrates the multi-stage process of shaping a position of support for the post-mortem organ donation among the population - from understanding the humanity of this activity to concrete steps to support it. At the same time, propaganda of organ donation is important through the involvement of the media, educational system resources, and scientific professional communities. In Russia, it is necessary to start outreach with the population concerning organ donation from the first stage, to facilitate an understanding of the need for its development in order to save the lives of seriously ill people, and therefore systematic work is needed using opportunities primarily from television and Internet sources.
Bioethics. 2019;12(1):45-48
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The medical confidentiality in the practice of surgical dentistry and maxillofacial surgery
Fomichev E.V., Afanasyeva O.Y., Dronov S.V., Blyudnikov S.A.
Abstract
The way to develop the health care system in the Russian Federation is to improve the quality of medical care. One of the main target is the regulation of relations in the "doctor-patient" system. These relationships are rather difficult and not always clear for both doctors and patients. Doctors treat patients, but at the same time they get acknowledge of various personal information. And this personal information is often extremely important to the patient, especially if patients are treated for the diseases associated with their appearance. This is especially evident when patients are referred to oral and maxillofacial surgeons and dental surgeons. In the article the authors presented the legal basis regulating the concept of medical confidentiality. The goal of the study was to determine the level of legal literacy of the maxillofacial surgeons, dentists, surgeons on the matter of information related to medical confidentiality, and to develop an algorithm for resolving disputes related to the disclosure of medical confidentiality. To achieve this goal, the authors developed a questionnaire and conducted a sociological study in compliance with the principles of research ethics. The study was conducted at the beginning of 2018, 25 doctors took part in the survey. The gender ratio was typical for representatives of these professions and did not have any specific features that distinguish it from other regions of the Russian Federation. After analyzing the data and reviewing the regulatory framework, the authors came to the following conclusions and practical recommendations. Doctors in most cases gain proper knowledge, according to information related to medical confidentiality. But this information requires specification and simpler presentation, since doctors do not get legal education. It is necessary to discuss and introduce in practice health care algorithms of settling down controversial situations Мат concerning medical confidentiality and other conflict situations at dentists’ regional associations meetings.
Bioethics. 2019;12(1):48-51
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Problems of bioethics in veterinaria: transplantation of dogs organs
Kozhevnikova M.P.
Abstract
The article reviews the bioethics of veterinary medicine as an alternative to the professional ethics of a veterinarian. From this position the transplantation of organs in the field of veterinary medicine is analyzed, its ethical problems are compared with the ethical problems of transplantology in human medicine. The case of two recent kidney transplantations to dogs in Poland, and the public reaction to them, as well as kidney transplantation to dogs in Moscow, which have been already conducted for several years, are described. The problem of organ donation in the field of veterinary medicine and the quality of life of donor dogs is being raised. The author argues that these cases go beyond professional ethics and should be considered more widely, ге. in the framework of bioethics.
Bioethics. 2019;12(1):52-56
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New domestic research in the field of bioethics
Navrotskiy B.A., Rukhtin A.A.
Abstract
The relevance of bioethical research is undeniable in the era of intensive development and implementation of new biotechnologies of human improvement. At the same time, bioethics has been denied the status of a scientific specialty in our country. This seriously hinders its development. Recent achievements in the field of bioethics show that the number of social risks of practical application of new biotechnologies increases without its explanatory hypotheses and forecasts. The article substantiates the proposals to change its scientific status on the example of the latest achievements in bioethics
Bioethics. 2019;12(1):57-59
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New opportunities bioethical training of future doctors
Petrov A.V., Kostenko O.V.
Abstract
The Commission on social and humanitarian areas of scientific and educational activities in medicine has been approved by decision of the Presidium of the Cluster "South" of the Ministry of Health of the Russian Federation/ The Commission began its work in January 2019. This is the first attempt to unite humanitarians of medical universities in our country. The Commission plans, in particular, to promote and protect biomedical ethics as a mandatory discipline in secondary, higher and postgraduate medical education.
Bioethics. 2019;12(1):59-60
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Bioethics of the XXI century: national interests and international research
Donika A.D., Shestakov A.A.
Abstract
The article presents an overview of modern research in the problem field of bioethics and medical law, presented in the framework of the 13th World Conference on Bioethics, Medical Ethics and Health Law, organized by the International Network of Bioethics Departments of UNESCO. The conference was attended by representatives from 77 countries of five continents, including 6 - from leading medical and humanitarian universities in Russia. To illustrate the current trends, a brief overview of the reports presented at the parallel sessions “Medical Ethics: Management” and “Ethical Aspects of Transplantation”, co-chaired by Russian scientists, is presented. In general, discussions organized within parallel sections demonstrated the relevance of bioethical issues in the medical practice of all countries, identified research trends in this field and revealed national characteristics.
Bioethics. 2019;12(1):60-62
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Ethics and ethnicity in medical tourism
Shchekin G.Y., Osyko A.N., Bakhtin V.A.
Abstract
The Round table on the topic "Geography of medical tourism: problems and prospects" was held in the editorial office of the journal "Bioethics" (on March 28, 2019) with the support of the Volgograd state medical University and the Volgograd medical research center. It was attended by scientists of the VSMU and VNC, foreign experts in the field of medical tourism, representatives of Russian clinics included in the activities for the development of medical tourism. two fundamentally opposite approaches in assessing the experience of the development of medical tourism in different ethno-cultural environments were noted during the discussion. One approach involves the active participation of the state in this process, the other absolutes the role of private medicine. We are mainly interested in ethical arguments in this dispute.
Bioethics. 2019;12(1):62-63
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