I. Purpose of the lesson:

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

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

3. Familiarize yourself with the main ethical documents: “Convention on Human Rights and Biomedicine”, “Hippocratic Oath”, “Oath of the Russian Doctor”.

II. Motivational characteristics:

Problems medical deontology And medical ethics In recent years, they have attracted increasing attention from scientists, practitioners, and the general medical community. This is due to many reasons, among which, first of all, we should mention the increasing importance of moral, moral, ethical factors in relationships between people. The increasing complexity of the diagnostic and treatment process and the constant introduction of innovations generated by modern science require knowledge from the doctor ethical standards regulating the behavior of a physician and the main documents containing these norms.

III. Class equipment:

2. Tasks on the topic of the lesson.

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

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

1. First known source of the concept medical ethics?

a) Bible

b) Book “Ayurveda”

c) “Hippocratic Oath”

d) “Canon of Medical Science”

2. Patron of healing in ancient Greek mythology?

a) Asclepius

c) Apollo the healer

d) Artemis

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

4. Who owns the words: “A doctor must have the eye of a falcon, the hands of a girl, the wisdom of a snake and the heart of a lion”?

a) Avicenna

b) Plato

c) Paracelsus

d) Aristotle

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

a) Asklepion

b) Yatreya

c) Hospitals

d) Hospitals

6. After which Russian doctor was the institute in Bombay named?

a) Zabolotny

b) Savenko

c) Samoilovich

d) Khavkin

7. Who coined the term “deontology”?

b) Bentham

8. A classic of Soviet deontology?

a) Ivanov

b) Petrov

c) Pavlov

d) Mechnikov

9. The main moral idea of ​​Avicenna’s “Canon”?

a) Pragmatism

b) Humanism

c) Skepticism

d) Stoicism

10. Which document for the first time in Russia defined the punishment of doctors for neglecting their duties?

a) Military regulations

b) Maritime regulations

c) Zemstvo Charter

d) City charter

11. Who proposed the term bioethics?

a) Potter

b) Freud

c) Percival

d) Kant

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

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

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

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Medical ethics(Latin ethica, from Greek ethice - the study of morality, morality), or medical deontology (Greek deon - duty; the term “deontology” has been widely used in Russian literature in recent years), is a set of ethical standards and principles of behavior of medical workers when performing them of their professional duties.

According to modern ideas, medical ethics includes the following aspects:

Scientific – a section of medical science that studies the ethical and moral aspects of the activities of medical workers;

Practical – an area of ​​medical practice, the tasks of which are the formation and application of ethical standards and rules in professional medical activities.

Any medical worker should have such qualities as compassion, kindness, sensitivity and responsiveness, caring and attentive attitude towards the patient. Ibn Sina also demanded a special approach to the patient: “You should know that each individual person has a special nature inherent to him personally. It is rare or even impossible for anyone to have the same nature as him.” Great value has the word, which implies not only a culture of speech, but also a sense of tact, the ability to lift the patient’s mood, and not to hurt him with a careless statement.

The doctor’s behavior, both from the point of view of his internal aspirations and from the point of view of his external actions, must be motivated by the interests and welfare of the patient. “Whatever house I enter, I will enter there for the benefit of the sick, being far from everything intentional, unrighteous and harmful,” wrote Hippocrates. The practical attitude of a doctor towards a person, initially focused on care, help, support, is certainly the main feature of professional medical ethics. Hippocrates rightly noted the direct relationship between philanthropy and productivity professional activities doctor Philanthropy is not only a fundamental criterion for choosing a profession, but also directly affects the success of medical practice, largely determining the measure of medical art. “Where there is love for people,” wrote Hippocrates, “there is love for one’s art.”

Of particular importance in the medical profession are such universal norms of communication as the ability to respect and listen carefully to the interlocutor, demonstrate interest in the content of the conversation and the patient’s opinion, and correct and accessible construction of speech. The neat appearance of the medical staff is also important: a clean gown and cap, neat replacement shoes, well-groomed hands with short-cut nails. Even in ancient medicine, the doctor told his student followers: “Now leave your passions, anger, greed, madness, vanity, pride, envy, rudeness, buffoonery, falsehood, laziness and all vicious behavior.”

PRIMUMNONNOCERE (lat.) - FIRST OF ALL, DO NO HARM - this statement is the main ethical principle in medicine.

The moral responsibility of a medical worker implies compliance with all principles of medical ethics. Incorrect diagnosis, treatment, and behavior of the doctor and representatives of nursing and junior medical personnel can lead to physical and moral suffering for patients. Such actions of a medical worker as disclosure of medical confidentiality, refusal of medical care, violation of inviolability are unacceptable privacy etc.

Caring for a patient involves, among other things, also observing certain rules of communication with him. It is important to pay maximum attention to the patient, reassure him, explain the need to adhere to the regimen, take medications regularly, and convince him of the possibility of recovery or improvement of his condition. Great care must be taken when talking with patients, especially those suffering from cancer, who are not usually told the true diagnosis. And today the statement of the great physician of antiquity, the father of medicine, Hippocrates, remains significant: “Surround the patient with love and reasonable consolation, but, most importantly, leave him in the dark of what threatens him.” In some countries, the patient is still informed about the seriousness of the disease, including the possible death (Latin letalis - fatal), based on socio-economic considerations. Thus, in the USA, a patient even has the right to initiate legal proceedings against a doctor who hid the diagnosis of a cancerous tumor from him.

Iatrogenic diseases

Violation of the deontological principles of communication with a patient can lead to the development of so-called iatrogenic diseases (Greek -iatros - doctor, -gepes - generated, arising). Iatrogenic disease (iatrogenics) is a pathological condition of a patient caused by careless statements or actions of a doctor or other medical worker that create in a person the idea that he has a disease or the particular severity of his disease. Inappropriate, wounding and harmful verbal contacts for the patient can lead to various psychogenic iatrogenies.

However, more than 300 years ago, the “English Hippocrates” Thomas Sydenham (1624–1689) emphasized the danger for the patient not only of the actions of a medical worker, which traumatize the patient’s psyche, but also of other possible factors - undesirable consequences of medical manipulations. Therefore, at present, any diseases the occurrence of which is associated with certain actions of medical workers are considered iatrogenic. So, in addition to the psychogenic iatrogeny (iatropsychogeny) described above, there are:

Jatropharmacogenies: a consequence of drug exposure to the patient - for example, side effects of drugs;

Manipulative iatrogenics: adverse effects on the patient during his examination - for example, complications during coronary angiography;

Combined iatrogenies: a consequence of the influence of several factors;

So-called silent iatrogenies are a consequence of the inaction of a medical professional.

Medical secret

Deontological issues of patient care include the need to maintain medical confidentiality. Medical workers do not have the right to disclose information about a patient of a deeply personal, intimate nature. However, this requirement does not apply to situations that pose a danger to other people: sexually transmitted diseases, infectious diseases, infection with the human immunodeficiency virus (HIV), poisoning, etc.

In these cases, health workers are required to immediately inform the relevant organizations of the information received. In order to carry out sanitary and epidemiological measures in the outbreak when identifying infectious disease, food poisoning or pediculosis, the nurse is obliged to inform the sanitary-epidemiological station by telephone within 12 hours from the moment of diagnosis and at the same time send there a completed emergency notification form (form No. 058/u).

Errors and medical violations

Compliance by a medical worker with moral and ethical standards involves not only fulfilling his duties, but also bearing responsibility for evasion or unprofessional performance of his duties.
"Fundamentals of legislation Russian Federation on the protection of citizens' health" (1993) regulate the legal liability of a medical worker for causing harm to the health of citizens.

Art. 66 – “Grounds for compensation for harm caused to the health of citizens.”

Art. 67 – “Reimbursement of costs for providing medical care to citizens who have suffered from illegal actions.”

Art. 68 – “Responsibility of medical and pharmaceutical workers for violation of citizens’ rights in the field of health protection.”

Art. 69 – “The right of citizens to appeal against actions government agencies And officials, infringing on the rights and freedoms of citizens in the field of health care.”

Orthodoxy and medical ethics

Orthodoxy, being historically and logically the first Christian faith, formed the tradition of an ontological understanding of morality, i.e. the deep inclusion of morality in a single and holistic “order of the world.”

That is why in Orthodox moral values, and the first of them - love for God and neighbor - is not only a desirable norm of behavior. This is the principle of being, the law of the “structure of the world”, without compliance with which the “connection of times” and meanings disintegrates, one of the links of which is meaning human life. The meaning of human life in Christian ethics is directly related to serving one's neighbor.

In this regard, healing is essentially one of the unique human professions, the meaning and purpose of which coincides as closely as possible with “doing good”, with the Christian values ​​of mercy, philanthropy and saving lives. It is no coincidence that the first model of the social institution of health care as an active manifestation of mercy and philanthropy was implemented in Christian monasteries. “Such is the power of mercy: it is immortal, incorruptible and can never perish” (John Chrysostom).

MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS

EDUCATIONAL INSTITUTION

"GOMEL STATE MEDICAL

UNIVERSITY"

Department of Public Health and Healthcare

History of medical ethics. Medical logos

Educational and methodological manual for 1st year students of the medical diagnostic faculty of higher medical educational institutions

Gomel 2009

Compiled by: Petrova N.P.

Intended for conducting seminars at the Department of Public Health and Healthcare in order to obtain knowledge, skills and abilities in the history of medicine on the topic: “History of medical ethics. Medical emblems". Compliant curriculum and a standard curriculum for the discipline “History of Medicine”, approved by the Ministry of Health of the Republic of Belarus.

Topic: history of medical ethics. Medical logos

2. Total class time

The topic is studied for 2 hours. The seminar lesson consists of 3 parts. The first part of the lesson involves analysis and discussion of the main issues of the topic. The second part discusses student work on the topic under study (UIRS). In the third part, a test control of knowledge and summing up of the lesson are carried out.

3. MOTIVATIONAL CHARACTERISTICS OF THE TOPIC: knowledge of the basics of medical ethics will help students understand what moral, ethical and value-legal principles underlie modern ethics.

4. OBJECTIVE OF THE CLASS: introduce the development of ethical principles in various historical eras; medical emblems.

5. OBJECTIVES OF THE LESSON: understand historical principles and models of medical ethics; Oath of a doctor of the Republic of Belarus; medical emblems, their meaning.

6. Requirements for the initial level of knowledge The student must know:

― basic historical principles and models of medical ethics;

― historical and ethical medical documents;

― Oath of a doctor of the Republic of Belarus;

- medical emblems and medical holidays.

The student must be able to:

- distinguish the main types of medical emblems.

― use the acquired knowledge when studying at specialized departments and to improve their professional activities;

7. Test questions on the topic of the lesson

1. Medical ethics, definition, aspects, categories, problems.

2. Historical medical and ethical documents.

3. Historical principles and models of medical ethics.

4. Oath of a doctor of the Republic of Belarus.

5. Medical emblem, types, history, meaning.

6. Medical holidays, types, meaning.

8. Training material

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

Since ancient times, a doctor has been considered a person performing a highly moral task. For example, the inscription on the Temple of Asclepius in the Acropolis reads: “...he, like God, must be the same savior of slaves, poor people, rich people and heirs to the throne and be a brother to everyone, that’s what help he should provide.” In Western countries, for quite a long period, there was a special attitude towards the sick. A striking example of this is the activities of the Knights Hospitaller Order of St. John in Jerusalem, founded at the end of the 11th century. In the Middle Ages, upon formal initiation into this brotherhood, each member of the order made an ancient vow: “The brothers of the Hospital should serve our masters, the sick, with zeal and devotion, as if they were the slaves of their masters.”

Doctors often have to make decisions related to the life, health, dignity and rights of people. It is now an axiom that medical care cannot be complete if the most highly professional doctor does not have ethical qualities. Therefore, ethics - the principles of morality and the rules of behavior based on them - occupy a special place in medicine.

Ethics – the doctrine of moral norms and rules that determine the relationships between people in the family, society, everyday life and work.

Medical ethics― a set of norms of behavior and morality of medical workers. The word "ethics" comes from the Greek ethos- custom, disposition.

Medical ethics considers:

attitude towards a person with an impaired health condition or risk of developing a particular pathology;

studies the developmental features and dependence of the moral behavior of a medical worker on the conditions of his practical activity;

determines the norms of behavior of a medical worker in everyday life, his culture, physical and moral cleanliness.

The most complete and accurate standards of behavior for a doctor were formulated by Hippocrates more than 20 centuries ago. A high level of morality and duty is contained in his words: “Whatever house I enter, I will enter there for the benefit of the patient...”. The outstanding medical reformer Paracelsus (1493-1541) also contributed to the development of medical ethics: “a doctor should think about his patient day and night”; “a doctor does not dare to be a hypocrite, a torturer, a liar, or a frivolous person, but must be a fair person”; “the power of a doctor is in his heart...”; “The greatest foundation of medicine is love.” Written sources of the Russian state of the 9th-11th centuries also contain information defining the norms of behavior of a doctor. Peter 1 issued detailed regulations on medical activities and physician behavior. The Moscow doctor of the past F.P. Gaaz spoke about the need to listen to the needs of people, take care of them, not be afraid of work, helping them with advice and deeds, in a word, to love them, and the more often this love is shown, the stronger it will become. Representatives of domestic medical science of the 18th-19th centuries made a great contribution to the development of the ethics of medical workers: D. Samoilovich, M. Mudrov, N.I. Pirogov, S.P. Botkin, V.M. Bekhterev. Advanced zemstvo doctors created the concept of medical duty.

Deontology- the doctrine of duty, based on the principle of “observance of duty” (Greek deon - due + logos). The term “deontology” was introduced by the English philosopher I. Bentham at the beginning of the 19th century to designate a theory of morality. Before the introduction of the term deontology in philosophy, the universal moral law of I. Kant was in force, according to which all people should act. Their actions must comply with current legislation, and then they are both legal and moral.

Medical deontology― the science of professional behavior of a medical worker, i.e. compliance with ethical standards by medical workers in the performance of their professional duties. The term medical deontology was introduced by the outstanding Russian surgeon N.N. Petrov.

The theoretical basis of deontology is medical ethics; deontology, manifested in the actions of medical personnel, is the practical application of medical ethical principles.

The basic principles regulating the moral character of a doctor have been formed and changed over the centuries depending on the political system that has developed in a given society, socio-economic and class relations, level of culture, national and religious traditions, etc. Accordingly, the requirements imposed by society in different historical eras on the physical, moral and intellectual qualities of a doctor and his professional skills changed and were clarified.

Long before the appearance of the term deontology, the basic principles governing the rules of conduct of a doctor and a medical worker were contained in the Indian code of laws of Manu, which lists the rules of conduct for a doctor. The most outstanding works of the Ancient World, which raise questions of deontology, are: “On the Nature of Life” by the Chinese physician Huang Di Nemjin; “The Science of Life” by the ancient Indian physician Sushruta; “Instructions”, “On the Physician” by Hippocrates. The ancient Indian treatise on medicine “Charaka Samhita” contains a number of requirements for a doctor: dedication, modesty, constant concern for improving people’s health. Where it is also said that a doctor must have a pure, compassionate heart, a strictly truthful character, a calm temperament, and be distinguished by the greatest moderation and chastity.

Hippocrates gave a number of valuable advice. He actually wrote the first page of the chronicle on deontology. He expressed his attitude to medicine in the following thought: “... and everything that is sought for wisdom is all in medicine, namely: contempt for money, conscientiousness, modesty, simplicity of dress, respect, judgment, determination, neatness , an abundance of thoughts, knowledge of everything that is necessary for life.”

The emergence of mass environmental movements in different countries, commitment to a healthy lifestyle, higher demands on medical and healthcare services are just some of the manifestations of medical trends. In these conditions, the relationship between doctor, patient and relatives has also changed, which is influenced by the level of education of the population and increasing attention to human rights, in particular to the rights of the patient. This entire complex determined the further development of medical ethics and the emergence of an integrated field of knowledge of biomedical ethics - bioethics. This term was introduced by the American biologist V.V. Potter in 1969. According to his definition, bioethics is the combination of biological knowledge and human values.

In other words, medicine at the end of the 20th century can manipulate and control a person’s life (for example, genetically correct a person’s characteristics, allow organ donation without the donor’s consent, destroy life in the embryonic stages, refuse treatment or stop medical care for a hopeless patient). Such possibilities conflict with established moral values ​​and principles. Due to this contradiction, bioethics is formed as a system of knowledge about the boundaries of permissible manipulation of human life and death.

Medical ethics is the same for doctors of all specialties, but medical deontology in each medical specialty has its own specifics.

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

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

The idea of ​​humanism has specific expressions in Hippocrates: “Whatever house I enter, I will enter there for the benefit of the patient... I will direct the regime of the sick to their benefit... refraining from causing any harm and injustice...”. The most striking manifestations of the humanism of Hippocratic ethics include the commandments about medical confidentiality and the unconditional value of any human life.

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

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

Medical ethics requires respect for human suffering, even in the case of a captured enemy, as reflected in the International Convention of the Red Cross concerning the Treatment of Prisoners of War (1929).

The main objectives of medical deontology are:

1) studying the principles of behavior of medical personnel aimed at maximizing the effectiveness of treatment;

2) exclusion of unfavorable factors in medical activities;

3) studying the system of relationships that are established between staff and patients;

4) elimination of the harmful consequences of inadequate medical work.

Main aspects of medical deontology:

- doctor and society;

- doctor and patient;

- relationships between doctors, medical personnel;

- medical confidentiality;

― medical errors;

— ethical assessment of the experiment.

A medical worker is entrusted with a huge public duty - taking care of preserving the health of people and curing the sick; he is entrusted with the most precious thing - the health and life of people. The doctor is a member of society, and he must be guided in his actions by the same principles as other members of this society. Medical deontology cannot be considered in isolation from society’s attitude towards doctors.

A doctor's love for a person is a fight for the patient, the use of all means and possibilities, tireless thoughts about him and the search for a way out, it is the mobilization of all forces and even working beyond all strength and possibility. Of course, this activity must be supported by competence, experience, and be based on extensive and accurate professional knowledge and skills.

From the history of medicine it is known that back in the 3rd century BC. In the composition of the Indian folk epic “Ayurveda” (“Book of Life”), issues of the doctor’s attitude to the patient and the relationship between doctors were reflected. It is said here about the doctor’s personality that he should be modest in life and behavior, not flaunt his knowledge and not emphasize that others know less than you.

Medical ethics requires specificity in relations between all members of the team, regardless of rank and title. Respectful address to colleagues, as well as the white color of the medical gown, emphasizes the purity and high meaning of the profession. This principle must be adhered to especially strictly if communication occurs in the presence of the patient. In the eyes of the patient, the doctor should not question the professionalism of his colleague. The situation with a colleague must be discussed in person and in private.

Doctors should treat nursing and junior medical personnel with respect. A modern nurse is a highly qualified worker who knows and can do a lot. She is the doctor's first assistant, without whom the treatment process is impossible. Respectful relationships with nurses, especially for a young specialist, allow a lot to be learned and a lot of mistakes to be avoided.

According to the principles of deontology, in relation to the patient, a medical worker must show maximum attention and apply all his knowledge to restore health or bring relief to the patient in his suffering; tell the patient only that information about his health that can be beneficial.

Medical secret- one of the basic concepts of medical ethics. Social and medical attitudes towards professional secrecy have developed historically. No deontological concept has undergone as many influences as medical confidentiality.

Since ancient times, the existence of provisions on medical confidentiality has been known, which were quite widely represented in the famous Hippocratic Oath: “So that during treatment, as well as without treatment, I neither see nor hear about people’s lives that should not be disclosed, I will keep silent about that, considering such things a secret" , as well as in the oaths of the priests long before her.

During his activities, the doctor receives a lot of information, the dissemination of which can cause a lot of anxiety, trouble and even cause serious danger for the patient himself or for his family.

Every doctor, every medical worker must recognize himself as a bearer of the sacred tradition of inadmissibility of disclosing professional secrets.

Medical confidentiality means the following:

― information about the patient received by a medical worker from the patient or during treatment is not subject to disclosure;

― information about the patient that the medical worker should not tell him (unfavorable outcome of the disease, diagnosis causing psychological trauma to the patient, etc.).

The purpose of maintaining professional secrets is to prevent possible moral or material damage to the patient. When seeking medical help and receiving it, the patient has the right to maintain medical confidentiality. Medical confidentiality must be maintained in any case - we are talking about AIDS or some other disease. Disclosure of information constituting medical confidentiality by persons to whom it became known during training, performance of professional, official and other duties is prohibited.

The citizen must be assured of a guarantee of confidentiality of the information transmitted to him. With the consent of the patient or his legal representative, it is permitted to transfer information constituting medical confidentiality to other citizens, including officials, in the interests of examining and treating the patient, for conducting scientific research, etc.

If in ancient times and even in times closer to us, the observance of medical secrecy was absolute in relation to everything that was known to the doctor, now moral and legal deviations from observance of the rules of medical secrecy have multiplied. Deontology and medical law state the limitations of this secret caused by social necessity.

Submission of information constituting medical confidentiality without the consent of the citizen is permitted:

- for the purpose of examining and treating a citizen who is unable, due to his condition, to express his will:

- when there is a threat of the spread of infectious diseases, mass poisonings and injuries;

― at the request of the bodies of inquiry and investigation, the prosecutor’s office and the court in connection with an investigation or trial;

- in case of providing assistance to a minor under the age of 15 - to inform his parents;

- if there are grounds to believe that harm to a citizen’s health was caused as a result of illegal measures.

Persons to whom information constituting medical confidentiality is transferred in accordance with the established procedure bear disciplinary, administrative or criminal liability for the disclosure of medical confidentiality.

Medical errors.

N.I. Pirogov should be considered an example of a doctor’s attitude towards his professional mistakes, who wrote: “I... want, by recognizing and assessing my own mistakes, to warn young doctors from repeating them... Only in this way do I think to compensate for the lack of my experience and excite their listeners love for the truth."

Medical errors are divided into four groups:

Diagnostic errors – failure to recognize or misdiagnose a disease;

Tactical errors - incorrect indications for surgery, erroneous treatment tactics;

Technical errors – incorrect use of medical equipment, unreasonable use of medical supplies;

Deontological errors (iatrogeny).

The first requirement is the recognition of errors in diagnosis, since this is an issue with a large moral burden. The doctor on whom the fate of the patient depends, especially the doctor who shapes other doctors, must always tell only the truth, argued N. I. Pirogov. Secondly, as J. L. Petit said, mistakes, if hidden, can turn into crimes. We learn more often and more from mistakes than from successes. A good doctor is one who rarely makes mistakes, says Hippocrates, but an excellent doctor is one who admits to making a mistake.

Another requirement in connection with overcoming errors, especially in the diagnostic field, is the constant development of the clinical sense of the doctor, especially in our days, when medicine, while gaining in a technical sense, risks losing in humanity. Clinical sense, defined as the ability to fully and correctly assess a painful condition, implies theoretical training, practical experience, adequate judgment, the use of technology without worshiping it, and the presence of ethical and psychological connections with the patient.

The diagnostic doctor is accused ofThe following are considered valid errors:

Failure to conduct a thorough examination of the patient;

Not using additional methods to establish a diagnosis;

Refusal to consult with other specialists on personal initiative or at the request of the family, etc.

ImputedThe following are considered therapeutic errors:

Intervention with misdiagnosis; ignorance of the properties of the medicine;

Failure to obtain the patient's consent after informing;

Failure to monitor the progress of treatment, etc.

Limiting the errors attributable to those not attributable to the doctor should be carried out through a specific analysis of the conditions of his work. The question is always asked: did the necessary conditions exist for the diagnosis to be accurately established, and did the doctor do everything possible in accordance with these conditions? Only on this basis will the most correct conclusions of a legal and deontological nature be made.

If clinical or laboratory data are insufficiently assessed or if they are incorrectly interpreted, the doctor may make an erroneous diagnosis. Thus, ignorance of symptomatology, indecisiveness, self-doubt, fear of responsibility, negligence, superficiality or haste are included in the scope of ethical assessment of medical practice.

Iatrogenesis (Greek yatros - doctor and genius - I arise) - a disease caused by undesirable or unfavorable consequences of medical interventions and leading to various dysfunctions of the body, restrictions on usual activities, disability or death. Doctors have long known that inept use of words or the prescription of certain medications can harm the patient. The term “iatrogenics” became widely known in medicine thanks to the article “The Doctor as the Cause of Mental Illness” (1925, O. Bumke).

Clinical experiment– the most important source of new knowledge. Currently, its implementation is regulated by numerous legal and ethical standards that protect the life, health and rights of volunteers. Forced clinical experiences are widely recognized as illegal and immoral.

This has not always been the case in history. Medicine became a science, and quite late compared to other exact sciences, only when it recognized the need to be experimental medicine. Back in 1847, young C. Bernard opened a semester at the Paris Faculty of Medicine with the dictum: “Scientific medicine, the course of which I am obliged to read, does not exist.” Only after medicine, according to I. P. Pavlov, went through the flames of experimentation, did it turn into what it is today, that is, scientific medicine.

The Ptolemaic laws and medical ethics of two thousand years ago allowed doctors of ancient Alexandria to use criminals sentenced to death for experiments. The most striking and terrible example of medical crimes is the experiments of Nazi doctors. The material for their experiments were concentration camp prisoners and patients in German hospitals. At the same time, the so-called Nuremberg Code was published, recognizing the right to experiment and at the same time formulating the rules for its implementation. But even after the publication of this code, unfortunately, experiments on people did not stop being carried out, which cause criticism from the point of view of ethics and humanity. In 1949, for example, in the United States, various antimalarial drugs were tested on 700 prisoners, of whom 4 died. As a result, the so-called Declaration of Helsinki was adopted, published in 1964. It expanded and clarified the Nuremberg Code.

Controlled studies have in many cases helped accelerate the understanding of the effectiveness of preventive and therapeutic methods and their rapid introduction into widespread practice. Examples include work on the effects of vaccination on polio or confirmation of the effectiveness of streptomycin on tuberculous lesions in humans, obtained in the early 50s.

Studies that followed the control group principle very often revealed the absence, and sometimes even the harmfulness, of many new therapeutic methods that had a subjectively positive assessment. An example is an objective assessment of the ineffectiveness of dressing for angina pectoris. Many patients could have avoided unnecessary surgical risks (deaths have been reported) if follow-up studies had been performed beforehand. Another, even more convincing example is the method of treating stomach ulcers by cooling (freezing). This method was put into practice in 1962. However, a control clinical study, which was conducted later and in which 5 medical institutions took part, found that the method is of no value and is even harmful, because freezing the ulcer can lead to necrosis of the stomach wall.

From all the arguments presented for and against a clinical experiment, first of all, it follows the need to clarify the fundamental question, namely: is the experiment conducted on humans justified and fair? The answer to this question, taking into account the sad experience mentioned above, is unambiguous. The need to conduct an experiment on humans is beyond doubt and is recognized by everyone. Medicine cannot move forward without this. Experiments carried out on humans help develop more effective preventive and therapeutic methods for the people of the future. Of course, experiments on animals also bring a lot of value; this is where we should always start. But the final verification of the proposed methods can only be done by observation in humans. Thus, the question is not whether to conduct an experiment, but how to conduct it, that is, how to obtain the most information during an experiment and comply with ethical standards.

Society also cannot refuse the opportunity to conduct clinical experiments. Otherwise, it would mean slowing down the development of medical science, which would ultimately benefit no one and would not benefit public health in the first place. But, on the other hand, society must do everything to ensure that cases of abuse of patients’ trust in doctors do not occur and that the latter do not use them in ill-conceived experiments that contradict the principles of medical ethics, examples of which were given above.

Main problems of medical ethics:

The relationship of the doctor with the healthy and sick and relatives.

Rights to information.

The right to die. Euthanasia.

Organ transplantation.

Ethical problems of genetics and genetic engineering, etc.

The doctor must ensure in advance that his information for the patient’s family members is clear, precise, understandable, does not exceed acceptable limits and is sufficiently reasoned. Relatives are strongly influenced by the doctor’s conviction, his personality and reputation, the reasoning behind certain proposals or actions, and finally, the culture of the entire medical conversation.

Euthanasia one of the ethical problems of medicine. The term “Euthanasia” comes from the Greek words “evos” - “good”, and thanatos - “death”, literally meaning “kind”, “good” death, as the Greeks called honorable death for the fatherland. In the modern understanding, this term means a conscious action or refusal to act, leading to the quick and painless (not always) death of a hopelessly ill person, with the aim of ending intractable pain and suffering.

Classification of euthanasia:

a) passive – cases when the patient’s death occurs as a result of cessation of medical measures to prolong life;

c) active – cases when special means are used that lead to death.

There is also a distinction between voluntary euthanasia - at the request of the patient himself and forced euthanasia, which is carried out at the insistence of relatives, society or government agencies. The immorality of the latter is not accepted by doctors, society, or the law. And the permissibility of voluntary euthanasia is the subject of fierce debate. Doctors, like all modern society, are divided into supporters and opponents of euthanasia.

The acceptability of voluntary euthanasia is the subject of fierce debate.

The problem of euthanasia became acute in the 20th century due to the progress of medicine. Opportunities have emerged to support the lives of incurable patients with the help of artificial respiration devices, blood circulation, artificial kidneys, and medications.

Since the late 19th century, the attention of physicians, lawyers and philosophers has been drawn to the moral problems associated with organ transplantation.

Mentions of the transplantation of certain organs and tissues are found in Greek mythology, Christian legends (for example, the legend of Cosmas and Damian), and folk tales of the early Middle Ages. There is a legend that the Chinese surgeon Hua Tu (2nd century AD) removed the affected internal organs and transplanted healthy ones in their place.

Modern medical technologies make it possible to transplant various organs to patients: kidney, heart, lung, bone marrow. They are removed from the corpses of people who have received fatal injuries. After receiving a fatal injury, the donor is taken to the hospital, pronounced dead and immediately taken away required material for transplantation. This gives rise to an insoluble ethical problem - the need for the death of one to save the other. The problem arises: to carry out resuscitation measures for him or not?; What criteria are used to determine the death of a donor?

Thanks to organ transplant operations in different countries, thousands of people have been saved. On the one hand, an extremely promising opportunity has opened up for humanity to treat patients previously considered doomed, but on the other hand, a whole range of ethical problematic issues have arisen. For example, is it moral to spend money on a transplant? Organ transplants are expensive operations that consume significant healthcare resources. Is it moral to obtain organs from living people? After all, organ transplantation from a living donor involves serious risks for the latter. Firstly, this is the risk associated with the surgical operation itself, which is always very traumatic for a person. Secondly, having lost one of the paired organs or part of an organ, the donor becomes more vulnerable. The fundamental Hippocratic principle of doctors - “do no harm” - is being violated.

The use of a human corpse as a source of organs for transplantation also causes a whole range of moral problems. All world religions prohibit causing damage to the body of a deceased person, prescribe a careful and respectful attitude towards it, and any act of action on it is a reprehensible act that insults the memory of a person.

How to equitably distribute scarce resources for transplantation? Should the resulting organ be “given away” to people with antisocial behavior (for example, people suffering from drug addiction)? Will it be fair to treat disabled people while there are hundreds of children and young able-bodied people on the waiting list? The Constitution of the Republic of Belarus establishes health protection and medical care as an inalienable right of every citizen. Therefore, when distributing organs, transplantologists are guided by the following criteria: the degree of compatibility of the donor-recipient pair; extremeness of the situation; duration of stay on the “waiting list”. It is important that all this is sufficiently implemented in practice. The choice of recipients is always an ethical act.

Ethical problems of genetics and genetic engineering.

Genetics (Greek genetica – related to origin) - the science of heredity, variability of organisms and methods of controlling them. The term was coined by William Bateson (1861-1926) in 1906. The gene (Greek genos – genus, origin) is an elementary unit of heredity. It was introduced in 1909 by the Danish scientist V. Johannsen). Gene rearrangement is called mutation (lat. mutation - variability).

Czech naturalist Gregor Mendel (1822 – 1884) became the founder of genetics. Mendel established the laws of heredity.

The objectives of genetics are:

Study of the structure of units of heredity (genes);

Analysis of the mechanism of gene functioning;

Implementation of genetic information (in particular, to increase the productivity of livestock and agricultural structures);

Analysis of gene functioning at different stages of organism development.

Thus, genetics studies two fundamental properties of living systems - heredity and variability.

The amazing achievements of genetics have made it possible to reach the molecular level of knowledge of the genetic structures of the body and inheritance, to reveal the essence of many serious human diseases, and to come close to gene therapy.

Clinical genetics is one of the most important areas of modern medicine, acquiring real preventive significance. It turned out that many chronic human diseases are a manifestation of a genetic load, the risk of their development can be predicted long before the birth of a child, and practical opportunities have already appeared to reduce the pressure of this load.

Rapid progress in deciphering the human genome has significantly expanded the range of studies to identify genetic predisposition to perform muscular activities of various types and durations. One of the most important practical achievements of molecular genetics for sports is the development of DNA diagnostic methods that make it possible to identify DNA sections responsible for the genetic determination of certain metabolic and functional traits, and among them - for the development of human motor function

Today, human genome researchers talk about the brilliant prospects of gene diagnostics and therapy. However, without experience of negative consequences, they still recognize the degree of risk of their activities. Professor Jean Dausset, winner of the Nobel Prize in Physiology or Medicine (1980), states: “In the field of human genetics, the unwise use of new technologies can lead to catastrophic consequences.” Genetic scientists, philosophers, politicians, and sociologists are faced with the need to solve a whole complex of real ethical problems of gene technologies. Can a person (scientist, genetic researcher, politician) become a co-author of biological evolution? Can and should the reality of biogenetic inequality (abilities, health) become the basis of social inequality? Can science change the principles of democratic governance of society? Can the state and society regulate the process of scientific research, and if “yes,” then “how”? Should genetic testing be made available to everyone and cover the entire population? Should genetic testing become mandatory? Should it be mandatory for people getting married or pregnant? Can genetic diagnosis be considered a basis for abortion (termination of pregnancy)? Is it ethical to inform a person about his predisposition to a particular disease? Especially if medicine cannot yet prevent its development? Is it acceptable for genetic testing data ("gene passport") to be used by insurance companies and employers? Is it ethical to create “spare parts” for the market of organs, tissues, genes using intrauterine embryos? Are such procedures with embryonic material generally acceptable? Can the genome become a criterion for assessing personality? How to guarantee and ensure the confidentiality of genetic testing materials? Should information about the results of genetic testing be shared with all family members? Should people know their genetic future? Do they have the right to choose - to know or not to know? Is it possible to force them to be informed about this? Can genetic testing of the population become the basis for the classification of population groups and the basis for the authorities to restrict the freedoms of “disadvantaged” people? Will science limit itself to decoding pathological genes or will it go further to the search for genes responsible for human behavior? Is it possible to improve or “harmonize” man and the human race by selectively breeding certain individuals? These questions constitute the essence of the ethical issues of gene technologies. They are closely related, and each of them is not an arbitrary construction of the inventive human mind, but a natural consequence of already existing scientific practice.

Genetic engineering- experimental science. This is a set of methods that allow, through operations (in vitro, outside the body), to transfer genetic information from one organism to another. The goal of genetic engineering is to obtain cells (primarily bacterial) capable of producing some “human” proteins on an industrial scale; in the ability to overcome interspecies barriers and transmit individual hereditary characteristics.

The formal date of birth of genetic engineering is considered to be 1972. This year, a group of researchers led by American biochemist Paul Berg, working at Stanford University, near San Francisco in California, reported the creation of the first recombinant DNA outside the body. It is also called hybrid, because. it consists of DNA fragments from various organisms. The first recombinant DNA molecule consisted of fragments of Escherichia coli, a group of genes from this bacterium itself, and the complete DNA of the SV40 virus, which causes the development of tumors in monkeys. Such a recombinant structure could theoretically have functional activity in both E. coli and monkey cells. She could “walk” like a shuttle between a bacterium and an animal. For this work, Paul Berg was awarded the Nobel Prize in 1980. The main methods of genetic engineering were developed in the early 70s of the last (XX) century. Their essence is the introduction of a new gene into the body.

Thus, genetic engineering is aimed at creating organisms with new combinations of hereditary properties by constructing functionally active genetic structures in the form of recombinant DNA from fragments of the genomes of different organisms that were introduced into the cell.

Advances in genetics and nucleic acid chemistry have made it possible to develop genetic engineering methodology:

Discovery of the phenomenon of restriction-modification of DNA and isolation of restriction enzymes to obtain specific enzymes;

Creation of methods for chemical and enzymatic gene synthesis;

Identification of vector DNA molecules capable of transferring foreign DNA into a cell and ensuring the expression of the corresponding genes there;

Development of transformation methods in various organisms and selection of clones carrying recombinant DNA.

Using genetic engineering methods, it was possible to obtain interferon and insulin. Today, the object of biotechnology is not only an individual gene, but also the cell as a whole.

This makes it possible to obtain completely new organisms that did not exist in nature. But at the same time, there is a danger that artificially created organisms can cause unpredictable and irreversible consequences for all life on Earth, including humans.

Genetic and cellular engineering drew humanity's attention to the need for public control over everything that happens in science.

Until now, EU member countries have not decided on the prospects of genetic technologies in agriculture and food industry. According to the French microbiologist Jean-Paul Prunier, “by manipulating molecules and grafting one plant with the cells of another, including artificially grown ones, it is possible to obtain a wide variety of fruits, cereals and root vegetables. Moreover, they are high-yielding, almost immune to diseases, pests, and lack of water.” and light or drought." However, many scientists have found that the consumption of genetic products leads to irreversible changes in the body of humans and animals.

Various socio-ethical problems arising in society in connection with the development of genetics revolve mainly in the plane of questions of whether it is permissible to use the capabilities of human genetics to improve his somatic and mental health, abilities, and if so, under what conditions, to what extent, not whether this way of interfering in human nature will lead to a violation of his health, to undesirable consequences of a moral and psychological level, to harmful or dangerous social consequences. Already in the 30s, when human genetics was just in its infancy, relatively simple ways of improving the qualities of a biological species through targeted crossing of individuals, discovered by genetics and recommended for animal husbandry and crop production, were adopted by reactionary and fascist regimes to justify genocide and implement racist eugenic measures (e vgenics(from the Greek evgenek - “good kind”, “thoroughbred”) - a form of social philosophy, the doctrine of a person’s hereditary health, as well as ways to improve his hereditary properties). IN modern science many problems of eugenics, especially the fight against hereditary diseases, are solved within the framework of human genetics. Due to the rapid development of genetics, eugenics as an independent science has lost its meaning. The concept of "eugenics" was introduced in 1883 by the pioneer of mathematical statistics, Francis Galton (1822-1911), applying his cousin Darwin's idea of ​​selection to humans.

Today, developmental biology and genetics have carried out the development of an organism from a somatic cell of the body, creating a twin organism. This gives rise to a range of new problems of a moral and legal nature. Society has not yet realized the danger of flooding the environment with synthesized chemicals.

In the last decade, genetics has increasingly invaded the practice of healthcare and everyday life. Therefore, every doctor of any specialty should have certain genetic knowledge.

The active development of genetic engineering will help solve important medical and economic problems. Naturally, genetic engineering problems continue to worry the scientific community.

Any problem of medical ethics is considered based on the fundamental principles:

autonomy;

awareness of the patient (parents) about his state of health and the need to obtain consent for medical interventions;

confidentiality;

safety for the patient;

respect for the dignity and value of every patient's life;

social justice.

Under autonomy is understood as a form of personal freedom in which an individual acts in accordance with his freely chosen decision.

It is very important in modern healthcare compliance with the principle of informed voluntary consent. This principle means that the medical professional must inform the patient as fully as possible and give him the best advice. Only after this the patient must choose his own actions. Providing incomplete information is not permitted.

Confidentiality- a norm of ethics and law that prohibits medical workers from disclosing certain information. In one form or another, the confidentiality norm is found in numerous codes. professional ethics medical workers, lawyers, psychologists, journalists, etc. This rule applies to all persons who, by virtue of their official or professional position, became the owners of this information.

The primary responsibility of every healthcare worker no harm or damage to health patient. Neglect of this duty, depending on the damage to the patient’s health, may become the basis for bringing a medical worker to legal liability.

Respect for the patient's human dignity the responsibility of every doctor. When communicating with a patient, the doctor should not forget about the following rules:

Always listen carefully to the patient when asking him a question;

Always be sure to wait for a response;

Express your thoughts clearly, simply, intelligibly.

Showing arrogance, dismissive or demeaning treatment of a patient is not acceptable.

In modern conditions, the principle is especially important social justice, which means the obligation to provide and equal access to medical care.

Equality and justice.

Good and good.

Professional duty.

Responsibility.

Honor, dignity, conscience.

The principles and categories of ethics are its theoretical apparatus. At the same time, they have normative and evaluative content. In other words, the principles and categories of morality should be considered from two points of view: in the normative-evaluative plane - as values ​​and in the theoretical plane - as fundamental concepts of ethical science. If we, for example, consider the imperative force (priority role) of the consciousness of moral duty in comparison with other motives of a person’s behavior in a certain life situation, then we understand “duty” primarily as a moral value. If, considering the relationship between the individual and society, we come to the conclusion that personal freedom (moral freedom) naturally appears as a consequence (often as subordination) to moral duty, then we understand “duty” primarily as an ethical category.

IN modern society medical humanism is elevated to a higher level, which we will see when considering the professional morality of doctors from the standpoint of categories - equalityAndfairliveliness.

Medical ethics requires seeing the patient first and foremost as a patient, establishing a certain equality of all people in the face of illness and death. People's moral sense is especially sensitive to the inequality of distribution of “medical services” in society.

None of the doctors has the right to forget that in the hospital and in the clinic (dispensary) they always deal with a mass of patients, a significant part of the work with each of whom (the treatment of each) is carried out in front of others. Figuratively speaking, every physician takes the first ethical exam in front of his patients on the subject of “equality.” Accepting one of the patients bypassing the queue (without medical indications) is a multiple moral evil: a manifestation of disrespect for many people at the same time, disregard for the condition of the patients, a cynical, defiant demonstration of immoral behavior by doctors.

At the same time, medical ethics cannot ignore issues related to “patient ethics.” The ethical position of the patient will be when he treats with understanding any case of fair unequal attention that the doctor pays to some patients due to natural differences in the course of their illnesses.

In medical practice, first of all, attention should be paid to such manifestations of good as life and health. When we make these highest manifestations of good the subject of social and moral relations, we talk about them as values. In his professional activity, a physician deals with countless concrete manifestations of good. An improvement in the patient's condition, a random coincidence of circumstances contributing to the success of treatment, and the ignorance of a significant part of patients regarding the prognosis of their disease - all this is good. As we see, the category of “good” tends to reflect the objective state of affairs from the point of view of their compliance with the attitudes and expectations of a person (patient, doctor). Good (like evil) is the most general moral concept. Even when a person’s actions are not crowned with practical success due to some external circumstances, the moral choice he has made correctly allows us to say about this person that he has not betrayed himself as a person, since he strived to do good.

In general terms, the model of moral choice in medicine has been developed since the emergence of professional ethics: the welfare of the patient is the highest priority goal of a doctor’s professional activity. In medical practice, the patient, in a certain sense, personifies the category of “good,” and the doctor (physician) personifies the category of “good.”

In the patient’s mind, an exemplary doctor is a man of duty, for whom providing assistance to a patient is not only an official duty, but a truly moral act. A true doctor will always overcome those incidental circumstances (selfish or selfish temptations) that can make it difficult for him to fulfill his medical duty. This is evidenced by the immortal lines of the “Hippocratic Oath”: “Whatever house I enter, I will enter there for the benefit of the sick, being far from everything intentional, unrighteous and harmful...”.

Fidelity to professional duty requires both wisdom and a kind of moral fortitude, moral toughness. In this case, when speaking about wisdom, we mean the degree of development, maturity of the doctor’s mind, his awareness of the collective moral and ethical experience of his colleagues, and most importantly, the ability to draw reasonable conclusions not only from his own successes, but also from mistakes. Moral fortitude should also be understood as the doctor’s acquisition of a unique moral and ethical experience in overcoming various kinds of temptations. For example, if a doctor is treating a patient who occupies a high social position and has great public authority, then his professional duty should prompt him to choose a line of decent behavior that allows him not to belittle his professional and personal authority.

Ethics, following the category of “duty,” considers category "responsibility". Responsibility is a specific measure of duty. It is generally accepted that the responsibility of doctors in their work is enormous. This is probably the most common moral judgment about medical work. Some people sometimes have an exaggerated idea of ​​the responsibility of medical workers. Conscious of his professional responsibility, a medical worker from the question “What should?” moves on to the question “What and how to do?”

Consciousness, a sense of responsibility is, in a sense, a state, a personal quality of a physician, the tension of the forces of his spirit, which sets the direction for volitional decisions. Responsibility is undoubtedly the most important moral quality of a physician; it is consciousness, a sense of Responsibility that fuels his professionalism as a whole, it is the “growth hormone” of his very personality. The moral energy of the professional responsibility of a medical worker is then concentrated in a variety of specific deontological imperatives, for example, the following: under no circumstances should the promise given to the patient be broken; in relation to patients, the doctor is prohibited from antipathy, irritation, resentment, haste, impatience, and forgetfulness.

The work of medical workers is associated with enormous responsibility, but this also explains the attractiveness of the medical profession. A person is attracted to healing by the space for the development of his personality. The responsible or irresponsible attitude of a specialist to his work determines “merit” or “guilt” as a moral phenomenon.

It should also be said that the concept of professional responsibility in medicine also has a legal meaning. Moral responsibility, of course, “overshadows” legal responsibility, while legal responsibility in its own way “extends” over moral responsibility. Legal laws reflect the relationships between doctors and patients, doctors and society, which have a particularly deep social content. Along with deontological self-education, the doctor is obliged to engage in legal self-education.

The process of self-education is unthinkable without a person’s assessment of his personality as a whole. Moral self-awareness can be expressed by the following concepts (categories): honor, dignity, conscience.

Concept "honor" reflects the assessment of the individual by society, since he belongs to a certain social group (“work honor”, ​​etc.), as well as the attitude of the individual himself to this assessment. Not to lose yourself in the eyes of other people, especially your social group and professional environment, is the internal law of every person. The white coat and cap symbolize the untainted honor of medical workers. A medical student should already have a sense of professional honor in the first year. The professional sense of honor of medical workers, as a single alloy, includes pride in medical humanism, awareness of the enormous social significance of medical work, and faith in the power of a scientific medical title.

Those receiving the right to practice medicine must work with the responsibility required by the laws and traditions of medicine. Failure to meet the required professional level is unacceptable from the point of view of professional honor.

Like any person, a doctor values ​​self-respect; at the same time, a good reputation is a form of medical authority, and good reputation is a conductor of trust between a doctor and a patient. Consciousness professional dignity is not developed by a medical student immediately, it is equivalent to scientific training, professional skill and is the fruit of internal spiritual work and moral self-education.

The professional dignity of a doctor collectively characterizes him moral qualities. Independence, independence, freedom of moral decisions - these are the components of a person’s personal dignity. Consciousness and a sense of personal dignity exclude cowardice, flattery, self-humiliation and lack of self-confidence.

The relationship between doctors and patients requires special tact and adherence to a kind of etiquette. There are specific rules of conduct for medical workers, in which direct prohibitions play a significant role - what and how medical personnel are not allowed to do. The example of senior colleagues is of great educational importance. The purpose of education (and self-education) is to develop consciousness and self-esteem, which ultimately determine the rules of professional etiquette for doctors and nurses.

If dignity is the desire of an individual not to be at odds with himself, then conscience- this is the desire of the individual not to come into conflict with the truth of life

Conscience is the enemy of complacency and complacency. Professional dignity, going through “self-criticism of conscience,” is strengthened and deepened. The ethical category of conscience is called upon to play a vital role in solving all controversial problems generated by medical practice. I would especially like to emphasize that it is a matter of conscience for a doctor to constantly self-assess his attitude to medicine - to its past and future, to its historical fate.

Professional conscience requires from a doctor such a “deepening into the profession” in which the historical variability of the subject of medicine is realized and the place of medicine in society is comprehended.

Medical ethics is very dynamic, so it is necessary to constantly pay close attention to its various aspects. In order to understand what moral, ethical and value-legal principles underlie modern biomedical ethics, one should at least briefly characterize their development in various historical eras.

Historical medical and ethical documents

Moral requirements for people involved in healing were formulated back in the slave society, when the division of labor occurred and healing became a profession. The most ancient source in which the requirements for a doctor and his rights are formulated is considered to be dating back to the 18th century. BC Code of laws of Hammurabi, adopted in Babylon. Some paragraphs of laws relating to intentional and unintentional bodily harm are related to the legal aspects of the activities of healers. According to the laws of Hammurabi, in case of successful treatment, the healer received a very high reward.

Given the general severity of Hammurabi’s laws, such a high payment to a healer for treatment was associated with a great risk of his profession due to the custom of “talion” (from the Latin talio - retribution) - retribution to equals for equals. Thus, in case of an unfavorable outcome of treatment, the healer was subjected to severe punishment.

Issues of deontology are also reflected in the oldest monuments of Indian literature - in the code of laws of Manu (1-2 centuries AD) and in Ayurveda (Science of life; 9-3 centuries BC), where high standards were required from a doctor moral and physical qualities.

Charaka's medical treatise Charaka Samhita (Ancient India) describes a teacher's sermon to a medical school student.

“If you want to achieve success in your activities, wealth and fame and heaven after death, you must pray every day, rising from sleep and going to sleep, for the welfare of all beings, especially cows and brahmanas, and you must strive with all your heart for healing sick.

You should not betray your patients even at the cost of your own life...

You should not drink alcohol, you should not do evil or have evil friends...

Your speech should be pleasant...

You must be reasonable and always strive to improve your knowledge.

When you go into the house of a sick person, you must direct your words, thoughts, mind and feelings to nothing other than your sick person and his treatment...

Nothing that happens in the house of a sick person should be told elsewhere, and the condition of the sick person should not be told to anyone who, using the knowledge gained, could harm the sick person or others.”

Recorded in the 1st -2nd centuries. AD, this sermon bears the characteristic features of its time, but in its main ethical provisions it is very similar to the “Oath” of ancient Greek healers (written in Alexandria in the 3rd century BC). This indicates uniform principles of medical ethics in different countries of the Ancient World.

“The Hippocratic Collection”, which contains five essays “Oath”, “Law”, “About the Doctor”, “On Decent Behavior” and “Instructions” give a complete picture of training, the moral education of healers and the requirements that were placed on them in society.

During the training process, the future healer had to cultivate and constantly improve “contempt for money, conscientiousness, modesty, determination, neatness, abundance of thoughts, knowledge of everything that is useful and necessary for life, aversion to vice, denial of superstitious fear of the gods, divine superiority... After all, the physician-philosopher is equal to God” (“On Decent Behavior”).

The physician must learn to remember medicines, how to prepare them and use them correctly, not to get lost at the patient’s bedside, to visit him often and carefully observe the deceptive signs of change. “All this must be done calmly and skillfully, hiding much in one’s orders from the patient, ordering with a cheerful and clear gaze what should be done, and turning the patient away from his wishes with persistence and severity” (“On Decent Behavior”).

When treating a patient, it is necessary to remember the first commandment: “first of all, do no harm.”

When worrying about the health of the patient, the healer should not begin by worrying about his remuneration, since “paying attention to this is harmful for the patient.” Moreover, sometimes it is appropriate to treat “for free, considering grateful memory higher than momentary glory. If the opportunity arises to provide help to a stranger or a poor person, then it should be given to such people in particular... It is better to reproach those who are saved than to rob those in danger” (“Instructions”).

Along with high professional requirements, great importance was attached to the appearance of the healer and his behavior in society, “for those who themselves do not have a good appearance in their body are considered by the crowd to be unable to take proper care of others.” Therefore, a healer should “keep himself clean, have good clothes and rub himself with fragrant ointments, for all this is usually pleasant for the sick... He must be fair in all circumstances, for in many matters the help of justice is needed” (“About the Doctor”).

Upon completion of his studies, the future healer swore an oath, which he inviolably followed throughout his life, for “whoever succeeds in the sciences and lags behind in morality is more harmful than useful.”

In the 3rd century. BC In the Library of Alexandria, the oath was first formalized in literature and included in the “Hippocratic Collection”; later in wide circles it began to be called in honor of Hippocrates (by his name).

I swear by Apollo the physician, Asclepius, Hygia and Panacea and all the gods and goddesses, taking them as witnesses, to honestly fulfill, according to my strength and my understanding, the following oath and written obligation: to consider the one who taught me the art of medicine on an equal basis with my parents, to share my wealth with him and, if necessary, help in his needs; consider his offspring as their brothers, and this art, if they want to study it, teach them free of charge and without any instruction, communicate oral lessons and everything else in the teaching to their sons, the sons of their teacher and; students bound by an obligation and oath according to the medical law, but to no one else.

I direct the treatment of the sick to their benefit in accordance with my strength and my understanding, refraining from causing any harm or injustice. I will not give anyone the deadly means they ask from me and I will not show the way for such a plan; in the same way, I will not give any woman an abortion pessary.

I will conduct my life and my art purely and immaculately. In no case will I perform sections on those suffering from stone disease, leaving this to the people involved in this matter. Whatever house I enter, I will enter there for the benefit of the sick, being far from everything intentional, unfair and harmful, especially from love affairs with women and men, free and slaves.

Whatever during treatment - and also without treatment - I see or hear about human life that should never be disclosed, I will keep silent about it, considering such things a secret. May I, who inviolably fulfill my oath, be given happiness in life and in art and glory among all people for eternity; to the one who transgresses and takes a false oath, let the opposite be true.

The norms and rules of medical ethics in Ancient Greece were strictly followed and were the unwritten laws of society, for, as they say in the “Instructions,” “where there is love for people, there is love for one’s art.”

Thus, Hippocrates defined the relationship between doctor and patient, as well as between doctors.

The Hippocratic Oath has survived centuries. It is noteworthy that the 2nd International Congress of Deontology (Paris, 1967) considered it possible to recommend supplementing the oath with a single phrase: “I swear to study throughout my life!” 3 International Congress “Doctors of the World for the Prevention of Nuclear War” (1983), made a proposal to supplement national and international codes on the professional moral duty of a doctor, which are based on the “Hippocratic Oath,” with a clause obliging doctors to fight against nuclear disaster...

Today, each country has its own “Oath” or “Oath” of a doctor. While preserving the general spirit of the ancient Greek “Oath,” each of them corresponds to its time, the level of development of medical science and practice, reflects national and religious characteristics and general trends world development.

On April 26, 1994, by resolution of the Presidium of the Supreme Council of the Republic of Belarus, the text of the Oath of the Doctor of the Republic of Belarus was approved.

Oath of a doctor of the Republic of Belarus.

Receiving with deep gratitude the title of doctor bestowed upon me by medical science and practice, in front of my teachers and colleagues I SWEAR:

― help every patient at any time, regardless of his social origin, religion and nationality;

― always keep professional secrets;

― constantly improve your medical knowledge and medical art, contribute through your work to the development of medical science and practice;

Seek advice from your colleagues, if the interests of the patient require it, and never refuse them advice and help;

― preserve and develop the noble traditions of domestic medicine;

- always remember the high recognition of the doctor, responsibility to the Belarusian people and the state.

I promise to carry fidelity to this oath throughout my life.

Doctors of the East had a huge influence on the development of deontology. Ibn Sina (Avicenna), the creator of the “Canon of Medical Science,” considering various aspects of medical practice, emphasized the uniqueness and individuality of those seeking medical help: “...Each individual person has a special nature inherent in him personally.” Ibn Sina is also credited with the saying: “A physician must have the eye of a falcon, the hands of a girl, the wisdom of a snake and the heart of a lion.” One of the main ideas of the “Canon of Medical Science” is the need to prevent disease, to which the efforts of both the doctor, the sick and the healthy should be directed.

It is noteworthy that for a long time the problem of the doctor’s relationship with the patient was considered in terms of their cooperation and mutual understanding. Thus, the doctor and writer Abu al-Faraj, who lived in the 13th century, formulated the following address to a sick person: “There are three of us, the disease and I; If you are sick, there will be two of you, I will be left alone - you will overcome me; if you are with me, there will be two of us, the disease will remain alone - we will overcome it.”

In Russia, issues of deontology were legally reflected in a number of documents from Ancient Rus'. Thus, in the “Svetoslav’s Collection” (11th century) there is an indication that monasteries should provide shelter not only for the rich, but also for the poor and sick. The set of legal norms of Kievan Rus “Russkaya Pravda” (11-12 centuries) approved the provision on the right to medical practice and established the legality of doctors charging fees for treatment from sick people. The Naval Charter of Peter 1 formulated the requirements for a doctor, but his duties were considered in isolation from medical rights.

Leading Russian medical scientists have done a lot to promote the humane nature of medical practice. S.G. Zybelin, D.S. Samoilovich, I.E. Dyadkovsky, S.P. Botkin.

In modern conditions, issues of deontology are given great attention in all countries. A number of declarations, codes, and rules have been adopted that are designed to define ethical standards of behavior for doctors. In many countries (France, Germany, Italy, Switzerland, USA, etc.) there are national codes of deontology. A number of documents are international in nature. These include the Geneva Declaration (1948), the International Code of Medical Ethics (London, 1949), the Helsinki-Tokyo Declaration (1964, 1975), the Sydney Declaration (1969), the Declaration on the Attitude of Doctors towards Torture (1975), etc.

The Geneva Declaration is based on the Hippocratic Oath,” but it also reflected the most pressing social problems of the 20th century. Thus, the declaration included the following phrases: “I will not allow religion, nationalism, racism, politics or social status to influence the performance of my duty... Even under threat, I do not use my knowledge in the field of medicine against the laws of humanity.” The last phrase, reflecting the experience of World War II, consolidates the provisions of the “Ten Nuremberg Rules” (Nuremberg Code, 1947), which emphasize the inadmissibility of criminal experiments on people.

Since the time of Hippocrates, medicine has developed a unified ethical principles. These principles are aimed at protecting the interests of the patient and their humanity.

Historical principles and models of medical ethics.

And.

EthicsHow does a scientific discipline answer the question ofwhat norms and goals or values ​​people should guide their activities.

Morality ( moralitas , the term was introducedfrommore - generally accepted, unspoken rules) - ideas accepted in society about good and bad, right and wrong,, as well as a set of norms of behavior arising from these ideas.

The concept of morality is used to designate a part or level of morality as a whole.

Morality - a special form of social consciousness and type of social relations, one of the main ways of regulating human actions in society with the help of norms.

Moral -a system of internal human rights based on the humanistic values ​​of kindness, justice, decency, empathy, and readiness to help.

Initially, the meaning of the word was joint housing and the rules generated by joint living, norms that unite society, overcoming and. As society develops, the study of , , , , , is added to this meaning. Developed by ethics - ,, , etc., guide moral development social institutions and relationships.

In science, ethics is understood as a field of knowledge, and morality or ethics is what it studies.. In living language this distinction is not yet available.

The term ethics is sometimes also used to designate a system of moral and moral norms of a certain social group.

Basic Ethical Issues

The problem of criteria and virtues and vices

Problem and purposes

Problem

The problem is its combination with natural desire

Classification of ethical values

All the variety moral values divided into basic and private. The first, which underlies all the others, includes goodness and the associated values ​​of nobility, completeness and purity. Private values, or virtue values, are divided into three groups:

values ​​of ancient morality - justice, wisdom, courage, self-control; this also includes values ​​based on the principle of the middle;

the values ​​of the “cultural circle of Christianity” - love for one’s neighbor; truthfulness and sincerity; hope and loyalty; trust and faith; modesty, humility, distance; values ​​of external treatment;

other values: love for the distant, giving virtue, personal love.

Ethics is inseparable from its very origin. This term was first used to designate a special field of “practical” research, because it tries to answer: what should we do?

Aristotle called the main goal of moral behavior - activity in its entirety, that is. Self-realization of a person is reasonable actions that avoid extremes and hold on. Therefore, the main virtue is moderation and prudence.

According to a student of Plato, the goal of ethics is not knowledge, but actions. The question of what good is in ethics is connected with the question of how to achieve it.

Aristotle notes that human actions are expedient, that each activity has its own goal, that goals form a hierarchy. According to Aristotle, one should assume the highest, final goal, which should be desired for its own sake, and not be a means to some other end. It is precisely this, as good in the proper sense of the word, or the highest good, that will determine the measure of perfection of man and social institutions.

The highest good is usually called happiness. Happiness requires external goods and luck, but mainly it depends on the perfect activity of the soul - on activity consistent with virtue. The property of the soul to act in accordance with virtues is, according to Aristotle, the subject of ethics.

Functions of ethics:

1. moral and educational;

2. educational and educational

In ethics, two areas can be distinguished - normative ethics, aimed at life science, and theoretical ethics, cognizing morality. This division into different, although interrelated, disciplines took shape in the 2nd half of the 20th century.

Theoretical ethics - this is a scientific discipline that considers morality as a special social phenomenon, finds out what it is, how morality differs from other social phenomena. Theoretical ethics studies the origin, historical development, patterns of functioning, social role and other aspects of morality and ethics. Its methodological basis is knowledge, concepts and ideas relating to the scientific knowledge of morality.

Normative ethics searches for a principle (or principles) that regulate human behavior, guide his actions, establish criteria for assessing moral goodness, as well as a rule that can act as general principle for all cases

2. Medical ethics.

Medical ethics is a section of the philosophical discipline of ethics, the object of study of which is the moral and ethical aspects of medicine.

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

Medical ethics arose thousands of years ago, simultaneously with the beginning of healing. Many of the oldest written sources on medicine, along with advice on maintaining health and treating diseases, set out the rules of conduct for a doctor.

Stages of development of medical ethics:

1. 8-3 centuries BC – 5-4 centuries BC

Formation of new laws: “Do no harm”, “Do not kill”, “Providing assistance to a sick person is good, failure to provide assistance is evil.”

Principles of medical ethics: justice, beneficence, non-maleficence

First stage of formation moral code people who chose healing as a professional activity began with the “emerging medicine” and ended with the appearance of the works of Greek philosophers.

A special contribution to the development of medical ethics at the first stage was made by:

Socrates (469-399 BC) -"Father" of ancient ethics.

The basic principle of Socrates is the identity of virtue with knowledge. Virtue is knowledge or wisdom.

Aristotle (384 – 322 BC) author of “Nicomachean Ethics”, “Great Ethics”.

The specificity of ethics, according to Aristotle, is that it equips a person with methods and means of influencing the world around us and the people living in it. She does this by forming ideas about what should be, about good and evil, about ideals.

One of the most ancient medical-ethical documents is the “Hippocratic Oath”.

This oath was taken by graduates of the famous Asclepiad school, the founder of which was considered the god of medicine, Asclepius. Its most famous graduate was the famous Hippocrates the Great of Kos.

The oath is a document consecrating to us the medical life of medical schools from the time of Hippocrates. At that time, medical schools and associations (corporations) of doctors had already appeared. When joining a medical corporation, a doctor must behave accordingly:refrain from any reprehensible actions and do not lose your dignity . The appearance of the Hippocratic Oath was caused by the need to dissociate ourselves from single doctors, various charlatans and to ensure public trust in doctors of a certain school.

2. IIThe stage of development of Medical ethics is the formation of monotheistic religions (Buddhism, Christianity, Islam).

Doctors of the East had a huge influence on the development of medical ethics and deontology.Ibn Sina (Avicenna) - creator of the “Canon of Medical Science” - considering various aspects of medical practice, he emphasized the uniqueness and individuality of those seeking help. He owns the saying “The doctor must.”

Ibn Sina demanded a special approach to the patient: “You must know that each individual person has a special nature inherent to him personally. It is rare or even impossible for anyone to have the same nature as him.” The word is of great importance, which implies not only the culture of speech, but also a sense of tact, the ability to lift the patient’s mood, and not to injure him with a careless statement.

3. The third stage of the development of Medical Ethics is the creation of medical faculties at universities and the unification of doctors into corporations.

In the 10th century a medical school began to take shapeto Salerno , which reached its peak in the 12th century, translating medical books from Arabic into Latin. It wassecular The school is not a church school. Her main achievement is the creation of new medical literature. The course of study was 3 years of philosophy, 5 years of medicine, 1 year of practice, an exam, after which a license was obtained. This was the first faculty in the East. Following him, universities began to open in Europe.

The first Moscow University in Russia was opened in 1755. The Faculty of Medicine began work in 1758. Graduates of medical faculties made the so-called faculty promise, the text of which was usually a version of the Hippocratic oath.

At the beginning of the 19th century. the English doctor from Manchester T. Percival, in the book “Medical Ethics,” outlined “a set of established rules and instructions in relation to the behavior of doctors and surgeons in hospitals and private practice, in relation to pharmacists, in cases that require knowledge of the laws” (1803).

4. IV stage of development of Medical ethics - Deontological stage

Deontology (from Greek.deontosdue andlogos-teaching) – sectionethics , which deals with issues of duty and moral demands.

The term “deontology” was introduced in English. philosopher Jeremy Bentham, who used it to meanteachings about morality in general.

Jeremy Bentham - British lawyer and thinker (first third of the 19th century) is the most prominent representative of utilitarianism. At its core ethical theory lies the principle of utility.

The goodness, the moral meaning in our actions is determined by their results - how much they give us pleasure (how beneficial) and how much they help us avoid suffering.Since from a moral point of view all people are equal, they must always remember the public interest, which is the totality of personal interests.

Bentham compiled a kind of scale - the “ladder of pleasures” and the “ladder of suffering”, taking into account their intensity, duration, etc. In order to popularize this theory, he composed a poem: “We can “count” both pleasure and pain. We need to know clearly what they may be. They can be intense, they can be long-lasting, they can be fast, they can be effective and they can be clean.

5. Since the 70s XX century a new one has begun V stage of development of medical ethics - bioethics.

Bioethics arose from a combination of philosophy and medicine, but turned into a practical philosophy that makes it possiblewise doctor rise to divine heights when deciding matters of life and death.

Principles of bioethics - compliance with:

Individual autonomy

Free will and choice,

Informed consent.

Historical models of moral medicine:

1. Hippocratic model (“do no harm”)

The principles of healing laid down by the “father of medicine” Hippocrates (460-377 BC) lie at the origins of medical ethics as such. In his famous “Oath,” Hippocrates formulated the duties of a doctor to his patient. Many centuries have passed, but the “Oath” has not lost its relevance; moreover, it has become the standard for constructing many ethical documents.

2. Paracelsus model (“do good”)

The model of medical ethics developed in the Middle Ages. Its principles were most clearly outlined by Paracelsus (1493-1541). In contrast to the Hippocratic model, when the doctor wins the social trust of the patient, in the Paracelsian model, paternalism - the emotional and spiritual contact of the doctor with the patient, on the basis of which the entire treatment process is built - acquires primary importance.

In the spirit of that time, the relationship between a doctor and a patient is similar to the relationship between a spiritual mentor and a novice, since the concept of pater (Latin - father) in Christianity extends to God. The whole essence of the relationship between a doctor and a patient is determined by the good deed of the doctor; the good, in turn, is of divine origin, for all Good comes from above, from God.

He contrasted the mutual responsibility that reigned in the medical world with other principles:

- “a doctor should think about his patient day and night”;

- “a doctor does not dare to be a hypocrite, a tormentor, a liar, or a frivolous person, but must be a righteous person”;

- “the strength of a doctor is in his heart, his work must be guided by God and illuminated by natural light and experience”;

- “The greatest basis of medicine is love.”

3. Deontological model (the principle of “observance of duty”)

The model is based on the principle of “observance of duty” (deontos in Greek means “due”). It is based on the strictest adherence to moral requirements, compliance with a certain set of rules established by the medical community, society, as well as the doctor’s own mind and will for mandatory compliance. Each medical specialty has its own “code of honor”, ​​non-compliance with which can lead to disciplinary sanctions or even exclusion from the medical profession.

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

Modern medicine, biology, genetics and corresponding biomedical technologies have come close to the problem of predicting and managing heredity, the problem of life and death of the body, control of the functions of the human body at the tissue, cellular and subcellular level. The issue of respecting the rights and freedoms of the patient as an individual is more pressing than ever; compliance with the patient’s rights (the right to choice, the right to information, etc.) is entrusted to ethical committees, which have actually made bioethics a public institution.

In the 19th-20th centuries. Anatoly Fedorovich Koni (an outstanding judicial figure in Russia at the end of the 19th and beginning of the 20th centuries, a legal scholar) made a huge contribution to the development of medical ethics. A.F. Koni had encyclopedic knowledge in the field of Russian and foreign law, history, philosophy, medicine, and psychology. One of the aspects of his activity was the development of moral and ethical principles of medical practice, in particular the issue of medical confidentiality.

In his fundamental work “On Materials on Medical Ethics,” A. F. Koni analyzes a number of issues of medical deontology – the moral duties of a doctor towards the patient and his relatives, “the possibilities of hastening death in hopeless cases,” etc.

“The doctor lives constantly with a sense of responsibility to the suffering, witnesses the suffering of the sick, and sometimes exposes himself to the danger of infection, showing everyday heroism.” A.F. Horses.

According to modern ideas, medical ethics includes the following aspects:

1. Scientific branch of medical science that studies the ethical and moral aspects of the activities of medical workers

2. Practical area of ​​medical practice, the objectives of which are the formation and application of ethical standards and rules in professional medical practice

Basic aspects of medical ethics:

health professional and society;

moral qualities and appearance medical worker;

healthcare worker and patient;

medical worker and patient's relatives;

medical confidentiality;

relations between representatives medical professions;

improvement of knowledge;

ethics of experiment.

Moral and ethical aspects have played a fundamental role in the activities of nurses at all times. In fact, the profession itself grew out of a woman’s desire to help a sick or injured person. Women, nuns or laywomen, devoted their entire lives to this high service. The Holy Scriptures tell us that even in the initial period of Christianity, people appeared, driven by love and compassion, who voluntarily devoted themselves to caring for the sick and wounded.

And therefore, when in the middle of the 19th century. Almost simultaneously, professional nurses appeared in England and Russia (that is, women who not only had a desire to serve their neighbors, but also possessed certain medical knowledge and skills); their profession was based on the same ethical principles.

A doctor is one of the most ancient professions; it is a very important and, at times, heroic profession. Doctors are responsible not only for the life and physical health of their patient, but also for his moral health. In order to perform their duties efficiently, medical knowledge alone is not enough, so doctors need to know certain rules and norms of communication with the patient.

Medical or medical ethics is a very important part of the professional activity of doctors. It consists of ethical standards, as well as the responsibilities of medical workers. Every doctor must adhere to medical ethics.

Of course, every medical worker, in addition to professional knowledge, must have such qualities as respect for the patient and a desire to help. This is especially necessary for patients who are having a hard time with their diagnosis, for example, HIV-positive people. It is very important to hear words of support not only from loved ones, but also from your doctor. It is very important for the patient to be listened to, to know that he is respected and not judged, and to receive accessible information. Medical ethics also includes the ability to competently communicate not only with patients, but also with their relatives; they also need to explain everything clearly and competently, and show sympathy. This is especially necessary in situations where a person is given an unfavorable diagnosis (for example, information about a positive HIV test).

Meanwhile, it is worth noting that medical ethics is closely related to the concept of “medical confidentiality” (socio-ethical, medical and legal concept, which prohibits the disclosure of personal data to third parties). The doctor has no right to disclose to anyone any information about the patient’s diagnosis, disease, health status, as well as information about the fact that the person applied to medical institution, his personal life and treatment prognosis. Article 13 Federal Law No. 323-FZ “On the fundamentals of protecting the health of citizens of the Russian Federation” secures the citizen’s right to maintain medical confidentiality. If a doctor fails to comply with this citizen’s right, he may be held accountable.

Compliance with medical ethics involves maintaining medical confidentiality. Doctors have the right to disclose personal information about the patient and his diagnosis only if this is necessary for his treatment, and if the patient himself has consented to the disclosure of his personal data. In addition, in the event of a judicial request requiring the disclosure of this data for legal proceedings, or when conducting medical-military examinations.

It is worth noting that not only doctors must observe medical confidentiality, but also all those who, due to duty, had to learn details about the disease or confidential information about the patient (pharmacists, paramedics, nurses, orderlies, pharmacy pharmacists, etc.).

In modern society there are quite a lot of dangerous and incurable diseases, and the doctor should not disclose this information about the patient. Article 61 of Federal Law No. 5487-1 “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” guarantees the right of non-disclosure of information about HIV-positive people; it also provides a list of situations in which disclosure of medical confidentiality is permitted.

Today, medicine has become much more advanced, doctors are widely educated, so patients do not have to worry about someone finding out their personal information. Medical professionals are obliged to maintain medical confidentiality, and the law is on the side of patients in this aspect. Medical workers it is worth remembering that help and support are expected from them, so it is important for them to be not only good professionals, but also patient people.