How have the principles of bioethics changed modern clinics?

Candidate of Philosophical Sciences, Head of the Department of Philosophy of Education of the Faculty of Philosophy of Moscow State University, specialist in philosophical problems of biology and medicine.

The concept of "bioethics" paradoxically combines the word "bio" ("life, living") and "ethics". Ethics is philosophical knowledge, a branch of philosophical science about morality, about public consciousness, which regulates relations between people from the standpoint of good and evil, proper and improper behavior.

It is generally believed that bioethics is replacing medical deontology. The term "deontology" was introduced in the XIX century by the philosopher Bentham to indicate that people's behavior should obey certain rules. These rules, developed, for example, for individual medical areas, allow the doctor, communicating with the patient, to know which actions the medical community considers correct, proper, and which actions are prohibited. 

Deontology made it possible to build not only relationships between a doctor and a patient, but also relationships within medical teams. However, when people, including doctors, make decisions related to conflicts between different values, it is usually not enough for them, it is not enough just to operate properly, people want to think about what underlies certain norms.

Bioethics arises as an attempt to develop guidelines in biomedicine, following which it would be possible to prevent the negative consequences of the development of biomedical sciences, the use of medical technologies to the detriment of both an individual and humanity as a whole.

The term "bioethics" was first used in the literature at the very beginning of the 70s of the XX century. American biochemist Potter in his work "Bioethics: a Bridge to the Future" defined bioethics as a discipline that combines biological knowledge with knowledge about human values. To date, bioethics has been used as a concept denoting a special type of knowledge, a special academic discipline, a new type of social institution. Bioethics as knowledge from the 70s to the 90s of the XX century developed as a descriptive discipline - it fixed collisions that arise between people who are forced to make decisions in situations vital to them or to another person when they were associated with the development of medical and biological knowledge. For example, when a patient had a request for euthanasia, or when a researcher was engaged in vivisection, or there was a question about the justification of the practice of abortion.

Over time, bioethics began to move from description to regulatory regulation. The difference is that bioethics needed answers to the most fundamental questions: what is a person, what value system is guided by a person in making certain decisions, where are the boundaries of risks in biomedicine, is a person entitled to use an experiment on animals for their own purposes, denying animals the status of value-significant objects? The answer to these and other questions turned out to be very difficult. But bioethics created a special type of knowledge in which the opinion of a professional, doctor, researcher needed to be made equal to the knowledge of an ordinary person, a carrier of ordinary consciousness – sometimes they say "a man from the street" or "profane".

If we are talking about medicine, there are conditionally two plans in the suffering of each patient. One objective one is what happens to a person's physicality during illness, how the realities of illness distort the somatic and mental manifestations of human life. But every suffering has another, sometimes more important aspect – biographical. Only the patient himself can imagine the situation with a forecast for the future, only the person himself knows how he would like to be treated, how he treats himself, life, what are the meanings of his own life, whether they are secular or religious, confessional values, only the person himself knows about economic and social the circumstances of his life. Bioethics is a space of dialogue where the position of a professional doctor and the position of a patient strive to be equal, in this dialogue a unique personal position is born regarding the following bioethical situations.

The first block of bioethics problems is the problems of the beginning of life: the discussion of the status of the embryo, the justification of the practice of abortion, the validity of the use of new reproductive technologies – artificial insemination, surrogate motherhood, in vitro fertilization.

The second set of problems discussed in bioethics are problems related to the end of life: problems of death and dying, criteria of death, justification, legalization of euthanasia. Bioethics draws attention to the fact that in modern medicine, the beginning and end of human life lose the status of a natural task, become events that depend on someone's decision: an individual patient, family, doctor, researcher.

The third set of problems is the problems associated with the possibility of medical intervention in the mental and physical integrity of a person – during transplants, experimentation, and psychiatric care.

The fourth block of bioethics problems is the problems arising as a conflict between the interests of the state, society on the one hand and the interests of the individual on the other hand in matters of health protection. For example, the situation of vaccination, restriction of a person's freedom to move, if, for example, he found himself in a territory where quarantine for a disease has been declared.

Bioethics discusses all these problems both descriptively and normatively. Today, bioethics is becoming a mandatory discipline for those who study in the specialty "medicine" – future doctors, and those who study in the specialty "pharmacy" – future pharmacists.

But bioethics is not only a special kind of knowledge or an academic discipline, it is also a social institution. Bioethics forms a special kind of organizations, structures, in order to organize the bioethical discourse that we talked about. These are bioethical committees, bioethical commissions, which are formed at different levels – from microsocial to macrosocial. Today, bioethical committees necessarily exist at all major clinics or biomedical research centers. No leading world journal accepts an article outlining the results of experiments involving humans or animals, unless a conclusion of the bioethical committee was received prior to the start of the experiment that bioethical rules were not violated during the experiment.

What are these rules? What principles of solving bioethical problems does bioethics pay attention to? If we are talking about a person, then these are the following principles: the rule of truthfulness, the rule of confidentiality, and the most important rule is the principle of respect for the autonomy of the individual, respect for a person who has dignity not by virtue of social status, education or financial situation, but by virtue of his birth as a person.

Today, the question of whether it is possible to replace bioethics with the study of medical law is widely discussed. Is it enough to act ethically correctly, to follow only legal norms? The question is not so simple. Those who propose to replace bioethics with legal norms, as a rule, proceed from moral relativism, imagining that there are many moral norms, they are different, a person acting in accordance with moral norms may come into conflict with other norms, and if you act according to the law, then this guarantees proper behavior.

However, in the history of the XX century in biomedicine there are many examples of how legal practices from a legal point of view were ethically completely incorrect, inhumane.

For example, the practice of euthanasia in Nazi Germany. Therefore, the discussion of ethical problems of biomedicine cannot be replaced by law. In some situations, the pace of development of medicine and technology is so high that the law simply does not have time to settle all the emerging innovations. And in some cases, a law with an exact formulation is simply insufficient to take into account the personal dimension of bioethical situations.

Our great philosopher Vladimir Solovyov, arguing about the relationship between law and morality, drew attention to the fact that, following morality, we act in accordance with our internal needs and attitudes. When we act in accordance with the norms of law, an external system of coercion operates, and this, of course, is an act a step lower than following an internal ethical call.

Bioethics is just beginning to unfold both as a special knowledge and as a social institution. In the future, the role of bioethics will increase, as it is a practice that teaches each person to make decisions in difficult, vital situations, to make decisions that are related to the boundaries of their own existence. In the history of culture, there were previously relatively few situations when an ordinary person found himself in a situation of difficult life choices. The modern development of science has required everyone to make such a choice, and this choice cannot actually be avoided by a modern person. Bioethics teaches how to make this choice.

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28.09.2015