Modern bioethics provides a systemic response to ‘problematic issues’ of ethical and legal nature, which objectively arise under the influence of scientific and technological progress in medicine and in modern clinical practice in particular. Change in the social and economic situation within the countries, globalization, mix of cultural and religious traditions, latest achievements of science and medicine play a  major role in awareness of the processes occurring in modern medicine. In our opinion, the most essential distinctive features of the modern society are as follows:

1. Post-modernism. The modern society is often characterized as postmodern. It discards common truth or takes truth as a subjective notion. It is also characterized by a variety and fragmented nature, lack of the single metanarrative.
2. Mass culture. The modern society is strongly influenced by mass culture. Mass communication is essential in establishing values, standards and the way people think. The effect of this is standardization of thinking and loss of individuality.
3. Great importance is attached to the individuality and expression of one’s own personality. The individuals strive for self-expression and self-realization, seeking their place in the society and giving importance to own needs and desires.
4. Technological progress. The current technological progress is essential. Development of information and communication technologies influences all spheres of life including healthcare, education, personal life and social communication.
5. Variety and multiculturalism. The Russian society has a specific variety and cultural pluralization. Multiculturalism and globalization resulted in mixing and interaction of various cultures, languages, religions and traditions in Russia and globally. It should be stressed that these are only some possible features of the modern society from the philosophical point of view.

All of the aforesaid demands that a specialist should be well-informed of the processes currently occurring in the modern world. For this, a young man who has taken the path of medicine should be able to properly estimate and comprehend the challenges associated with new technologies and latest medical knowledge including cloning, gene sequencing, prenatal diagnostics, new reproductive technologies, and euthanasia. Within the modern society, where an individual comes across such problems as the right to take an independent decision about the end of life and right to end-of-life assistance, philosophical science deals with anthropological risks of undermining the human nature itself. It becomes obvious that as a subject of clinical medicine and bioethics a modern human needs answers to the following questions:

• What does it mean to be a human?
• What system of values does the human adhere to today?
• How can the limits of what is permitted be determined in modern medicine?

THE CURRENT VIEWS ON EUTHANASIA

It is known that euthanasia is a process, which is closely interrelated with a variety of ethical aspects that produce different opinions and disputes among professionals. The issue of voluntary withdrawal from life is complex due to closely interwoven interests of the personality and society, as the society will never be indifferent to a human life or death. Attitude to euthanasia is determined not just through the consciousness of what death is but also through the fact that life is interpreted as the highest human value. It is what the meaning of life is.

According to the critics of euthanasia, a doctor’s activity should focus on the preservation of life and treatment, but not on life termination. The embodiment of ‘no harm’ principle contradicts the possible consent of a patient and assistance provided by medical personnel. The chance for a terminally ill patient raises objections from those who believe that refusal from the fundamental moral principle of biomedical ethics can have serious complications and lead to the degradation of morality. Is not it a ‘slippery slope’ in this case? [1]

The phenomenon means that a procedure can be misused or applied in an unnecessary way to an ever-increasing group of people for selfish purposes. According to the specialists who describe manifestations of this phenomenon, it is enough to legalize any disputable medical practice once, and it will be applied more and more frequently, even in case of strict regulation, resulting in extensive application. Another euthanasia-related ethical issue consists in determining when a patient’s suffering is unbearable and irreversible. The followers of this opinion are usually afraid that practicing euthanasia can open the way to abuse and violence, as it is complicated to establish a clear line between the way of how to relieve sufferings and the act of violence.

Being guided by the idea of ‘common good’ and taking into account that modern society is hedonistic, with no evident signs of altruism but with strong nihilistic features both in common culture and civilization culture, followers of euthanasia believe that every person has a right to death with dignity and autonomous right to dispose own body after death and decide when to die. In their opinion, if a patient who suffers a lot due to an incurable disease is aware of his wish to die, he is entitled to such a possibility. Euthanasia supporters emphasize that it is necessary to respect a patient’s autonomy and reduce sufferings. Following the euthanasia discourse and reaching beyond conservative traditions in bioethics with human dignity and life value being the focus, liberal bioethics with an emphasis on personal freedoms and achievements of scientific and technical progress is aimed at permissive trends in medicine relating to euthanasia. But if it is believed that the life provided to us is absolute because it is given not as a service or product the person can use the way he desires, but as a gift of a supreme power, the assumption is disputable. Thinking about euthanasia from the perspective of the interrelation between the subjects of clinical medicine, the right to choose the way of departure from life, resulting from the principle of autonomy respect, imposes a function to perform actions aimed to implement this right on another subject. This right is actually granted by a patient/ patient’s relatives to medical workers and allows to terminate the patient’s life intentionally. This approach to euthanasia-related discourse makes the problem public. The society starts perceiving euthanasia as public assistance in passing, and as authorized homicide where euthanasia is legalized.

Kant uttered statement that forms the basis of almost any international and national ethical codes, declarations and other instruments, which regulate the ethical and legal part of medical interventions within the physical and mental human existence: ‘Humanity must always be treated as an end, not merely a means to accomplish any tasks, even if they were for the general good’ [2]. By formulating the categorical imperative, Kant asserts distinctiveness of every human being through acceptance of an unconditional rule, which can’t be violated. He believes that we should always treat reasonable beings as an ultimate goal, but not as an intermediate step or means for something else. ‘I can’t end your life only because it is difficult for you’ [2]. In other words, a human being can’t interrupt his life only because it became unbearable. The act (voluntary departure from life) uses the will to terminate it. According to Kant, this contradicts our reasonable nature. Those who apply the principle of sanctity to euthanasia believe that life termination is ethically incorrect under any circumstances. This is an extremely strong requirement of biomedical ethics. It means that the benefit of a person is not just comparable to that of humanity, but is even more significant.

Owing to modern technologies, it is now possible to support life though it was impossible to do so in the recent past. It also prolongs the sufferings of hopelessly sick patients in many cases. Patients do not always take the actions as justifiable.

Euthanasia-related discussion inspires to another ethical issue regarding human ‘improvement’ and using the latest achievements of science and technologies. If it is impossible to achieve the desired result striving for perfectionism and using the latest science achievements, is not it better to resort to the voluntary departure from life in case of a severe and inevitable disease? Discussing now sentencing for Nazi doctors and researchers who performed inhumane experiments for the benefit of science following formal logics, we can state that followers of liberal bioethics reject moral achievements of the Nuremberg trial. Development of any system, even the most progressive one, which aims at improvement and perfection of human possibilities with no ethical part, is doomed to degradation. A person of today does not only own the body but can also use it at own discretion. It means the person is free to select objectives and means of influencing the body, modify and improve faults or get rid of the bodily form. But it is the person now who is responsible for the outcomes as the unified interpreting traditional community and common metanarrative gave way to the pluralism of instances with different degrees of rationality and scientific validity [3].

So, if failed to consider the ethical factor and feel responsible for the acquired improvements, the society can come across groups of people with certain unique possibilities, including the possibility to take an independent decision about departure from life, which has been embedded in the legislation of various countries. Then they will be put one or even several levels above ‘common’ and ‘not improved’ people who were born and have been living on other traditional and cultural territories and have no such a choice.

A human being is dual in nature. Morality is revealed on the other side of the duality through the struggle of immanent and transcendent origins (common and spiritual, empirical and ideal, diabolic and divine, vain and eternal). Commenting on the problem, Augustinus, Kant or Berdyaev, tried to solve it as the key ethical issue. They saw the basic moral issue in the matter of internal contradiction of human existence, how the matter is related to the possible implementation of freedom and how a human being can implement a common and ideal moral principle, which would introduce the individual to the absolute, through certain acts related to private circumstances of life and death [4]. Thus, euthanasia is not permitted within the world view, which treats the life as the highest good.

Moreover, the ethical aspect of euthanasia-related discussion is embodiment of ‘no kill’ religious rule. Euthanasia definitely contradicts the principle. Modern ethical problems with the main request of doing good to a patient are closely related to such a personal trait of a doctor as mercy. The global healthcare paternalistic positions have been predominant and undoubtful until the middle of the XX century. Today, the doctor’s values and ideas of what is good for patients can be counter to what the patients think about the same. By following the ‘no harm’ principle, biomedical ethics warns future physicians against harming their patients and calls to follow ethical principles and current legislation. We, however, believe that by implementing the ‘do good’ bioethical principle, which is currently closely connected with comprehension of our society as hedonistic one aimed at the improvement of a human being and constantly exchanging the ‘good’, a doctor is not able to harm the patient being ‘merciful’ by nature and following his mission as a physician. Ethical culture of a physician is a constituent of medical professionalism. It should be and is applied to all specialties having specific features in every case [5].

MATERIALS AND METHODS

In this article, we do not set the task of determining the views of various groups of individuals ‘for’ and ‘against’ the voluntary departure from life. There has been enough research, which reflects opinions of doctors, medical students, and paramedical personnel; it always leads to a great interest of researchers. But as the modern society is hedonistic, not inclined to self-sacrifice and patience, but is more oriented on improvement and search of the good, we’d like to cite the interview held among the first-year students from the Orel State University in 2021. The students were asked about their values. In our opinion, the research outcomes display how representatives of the modern society perceive their selected profession and entire life and give a sense of values among young people. 300 first-year students admitted to the University in 2021 were interviewed.

RESEARCH OUTCOMES

By analyzing the diagnostics of the real structure of a personality’s values, the following kinds and types of values enumerated by medical students from Orel State University have been analyzed and grouped (figure).

It is illustrative that pleasant pastime and rest (selected by 98% of those interviewed), assistance and mercy to others (97%), searching for and enjoying the beautiful (76%) and being respected by people and having influence (75%) are in the same line. They are followed by high social status (49%) and understanding new things in the world and nature (48%). For first-year students, cognition and high social status are more important, whereas health and love go to the background. Philosophical knowledge allows to review the outcomes via the prism of moral and ethical knowledge and draw analogies between the features of the hedonistic society and other outcomes. In the modern society, hedonistic tendencies can be observed in various aspects.

1. Consumer culture: the society of today is consumer-oriented, where satisfaction through consumption of goods and services is essential. People try to enjoy their life to the fullest extent by acquiring material goods and luxury to be satisfied.
2. Entertainment and entertaining industry: modern technologies and entertaining possibilities enable people to enjoy various forms of entertainment such as games, movies, music, social networks, fun and rest. They satisfy our need in pleasure and rest.
3. The individualistic approach to life: within the hedonistic society, every individual tries to satisfy own needs and be happy. Separate personal interests and individual well-being occupy the central position.
4. High degree of freedom and autonomy: the modern society is freer and more autonomous in taking decisions about the life and gaining satisfaction. People can choose and be flexible creating conditions for their hobbies.

It should, however, be noted that hedonism as the life style has disadvantages and limitations. Hedonism is mainly criticized due to potential negligence of moral and ethical aspects, and possible occurrence of emptiness and lack of meaning in life.

CONCLUSIONS

To make proper decisions and determine own positions and ethical reference points under the changing biomedical conditions, in the view of latest achievements of scientific and technological progress, where the legal area often lags behind the ethics, bioethics is turned into the dialogue field specialists, and medical students. It is used by philosophers, religious leaders, doctors, lawyers, state and political leaders to discuss the issues of voluntary departure from life and end-of-life issues. All aspects of euthanasia discourse result in complex ethical dilemmas. Various positions on this issue can be available within the society. It is essential to have in-depth debates and consider the opinions of different parties to find the optimal solution that takes into account both human sufferings, and ethical standards of the society. However, comparing the arguments ‘for’ and ‘against’ the legalization of euthanasia of scientists and specialists, we find the counterarguments as more fundamental and ethical. When ‘Grounding for the metaphysics of morals’ was published for the first time, Kant was accused of no new ethical principles created; he stressed the arrogance of philosophers who wished to establish the new ethical principles, as if no prior scientific thought was aware of the concept of duty. Kant was proud to find not a new moral principle, but a new formula of human existence. According to it, moral was embedded into the human mind, but not in the environment.

The idea of responsible existence of a person in the world is the ethical emphasis of Kant’s philosophy. A person who decides to be a doctor can’t step over ethical standards and rules while carrying out the professional activity. Fulfillment of duty became the foundation for the selected way many centuries ago.