Humanitarian knowledge is currently lagging behind the scientific knowledge. If the latter consists of fundamental theoretical systems, universal laws and generalization of an enormous number of factors, humanitarian sciences are still at the descriptive stage of development (collection of facts and their primary systematization). It relates to ethics and applied ethics. Ethics is still based on a multiple of particular rules, each of which regulates certain private forms of behavior. Immanuel Kant attempted to make ethics be more universal, when all private norms are brought under the unified ethical law, which is a categorical imperative [1]. This is how a deontological approach in theoretical ethics has emerged. However, it did not result in sufficient universality of ethical knowledge, as the approach was opposed to another ethical trend such as utilitarianism. As deontologism is too tough about the idea of ethical standards irrespective of certain circumstances (context), utilitarianism, on the contrary, ties its estimates to the current context and relies on a more pragmatic criterion of profit and benefit of an act.

In the end, ethics fails to integrate more private branches of deontologism and utilitarianism, and is again doomed to domination of the specific over the general. The unsatisfactory ethical knowledge produces a strong influence on applied ethical branches, and medical ethics, in particular. The point is that any particular rule is always conditional, it seems moral unless it comes across any other very similar rule, when accomplishment of one rule denies accomplishment of the other rule. For instance, should we tell the patient the truth about the fatal diagnosis (truth) or not (mercy)? Such situations occur all the time, and need to be solved primarily with ethical theory. But while ethics is built on a multiple of specific standards, it can’t offer qualitative solutions when there is a conflict of rules. It is, however, necessary to follow Kant and move towards integral ethics based on the universal moral law.

But unlike moral rigidity of Kant and taking into account a more flexible methodology of utilitarism, a more flexible and rather universal image of integration into the modern ethical knowledge is required. A possible project of building integral ethics and its applications in medical ethics will be presented below. According to our hypothesis, the principal moral law is the law of development. Good ultimately means something aimed at the development of a human being and society or support of the already achieved level of development. Evil is, on the contrary, something that prevents a human being and society to be developed or destructs the balance that has already been achieved. The law of development is universal, it acts both within the society and nature (prehuman and inorganic nature). But in the society the act of development goes through the freedom of intelligent beings and is ethically defined.

MATERIALS AND METHODS

Hypothesis of the highest moral law as the law of development requires first and foremost to determine the path of development. The global thought in this area has already done some work and provided a few solutions. In this direction, the outcomes were mainly obtained by the school of German classical philosophy [2]. Ideas expressed by these philosophers are very simple. Any event or system is based on certain basic contrasting qualities (basic polarities include thesis and antithesis), whereas any conditions represent certain compositions of basic polarities that ideally strive for synthesis. Transition from the polarities of thesis and antithesis to synthesis is the simplest case of development. Find the ‘portrait of polarity’ for every system, i.e., which basic polarities form its basis and what type of composition is typical of the system (polar portrait is a composition type of basic polarities). Subsequently, it becomes evident how the system can be synthesized or developed.

German philosophers repeatedly used this methodology in all spheres of existence such as nature, society, spirit, art, religion and ethics. Attempts were made to create polar portraits of any systems and restore some properly organized existence thereupon.

Subsequently, the methodology of building polar portraits was developed in some subsequent philosophical systems. In our opinion, the new stage of its development was achieved in the Russian philosophy of all-unity founded by Solovyov VS [3]. In particular, it shifts away from the rigid triadic methodology of development and pays more attention to facts and certain organization of private systems used to create portraits in a more seamless fashion. There is no need to have two basic polarities only. It is a special case of any set of these polarities, which can result both in multilayer and multidimensional synthesis. In ‘Justification of good’, Solovyov is coming close to formulation of the law of good as the law of development [4]. Development is the growth of unitotality whereas the good is the same unitotality, that has been duly achieved in the life of the society and human being.

In his work, the author [5] takes another step to develop this methodology. A new mathematical appliance that expresses basic polarities and their compositions has been suggested. The Euclidian structures of vector space (vector space with scalar product [6]) with basic polarities being interpreted as orthogonal (perpendicular) base vectors within some multidimensional space. In this case, the polar portrait of the system looks like the vector superposition of basic polarities:

form. 1

where Р is the current polar vector as the polar portrait of the system, P_i means basic polarities as basic polar vectors; numbers аi, where 0 ≤ a_i ≤ 1 represent coefficients with which basic vectors are included into current polar vector P.

Here, vector of synthesis C is the vector sum of basic polarities

form. 2

In this case, it is suggested to use a simple measure of development as the value of the projection of current polar vector Р on C synthesis vector:

М(Р) = (Р, е_С) = |P|cos(P^C), (3)

where е_С = С/|С| is vector C ort (vector with the same unit length and direction as vector С), (Р, е_С) is the scalar product of vectors Р and е_С, |P| is the value of vector P, cos(P^C) is angle cosine between vectors P and C.

The measure of development is simple enough: the polar vector is more developed when it is closer to the synthesis vector (the more synthesis it has).

Thus, intuition and qualitative methods of representatives of German and Russian philosophy acquire a stricter and qualitative expression.

On that basis, the law of development can be formulated as follows: S(t) system, t that changes over time and has Р(t) polar vector in the system of basic polarities (Рi) as its polar portrait, i = 1…n is being developed if the relation is fulfilled:

dM(P(t))/dt ≥ 0, (4)

i.e. the system measure of development (М(Р(t))) is growing (dM(P(t))/dt > 0) until it achieves its maximum value within the system of polarities (dM(P(t))/dt = 0).

The formulation reminds of the second well-known law of thermodynamics (dН/dt ≥ 0, where Н means entropy of the system), law of growth (non-decrease) of entropy within the isolated thermodynamic system with the law of development being formulated for another measure such as the polar measure of development (3).

The basics of integral ethics can be formulated with the mentioned structures and methods. In the first turn, the highest ethical law (the law of good) can be defined as follows: the good is an act of an intelligent subject aimed to maximize the measure of development within this context of implementing this act and is committed by the subject in a free and conscious way.

The formulation needs to be clarified to some extent.

First, an act means an action or inaction of a subject (human being or community).

Second, maximization of the development measure means to select the maximum measure of development among all possible alternatives, including, if it is not possible otherwise, selection of the alternative when the measure of development is decreasing though less than in case with all other alternatives (choosing ‘the lesser of two evils’). In a stricter way, this can be represented as follows:

Let’s admit that subject S faces the current situation A. Under these circumstances, only acts of subject Д₁…Д_n are possible, that change the situation A into some situations В₁… В_n respectively, i.e. B_i = Д _i(А), where i = 1…n. Subsequently, polar portraits of situations А и B_i are suggested, i.e. Р(А) is a polar portrait (polar vector) of situation A, Р(B_i) is a polar portrait of situation B_i. Measures of situation development are determined such as М(Р(А)) = М(А) is a measure of development of situation A, М(P(B_i)) = M(B_i) are measures of development of situations B_i. In this case, it is assumed that within the described context, the good for the subject will be act Д⁺ in relation to which the following condition is applied:

М(D⁺) – М(А) = max_i{M(D_i(А)) – M(A)}, (5)

i.e., gain of the development measure in act Д⁺ will constitute the maximum of all possible effects within the context of Д_i acts. A Д⁺ act is an act of Д_i.

Based on the maximization principle (5), it is offered to solve the conflict of rules, when every Д_i act is followed by the respective standard. Then it is necessary to select the standard, which maximizes the measure of development within the context, i.e. the one being assumed by act Д⁺. The methodology is used to achieve integration of universality of the highest ethical law according to a deontological approach, and a possibility of a more flexible value calculation typical of utilitarism.

Third, it is assumed that subject S should be a reasonable subject, i.e. be free to commit acts. It should also select act Д⁺ deliberately, because the act maximizes a measure of development within the context. There is no need for a subject to calculate the measure and be aware of the math of vector spaces. The subject should have an intuitive sense of the development measure and combine intuition with rational measures used to interpret the good as methodology of maximization of the development measure.

Integral ethics as an applied theory of development is built on the formulated methodology. The theory of development is the most common knowledge in relation to which any ethics (even the most integral one) is only a supplement to the universal theory of development in relation to ethical and moral spheres of life of rational subjects and their communities.

Some basic standards of medical ethics have been analyzed using the methodology described. It has been shown that they are well correlated with the described methodology of maximization of the development measure in certain context. It is, thus, shown that medical ethics is also an applied section of integral ethics and theory of development.

RESEARCH OUTCOMES

The methodology described above is used to examine three basic rules of classical medical ethics such as the standard of mercy (‘do good’), the ‘no harm’ standard and the ‘medical privacy’ (confidentiality) standard. Prior to their direct analysis, the polar portrait of sickness and health should be analyzed.

In general, an organism, a living being can be represented as a complex system with multiple basic polarities and current condition in the polar basis. In this case, health constitutes such conditions of a living system, when the polar portrait is close to the synthesis vector, whereas any types of a disease can be expressed through the loss of system integrity represented as a polar vector deviating from the synthesis vector in a more or less significant way and reducing the measure of development within the system of basic polarities.

In this case, a physician is facing the following tasks: first, to understand the current condition of a person (empathy), second, help the person avoid sufferings and acquire a more favorable condition (developing reflexion) by distancing from the dominant current condition. In terms of polarities, it can be expressed as follows: 1) understand the current polar portrait of system P, 2) make the polar portrait approaching synthesis C.

It is the same as rescuing of those drowning: first, we need to dive into the water and go down with the drowning person to determine his location and how to help. Then we catch a person and take him to the surface. Here, we deal with two basic acts such as 1) diving (immersion into a disease) and 2) taking to the surface (improved health). We need to be strong enough not just to dive, but also to be able coming up from the depth, taking the drowning person to the surface. A physician’s activity should be of the same structure: first, dive into the disease to understand it and see it from the inside, feeling for the patients and his sufferings, understand the ‘internal portrait of the disease’, and then take the patient to the surface of health. Thus, a process of treatment is a unity of empathy and developing reflexion.

Taking into consideration the presented definitions and images, let us consider the standards of medical ethics mentioned below from the point of the theory of development.

1. The standard of mercy (‘do good’)

According to the standard, the profession of a physician is the good for a patient. Taking into account the polar portrait of health and disease described above, a physician first dives into a disease, determines a patient’s condition as a current polar portrait of the disease, and then changes the polar portrait towards the synthesis vector. Let’s express the process in a stricter way.

Let a patient have polar portrait P within some polar space with the basis of basic polarities Р₁…Р_n. The disease availability means that the measure of development is insignificant in this case (М(Р) < |С|). A doctor needs to determine the polar portrait P for the disease (a patient’s condition) and do good for the patient. This can be expressed as a change in the current polar portrait P for the patient until a new condition of Р’ has been reached, where М(Р’) > M(P), the integrity of a patient will be increased (measures of synthesis), i.e., transformation into a new condition with the polar portrait Р’ and a greater measure of development. Within the vector model, the polar vector Р’will provide a projection of a greater value on the vector of synthesis C as compared with the initial vector P. In this case, a change in the polar portrait from Р to Р’, which can be expressed through the increment vector ∆P = Р’ – P, will be presented as a physician’s act. Using the properties of the scalar product, we can determine the measure of development both of Р and Р’, and ∆P:

М(∆P) = М(P’– P) = (P’ – P, e_C) = (P’, e_C) – (P, e_C) = M(P’) – M(P) (6).

If М(Р’) > M(P), then M(P’) — M(P) > 0, i.e. М(∆P) > 0. Thus, the standard of mercy urges a doctor to commit such acts towards a patient that will involve the growth of the development measure, i.e., strategy of maximization for the measure of development which is a selection of ∆P with a positive measure of development М(∆P) > 0. In the presence of several acts, a measure of development with a maximum increase is selected according to (5).

Thus, the standard of mercy will be interpreted as a special case of the development law.

2. The ‘no harm’ standard

This standard urges a doctor to help a patient and, at least, not to harm him. This can be interpreted as prohibition of such acts of a physician that will reduce the measure of a patient’s development, i.e. prohibit ∆P acts, where М(∆P) < 0. The prohibition is the same as inequality М(∆P) ≥ 0. As we have found out, the standard of mercy within the inequality of М(∆P) ≥ 0 expresses the moment of strict inequality М(∆P) > 0. Then the ‘no harm’ standard is valid only in relation to М(∆P) = 0. If you fail to provide aid, i.e., to commit ∆P, where М(∆P) > 0, then you should use act ∆P only, where М(∆P) = 0, meaning that a patient’s condition should remain the same.

Thus, if within the standard of mercy, a physician chooses among positive alternatives, where М(∆P) > 0, then within ‘the no harm’ standard a physician moves in the space of negative (М(∆P) < 0) and zero (М(∆P) = 0) alternatives, which is expressed through the principle of maximization of development measure (5) as selection of the zero alternative. Generally, the mercy and ‘no harm’ standards determine the activity of a physician as certain special maximization cases of the development measures. So, they are special cases of the development law and the law of good.

3. Privileged medical information

This standard preserves the space of trust between a physician and a patient, as the patient has to entrust the doctor with personal data, which should not become property of the third persons. The information can be delivered to a physician only if it remains confidential to others. In its turn, the personal information is essential to build a complete portrait of the disease, its symptoms and history of development, which is a necessary condition of proper diagnosis and treatment.

Thus, the privacy of personal information is a condition for creating an adequate portrait of disease P, the lack of which makes subsequent acts of physician ∆P impossible; if М(∆P) > 0, the patient will go through convalescence as an increased measure of development. Based on the principle of medical confidential information, the patient provides the physician with access to personal information, allowing for empathy, including immersion into the internal portrait of a disease, and coming across additional data, which are commonly required to restore a true portrait of the disease. Let’s remember the example with the drowning person. The confidentiality standard means that the patient allowed the physicians to dive into deep waters to bring him back to the surface of health.

It should also be noted that personal data, which can be shared by a patient only if the standards of confidentiality are followed, constitute a part of complete data about a disease, some symptoms used to restore a complete portrait of a disease. Shifting from symptoms to nosology is also a special case of synthesis, i.e., law of development, when a physician integrates facts in his consciousness, including personal information, and turns them into a synthetic model of a disease, which can embrace all available facts. Here, we deal with some polar basis Р₁…Р_n, which expresses the special factual knowledge of a disease, with the polar portrait of the diseases as a synthesis vector С = Sⁿ_i=1P_i of the facts. Establishing diagnosis is a case of moving from basis P_i, i = 1…n, to the integral portrait of a disease as the vector of synthesis C for basic polarity symptoms.

Thus, the standard of confidentiality also expresses the ideas of synthesis and development in medical ethics and medical profession supporting the necessary (personal) part of the polar symptomatic basis. Without it, complete diagnostics as a private case of synthesis and uniting factors into the integral portrait of a disease is impossible. Creating a complete image of a disease, a physician is engaged in medical empathy, identifying himself as a patient, trying on signs of the patient and, owing to that, restoring an adequate portrait of a patient’s abnormal condition.

During the unified process of diagnostics and treatment as a unity of medical empathy and developing reflexion, the standard of medical confidentiality means the first moment of empathy, whereas the standards of mercy and ‘no harm’ constitute the second moment of developing reflexion. The three standards are different parts of the expression and provision of a common process of medical activity as a special case of the development law.

DISCUSSION OF RESULTS

Three important standards of classical medical ethics (mercy (do good), no harm and medical confidential information) were taken as special cases of the development law. It has been shown that the fundamental foundations of these standards are based on the intuition of development and its various aspects. It is, thus, suggested that subsequently the same should be done in relation to other standards of medical ethics. It is an inductive generalization, which requires a subsequent extensive study and implementation of a new research project. We are now declaring that the project can be possible. At the same time, during the analysis of three standards some common methodology can be observed; we can assume a rather regular pattern in medical and ethical definitions. If ethics is based on the law of development as the principle of maximizing the development measure, it is logical to suggest that special ethical standards will constitute implementation of the universal strategy. It should, however, be repeated that the topic is new enough. It requires subsequent research. We encourage the scientific society to pay attention to the methodology presented within the work and discuss its possibilities and perspectives.

CONCLUSIONS

If the obtained findings are generalized, a fundamental conclusion should be made that medical ethics is not just an applied aspect of general ethics. First, common ethical theory can be redefined differently in many ways such as an applied direction of universal theory of development and as integral ethics. Second, medical ethics is an applied direction of integral ethics in this case. The latter should be taken as a variant of general ethics based on the principles of theory and law of development.

Such an approach to interpretation of medical ethics denotes its closer relation to purely medical aspects of medical activity. Both natural- science, and humanitarian parts of a medical profession act as a fundamental unity: somatic or mental and spiritual. The process of diagnostics and treatment is of a single nature as well, which shows that a medical profession is aimed at preservation and intensification of the development measure of a suffering person.