Healing is a human activity that has been regulated with a bunch of moral, legal, religious, and ethical standards for ages. The role of public regulators has evolved throughout history in response to significant changes in medical landscapes. The changes were mainly related to emergence and practical application of new medical technologies. They yielded to others and moved to the periphery, while others developed with their subject field expansion. In spite of what has been said above, they are all important today in one way or another, whereas some of them can even experience their own Renaissance. Despite the boosted significance of legislation in some self-proclaimed legal states, ethical norms still play an additional but prominent role in regulating a bunch of complex social doctor-patient relationships (in a broader sense, the relationship between the medical professionals in general, patients and their legal or contractual representatives).

An emerging trend of returning to basic and traditional values of Russian people seen in Russian national policy today should not be ignored as well. The technical and conceptual updates and amendments to the Constitution of the Russian Federation [1] were proposed in 2020.

According to Part 1 of Article 114 of the Constitution of the Russian Federation, the Government of the Russian Federation ensures the implementation of a uniform state policy in the spheres of culture, science, education, healthcare, social welfare, support, strengthening and protection of the family, and preservation of traditional family values.

Also, we cannot ignore the new article of the Constitution (67.1), which is devoted to preserving the memory of ancestors who conveyed to us ideals and belief in God, as well as continuity of development of Russia.

To understand the goals and objectives of modern state policy in this area, it is necessary to refer to Decree of the President of the Russian Federation dated November 9, 2022 No. 809 ‘On approving the fundamentals of state policy to preserve and strengthen traditional Russian spiritual and moral values [2]. The Russian Federation views traditional values as the foundation of Russian society, enabling it to defend and strengthen its sovereignty, and ensure the unity of our country with its diverse ethnic and religious structure.

Decree of the President of the Russian Federation No. 314 dated May 8, 2024 ‘On approval of the fundamentals of state policy of the Russian Federation in the field of historical education’ is another strategic planning document [3]. The decree states directly that scientific historical knowledge and education are the fundamentals of historical education in Russia.

A deep understanding of traditions and self-awareness of our people is impossible without the knowledge of our past history and without the images that live in the memory of several generations. In this regard, thorough examination of various sources and time-tested literary texts, in particular, are essential for socio-humanitarian knowledge in general, for certain areas of economics and the socio-cultural sphere of our society. They form and maintain civic identity and historical memory [4], and allow solving both general and special tasks of many modern sciences [5, 6].

The above makes it possible to discuss the position of medical ethics in the second half of the 19th century in Russia as viewed by Anton P. Chekhov in this short publication. The author’s subjective choice is explained as follows.

First, Chekhov was a practicing physician who had firsthand knowledge of the problems that can arise in doctor-patient relationships (both in large cities and in the countryside). Some of the problems were described in his stories, while others were discussed with his colleagues and friends.

Second, Anton Pavlovich is not only a doctor and a writer. Also, he is a public figure who is widely known in Russia and abroad. Thus, Chekhov’s contemporaries couldn’t help noticing his articulation of ethical problems in medicine and his personal attitude hereto [7].

Third, Chekhov’s ethical legacy is increasingly becoming the subject of research interest among modern scientists [8]. Thus, it shows that his pieces of works, correspondence, and statements contain explicit and hidden meanings, both common and special ones.

The legacy of A. Chekhov is diverse. It covers customary, medical and even legal issues. In this article, a medical aspect is of a great value.

For example, Chekhov’s “Ward Number Six” focuses on several ethical principles and their practical implementation in psychiatric practice of those years. Dr. Andrey Yefimitch visited his patient and prescribed ‘cold compresses on his head and laurel drops, shook his head, and went away, telling the landlady he should not come again, as one should not interfere with people who are going out of their minds’ [9]. The patient was soon put into the ward for venereal patients. But as he disturbed others, he was afterwards, by Andrey Yefimitch’s orders, transferred to Ward No. 6.

The short fragment of the well-known story covers the issues of provision/non-provision of aid to a patient, autonomy and medical duty, and the obligation not to harm a patient. Anton Chekhov shows how medicine is developed and how medical care is provided on site. On the one hand, the doctor does not interfere with people who are going out of their minds at the outpatient stage (does he implement the principle of autonomy?), and on the other hand, he fails to provide the patient with necessary medical care, which soon makes the patient confined to a hospital bed. Thus, there arises a question if a doctor can harm his patient by doing nothing. It is difficult to see malicious intent in Dr. Andrey Yefimitch’s actions; it is rather a matter of everyday practice, which is sometimes quite far from high ethical principles, especially when it comes to psychiatry. However, we believe that raising the issue of improper performance of professional duties by the doctor is appropriate here.

Anton P. Chekhov subsequently states that a round man with “a stupid face, utterly devoid of thought” stays in ward number six. It turns out that Nikita, the watchman who has to clean up after the man, beats him terribly ‘with all his might, not sparing his fists’.

The writer briefly touches the issue of underdeveloped psychiatric aid in the country, and stresses that medical, psychiatric and penitentiary functions are poorly combined herein. Country doctors started paying attention to psychiatry by the end of the seventies only; the field of medicine turns out to be separated starting from the mid-eighties of the XIX century. During the same period, humanistic traditions in Russian psychiatry began to emerge and be introduced thanks to the works of Korsakov SS and his followers [10].

It is well known that ‘Ward Number Six’ was first published in 1892 when reforms in Russian psychiatry were initiated. Thus, the writer and public person made his own contribution to the development of psychiatry in Russia. The story, read by many people including high-level officials, influenced their thoughts and, consequently, could affect taking certain managerial decisions.

‘On Official Duty’ is an iconic story by Anton Chekhov [9]. Dr. Starchenko, an experienced man, and the young examining magistrate Lyzhin happen to meet under the same roof. They have different views and experience, and belong to different professional areas… The doctor is a true cynic whereas the magistrate hasn’t become a cynic yet. Medicine and law have a lot in common: both a doctor and a magistrate work with people; they both see a person in a bad light; in practice, they are guided by duty, law, professional ethics, as well as psychological and other techniques that allow them to achieve their goals. Nevertheless, not all of us act as the duty calls. If we did, the world would be a better place. In ‘Surgery’ [9], a short story by A. Chekhov, one violation follows another one in the hospital setting where both medical ethics and the rule of law are lacking.

A feldsher (a mid-level medical practitioner) substitutes a doctor. The problem is older than the hills; however, the practice shows that even today feldshers can substitute doctors while performing certain functions. There are still criminal cases when mid-level medical practitioners are charged with harming or even killing a patient because they were performing some functions that they were not good at. Therefore, this is an old problem that hasn’t been resolved yet.

The short story makes us reflect on duty, professionalism, medical harmlessness, truthfulness, justice and so on, which is not easy.

In ‘Enemies’, the issue of choice is particularly pressing [9]. Should he stay with his wife who is experiencing the tragedy of the loss of their son or without hesitation accompany a patient who stays many kilometers away from the doctor’s place? The doctor, with a heavy heart, agrees to accompany the patient yielding to professional duty and law… He remains high even in the face of difficult personal circumstances. Just imagine his condition when he understood that he had only been a pawn in the game of others. For some people, there is nothing sacred…

In the 19th century, we dive into the remarkable scientific discoveries with innovations introduced into economic, social and cultural spheres. Anton Chekhov followed these ones and had great hopes for them. Thus, the character of the story entitled ‘My life’ [9] reflects on physical, mental, productive and unproductive labor, as well as a just world order.

‘The Cherry Orchard’ is the play devoted to the technological advances [9]. However, not all accomplishments should meet immediate support. According to Anton P. Chekhov, progress is linked to justice and implementation of the ethical principle of doing good. Properly set goals allow us to understand a well-known statement from ‘A Dreary Story’ by Chekhov saying that science is the most important, the most splendid, the most essential thing in the life of a man… This is what a professor of medicine thinks. In spite of the years lived as well as positive and negative personal experience, the professor is sure that medicine is the best science, doctors are the best people, and medical traditions are the best ones.

Healthcare technologies have significantly changed in the past 100 years (owing to the development of effective medicines, diagnostics means, minimally invasive surgeries, etc.). It seems that the majority of industry issues must have been solved if not all of them. However, the issues of providing access of general public to high technologies and fair distribution of healthcare resources are being widely discussed today. A. Chekhov notes that the process is not linear.

The memoirs of contemporaries about the writer, the writer’s correspondence with friends, colleagues, and family members are also of great value for understanding Chekhov’s ethics.

Anatoly F Koni, a renowned lawyer and a forensic orator, described the people around the writer as follows: ‘Enough phosphorus but no ferrum’ (only a doctor could use the comparison!); ‘What we need is temperament but not apathy’ [11].

A. Chekhov frequently conveyed the issue of healing, medical interventions and their consequences to his readers, friends and colleagues with a touch of humor. We believe that it allowed to raise acute professional issues, including ethical ones, implicitly, on the one hand, and to solve the issues without extra tension and official tone intrinsic to formal meetings, conferences, councils, etc., on the other hand.

‘I do not believe that we live in stressful times as humans have always had a stressful life’, he said [12]. The words are relevant even today. A famous slogan of the 20th century said: ‘All illnesses are caused by stress’. Another slogan was as follows: ‘A doctor can have terrible days and hours. Please God don’t let anyone go through it… These can be experienced by doctors only. This is the reason why they should not be judged strictly for their misdeeds’ [12].

Chekhov addressees included about one hundred of doctors, his contemporaries. It is impossible to count the letters obtained by the writer from doctors. In the letters, they discussed not only highly professional issues of diagnosis and treatment of internal diseases, but also the issues of medical ethics, mistakes leading to conflicts, complications of diseases and death of patients.

Thus, it can be concluded that further study of Anton Chekhov’s legacy through the prism of medical ethics and its principles is essential.