Medical Ethics

ISSN Print 2713-0894 ISSN Online 2713-0908

BIOMEDICAL JOURNAL OF ERMC EASTERN EUROPEAN

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Lukovich M, Meistorovich K, Knezhevich D

Recently, there has been tension is our society because of health-associated problems resulting from at least two factors. First, we are facing collision of neoliberal economics with the traditional ethics of our society. Simplistic understandings of social tendencies typical of our society and processes within the global community provoke a reaction in the form of various conspiracy theories supported by a dualistic ethical approach within our society. In one case, it is based on neoliberal trends and is increasingly manifested through the views of non-governmental organizations. In the other case, it is extremely conservative and tied to the traditional morality. The politics that tends to act within the bounds of the possible goes through both options, creating even more confusion. Another factor, which is no less important, includes blurred connotation and denotation of such notions as ‘freedom’, ‘sovereign’, ‘sovereign decision’, ‘human life sacredness’, resulting in various misinterpretations. The purpose of this article is to review the occurring dilemmas by disclosing the terms in the historical context. The possible conclusion is that the common global tendency of law harmonization under the influence of neoliberal economics is far from the dream about the Perpetual Peace as seen by Kant two hundred years ago. Regular standards that form the basis of the social ethics occupy less space in the legislation just like the ethics itself, even if used as a corrective measure, with economic logics taking up a larger place. There will be a ‘market price’ for everything (Kant). In the light of the above, we tried to review vaccination and euthanasia as two very specific and pressing issues.

Received: 2023-08-16

Published online: 2023-09-12

DOI: 10.24075/medet.2023.018

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VIEWS 1652

The shortage of healthcare personnel is a contemporary issue of national healthcare. At the same time, admission to medical colleges and universities is always highly competitive. However, having become a doctor, many specialists either seek private medical practice or retire from medicine. It is widely thought that low earnings of healthcare professionals are the reason for that. But this is not entirely true. The article summarizes the results of a sociological trial used to conclude about the hierarchy of reasons for the reduction in the number of physicians in state medicine of modern Russia. The trial was conducted in a typical region of the Russian Federation — the Volgograd region. An expert survey of the heads of state medical organizations was used. It turned out that ethical and legal insecurity of doctors promoted retiring from medicine and seeking private medical practice. It is the profession that healthcare professionals worry about the most; they have to shun medicine due to the decline of the value of the profession in the society and inattentiveness to healthcare professionals, which is most acutely felt by young physicians. Thus, care for medical personnel, especially young specialists, is the most pressing issue. That’s why mentors of medical beginners play a specific role as they do not only educate but also raise devotion to the profession. At the same time, mentors need state support as well. The article suggests which forms of support can be provided.

Received: 2023-08-03

Published online: 2023-09-11

DOI: 10.24075/medet.2023.017

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Kolbin AS, Emelianova LI

Historically, instead of conducting well-designed research studies in the pediatric population, drug monographs indicate that safety and efficacy in children have not been evaluated. Among the main challenges in clinical trials for children, ethical issues occupy a special place, as they arise at almost all stages — from clinical trials to extrapolation. In the article, the authors present the history of clinical research in pediatrics and neonatology, how the view of involving children in clinical trials has changed, the specific ethical problems of children’s participation in clinical trials, legislative initiatives and other agreed measures taken and what they have led to. The ethical issues of microdosing in pediatrics, methods for the first-in-pediatric dose selection, issues of acceptability and drug development for the treatment of rare diseases are discussed separately. Conducting trials in the most vulnerable pediatric groups — newborns and premature newborns — is presented in detail. The potential reasons for trial failures in children are presented with specific examples.

Received: 2023-05-29

Published online: 2023-06-28

DOI: 10.24075/medet.2023.016

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Fokina DS, Zhukova OV, Khokholov AL

Liver and kidney transplantation is the most effective and frequently the only radical method of treatment of patients with end-stage chronic kidney/liver diseases. Expenditure on transplantation is rather high. A number of patients with a reduced function of kidneys or liver is increasing rapidly. Thus, the problem is pressing and interdisciplinary. It has serious social and economic consequences for the Russian Federation. In this respect, analysis of the structure of use of medicinal preparations (MPs) enables to rationalize their application in clinical practice. This allows to carry out targeted measures to improve costly drug-induced therapy. Having analyzed prescriptions, it has been found out that MPs related to 52 pharmacotherapeutic groups were used in pharmacotherapy during kidney and liver transplantation within the analyzed period. ABC analysis revealed preparations included into group A, a group of immunosuppressants with the largest costs.

Received: 2023-05-10

Published online: 2023-06-28

DOI: 10.24075/medet.2023.015

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VIEWS 1106

The article is devoted to the role of humanitarian education in medical universities of Russia. Events of recent years (lack of attention to the value orientation of students and, as a consequence, leaving the profession or feeling unsatisfied with it) that occurred in Russian healthcare determined the interest in this issue. The research data were obtained using the systemic approach. Owing to this, medical education was viewed as a non-integrated set of scientific, clinical proper and humanitarian knowledge and assessments. In this respect, the perspective of using humanitarian expertise of academic courses has been discussed. This was done to coordinate the efforts of socialization agents in development of professional orientation among medical students. A comparative analysis of the effect of High-Hume technologies and mentorship on the positive solution of this problem has been performed. A conclusion about the use of the complementary principle while implementing High-Hume and mentorship has been made. Search for the aggregator of integrative processes in medical and humanitarian preparation enabled to conclude that bioethics is a system-forming factor of developing professional orientation in medical education. Recommendations on the use of scientific and organizational achievements in bioethics in the practice of medical education have been developed.

Received: 2023-05-07

Published online: 2023-06-06

DOI: 10.24075/medet.2023.014

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VIEWS 1271

The article presents the rationale for formation of the social and psychological support service at a higher educational institution by the example of the Yaroslavl State Medical University (YSMU). The service is of particular importance, as the initial period of study at a university is associated with significant shifts, breaking of pre-existing stereotypes, stress, high anxiety and internal stress. This is a complicated stage of a human life, when not only physical, but also mental health of a person is finally formed, needs, motivation and personality of a future doctor are created, affecting the rest of the life. So, a higher institution is interested in the formation of a favorable educational and pedagogical environment, preservation and strengthening of students’ health, better effectiveness of education and quality of knowledge, and, thus, prevention of being expelled from the University. It should be noted that the need in this area development is confirmed by survey of students from the YSMU. The obtained results confirmed that the students were interested in the development of social and mental aid and support. It was the basis for creation of the Center for Social and Psychological Support at the University. According to the survey, the students need this kind of aid. Supply of students with practical aid, social support and support of mental health of students, and prevention of social disadaptation are the main problems solved with the help of professionals from the Center for Social and Psychological Support of the Yaroslavl Medical University.

Received: 2023-04-19

Published online: 2023-05-30

DOI: 10.24075/medet.2023.013

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VIEWS 1234

Kazanova AM, Zyryanov SK

Currently preterm births are the leading causes of newborn mortality in developed countries. There is growing concern in the medical community about the moral and ethical implications of therapeutic care for these patients. The article raises the problem of joint decision-making by neonatologists and parents on the treatment of premature newborns. Including the question of who is most qualified to make decisions regarding the initiation, termination or withdrawal of life-sustaining treatment for preterm infants. The rest of the life of surviving premature newborns may be associated with inconvenience and suffering in everyday life, and understanding of responsibility for the life of the patient and the child greatly complicates the decision. Another important issue is the relationship between intensive care nurses and parents in caring for premature newborns. The article describes the life experience and ethical and moral problems that medical personnel face during caring for premature newborns.

Received: 2023-02-06

Published online: 2023-05-30

DOI: 10.24075/medet.2023.012

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VIEWS 1328

Ushkalova EA, Zyryanov SK, Butranova OI

Pregnant women are a very special category of patients. The risk-benefit ratio of using various drugs in this case presents a significant medical, social and ethical problem. The increase in the age of onset of the first pregnancy is associated with the increasing prevalence of chronic pathology. Obesity, cardiovascular diseases, diabetes mellitus, hypo- or hyperfunction of the thyroid gland, as well as many other conditions contribute to the active use of drugs of various pharmacological groups throughout the entire period of pregnancy, including early periods. The current practice of pharmacotherapy in pregnant women is based mainly on the use of drugs with an uncertain teratogenic risk. Not including pregnant women in clinical trials is an ethical issue as significant as their potential inclusion. Previously, for a long time, vulnerable categories included generally all women of reproductive age, whose inclusion in clinical trials became possible only in the mid-1990s. Pregnant women were considered vulnerable until 2019. The orphan status of pregnant women in terms of inclusion in clinical trials limits their right to receive highly effective and safe medical care, which makes it relevant to review the existing ethical principles in relation to this category of patients and a to perform a detailed analysis of existing barriers for certain types of drug trials.

Received: 2023-01-30

Published online: 2023-05-23

DOI: 10.24075/medet.2023.011

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VIEWS 1281