Medical Ethics

ISSN Print 2713-0894 ISSN Online 2713-0908

BIOMEDICAL JOURNAL OF ERMC EASTERN EUROPEAN

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Koshechkin KA, Khokholov AL

The integration of artificial intelligence (AI) in healthcare presents unprecedented opportunities for improving patient care and outcomes, yet it also brings forth a myriad of ethical dilemmas that demand careful consideration. This article examines the ethical challenges posed by AI in healthcare, ranging from concerns about algorithmic bias and patient privacy to issues of transparency, accountability, and professional autonomy. Through a comprehensive analysis of relevant literature, case studies, and regulatory considerations, the study explores the multifaceted ethical implications of AI technologies in clinical practice. Key findings underscore the importance of promoting transparency and accountability in AI algorithm development and deployment, as well as the need for robust regulatory oversight and ethical guidance to ensure patient rights and safety. Despite the complexities and challenges, AI offers immense potential to enhance patient care and healthcare efficiency when navigated responsibly and ethically. By prioritizing ethical principles and collaborative efforts, stakeholders can harness the transformative power of AI while upholding the highest standards of ethical healthcare practice.

Received: 2024-02-16

Published online: 2024-03-31

DOI: 10.24075/medet.2024.006

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VIEWS 502

Biography of Sergey Spasokukotsky, the outstanding Russian surgeon, is closely related to the Yaroslavl Territory. He spent his childhood in the Danilovsky region, coming from a large and friendly family of a zemstvo doctor. In 1880–1888, he studied at the Men’s Gymnasium after his family had moved to Yaroslavl. The building now belongs to the Yaroslavl State Medical University where a representative of his scientific school, Professor Busalov AA, worked decades later. Life and activity of Sergey Spasokukotsky represent a bright example of unselfish service to medicine. Being a graduate of the Emperor’s Moscow University, he had a chance to continue his medical career in Moscow but went to the province where he worked as a zemstvo doctor for many years, actively implementing advance achievements of medicine into abdominal surgery, neurosurgery, pulmonary surgery, creating novel and modifying available surgeries. S. Spasokukotsky and his student developed an affordable and effective method of preparing a surgeon’s hands for a surgery with 0.5% ammonia solution (method by Spasokukotsky and Kochergyn). The scientific and practical activities of Sergey Spasokukotsky resulted in the development of a large scientific school with an ultimate scientific social responsibility, originality, great depth and boldness while solving the issues of surgical pathology.

Received: 2024-03-05

Published online: 2024-03-26

DOI: 10.24075/medet.2024.004

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VIEWS 463

The article explains what an antibacterial reserve preparation means. It has been shown that the drug belonging to the group is determined by its pharmacological properties only such as a clinically significant (sufficient for empirical application) activity in relation to Pseudomonas aeruginosa or nosocomial (methicillin-resistant) strains of Staphylococcus aureus. It allows to differentiate between two categories of reserve antibiotics, which exert an anti-Gram-negative and anti-Gram-positive activity. There is an exhaustive list of preparations included into each group and available in the Russian market. Meanwhile, no drugs that correspond to inclusion requirements for both groups are available. Possible conflicts that occur during clinical application of antibacterial reserve drugs are comprehensively analyzed. It is based on divergence of interests of a patient and the patient’s representatives, treating physician, management of the clinic, hospital epidemiologists and manufacturers of reserve generics. Economic and general biological (selection of drug-resistant strains in extensively wide application) arguments commonly contradict the legal (compliance with clinical recommendations), moral and ethical (independence of aid quality from the patient’s prognosis) standards. The Legislator’s position in relation to the issue has been reviewed. Imperfect regularity framework and insufficient legal safety of a doctor make it possible to resolve conflicts through concessions and agreements including reserve antibiotics prescribed as per conditionally social indications.

Received: 2024-02-19

Published online: 2024-03-15

DOI: 10.24075/medet.2024.003

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VIEWS 473

The article defines the term ‘bioethics’ taking into account the common regulatory act, shows the interrelation between bioethical and legal regulations, and defines the mechanisms that enhance and improve effectiveness of ethical standards by turning them into legal regulations. Basic regulatory legal acts such as laws and subordinate acts in health regulation are reviewed and analyzed for the presence of an ethical constituent. Critical areas in the regulatory acts are specified; certain ways of their ethical transformation are mentioned. Insufficient ethical substantiation of regulatory provisions in the body of legislation and lack of universal declarative regulations are found. The role of a new subject of bioethics and law (future generations), which significantly expands the area of ethical issues, including applied medical sciences, has been denoted. The conflict between modern ethics and interests of future generations can be a complex issue and should be solved immediately on a constant basis. Ethical and legal principles of future generations — precaution and non-regression — were introduced. It is indicated that the standards of ethical and legal regulation of interests of future generations should be developed.

Received: 2024-01-29

Published online: 2024-03-14

DOI: 10.24075/medet.2024.002

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Samarina EI, Lileeva EG, Rybachkova JV

Bioethical approach to determine the feasibility of using medicines involves systemic analysis of pharmacoepidemiological and pharmacoeconomic aspects of treatment, especially while treating the most common and chronic diseases. Psoriasis is the most common disease of the skin and subcutaneous tissue, accounting for 15% of cases. The rate of psoriatic complications constitutes 6–42%. Skin lesions, psoriatic arthritis, cardiovascular diseases, metabolic syndrome, inflammatory intestinal diseases, mental disorders and malignant lesions produce a great effect on health, duration and quality of life, and result in early loss of labor capacity and disability of patients. So, it is important to study effectiveness and safety of systemic medicines in patients with severe and moderate-to-severe disease and perform subsequent analysis of possible use and comparison of the effectiveness of various combinations. Most affordable but ineffective medicines commonly cause real growth of further expenses on treatment, and postpone administration of more effective, though much more expensive medicines. Economic aspects of rational use of healthcare resources are becoming increasingly important whereas pharmacoeconomic values are crucial while selecting a treatment strategy.

Received: 2024-01-24

Published online: 2024-03-11

DOI: 10.24075/medet.2024.001

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VIEWS 417

Intensive development of modern science expands the scope of bioethical issues. Debates on ethical aspects of bioinformatics, neurotechnology, genetics, bioeconomics, ethics of preclinical and clinical trials are actively developing. Axiology of bioethics is of particular relevance. It is the structure of valuable categories that determines the priorities of ‘human science’ development taking into account the historical experience of interaction between a person and community, and criteria of civilized changes in the actual and perspective (prognostic) sense. Development of bioethical axiology is influenced by the challenges of technological development of the current decade, the issues that objectively demand a reaction on the part of the state and society. One of the main tasks of modern bioethics is to develop bioethical thinking, and grounds for using bioethical axiology in the scientific process. Health axiology, which represents a fixed conscious attitude to the issues of health developed during the academic process to be subsequently used during a labor process, is practical expression of bioethical thinking. Bioethical dialogue is essential as it urges young perspective specialists to examine novel bioethical scientific issues and achieve technological country-specific goals. Focus on young scientist’s potential totally corresponds to the cross-cutting goal of axiological, prognostic and educational tasks of bioethics. Bioethical thinking is developed based on the experience of the school of ethics of scientific research, which is an educational project intended for young Russian researchers.

Received: 2024-02-05

Published online: 2024-03-04

DOI: 10.24075/medet.2023.035

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Shereshneva MV, Ilyin MV

In cardiac surgery, patient’s awareness and consent to surgery are problematic as due to the lack of previous medical background a patient can’t understand the processes occurring in the body and effects of exposure on them. Thus, provision of sufficient information by a doctor is a part of safe surgical strategy. An open randomized prospective trial involving 89 patients with stable coronary artery disease (CAD) was conducted. High rate of blood oxidation is believed to be an independent predictor of cognitive dysfunction development during the early postoperative period of coronary artery bypass grafting (CABG). Determination of blood oxidation rate is a tool of risk management during cardiac surgery starting from the stage of preoperative preparation, which is optimal to implement a safe strategy, including psychological and drug-induced support of the patient aimed at prevention of cognitive disturbances.

Received: 2023-11-26

Published online: 2024-02-28

DOI: 10.24075/medet.2023.034

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VIEWS 426

Shereshneva MV, Ilyin MV

Exposure on key modified risk factors, mainly hypercholesterolemia, arterial hypertension and diabetes mellitus, is an essential component of successful management of patients with coronary artery disease (CAD). As far as the concept of cardiovascular continuum goes, the predisposing behavioral factors that contribute to the development of these abnormal conditions include smoking, hypodynamia and obesity. Oxidative stress is closely associated with atherogenesis at every stage of progression. An open non-randomized prospective study is conducted. An observational group includes 89 patients with stable CAD. Key risk factors of cardiovascular diseases and their correlation with the values of induced blood oxidation were analyzed. Statistically significant (p < 0.05) positive correlation between hypercholesteremia and coefficient of oxidative activity (r = 0.22), smoking and initial rate of blood oxidation (r = 0.24), maximum rate of blood oxidation (r = 0.25), coefficient of oxidative activity (r = 0.24), diabetes mellitus and time of the initiation period (r = 0.25); negative correlation between smoking and time of the initiation period (r = –0.4) were detected. The results obtained show there is a correlation between a lifestyle and oxidative status of patients with stable CAD. Thus, influence on behavioral risk factors is the most important task of management of patients with cardiovascular pathology.

Received: 2023-11-26

Published online: 2023-12-29

DOI: 10.24075/medet.2023.033

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VIEWS 530