Medical Ethics

ISSN Print 2713-0894 ISSN Online 2713-0908

BIOMEDICAL JOURNAL OF ERMC EASTERN EUROPEAN

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The article analyzes the ethical problems that arise in the process of discourse on voluntary departure from life, examines the ethical aspects of existing views on euthanasia. It is noted that adherence to the principles and rules of biomedical ethics is of particular importance when making decisions regarding the end of life. The paper presents the relationship between the characteristics of modern society and hedonistic tendencies, determined when choosing the value orientations of young people who have chosen medicine as their future profession. In this regard, it is necessary to discuss issues related to the ethical aspects of euthanasia at interdisciplinary platforms in the professional community of representatives of medicine, philosophy, law and religious organizations. The author comes to the conclusion that following the norms of morality in the activities of a doctor, determined by the centuries-old achievements of philosophical thought, predetermines the trajectory of his professional activity in terms of the duty he performs.

Received: 2023-07-05

Published online: 2023-09-18

DOI: 10.24075/medet.2023.021

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VIEWS 458

Borisova AO, Nesterov RS

Preconception genetic testing for carrier diseases (PGT(C)) became a noticeable sociocultural phenomenon that raised various ethical issues with the individual and society. The issue of informing patients about the risks of giving birth to children with genetic abnormalities includes a range of questions about the probabilistic nature of genetic data, determinism, and cost and quality of medical and genetic counseling. Preventive tasks of genetics inevitably raise a question about the borders of a patient’s autonomy and mutual responsibility of the individual and society. In this article, ethical and philosophical analysis of sociocultural aspects of PGT(C) has been presented, including neoeugenic prevention traits, hubris and genetic fatalism.

Received: 2023-05-21

Published online: 2023-09-14

DOI: 10.24075/medet.2023.020

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VIEWS 512

In this article, ‘Sovereign Decision’ has been analyzed in the discourse of medical ethics (authors: Mihailo Lukovich, Katarina Meistorovich, Dunja Knezhevich). The interdisciplinary approach to the issue of axiological dissonance has been justified. It arises at the demarcation line of scientific private interests and society expectations and concerns implementation of research outcomes into the social practice. According to the authors, the ‘sovereign decision’, the key notion of the research, is a social phenomenon. In it, the legal sense of exclusive authorities becomes the imperative of an informed (ethical) choice in boundary situations of the subject’s legal elimination in relation to whom the ‘nominal’ or ‘exclusive’ medical decision is taken. By analyzing the issue of the ‘sovereign decision’ using the examples of vaccine prevention and euthanasia, the authors reveal the dialectic nature of the responsible choice. The issues that go beyond the subject of research seem perspective as well.

Received: 2023-08-16

Published online: 2023-09-12

DOI: 10.24075/medet.2023.019

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VIEWS 382

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 614

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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VIEWS 359

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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VIEWS 423

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 388

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 485