Bioethics journal

The Forum of Civil Initiatives “Russia 809” was held in St. Petersburg on July 28–30, 2024. In order to understand the full importance and social significance of this event, you need to go back a little bit. In 2014, Decree of the President of the Russian Federation No. 808 dated December 24, 2014 “On Approval of the Fundamentals of State Cultural Policy” (Collection of Legislation of the Russian Federation, 2014, No. 52, Article 7753) was published. The events taking place in the world forced us to return to some, not to say “many”, provisions of this document and seriously supplement it. This was done in two documents: Decree of the President of Russia “On Approval of the Foundations of State Policy for the Preservation and Strengthening of Traditional Russian Spiritual and Moral Values” dated November 9, 2022 No. 809 and Decree of the President of the Russian Federation “On Amendments to the Foundations of State Cultural Policy approved by Decree of the President of the Russian Federation dated December 24, 2014 No.808” dated January 25, 2023 No. 35.

Despite of active implementation of the concept of “evidence-based medicine” into all areas of medical education, clinical science and practical healthcare, the epistemological problems of this new scientific reality currently remain underdeveloped in the philosophy of science.

Aim: to identify the epistemological and ethical problems inherent in the evidence-based approach in medicine.

Methods: The epistemological and ethical aspects of the concept of evidence-based medicine were considered.

Results: At the current stage, evidence-based medicine reflects a transitional stage from the classical to the non-classical research paradigm. In this regard, the epistemological and ethical aspects of the concept of evidence-based medicine require further study and critical reflection.

Conclusions: The discourse of evidence adopted in medicine today is aimed at increasing the objectivity of medical knowledge from practical point of view. However, this approach is not without significant drawbacks, including the overestimation of statistical patterns at the expense of “individual clinical differences”, the implicit primacy of phenomenological settings over the theoretical layer in the postulated structure of the scientific program, the unjustifiably rapid doctrinalization of the approach and the stigmatization of its opponents.

The unreliability of modern methods of treating existential distress in incurable patients draws the attention of a number of specialists to the possibility of using such an effective means of combating thanataphobia as gaining a symbolic experience of death – rebirth in palliative care, the simplest and most effective way of generating which is the use of entheogens. However, the topic of psychedelic therapy of the dying patients causes a wary attitude of society, despite the habitually high level of narcotic saturation of the field of palliative medicine. This attitude seems to be clearly conditioned by the cultural tradition of the prohibition of eating fruits from the Tree of Life, traced back to the era of Sumer and Akkad. Interpretation and analysis of the content of the mythological works of this ancient civilization give grounds to assert that the initial reason for the historical taboo on entheogens was the effect of the experience of symbolic rebirth in the form of the formation of the so-called psychological “wholeness”, i.e. a state of complete inner serenity, accompanied by a sharp decrease in the need for “external” adaptive activity. This circumstance, without a doubt, posed a fundamental threat to the well-being and security of society in the conditions of the archaic availability of this class of psychotropic substances. Such an “adaptive-civilizational” nature of the ban raises the question of its expediency in relation to those incurable patients for whom palliative means of distress therapy used by modern medicine turn out to be untenable.

The article reveals historical aspects of the bioethics of research and innovation in pediatric surgery. Surgical innovations are inherently noble efforts aimed at improving the health of patients through a new method of diagnosis or treatment. Together with the freedom to create something new and innovate comes the need to protect patients from the potential risks associated with a new way of diagnosis or treatment. Throughout the development of medicine, from the Hammurabi Code to the adoption of international ethical guidelines for human health research in 2016, a tendency has been traced aimed at addressing the issue of the legality of using research on humans in general and in performing pediatric surgical interventions, in particular. From the time of the Belmont Report to the present, the guidelines for conducting human experiments have been based on four core values or principles underlying modern medical ethics: benevolence, non-harm, justice and personal autonomy. Children deserve special treatment from researchers and research ethics committees. For more than a hundred years, participation of children in scientific research has been disputed, nevertheless, there is a large number of examples in the scientific literature of involving children in this kind of activity. Children were previously seen as important participants in the progress of medical knowledge and the development of new drugs and vaccines. The development of pediatric surgery and the establishment of bioethical principles have led to the restriction of such reckless experiments on children. The development of pediatric surgery and the establishment of bioethical principles have led to the limitation of such reckless experiments on children. Monitoring of such investigations by the medical community is very important, in which ethics committees play a central role. The work of these committees is based on a set of international legal and advisory acts accumulated by humanity, which are fundamental in the field of bioethics.

Background: Globalization, digitalization and other processes of transformation of society have significantly transformed the patterns of people's daily lives. High technologies have simplified many socio-economic processes and at the same time complicated the structure and content of social relations, significantly accelerating the pace and dynamics of social processes, which could not but affect the mental and physical health of people. 9 out of 10 Russians (90 %) face stress at different intervals, as a result, studying the attitude of citizens to mental disorders and their willingness to seek qualified psychiatric help becomes an urgent task. The purpose of the work is to identify the attitude of citizens towards mental disorders, psychiatrists and psychiatry, as well as their readiness to seek qualified psychiatric help in the event of mental health disorders. Materials and methods: This article presents the results of a qualitative study using a focus group discussion by 30 people aged 18 to 65 years: from 18 to 35 years, 36–59 years and 60 years and older.

Results and conclusions: The main reason for the negative attitude of society towards mental disorders, psychiatrists and psychiatry is the low level of trust in the doctor, which results in partial or even complete failure by patients to fulfill medical appointments. The study made it possible to identify the social and psychological attitudes of representatives of all age groups, to come to a single agreed opinion regarding the negative attitude of society towards mental disorders and low willingness to seek qualified psychiatric help in the event of mental health disorders.

On September 23–25, 2024, the XII International Interdisciplinary Scientific and Practical Symposium “Man and (co) societies in the context of health care: problems of medical anthropology in the past, present, and challenges of the future” was held in Moscow. The symposium was organized by the Association of Medical Anthropologists (AMA) and the Miklukho-Maklay Institute of Ethnology and Anthropology (IEA) of the Russian Academy of Sciences. This traditional event gathered a huge audience this time, which is not surprising, because it was about the highest values – health and life. The issues of presentations and discussions are reflected in the names of sections and Round tables, for example: “Health care in the past and present”, “Healthcare in the context of health care in modern communities”, “Medical anthropology as an interdisciplinary scientific field: problems of interaction and research methods”, “Reproductive models and practices in the context of multicultural societies” “Medical Anthropology – medical psychology: problems and research in an interdisciplinary field”, “Relevance of Ayurveda approaches in modern health care and healthcare”, “Medical aspects of biological anthropology”, “Mental health in a sociocultural context”, “Modern healthcare and patient trust: new bioethical challenges”, “Biofacturing of human organs and tissues”.

The final plenary session was of the greatest interest, the topic of which was: “Medical anthropology: problems of profession formation, development of scientific direction, teaching of educational discipline, as well as professional (re)training of specialists in medical and assisting professions”. In this context, the problem of the relationship between medical anthropology and bioethics in higher education was discussed. In this article, we express our opinion on this issue.