Vol 15, No 1 (2022)


Bioethics in an era of change: unprotected groups

Sedova N.N.


The article deals with such a phenomenon as the reorientation of bioethics in the era of change. Attention is focused on the fact that the COVID19 pandemic has exposed new problems in practical medicine. Special attention should now be paid to the vulnerable groups that have been most affected by the pandemic – children and the elderly. At the same time, the author disagrees with the unification of gerontology and geriatrics into one, exclusively medical, scientific specialty in the list of the Higher Attestation Commission of 2022. The idea is expressed that bioethics can and should act as a phenomenon synthesizing all aspects of the accompaniment of old age. The author calls for the development of this direction, including on the pages of this magazine.

Bioethics journal. 2022;15(1):3-5
pages 3-5 views

Theoretical bioethics

Healing is an active merci and the foundation of solidarity. Discussion about the past and future of bioethics dedicated to the 75th anniversary of Pavel Dmitrievich Tishchenko

Tishchenko P.D., Sedova N.N., Petrov K.A.


Pavel Dmitrievich Tishchenko, one of the founders of Russian bioethics, turned 75 on January 10, 2022. Joining the numerous congratulations, journal “Bioethics” publishes the text of the discussion dedicated to this event. The discussion was initiated by the question of the history of Russian bioethics formation in the perspective of its simultaneous emergence in Moscow, Volgograd, St. Petersburg, Kazan. The participants exchanged opinions on the significance of I.T. Frolov's ideas for the formation of the Moscow School of Bioethics. The influence of the concept of "frontier" proposed by Tristram Engelhardt Jr. on the formation of distinctive features of Russian bioethics was revealed during the discussion. It is emphasized that at the early stages of its formation Russian bioethics was more concerned with the problems of clinical trials than with the moral dilemmas arising from medical practice. An important stage for self-understanding of bioethics was the events of the Afghan company, which exposed the imperfection of the healthcare system in the USSR. The discussion touches a critical examination of the traditional principles of bioethics. The conversation of the philosophical foundations of modern bioethics allowed to formulate two theoretical opinions. The firs assertion determines that philosophical theories delay with revolutionary changes in the field of medical and scientific practice. The second one determines the need for the formation of stable teacher-student relations sufficient for enculturation with the tradition of thinking. The participants noted the undoubted humanizing influence of these principles on clinical practice and scientific research. At the same time the risks associated with an attempt to transfer the principles that was established in the Western tradition into the practices of Russian medicine and science were identified. Speakers claimed the idea of harmonization the principles to the traditions of Russian philosophy and ethics. Thus, the medical art should be conceived as an active mercy, and many bioethical problems as social challenges that require solidarity. It was noted, that bioethics is transforming from type of value-based communication of specialists to a formalized procedure.

Bioethics journal. 2022;15(1):6-18
pages 6-18 views

Bioethics as deconstruction

Smirnov K.S.


The paradoxical perspective of bioethics supposing its explication as deconstruction is analysed in the article. The evolution of the program of deconstruction and its unexpected convergence with bioethical discourse is traced. Moreover, this discourse as itself can be considered as deconstruction of ethical thought. Bioethics in this case comes out as radicalization of ethics. Such kind of radicalization is necessary versus logocentric pressure and imposed consideration of human from the standpoint of so-called life sciences. Radicalization of ethics reveals insolvency of the liberal form of bioethics, reducing human essence to the totality of biological and social needs. At the same time conservative bioethics demonstrates heuristic potential coming from unique human ability for transcendence. Further, the logic of the development of bioethics allows to introduce the idea of bioethos as rhizomic, horizontal structure capable to become the alternative to the logocentric directons.

Bioethics journal. 2022;15(1):19-23
pages 19-23 views

The fate of medical and humanitarian education in Russia

Moiseev V.I., Moiseeva O.N.


The article points to various alarming tendencies of dehumanization of modern medical education in Russia and in the world. Apart from economical and political solutions, the article suggests to address the most fundamental reason for negative attitude to humanitarian subjects in modern biomedical education – the struggle between reductionist and holistic worldviews. While modern biomedicine is increasingly dominated by an increasingly rigid reductionism, which reduces living things to non-living things at the level of atoms and molecules, humanities knowledge is organically characterized by a holistic approach to the human being, i. e., holistic foundations and principles. The split of these two directions projects itself in the split of basic medical subjects and humanities disciplines. The authors see the only radical way to overcome this schism as a transformation of biomedical knowledge itself in the direction of holistic reductionism – a synthesis of holism and reductionism. This integrative type of knowledge will project itself into a fundamentally different, allied, relationship between the more reductionist and holistic strands of a single integrated biomedicine.

Bioethics journal. 2022;15(1):24-32
pages 24-32 views

Practical bioethics

The principle of "biological diversity through biological equity"

Tiras K.P.


The modern practice of biological research required the formation of a new ethics of biology, which became a synthesis of observation and experiment. The article considers the ethical aspects of modern biology from the point of view of criticism of the anthropocentric approach. A position has been put forward on the lifetime of a modern biological group as the main criterion for its place and role in the evolution of living things. The consequence of this is the need to form an attitude towards biodiversity as a one-time and equal coexistence of diverse groups of representatives of wildlife.

A conceptual connection is proposed between the new ethics of biology and the classical ethical construction – the "golden rule" of ethics, and the ethics of naturalistic biology, which is inextricably linked with it, coming from the ethics of science of Goethe and Meyen.

The proposed ethical concept of biology includes several elements, called "principles" by the author, which together cover all aspects of the ethics of biological research.

These are the principles:

  1. Biological diversity as the basis of biological "equality".
  2. "Watch no touch" – look, (but) do not touch – the ethics of "virtual experiment".
  3. "Ethical means accurate" – adherence to ethically "pure" approaches to an object as a condition for obtaining accurate information about a living object.
Bioethics journal. 2022;15(1):33-39
pages 33-39 views

Preimplantation Genetic Testing: An Orthodox-Christian Reflection on the Ethical Issues

Tarabrin R.E.


Background: Preimplantation genetic testing is used in In Vitro Fertilization to identify genetic abnormalities in embryos. Genetically defective embryos are not transferred to the uterus, resulting in a higher percentage of healthy babies born.
Aim: to study the ethical problems of using preimplantation genetic testing in Orthodox Christian discourse.
Materials and methods: An analysis of the provisions of Orthodox ethics, expressed in the church resolutions of the Russian Orthodox Church and the general church teaching on morality, was carried out in the context of their application for the biotic analysis of preimplantation genetic testing (PGT).
Results: Despite the fact that PGT can have positive implications for the choice of the mode of delivery later on and for the earliest possible initiation of intrauterine treatment, this practice meets with certain ethical objections in Orthodox Christian discourse. Identified genetic abnormalities of embryos in PGT encourage women to refuse to transfer the "diseased" embryo, leading ultimately to its death. The absence of intrauterine interaction between a mother and an embryo makes such a choice easily feasible. Given that Orthodox Christianity affirms the beginning of human life from the moment of conception, refusing to become pregnant with a "sick embryo" would be tantamount to its murder. In addition, among the ethical problems of PGT is the possibility of the use thereof for the embryo selection according to sex or other chosen characteristics, which also belongs to immoral actions in Orthodox Christianity.
Conclusion: Thus, the possibility for Orthodox couples to participate in assisted reproductive technology must exclude the use of pre-implantation genetic testing, which is ethically unacceptable within Orthodox Christianity. The couple starting IVF should be ready to give birth and bring up such a child, who will be the result of the fertilization in vitro.

Bioethics journal. 2022;15(1):40-45
pages 40-45 views

Social group "65 plus": Pandemic's ethical dilemma

Eremina M.V., Donika A.D.


Background: The conditions of the emergency create an unprecedented, but legitimate approach, when the rights and freedoms of the individual can be limited in the public interest. From the first days of the pandemic, a special social group of the population began to stand out, with the code name "65+".

Aim: to give an ethical assessment of the attitude of society to the population group "65+", to show the contradiction between medical and bioethical approaches to the criteria for selecting a group.

Materials and methods: The review of fundamental and modern works in the problem field was carried out. The empirical basis of the work was the materials of a sociological survey using Google forms (N = 520).

Results: According to the analysis of statistical indicators of employment in the Russia before the pandemic (2019), the share of employees aged 60–64 years was 32,4 %, in the range of 65–69 years – 13,7% of the size of the age group, which indicates the high social activity of the 65+ group (approximately every third or fourth pensioner continues to work) and demonstrates the labor potential of the group. At the same time, anti-epidemic measures related to restrictions on labor and social activity primarily affected this group, which led to stigmatization based on the age criterion. The long-term confrontation with the pandemic has weakened the psychological tactics of treating older patients that have not been fully developed in the national health care, based on the ethics of care. A survey of medical students (aged 21–24) conducted in March 2021 showed that the majority (82,8 %) of respondents viewed restrictions as unacceptable discrimination.

Conclusion: The review of updated research and the analysis of the current situation have shown that the phenomenon of the aging of the nation and the vulnerability of the older age group of the population to a new coronavirus infection have led to a contradiction in approaches to the considered age group from the standpoint of medicine and bioethics. The inherently humane measure of protection for a group that is especially vulnerable in terms of medical indicators began to be perceived by the society as a reason for stigmatization. The solution to the dilemma is possible in the context of the convergence of medical and human sciences in the interdisciplinary problem field of gerontology and geriatrics.

Bioethics journal. 2022;15(1):46-50
pages 46-50 views

Applied Bioethics

Reflections on the ethics of the patient

Tabatadze G.S., Kostenko O.V., Tabatadze V.G.


The article deals with one of the least studied moral and ethical problems – the behavior of the patient in relation to the doctor and medical staff. It is shown that the subjective moral and psychological qualities of the patient are of crucial importance. Such an important factor determining the patient's behavior as the motivations that guide him is analyzed. The moral and ethical qualities of the patient necessary for the harmonization of the patient-doctor relationship are highlighted. Long-term empirical observations in the system of patient-doctor relationships allow us to substantiate the conclusions that the nature of the connections between them is mediated by the goals they are guided by; that the patient's behavior depends on the level of his spirituality, his moral and ethical qualities, interests, values; that the harmonization of doctor-patient relations is ensured not only by the fact that that the doctor "should", but also by what the patient "should", i.e. by joint efforts.

Bioethics journal. 2022;15(1):51-57
pages 51-57 views

Euthanasia and palliative care in pulmonology

Yakovleva E.V., Borodulina E.A.


Background: Currently, euthanasia is officially allowed only in a number of countries, in most countries, as well as in the Russian Federation, it is prohibited by law. However, in clinical practice, there are a large number of incurable patients who experience intractable pain, so the problem of euthanasia is relevant.

Aim: to analyze the current state of the problem of euthanasia and palliative care in pulmonology.

Material and methods: review of domestic and foreign literature on the problem of euthanasia over the past 10 years has been carried out. Literature search was carried out using the e-library and PubMed databases.

Results: We present a medical and philosophical perspective. Currently, euthanasia (Greek "good death") is a way to quickly and painlessly die if there is a serious illness that is incurable, suffering and pain. The best and perhaps the only alternative to euthanasia is palliative care. In pulmonology, palliative care focuses on early detection of respiratory failure, dyspnea, fear and pain relief. The effective organization of palliative care in respiratory medicine depends on the well-coordinated work of pulmonologists, physiotherapists, nurses, and psychologists.

Conclusion: The problem of euthanasia to date still remains controversial from both medical and ethical points of view. The adoption of euthanasia by law may be a deterrent to governments from funding research into new treatments. The risk of abuse of euthanasia in order to obtain organs for transplantation or to get rid of seriously ill burdensome relatives cannot be ruled out. It is necessary to consider the issue of introducing additional educational cycles on the issues of modern achievements in palliative medicine, technical means of rehabilitation and the peculiarities of their use in patients with various diseases in the terminal stage in the training of doctors and nurses.

Bioethics journal. 2022;15(1):58-62
pages 58-62 views


Network form of teaching bioethics

Kostenko S.A., Vlasov S.N.


The digital educational environment makes it possible to widely implement the network form of education. The report gives an example of the exchange of lectures on bioethics between Rostov, Volgograd, Perm Medical Universities, Pushchino State Natural Science Institute. New opportunities are noted for students, masters and graduate students in familiarizing themselves with the ethical values ​​of life. A proposal is put forward to conclude agreements between universities, as provided for by the Federal Law "On Education in the Russian Federation", on the introduction of a network form of liberal education. And, above all, in the field of bioethics.

Bioethics journal. 2022;15(1):63-64
pages 63-64 views

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