Bioethics journal

Volgograd State Medical University was one of the first educational bases where the then new science of bioethics began to be taught. But before it became an officially recognized academic discipline (in 2001, a mandatory training course in this discipline was introduced for students of medical and pharmaceutical universities), many events occurred that showed the need for an ethical arrangement of any medical issue. The history of global bioethics is well known, thanks to the exceptional attention that scientists from all countries have been paying to it for almost half a century. But we want to see how bioethics originated and developed in one particular medical and philosophical locus. And it is hardly possible to find a better opportunity for this than the 90th anniversary of VolgSMU.

The article analyzes the problem related to the most important category of ethics and bioethics (good). The problem is that good as an act of mercy comes into fundamental conflict with the morality of achievement. At the same time, neglect of the act of mercy in modern conditions of supervisory capitalism threatens a catastrophic scenario for all mankind. The category of good is analyzed within the framework of a conservative version of bioethics. In this context, good is considered in two aspects: existential and political-legal. In the first case, good is defined as moral transcendence to Another, involving salvation, preservation of life, and help. In the second case, good is interpreted as the realization of the idea of equality and justice. It is pointed out that the realization of good (an act of mercy) is possible through the convergence of two processes: the return of traditional, humanitarian education based on direct, lively dialogue and spiritual growth, the moral awakening of the elites.

Ethical assessment of biotechnology – genetic engineering, genetic medicine and gene diagnostics, is associated with the need for initial metathetical grounds for the implementation of assessment procedures. development of accurate, individualized and effective therapeutic approaches. On the other hand, the conventionality of existing concepts of morality allows us to turn to the principles of the systemic nature of being as ontological grounds for the implementation of ethical assessment of technologies as, perhaps, a conceptual renewal of theoretical and practical bioethics. The failure to create a general theoretical paradigm of morality allows, as an initial idea of methodological consideration and subsequent analysis, to consider the general ideological principles of the formation of value-based general cultural narratives. As such, first of all, the principles of orderliness and “mutual protection” of the elements of the system of being are taken, which can also be applied to the ethical issues of gene therapy, in the process of which there is an intervention in the genetic material of a person. Based on these ontological foundations, it is necessary to clearly distinguish between therapeutic goals aimed at treating diseases and attempts to purposefully change human nature in order to avoid turning science into an instrument of social control. The inclusion of such technologies in practical use requires strict control and the development of ethical protocols that would protect human dignity and rights, and the need for the principle of limitation as a fundamental principle on which the procedures for the ethical assessment of new biotechnologies can be built is realized. The article highlights two main principles that can be considered as objectively existing ethical narratives based on the ontological arguments of morality: the principle of maintaining the integrity of the system and the principle of limitation. At the same time, these principles show a large degree of unity with each other. Based on the presented arguments, it can be concluded that gene therapy, despite its enormous potential, requires extreme caution in its application.

Neuroethics, being a specific kind of bioethics, is a striking example of the synthesis of traditional clinical challenges with dilemmas of modern biomedical progress. Some of its most complex problems are connected with the syndrome of cognitive impairment due to the extreme polymorphism of its manifestations, the variety of pathological conditions that give rise to it, the difficulties of its diagnosis and prevention and, finally, its direct harmful influence on the very subjective “core” of the human personality, destruction of the human Ego.

Background: the integration of artificial intelligence technologies into the medical field is happening at a rapid pace, which certainly contributes to the qualitative growth of high-tech medical services. At the same time, the involvement of the consumer in the field of AI-associated medical services is not absolutely complementary to other areas of the market, since it concerns priority values – life and health. The purpose of the work is to predict the ethical risks of deviation of the culture of consumption of AI-associated services in medicine.

Materials and methods: A secondary analysis of the 2024 and 2025 VTsIOM sociological surveys was conducted. The sample included 1,700 respondents aged 18 and over, divided into generational groups: the “digital generation” (born after 2001), “younger millennials” (born 1992–2000), older millennials (born 1982–1991), the reform generation (born 1968–1981), the generation of stagnation (born 1948–1967), and the generation of the thaw (born before 1947). Results: The largest number of positive patient expectations is associated with the hope that AI will influence the reduction of medical errors (41.2 %). In second place are expectations of a positive impact on the security of personal data in medical services (33 %). The least positive expectations are related to the possibility of AI influence on doctor-patient relationships. Only 28 % of respondents believe that the situations «in personal relationships between patients and doctors” and with «doctors’ bias towards patients of different ages» will improve. The digital generation is positive about AI’s participation in diagnosing diseases and recommending treatment (48 % feel “comfortable” and “rather comfortable”), while about half of the respondents in the older age group (46 % of the “stagnation generation”) expressed disapproval: “rather uncomfortable” and “not comfortable”).

Conclusion: It is possible to assume that a new “AI-techie” model of doctor-patient relationships will emerge in the near future, and patients of the “digital” and “millennial” generations are ready for it. The conducted analysis allows us to predict the risks of deviations in the culture of consumption of medical services associated with artificial intelligence. Given the skepticism of respondents aged 55+, we can assume the tactics of avoiding this type of medical services by patients of older age groups.

Background: The word “delicacy”, on the one hand, is associated with adequacy, sincerity and trust, on the other hand, actualizes negative emotions verbalized in reactions of fear, lying to the eyes, cowardice, falsehood, secrecy, which, according to N.I. Stepykin, “is evidence of a high degree of operationality of these speech actions”. That is why it is necessary to explicate the meanings of the concept of “delicacy” in various contexts of medical practice.

Aim: To consider the possibility of improving clinical thinking in moral interaction with patients.

Materials and methods: An analytical review of interviewing young doctors on the issue of improving the effectiveness of communication in medical practice has been conducted. The empirical base is represented by the materials of qualitative and quantitative sociological research (interview and questionnaire methods).

Results: Based on the qualitative analysis, a table of meanings of interaction between doctors and patients based on sensitivity has been compiled. Quantitative analysis revealed the pros and cons of delicate practices.

Conclusion: The authors examine the inconsistency of young doctors' reflections on the problem of sensitivity in modern conditions of medical care, analyzing an anthology of positive and negative meanings verbalized in reactions of benevolence and alertness, perseverance and tolerance, mutual respect and detachment, courage and indecision, accuracy and silence, necessary and unnecessary, which is useful for working within the framework of partnership and contractual models of healing.

This article examines the bioethical aspects of ritual and prophylactic circumcision of boys (CВ). Religious, cultural, and social factors influence not only the decisions of many parents to have their children circumcised, but also those of pediatric surgeons who are asked to perform such an operation. When or under what conditions is it considered ethical to circumcise the genitals of boys unless it is medically necessary? The central ethical issue at stake is that СВ in infants is contrary to standard surgical principles because there is no absolute medical indication for its performance. In most ordinary circumstances, genital cutting of any individual without his or her own informed consent is a gross violation of that individual’s right to physical integrity and sexual expression. The medical, ethical, cultural, and legal issues surrounding CВ performed without medical indications are numerous and complex, and are deeply rooted in Western civilization, which is unequivocally based on respect for basic human rights and on the protection of the physical and mental health of every member of society. The topic of СВ is a complex paradigm for today's pluralistic, multi-ethnic and multicultural society, in which various demands, traditions, rights, cultural, religious and ideological norms conflict with each other. Like any surgical operation, it carries a risk of complications, which can be defined as early (bleeding, inflammation, damage to the glans and urinary retention) and late (such as phimosis, penile torsion and urethral cutaneous fistula). СВ, based on cultural and religious factors that are deeply ingrained in some segments of society, should be conducted in conditions of maximum security in specialized medical institutions and with properly trained personnel.