Медицинская этика

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.

New forms of medical aid have been widely used in the presence of global digital transformation of medicine. This concerns not only medical equipment and ensuring access to health services, but also the entire healthcare system and doctor‑patient relationship. It’s impossible to imagine modern medicine without digital decisions. Digitalization of the available information and making it available for all participants of the doctor‑p atient system form the basis of subsequent development of clinical practice, breakthrough in scientific research, improved patient‑ centered healthcare, and comfort of system operation for people. This requires a general culture of values and ethical standards that should correspond to digital decisions. The article deals with the reasons for actualization of remote forms of doctor‑p atient communication during the COVID‑19 pandemic illustrated by telemedicine. Principle forms of telemedicine under modern conditions caused not only by the pandemic but also by digital transformation of medicine have been reviewed. Special attention is given to possibilities of telemedicine from the point of view of benefit, as well as to legal and ethical aspects from the point of view of risks.

In this article, the authors review the role of bioethics in the processes of risk communication and socio-humanistic support for innovative development of technoscience, and analyze its commitment to the concepts of precaution and prevention. More focus is put on certain ethical challenges of the 21st century associated with the development of artificial intelligence, deep learning in medicine, genome editing and ‘new parenthood’ practices. They have exploited the potential of bioethics in ethical and axiological reflection on the prospects of healthcare far-reaching reforms and in sociohumanistic assessment of transformed ideas about the human nature, family connections and established social order. It is shown that the experience of complex problem discussion and solving alongside with advisory mechanisms and bioethical procedures respond to pressing challenges of biotechnoscience and will be in demand in future.

Currently, systems based on artificial intelligence (AI) are finding increasing application in medicine. Acting as assistants of both the attending physician and managing physician, they can be a good help in solving a number of problems in modern healthcare, such as staff shortage, professional burnout and, in some cases, insufficient staff qualification. However, this leads to increased requirements for reliability of such systems. Introduction of a new advanced technology raises a number of ethical issues and problems, the solution of which is necessary to gain trust of people and reduce distrust associated with the use of AI technologies. It seems that if ethical standards determine and set the progressive development of artificial intelligence, this will lead to the maximum benefit from the use of this technology in healthcare. The paper examines the ethical aspects of transition of software into the category of medical devices. At the same time, legal and organizational mechanisms for solving ethical problems at both the international and domestic levels are provided. The activities of both public and government organizations in this field are considered. The need to obtain the permission of ethical committees for conducting clinical trials and ensuring informed consent of patients is emphasized. It also highlights the importance of integrating medical data into structured datasets that can be registered as databases. This will contribute to improved quality of medical research and practice.

The field of medicine has traditionally focused on such symptoms of a disease as pain, inflammation, and tissue deformity. However, according to the modern approach, it is necessary to identify the cause of the disease, which is often hidden deep inside the body. Examining genetic polymorphism as the basis for purulent complications after treatment of the lower limb injury was one of the method that could solve the problem. Epidemiological observations confirm that purulent complications after orthopedic surgery are associated with hereditary predisposition factors. This highlights the important role of genetic changes in development and course of this pathology. However, any medical intervention is associated with potential risks, including emotional pain of the patient, violation of personal data confidentiality and misuse of the obtained information. That is why it is important to think in advance about the possible consequences of genetic tests and to find ways how to resolve ethical issues.

Medical rehabilitation is currently in an active phase of its development. This relevant area of domestic medicine is essential for human health. It helps patients recover from long-term illnesses, effects of injuries and diseases of the musculoskeletal system, peripheral nervous system and has a huge impact on the prognosis and outcome of treatment in general. This publication provides a comprehensive analysis of the ethical aspects of medical rehabilitation with an emphasis on legal definitions in medicine, which will improve understanding and regulation of relationship between rehabilitation, prevention and treatment. The research includes the study of domestic and international regulatory legal acts concerning medical rehabilitation, history of the specialty, the formulations that laid the foundation for the concept further development, consolidating an integrated approach to the issue of medical rehabilitation, as well as review of the problem-associated scientific papers. Explaining the principles of medical rehabilitation will help doctors avoid legal risks associated with their professional activity and serve as a guideline for taking ethically sound decisions in difficult clinical situations, whereas patients will get a full picture of their rights within the framework of medical rehabilitation.

Glaucoma is the leading cause of irreversible blindness. Its leading symptom and the most important initial link of the disease pathogenesis is represented by an increase of intraocular pressure (IOP). Decrease of IOP is a basic notion in the therapy of glaucoma. Drug-induced therapy is currently the most widely spread initial intervention to decrease IOP. Prostaglandin analogues are referred to the basic group of pharmacotherapeutic agents, because they are the most effective and well tolerated. Beta-blocking agents are selected as an alternative. Other medicinal products to treat glaucoma include inhibitors of carbonic anhydrase for systemic (acetazolamide and methazolamide) and local (dorzolamide and brinzolamide) use. Systemic inhibitors of carbonic anhydrase are, on the one hand, more active than non-systemic medicinal preparations, and, on the other hand, have numerous side effects which are not safe for humans. Thus, medicinal preparations for local use are most frequently applied in the therapy of glaucoma. If necessary, they are combined with beta-blocking agents or alpha-adrenergic agonists.

The early XXI century was marked with entry into the market of a great deal of medicinal preparations with a totally new molecular-oriented mechanism of action. These results could only be made possible through achievements in molecular and cellular biology and completion of the Human Genome Project, in particular. Many pathogenic mechanisms of different illnesses, including oncological and autoimmune ones, were deciphered. The data stimulated the search for totally innovative therapy methods targeting at the key links of the abnormal process pathogenetic chain, collectively known as ‘targeted therapy’. The issues of personalized medicine, including the ethics, are considered through the study of the Coriell Institute.

The article describes stages of medical education development in the chronological order and discusses the principal models of university organization and the process of evolution of scientific approaches to their formation throughout history. Preconditions for reviewing approaches to a subsequent change in the model of university education and direction of the search at the core of the modern educational concept are enumerated. Advantages and shortcomings of third-generation universities formed under the effect of the industrial revolution are separately discussed. The value and role of the university at the modern stage of society and economy development are being considered. It is concluded that educational needs require fundamental transformation, selection of the widest specter and most qualitative level, implemented scientific and educational programs, search for new approaches to mass and elite education. State support, protection, commercialization of knowledge, interdisciplinary integration and cooperation with the leading companies and research structures as part of national scientific laboratories will enable transfer of technologies to develop a new generation university that corresponds to modern tasks and needs of the country intensive development.

The article contains the results obtained during an empirical study of health care practices among people of a large Russian city implemented in a combined strategy in 2020–2021. Our focus remains on the reference of citizens to the procedure of DNA diagnostics as a novel instrument of health-saving behavior and attitude to genetic knowledge in general. The obtained data allow concluding that genetic testing is not widely popular among population today, as only 9,5% of those interviewed have ever done it. DNA diagnostics is more frequently used by young women and men with high income and don’t trusting modern medicine, which probably reflects the actual condition of the market of genetic services in our country. Apart from financial possibilities, involvement into consumer genomics is influenced by insufficient trust in DNA information, and suspecting that players on the market of genetic services obtain economic profit. However, the most important argument against it consists in the discovered discrepancy between perception of genetic data as something inevitable and currently popular ideology of healthy lifestyle, meaning that a person can influence the outcome of the efforts made. As a result, research participants are not willing to become the everlasting ‘patients-in-waiting’ even in case of existing symptoms, but implement their ‘right not to know’. Under these conditions, an important task includes organization of active promoting awareness that unlocks potential, capabilities and limitations of genetic diagnostics.

The article is dedicated to Karl Fuchs, a distinguished medical practitioner, scientist, public figure and professor within the Department of Therapy, Pathology, and Clinical Medicine, who served as both the Dean of the Faculty of Medicine and the Rector of Imperial Kazan University. Born in Germany, Karl Fuchs committed his life’s work to the advancement of Kazan and well-being of its population. The central focus rests on the scientist’s character traits, ethical views and his contributions to the medical, educational, and public spheres. It is shown how eminent 19-century public figures in Kazan evaluated Karl Fuch’s life and work. The conclusions regarding the contemporary significance of his ethical principles are made.

Euphemisms in medical discourse ensure professionally and ethically sound doctor-patient communication. They are used to replace words and phrases that have a negative and undesirable connotation or appeal to foul language with neutral expressions. The basic areas of their common use are presented; the topics of medical discourse subject to euphemization and the objectives of using euphemisms in doctor-patient communication following the principles of deontology are highlighted. The professional medical language with Latin medical and clinical terms can serve as a means of euphemization. Thus, the issue should be explored to develop the linguistic worldview and communication culture among the future physicians and to communicate with the patient effectively.

The article investigates the ethical and pedagogical dimensions of education, specifically using the process of teaching Latin in medical schools as a case study. This outlines the core principles of pedagogical ethics and the professional code of conduct for university teachers. The results of a survey given to first-year students at the Department of Foreign Languages of Yaroslavl State Medical University (YSMU) regarding the teacher’s role in education are analyzed. The issue of what students look for in the personality of an ideal university teacher is being discussed. The study of Latin must be used to equip students with proper terminological skills, widen their intellectual horizons, and raise their general cultural literacy. The author stresses the essential mission of a modern teacher, noting that teaching skills and moral guidance cannot be separated.

This paper explores the ethical dimensions of technological mediation into the workflows of foreign language teachers at medical universities. By combining media education, digital didactics, and foreign language teaching, the author presents a model of technology-mediated competence that incorporates an ethical component. The study elucidates the testing principles, educational stages, and teaching techniques used to incorporate ethical concepts into foreign language reading. The text explores the risks and prospects of forming ethically responsible technological mediation in the context of the digitalization of medical education. It highlights the hurdles of adding artificial intelligence (AI) to classrooms and the need to teach critical thinking to all students and teachers.

Upholding ethical standards in pharmacy administration enhances a leader’s professional competency, ensuring the provision of premium medical care. Yet, organizations still struggle to agree on standard ethical practices. In pharmacy, this is worsened by leaders viewing their roles as mere paperwork, entirely divorced from ethical or socially responsible considerations. Consequently, exploring the professional ethics governing pharmacy executives is paramount for optimizing public access to pharmaceutical care. Application of general scientific methods reveals that managerial ethics is an amalgam of organizational culture, socio-psychological dynamics, and core professional practices. Pharmaceutical managers must integrate ethical principles and regulatory compliance into every facet of their professional duties. The foundational ethics of a pharmacy manager are developed progressively, beginning post-graduation and evolving through lifelong professional education.

This review examines the ethical and legal implications of creating pharmacogenetic passports during the preconception (prior to conception) and prenatal (intrauterine) periods. The work is based on a methodological differentiation between the stages of genetic testing.. Preconception screening aims to assess carrier status in prospective parents and ensure their reproductive freedom, while prenatal testing provides fetus-related data, raising bioethical issues regarding the protection of interests and self-determination of the future child. The technologies of non-invasive prenatal testing (NIPT), preimplantation genetic testing (PGT), and prospects for intrauterine pharmacotherapy in severe congenital abnormalities are discussed. Special attention is given to ethical conflicts such as a conflict between the right to health and the right not to know, limits of parental proxy, and risk of genetic stigmatization. Normative approaches are suggested to address the identified ethical tensions (minimum intervention, clinical benefit, and deferred choice). The analysis of the Russian legislation and international instruments (Oviedo Convention, the GINA Act, the GDPR) yields recommendations for the healthcare system and legal regulation.

The article presents an ethical analysis of randomized placebo-controlled trials (PCTs) conducted in developing countries in situations where effective treatment already exists elsewhere in the world. The authors examine a fundamental contradiction: the use of a placebo often becomes feasible only because of global inequality in access to healthcare, whereby the actual standard of care for the local population is the complete absence of treatment. Through two case studies: trials of drugs for HIV prevention and for the treatment of infant respiratory distress syndrome (IRDS) — the ambiguity of ethical evaluation is demonstrated. The key criterion for the acceptability of a PCT is identified as the degree of potential harm: while in the case of HIV the risk to participants was high but not fatal, in the case of IRDS the use of a placebo directly endangered the lives of infants. To provide a philosophical foundation for the problem, the authors employ John Rawls’ thought experiment of the “veil of ignorance” and Gerald Cohen’s test of interpersonal justifiability. From Rawls’ perspective, PCTs perpetuate injustice, because the standard of care cannot depend on a patient’s place of residence, and no one would agree to risk their life due to the contingency of being born in a poor country. Cohen’s test reveals the moral deficiency in the pharmaceutical companies’ reasoning: they themselves contribute to the inaccessibility of medicines and then use this as a justification for placebo controls. The conclusions argue for the necessity of a differentiated approach: prohibition of PCTs when lethal risks are involved, and permissibility only under the condition that the research is aimed at developing accessible treatment for the same vulnerable population.

The article analyzes the image of healthcare professionals shown in Russian poetry of the XX century through the lens of a duty. The topic declared as the subject of a special comprehensive survey has not been brought up in the Russian scientific field. The notion of ‘a duty’ is defined, a summary of research literature related to this issue is provided. The author mentions that the category of a doctor’s professional duty, which appeared in Russian poetry in the beginning of the XX century only, is firmly fixed and reflected herein during the entire investigated period. Meanwhile, poetry provides examples both for children and adults. In this paper, pieces of poetry by Mayakovsky VV, Chukovsky KI, Drunina YV, Zabolotsky NA and Rutkovsky MA have been analyzed. It is indicated that poetry produces a specific effect on the reader. The author concludes that the images of devoted doctors and nurses that have been created by Russian poets can play a significant methodological and educational role in developing the professional identity and personality of future healthcare professionals.

The paper analyzes information security issues in Russian healthcare in the context of digital transformation. Digitalization of the healthcare sector, including integration of information systems of medical and pharmaceutical organizations with the Uniform State Health Information System (EGISZ), improves the quality of medicines and healthcare provided to the population. Meanwhile, the risk of patient personal data leakage and computer attacks on healthcare organizational information systems is increasing. The purpose of the study is to develop an integrated approach to information security in medical and pharmaceutical organizations. The research uses content analysis, logical and structural analysis of scientific papers and regulatory legal acts in the field of information technology in healthcare. The authors identify the stages of information security regulation from protecting medical secrets to categorizing critical information infrastructure and using domestic software. The classification of security threats to digital systems is provided based on the location of the threat source depending on whether they originate outside or inside the organization’s network perimeter. The directions and evaluation criteria for improving information security are provided based on modern methods and technologies of information protection, including technical means of protection, legal mechanisms, as well as organizational and managerial methods.

Biobanking of patient- isolated microbial strains is a critically important tool for modern biomedical research, though it is associated with a complex of unresolved ethical and legal issues. The goal of this paper is to analyze the issues based on biobanking case studies at the National Medical Research Center of Coloproctology named after Ryzhykh AN. The focus is on the contradictions between the need for scientific progress and respect for the rights of donors, including obtaining informed consent and ensuring data confidentiality. The study material included legal documents and internal regulations describing how to work with microbial collections. During the analysis, isolated Russian legislation, lack of a clear legal status for biological samples and dependence of ethical aspects of work on local protocols and internal policy of the institution have been found out. The key conclusion is the urgent need to develop a specialized regulatory system that harmonizes the principles of bioethics with the practical tasks of biobanking, establishing clear rules for handling a patient’s microbiota and consent management mechanisms.