- Bioethics in Russia:History and Present-day Problems
It can be said that biomedical research and its ethical appraisal takes the lion’s share in the problem areas of bioethics as a whole. Accordingly, we devote an essential part of this article to biomedical research in Russia and a historical review of its ethical and legal regulations. We begin by describing some lines of development of medical ethics in Russia, which are mainly unknown abroad. Taking into consideration ethics of the medical profession, we highlight ethical issues arising from the practice of biomedical research. Then we discuss the initial phases of the emergence of bioethics in our country and offer a rather short description of some of the problem areas in Russian bioethics today.
I. Medical Ethics in Russia before 1991
We start at the very beginning of the previous century. In 1901, Memoirs of a Physician1 by Vikenty Veresaev (1867–1945), who was himself a doctor and writer, were published for the first time in the journal Mir Bozhiy (God’s World). It immediately stirred an enormous interest that went unabated for many years. Translations in English, French and German appeared soon after the first publication.
In his book, Veresaev sharply criticised violations of ethics in medical practice and research. In a chapter devoted to experiments in medicine (specifically in venereology), he extensively analysed cases of unethical experiments that were found via a thorough review of articles that had been published in medical journals. The search for these articles were systematically carried out by the physician Viycheslav Manassein, who was editor of the journal Vrach (Physician). [End Page 481] For many years, Veresaev’s book was at the centre of sharp discussions in Russian as well as in Western European literature.
With unprecedented candour and sincerity and, most importantly, a rare civic courage, Veresaev revealed to the broad reading public more than a few closely-guarded secrets of the medical profession. In so doing, he questioned, along with everything else, the existing notions concerning what should or should not be known about doctors by the general public. Veresaev began with the premise that keeping these corporate secrets is not a goal in itself, especially when such values as the health, rights and dignity of patients are concerned.
Much of what is covered in Veresaev’s book has not lost a shred of relevance in today’s world. His Memoirs could be used as an excellent manual for those taking a course of medical ethics. The author sheds light on many acute and complex ethical problems facing physicians. A position he holds throughout the entire book is very important and, to a great degree, appropriate for our times: he does not in any way take on the role of some kind of know-it-all who has ready-made solutions to all the moral conflicts of interest that a practising physician typically encounters in his work. On the contrary, he respectfully shows that in many real-life situations, there is simply no option that is morally irreproachable: the doctor cannot avoid making decisions that may be disapproved of by his colleagues as well as patients, and he has to bear full responsibility for those decisions.
One of the main motives of Veresaev’s book is his vigorous protest against the fact that it is often the poor person, the one occupying the lowest level in society and who is perhaps the most defenseless, whose rights and dignity are most trampled upon. It is worth recalling that, in general, this motive is to a great extent characteristic of the humanistic traditions of Russian medicine.
The issue of medical experiments on patients or, in his own words, “medical experiments on living persons”2 occupies a visible place among the topics discussed by Veresaev. His arguments and views on this subject are especially apropos and important today as a basis for comparison with current practices in biomedical research, and as a foundation for ethical standards and requirements that must be observed when conducting biomedical studies.
It is worth noting that Veresaev’s book was rediscovered in the West in 1972, when the American medical expert...