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Bioethics for the new Russia.

The past three years of the Hastings Center's Eastern European program have included many visits by foreign scholars to The Hastings Center--as I write in March 1992 I am one of them.

At home my country is undergoing profound social changes, which include thoroughgoing transformations of the entire health care system. The previous state-governed, over-centralized system, which was proved to be hopelessly inefficient, is now in a state of irreversible coma. A new system (if one is destined to emerge at all), can only come into being through a very painful and difficult transitional period, and will definitely follow more Western patterns. (I cannot discuss here differences among various Western systems, of course, nor the problems, often extremely serious, confronting them. What matters here is that they differ from the former Soviet model in that they are viable and their problems can be repaired.)

Among other things, this means that we in Russia will surely meet a significant number of bioethical problems that were scrutinized for many years in the United States, but have yet to become familiar to medical professionals and managers, to lawmakers, and to the general public in Russia--not only theoretically, as information from abroad, but also as matters for practical decision and action. To take only one example, now Russian law-making activities in such areas as health care insurance, the rights of patients and of different categories of citizens in relation to health care, the rights and duties of physicians, and so on, are heavily influenced by Western, and particularly by American standards and norms. The experience and knowledge that we Russians have gained through the Eastern European program cannot be over-estimated.

There is a Russian proverb that says, "There is no harm that does not also bring some kind of good." So, the impending collapse of our health care system makes the public and the mass media much more sensitive to many medical problems, including bioethical ones. Among the most hotly debated are such problems as underregulation of the use of human organs and tissues in transplantation; injustices in the distribution of very limited health care resources; abuses in psychiatry (and not only for political reasons); far from satisfactory conditions in most maternity homes, hospitals, and nursing homes; difficulties in the organization of hospices; and so on.

Up to now bioethics in Russia was developed mainly by small groups of enthusiasts, who--surprising as it may seem--have received more support from their Western colleagues than in their own country. Indeed, very often the major difficulties have been over-coming obstacles raised by the medical establishment. To recall our proverb once more, it was partly through such resistance that bioethicists were able to keep their intellectual independence.

Their main task in that time was to convince health care professionals, biomedical scientists, lawmakers, and the general public of the real significance for Russia of the problems studied in the realm of bioethics. Fortunately, these efforts have had visible results, though not necessarily great ones as yet. What seems worth mentioning is the development of courses in bioethics for students in philosophy, psychology, and medicine; and of postgraduate training in bioethics, including dissertations on such problems as informed consent and euthanasia; and participation by bioethicists in drafting laws related to medicine and health care for consideration by the Russian parliament.

Bioethics in Russia is gradually becoming a respectable field of scientific research whose practitioners publish from time to time in leading philosophical and medical journals. Some bioethical organizations have arisen, including the newly formed Russian National Committee of Bioethics in the Russian Academy of Science. The organization's attention will be especially directed to such fields as the ethical assessment of biological, psychological, and medical research and the protection of experimental animals.

Another, rather unexpected problem is emerging for bioethicists in Russia as well. Some pro-Fascist and nationalist groups are calling for a revival of eugenics in the worst forms known since the Nazi era. They argue that the genetic pool of the Russian population has been damaged over the past several decades and that it can be improved only through taking strong measures. Among those proposed have been compulsory sterilization of alcoholics and the drug-addicted, as well as mentally retarded persons; euthanasia of handicapped newborns; or restrictions on the intermarriage--or rather, reproduction--of Russians with Jews or persons from other ethnic groups. Given general social instability and unrest and the moral disorientation characteristic of so many people in present-day Russia, this development could be very dangerous. What is much needed is strong intellectual resistance to such ideas.

The radically new situation in the health care system and efforts on the part of bioethicists have conjoined to determine the prospects for Russian bioethics--the soil for its growing up is ready. One point must be noted, however. It seems that an authentic, well-established bioethics, as opposed to an imitation bioethics, can develop only within a modern, pluralistic democracy that pays a great deal of attention to human rights and liberties. At the same time, the development of bioethics can be seen as a component in the process of democratic reform. That means that bioethics will have a future only in a democratic Russia.

It is unlikely, for obvious reasons, that bioethics in Russia today will get any substantial support from the authorities. The best they can do is not to hinder its growth. I am sure that despite all difficulties, sooner or later we shall have in Russia a well-established bioethics. Its evolution, however, can be profoundly accelerated by support from our American colleagues, be it in the form of a continuing Eastern European program or otherwise. It seems to me that today this support can be more concentrated and goal-directed than previously. Big, expensive conferences such as the one in Prague last year seem not to be needed any longer--or at least they can be organized by Eastern Europeans themselves. What will be more helpful now is aid in training postgraduate students from Russia, in establishing small working teams for cooperative efforts to prepare textbooks and manuals directed to the Russian audience, both specialists as well as the wider public. It seems possible also to collaborate in conducting scientific research on such topics as environmental conditions and the health of the nation; on legal and ethical problems of medicine and health care; on the mental health of the nation; and so on. One possibility might be to establish a joint American-Russian periodical on bioethics.

The Center's Eastern European program has given a powerful impulse to the development of bioethics in Russia, the full significance of which will be evident only in future years (to the historians of Russian bioethics, I hope). I can also hope that American bioethicists have gained deeper understanding of problems and difficulties in biomedicine and health care delivery in our countries.

The relationship between American and Russian bioethicists is, I believe, a kind of intellectual wealth. Wouldn't it be most prudent not simply to preserve that, but to work to increase it?
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Author:Yudin, Boris
Publication:The Hastings Center Report
Date:May 1, 1992
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