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. 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. …