The main problems of the philosophy of medicine.

Medicine and philosophy are the oldest branches of knowledge. The subject of study of both is the system “man the universe”, the subject of knowledge is man. Hippocrates once spoke about the need for their interaction: “Medicine can do just as little without the general truths of philosophy as the latter without the medical facts delivered to it.”

The function of medicine in relation to philosophy is to awaken the intellectual fantasy with information about man as an object of knowledge and to contribute to the creation of principles, the advancement of new hypotheses. Thus, they complement each other, and as real scientific branches they have a common space of interests.

The philosophical problems of medicine traditionally include: value aspects of human health, norm and pathology in the light of the general theory of systems, ideas about euthanasia. But we must not forget that healing is a kind of branch of human activity, since its unique object is a person. The patient is afraid of the doctor, who considers it only as biochemical, physiological processes, and the disease as a violation of the biochemical balance of the body. Therefore, the main philosophical problem of modern medicine is the moral foundations of medical activity.

Deeply intruding into human existence, modern medicine faces many problems of a moral nature. The doctor has to come into contact with the intimate aspects of the patient’s life, trusting him with his personal, seminal secrets. A doctor cannot perform his functions like, for example, a seller, guided only by the principles “do not deceive”, “do not steal”, “be polite with the buyer”. His communication is extremely complex, varied. In each case, it is required to avoid the template, look for an individual approach and make responsible decisions, as it collides with the fate of people to whom it has no right to remain indifferent.

Life is threatened by disease and death, and medical workers must fight them for as long as each of them lives. A doctor often has no restrictions on working time: in his practical and scientific activities, he cannot work on the principle of “from” and “to”. After all, besides the fact that the situation sometimes requires a departure from the narrow norms of the labor regime (a surgeon, having operated on a patient in the morning, comes to visit him at night, because medical duty obliges him to think about the patient outside of working hours), the doctor is obliged to study all his life, otherwise he will not be able to successfully treated, will lag behind life. An ancient saying said: “Choosing healing, give everything.”

The doctor’s humanism, however, is not limited to communicating with patients within the clinic or hospital ward. We must never forget that illness is a drama with many “actors”. The reactions of the patient and his relatives are incredibly diverse, often difficult, almost unbearable. But the doctor’s mission is to understand and regret.

It is necessary to remember also about those specific temptations which lie in wait for the doctor. Often he treats people with power, managing large material values. And if he thinks about how to use these moments, then first of all he humiliates himself, his profession. Whoever he treats, he must have authority over him in order to have a favorable psychological effect on the patient. If he is placed in a dependent position, then he ceases to respect the moral strength in the doctor. Another important aspect is the preservation of medical secrecy. This unwritten law must be observed by everyone: one cannot talk about the diseases of patients who trust the doctor with the intimate aspects of life and who have every reason to demand that they not be made public. Such a situation cannot be understood as due to false shame: it is quite legitimate and natural. Especially in small towns, villages, collectives, the disclosure of medical secrets leads to the most undesirable consequences.

For example, a dentist told a young man that he had inserted artificial front teeth for patient X. It turned out that the girl was the bride of a young man who reacted negatively to the girl’s physical handicap, but the marriage was upset. The bride filed a lawsuit against the doctor, and the latter imposed a heavy fine on him, the calculation of which was based on the moral (and material) damage caused to the bride from the failed wedding.

But there should be no absolute medical secrecy. This problem cannot be separated from concrete life: in cases where the preservation of information can harm the interests of the individual and society, the prohibition on its disclosure is lifted. If the patient’s disease threatens society, the team, if he can infect others as a result of ill-considered actions, then, naturally, people should be warned. The judicial-investigative bodies have the right to know all the necessary information about the patient, even if it was entrusted to the doctor as a purely professional secret.

Finally, sometimes non-disclosure harms the patient himself, but if you inform relatives and friends about his illness in a timely manner, they can significantly help doctors in treatment.

Medicine has a specific feature: unlike chemistry, biology, and other branches of knowledge, it deals with a living person, moreover, an unhealthy one, and the use of its achievements is necessary right now for everyone who seeks help, a practical request is urgent. Biology, on the other hand, can take its time in its observations, honing and generalizing them. In technology, the method of work is simpler – calculation and standard (of course, with the undoubted complexity of mathematical calculations, drawings).

It is well known that one of the first tasks of the doctor is the correct recognition of the disease. It is often very difficult to do this, as evidenced by a considerable number of discrepancies in clinical and pathological diagnoses.

Diagnostics is a peculiar form of knowledge. Its specificity lies in the fact that the object is the most s / southern being – a person in a specific social and ecological environment, with his normal and pathological activities, the unity of biological and social, somatic and psychological, objective and subjective.

The process of making a diagnosis does not have clear boundaries between sensory and logical manifestations. S. P. Botkin said that already at the very beginning, not a simple collection of facts is required, but also their analysis, preliminary processing, separation of the main, essential from the secondary and accidental.

Symptoms of the disease are perceived directly by our senses – directly or indirectly (using laboratory and technical methods and techniques). Attracting ever-increasing technical possibilities that improve vision and hearing, the doctor must beware of excessive enthusiasm for technicalism. Technology and cybernetics cannot replace a thinking clinician. They just make it easier.

All physiological processes, in addition to a qualitative characteristic, also have a quantitative one, which makes it possible to apply various mathematical (statistical) methods for analyzing quantitative parameters. Qualitative differences are always associated with new quantitative characteristics. Quantity turns into quality, giving rise to certain shifts. The inflammatory process is a sharp increase in the “quantitative” expression of physiological processes. Having passed a certain quantitative line, they abruptly develop into pathological ones.

Thus, the doctor goes from the diagnosis of the disease to the diagnosis of the patient. In the simplest cases, he “recognizes” the disease, as when meeting a famous person, without detailing the logic of this “identification”. In more severe cases, an erudite and experienced doctor diagnoses with “medical instinct”, intuitively.

With the correct solution of the diagnostic problem, a diagnosis is formed that expresses the doctor’s judgment about the patient, which reflects the true state of affairs, a certain objective reality. The depth of knowledge of this reality depends on a number of conditions: the possibility of examination, the knowledge of the treating person, the level of his culture, etc. The formulation of the diagnosis completes the first stage of work and requires further reflection: the doctor prescribes therapeutic and preventive measures and continues to monitor the patient, evaluating the effectiveness of the proposed tactics, on the basis of which he clarifies the diagnosis.

Another aspect of the moral order, which the doctor has to deal with in the course of his activity, is bioethics, which is an important point for the growth of philosophical knowledge. The formation and development of bioethics is due to the increasing attention to human rights and the creation of new medical technologies that give rise to many problems that require legal and moral regulation.

The term “bioethics” has only an indirect relation to animals, plants and wildlife in general: it denotes the space of medical professional ethics. The situations analyzed by this scientific field are born in the field of modern biomedical research and new practice of medical care.

The development of bioethics contributes to the humanization of modern biomedicine. The main direction should be the legislative regulation of such issues as transplantology, determining the moment of death, the limit of life-supporting treatment for hopeless patients, etc. All these processes have exacerbated the moral problems facing the doctor, relatives, and medical staff. Is euthanasia allowed? Since when can a fetus be considered a living being? Where does human existence end? When does a doctor have the right to turn off the ventilator without committing murder? Many such issues, due to specific circumstances, are brought up for discussion outside the professional medical community. Doctors, philosophers, lawyers, politicians, economists, as well as patients, their relatives, and members of the public take part in the discussion on an equal footing. Behind this lies a profound shift in the minds of people.

Consider the issue of abortion. Previously, it was included only in the concept of medical science. Scientific knowledge itself acted as the beginning of a responsible human act, separating what is done reasonably from what happens due to a misunderstanding. Lawyers are now involved. This means that the doctor’s action may be unacceptable from a legal point of view, which clarifies the situation not in terms of true – false, but in terms of legal illegal. At the same time, from the theologian’s point of view, legitimate and scientifically based knowledge can be rejected because it is sinful. Involuntarily, a conflict arises. The meaning of bioethics is to try to discover the possibility of dialogue and modern medicine. The practice of bioethics forms the language of public discussion on vital issues, led by people who explain in different ways what is true and what is false. The emergence of bioethics about 30 years ago served as a response to problematic situations in clinical practice regarding euthanasia, artificial insemination, organ transplantation, etc. Their fundamental novelty lies in the following: 1) they are associated with the pace of trends in science and practice, where doctors and scientists manipulate the processes of birth and death; 2) within their framework, some of the classical ethical standards of healing found an obvious insufficiency; 3) a broad discussion of the problems has become a manifestation of the ideology of protecting human rights in medicine.

The dilemma of paternalistic and anti-paternalistic approaches in modern medicine is a cross-cutting one for all bioethics. Paternalists are adherents of traditional ethical norms. They consider it unacceptable to regulate the processes of birth and death. From their point of view, everything should happen naturally, be controlled by nature. At the same time, paternalistic morality is based on several premises: health and life are unconditionally priority values; “the good of the patient is the highest law” the ethical position of the doctor; The physician assumes all (or almost all) full responsibility for decision-making.

Anti-paternalists, on the contrary, believe that a person can and should use the achieved level of science and technology to solve the issue of birth and death. They proceed from the priority of the moral autonomy of the patient. The key category in this case is the rights of the patient. In 1972, the American Hospital Association adopts the world’s first “Patient’s Bill of Rights”, which begins with the words: “The patient has the right to considerate disrespect …”.

The social, moral, legal problems of the dying, “test-tube children”, volunteers on whom a new medicine is being tested, have something in common. For example, in a healthy person, the function of the lungs is carried out in such a way that we do not specifically think about how this happens. In patients who use the apparatus “artificial lungs”, they work effectively, provided a detailed study of the function of breathing. The essence of the apparatus-prosthesis is that it is “as if lungs”. Likewise, the vast majority of people daily exercise their “natural inalienable human rights” but have never read the Universal Declaration of Human Rights. Another thing is problematic situations that require a kind of “prosthetics of the guarantee of human rights”.

In Russia, the majority of doctors still adhere to the traditional paternalistic model of relationships with patients, professing the conviction of ethical justification in the conditions of doctoring the doctrine of “removed (saving) lies”. Among domestic oncologists, hematologists (who are much more deeply aware of the importance of informing the patient), there has only been a tendency to inform the patient of the diagnosis of those types of cancer, blood diseases that respond well to treatment.

The problem of “informed consent” – the right to consent before starting treatment – is one of the central ones in bioethics, where its normative content has been developed in detail. This right has become the source of perhaps the most dramatic bioethical dilemmas. From a formal logical point of view, consent to treatment and refusal are one and the same issue, resolved positively or negatively. In reality, these are in many ways different social decisions: consent is the domain of predominantly behavioral motives, while refusal is already an act.

The special role of the concepts of “informed consent” and “refusal of treatment” is determined not only by the spread of human rights actions in health care, but also by the importance of the problem of iatrogenic (diseases caused by a doctor). It is enough to point to such an iatrogenic factor as the unjustified or irrational use of many drugs to see that in medicine of the 20th century. the commandment “do no harm” is more relevant than in the time of Hippocrates. The same applies to the old medical and ethical maxim “the cure should never be worse than the disease” (for example, the side effects of electroconvulsive therapy used for severe mental illness, vertebral fractures, joint dislocations).

The progress of medicine is impossible without ongoing clinical trials and biomedical experiments on humans. Objective knowledge is a fundamental social value and therefore can serve as an excuse for the possible risk to the bodily and social well-being of people who are the subjects of research. At the same time, no matter how high the value of such knowledge is, in all cases it must be commensurate with no less significant values reflected in the principles of respect for a person as a person, charity and mercy, justice, solidarity.

No less dramatic and complex is the philosophical problem of euthanasia. The fact that every person has the right to life is obvious, but modern technology makes it possible to keep a dying person on the verge of life and death for a very long time. A moral problem arose: does a person have the right to die? Is it permissible for a doctor to risk using a new drug or a new device to prolong a patient’s life by a day or a year, or is experimenting on living people immoral? Is it worth continuing to artificially support the life of a person who is in a hopeless state? Does a handicapped infant with congenital mental and physical defects need life itself? All these questions are extremely relevant for modern medicine.

In the light of the problems of life and death under consideration, the question naturally arises of the legality of taking life out of mercy. Its moral aspect has been repeatedly discussed in the philosophy of different eras. Many cases of the murder of a seriously wounded or sick person are described at his request in order to save him from torment.

Recall that in the 1920s 20th century in the Criminal Code of the RSFSR there was even an article exempting from criminal punishment for intentional murder committed out of compassion at the insistence of the murdered. But current legislation does not solve this problem. This is a complex and contentious issue. The right to euthanasia – a voluntary painless death, according to some doctors, can have a person who is in a hopeless situation caused, for example, by an incurable and painful disease.

It has been argued in the legal literature that the right to euthanasia should include both the right of the patient to be euthanized and the refusal to resuscitate in order to reduce near-death suffering. In the first case, active euthanasia is carried out, which is called the “filled syringe” method, in the second, passive, or the “deferred syringe” method.

But if we agree with the provision of the possibility of such a right to die, then we need a legal act that can regulate the conditions for its implementation. And only a person of sound mind can decide such a question.

It is important to see another aspect of this problem. The advances in medicine, biophysics, biochemistry have led to the fact that a dying person, equipped with sensors, hoses, droppers, artificial organs, computer control, can stay in the intensive care unit for an arbitrarily long time. Therefore, a serious economic difficulty arises. A day spent in such a ward under continuous supervision is quite expensive for the state or relatives. Thus, economic and moral considerations clash here.

If euthanasia is prohibited by law, this does not mean that society should turn away from the terminally ill. For them, it is necessary to create special houses – hospices (of which there are already many in the country today, and abroad they have been practiced and used for a long time), where not only doctors, but people of other specialties should work to help patients live their last days. A truly humane society should not forget this category of people.

And one more circumstance should be kept in mind when speaking about euthanasia. Of course, material factors play a rather significant role, but moral laws cannot be based only on such considerations (expensive maintenance of the dying). Inevitably, a moral code of universal human solidarity must emerge. Its creation cannot be postponed: scientific and technological progress leaves no time. So far, legal science does not even have terms that could describe all the options that arise. It is necessary to look at the problem more broadly. The turn of the century is the time when a person rethinks himself, his place in nature and society, the formation of global ethical norms. One can believe that humanity has genes for curiosity and no genes for self-destruction.

Be First to Comment

Leave a Reply

Your email address will not be published.