The principle of "do no harm" is what doctors learn in their very first lesson. And no wonder - they should not make things worse in the first place. This is what the translation from the original language says “primum non nocere” - “first of all, do no harm.” Usually the authorship of the principle is attributed to Hippocrates. This is the oldest principle of medical ethics. But besides him, there are a number of other developments in this area.
Introduction
Initially, let's figure out where you can get quality information about the subject of the article. Studying within the framework of state courses is the most preferable, since in this case the training of doctors is carried out on the basis of medical schools and universities. Here you can always find specialists who will intelligibly and professionally convey the material to the students. Agree that doctors with vast experience and practice in human ailmentsunderstand very well, as well as in the processes of their cure. The topic of this article is the issue of bioethics. This is the name of the problem area. Moreover, they are not only cognitive (that is, those that require reflection), but they cannot do without quite serious actions and decisions. The immediate source of the problems considered by bioethics is the rapid progress of biomedical sciences and technologies, which has become very characteristic of the last third of the twentieth century. At first glance, this statement may seem ridiculous. After all, it affects exactly what was conceived and is being done now with undoubtedly good goals - alleviating human suffering, improving the quality and duration of his life. And this is the source of the problem. And considerable - they cause serious discussions and numerous disagreements. When it comes to solving them, responsible specialists need to be guided not only by traditional arguments, but also by values, accepted behaviors and emotions.
Now it can be argued that bioethics as a field of research, moral decisions and public debate is just taking its first steps. It should be noted that there is a wide variety of different ethical theories. The concept that was developed by American specialists James Childress and Tom Beechamp received the greatest recognition. It provides for the promotion of four fundamental principles. Taken together, it is compact, systematic, easy to read and understand.
First principle: do no harm
This is the most important moment in the work of a doctor. As previously discussed in the full version of the saying - "first of all, do no harm." That is, this is the most important thing. But in this case, the following question comes to the fore: what is meant by harm? In the case of biomedicine, this applies to the activities of a doctor and building his relationship with patients. Then the following forms of harm can be distinguished:
- Caused by inaction, by not helping someone who really needs it.
- Caused by selfish and malicious intent, bad faith.
- Originating in wrong, careless or unskilled actions.
- Caused by objectively necessary actions in a particular situation.
In the first situation, the problem is not only moral, but also legal/administrative. After all, the failure to provide assistance is associated with a failure to fulfill obligations that are provided for by law or regulatory documentation. Assume that a doctor on duty does not perform certain actions that a particular patient needs. In this case, he is responsible first for the failure to fulfill his duties, and then for the consequences that arose due to inaction. This situation is partially rescued by the fact that at the right time the doctor simply helped, spending his time and energy, to another person. It is also a completely different matter if the doctor is not on duty. In this case, he can easily eliminate himself. But from a moral point of view, such inactionis reprehensible. For example, in the United States, a professional association sometimes revokes a license that grants the right to practice medicine for such actions.
Continuing with the first principle
And now let's move on to the next point, talking about the harm caused due to bad faith. It is also more interesting from an administrative-legal point of view than from an ethical point of view. Although such an approach certainly deserves moral condemnation. An example is a situation where a doctor is simply too lazy to perform the required procedure. Or if he is busy with her, he is not doing well enough.
The next form of harm is that which is inflicted due to insufficient qualifications. By the way, the following words will be useful to everyone who, perhaps, will someday help other people. Remember the rule "do no harm"! If there is an injured person nearby, it is necessary to provide him with assistance within the framework of which there is confidence that it will get better. To do something with only a general idea, and even without sufficient qualifications, is to complicate the situation. It is better to leave the person in the hands of specialists. Send to more qualified staff for inspection. This is a very important point, which includes the principle of "do no harm." Bioethics also considers that a person who has qualified as a doctor, but does not know how to do the right things, deserves moral condemnation.
And the fourth form is objectively necessary harm. For example, during hospitalization, this is a limitation of opportunities. Prescribed procedures can be painful, for example, if you need to break a bone again, because the last time it healed unsatisfactorily. All this is done for good. In this case, the principle of “do no harm” should be taken as a call to minimize harm. Only what is necessary is allowed.
Second principle: do good
It is a continuation of the previous one and expands its content. “Do good” (in another translation, “do good”) is no longer a prohibition, but the establishment of a kind of norm, the achievement of which requires the performance of certain positive actions. The principle provides for the use of not so much rational considerations as feelings and emotions, such as pity, compassion. In this case, attention is focused not on the need to avoid harm, but on active actions to prevent or correct it. But since it is extremely problematic to demand self-sacrifice and extreme altruism from a person, this principle is perceived as a kind of moral ideal, and not an obligation. Although we should not forget that the goal of he althcare is to ensure the he alth and life of patients. For example, when humanity understood how diseases such as plague and yellow fever should be prevented, it was only natural that positive action was taken. They consisted in the adoption of special prevention programs that minimize or even cancel (as with smallpox) the circulation of these diseases. Whereas if the necessary measures were notaccept it would be morally irresponsible.
Another aspect of the principle under consideration is the content of the good being created. Medical paternalism provides that the doctor can rely solely on his own judgments about the patient's needs for counseling, information and treatment. It (this position) justifies coercion, concealment of information and deceit, if it is done for the good.
Third principle: respect for patient autonomy
In biomedical ethics it is currently one of the fundamental ones. This principle calls into question the exclusive and unconditional competence of the doctor in determining the good for the patient. It is envisaged that only an autonomous person should make a choice. But only where it is. In this case, it is also necessary to remember about responsibility. But at the same time, it will be useful to know what kind of action can be considered autonomous. Whoever implements it must act deliberately. In other words, he must have a certain plan, an understanding of what he is doing, the absence of external influences that can affect the final result. For example, when a doctor proposes to his patient a certain surgical operation, the second one does not need to have all the knowledge necessary for it in order to make an autonomous choice. Just enough to get to the bottom of the matter. Ultimately, the patient may or may not agree to the proposal received. In the first case, he accepts the doctor's intentions, making them his own decision. TheThe principle of the code of medical ethics is based on the notion that the human person is valuable in itself, regardless of circumstances. It should be noted that respect for patient autonomy is out of the question when it comes to special categories. These are children, patients with mental illness, persons under the influence of drugs or alcohol, and the like.
Fourth principle: fairness
This principle of medical ethics is perhaps the most controversial. It can be formulated as follows: everyone can expect to receive what is due to him. He alth protection can be calculated both for an individual and for a group of them, allocated on one basis or another. For low-income citizens, social benefits are provided. This is in line with justice. If support is provided to all groups of the population, then this principle is violated. By the way, its difference from those considered earlier lies in the fact that the assessments, decisions and actions of doctors do not affect a specific person, but different people or even entire social groups. The principle of justice has not absolute, but relative strength.
Let's consider an example. There was a situation with the transplantation of a donor organ. At the same time, there is a patient who occupies a more distant place on the waiting list, but he has a critical situation. In this case, you can give up the obligations that follow from the principle of justice and be guided by the postulate "do no harm." After all, the main task is to protect the he alth and life of people! Although fromobservance of the queue can be refused under the influence of the principle of justice, in which case they turn to the criterion of need and proceed from its current acuteness. When following this principle, it is necessary to take into account the existing relationships that form the social network between doctors, nurses, social workers, administrators and patients. After all, this affects individual, group and state interests, which are intertwined with he alth issues.
Truthfulness rule
Professional doctors build their activities not only on fundamental ethical principles. They supplement them with other norms. Among them, the so-called rules play a special role. Physician education includes them as well as principles. And the first among them is the rule of truthfulness. It states that the interlocutor needs to communicate information that, from the point of view of the speaker, is true. Sometimes it is interpreted in the form of a ban on telling lies. Truthfulness is a necessary condition for normal communication and social interaction. The philosopher Kant wrote that it is man's duty to him as a moral being. And lying to yourself is equal to destruction. To be honest (truthful) in all situations is to represent the sacred commandment of reason, unconditionally commanding and not limited by any external requirements.
It should be noted that the balance of values cannot be predetermined a priori by creating some kind of rule. But it must always be remembered that the right to tell the truth is not unconditional. The privacy of other people is the most important norm and moral value of modern civilized communities. A position that offers, albeit difficult, but truthful communication with people whose condition can be described as critical, is considered more preferable. There is also a dilemma here. For example, should the use of placebos be banned for the sake of the purity of moral principles and rules of medicine.
About privacy and the rule of informed consent
Medicine confidentiality is another development that is actively promoted to ensure the safety and convenience of patients. Confidentiality is designed to protect doctors and patients from intrusion from the outside, which was not authorized by the direct participants. In this regard, one point is important. Namely: the information that is transmitted by the patient to the doctor, as well as the data of the patient himself, obtained during the examination, should not be transmitted without the consent of the person whose state of the body they characterize. Why is it so important? The fact is that the disclosure of confidential medical information can complicate a person's life. This is manifested in relation to those around them, the decisions they make, and a number of other cases. Moreover, very often people become slaves of delusions. That is, they think that something is connected with a certain disease, in fact, it has nothing to do with it. For example, this is the statement that the immunodeficiency virus is transmitted through dishes. But reallyit "travels" through human fluids, and if hygiene is maintained at the proper level, then nothing threatens.
Privacy related informed consent rule. It is necessary to ensure that patients or subjects in biomedical experiments are treated with respect as individuals by medical professionals. It also helps to minimize the threat to their he alth, moral values, their socio-psychological well-being due to irresponsible or dishonest actions on the part of specialists. The application of this rule makes it possible to ensure the active participation of the patient in choosing a treatment method that is optimal not only in terms of medical effectiveness, but also the life values of the person himself.
On the relationship between doctors and patients
In short, there are four models of healing. They are distinguished by the leading moral principle that the medical worker adopts:
- Paracelsus model. It is consonant with the second principle “do good.”
- Hippocratic model. It is consonant with the first principle of “do no harm.”
- Deontological model. Built on the idea that it is necessary for the healer to fulfill his duty.
- Bioethical model. Provides respect for patient autonomy in the first place.
It should also be noted that the relationship between a particular doctor and a patient is subject to typification depending on the formed nature of moral and psychological ties. Wich's work can be cited as a well-known example:
- Paternalistic models. Provides for the attitude of the doctor to the patient as to the son. A separate option is the sacred (sacred) model. It provides that the patient perceives the doctor as a god.
- Not paternalistic models. Three types are distinguished here. The first model is instrumental (technocratic). In this case, moral and psychological relationships are reduced to a minimum. As a rule, it is she who can be observed when visiting narrow specialists. The next model is collegial. In this case, it is envisaged that the patient and the doctor can discuss topical issues of he alth and life practically as employees of medicine. And the last model is contract. It is most popular in paid medicine. Provides for strict adherence to the previously concluded contract.
About the Hippocratic Oath
How did it all start? Readers are probably interested in reading what the Hippocratic Oath is in Russian:
I swear by Apollo the doctor, Asclepius, Hygia and Panacea and all the gods and goddesses, taking them as witnesses, to fulfill honestly, according to my strength and my understanding, the following oath and written obligation: to consider the one who taught me the medical art on an equal footing with my parents, share with him your we alth and, if necessary, help him in his needs; consider his offspring as his brothers, and this is an art, if they want to study it, to teach them free of charge and without any contract; instructions, oral lessons and everything else in the teaching to communicate to your sons, the sons of your teacher andstudents bound by the obligation and oath under the law of medicine, but no one else.
I will direct the regimen of the sick for their benefit according to my ability and my understanding, refraining from causing any harm and injustice. I will not give to anyone the lethal agent asked of me, nor show the way for such a design; likewise, I will not hand any woman an abortion pessary. Purely and undefiled shall I conduct my life and my art. In no case will I perform dissections on stone sufferers, leaving it to the people involved in this matter.
Whatever house I enter, I will enter there for the benefit of the sick, being far from everything intentional, unrighteous and harmful, especially from love affairs with women and men, free and slaves. So that during treatment, as well as without treatment, I may not see or hear about human life from what should never be disclosed, I will keep silent about that, considering such things a secret. To me, who inviolably fulfills the oath, may happiness be given in life and in art, and glory among all people for all eternity; but to the one who transgresses and takes a false oath, let it be the opposite.
Conclusion
Here it is considered what bioethics is in general terms. If you are interested in the details of the formation of such a worldview, then you can visit the Museum of the History of Medicine. And in it you can observe exactly how medicine has developed since ancient times.
By the way, do you know when the medical worker's day is? Well, it will be very soon -June 16th. Knowing when is the day of the medical worker, we can thank the doctors we know for all the work they do, saving and supporting our lives.
