Ethical challenges of the XXI century
Natalia Leskova, "In the World of Science"
A conference on bioethics "Ethical Challenges of the XXI Century" was held in Moscow, attended by representatives of the UNESCO Bioethics Committee, the Ministry of Foreign Affairs of Russia, members of the Russian Academy of Sciences and the Ethics Council of the Ministry of Health of Russia, representatives of regional ethical committees. The meeting was devoted to the analysis of UNESCO official documents on bioethics: "Human Rights", "Bioethics and human Rights", "Human Genome", the Ethical Code of the professional community of doctors of Russia. This kind of discussion, reaching the international level, is a new milestone in the history of our country, the academician is sure Alexander Grigoryevich Chuchalin, who became the chairman of the organizing committee of this major event.
– Alexander Grigoryevich, why does bioethics seem so important and relevant to you?
– This is an urgent topic for the entire world community, although, if we talk about Russia, there are nuances here. Exactly 70 years ago, the Nuremberg trials ended. During this process, the Germans showed Sergeant John Woods. This is the executioner who carried out the death sentences of the Nuremberg and Tokyo Tribunals for war criminals. This event played a big role for the whole world, and issues of global ethics are closely related to the outcome of the Second World War and the Nuremberg trials. The whole world was looking for how to solve this problem.
It was at this time, in 1945-1948, that the World Medical Association appeared. The main document in the work of this structure was the International Code of Medical Ethics. Unfortunately, the Soviet Union did not participate in this work: it was believed that we had our own ethics related to the ideology that society lived by at that time. But the world community was looking for an idea that would form the basis of this document. Such a basis was the work of V.V. Veresaev "Notes of a doctor". It is our great achievement that a Russian doctor and writer has created a unique book dedicated to medical errors, and it has, in fact, become a world bestseller in terms of medical ethics.
V.V. Veresaev is the first author in the world who has approached the analysis of medical errors so thoroughly and in detail. In his book, he touches on his personal mistakes, analyzes the mistakes of English and German doctors... This is a very important book for all of us. It is no coincidence that the international medical community actively celebrated the 150th anniversary of the birth of V.V. Veresaev. Except for the Russian Federation. And it's amazing.
– Why is that?
– I think no one had any malicious intent, this is our illiteracy and emotional stupidity, which is characteristic of today's society. Nevertheless, the foundations of the international code stemmed from this great book.
At the very end of it, V.V. Veresaev raises the question: can society live without Tolstoy, without Beethoven? And he answers: yes, it can be a short time, but it cannot live a single day without a doctor. He was the first to formulate this simple but important idea. Society cannot live a single day without doctors.
Unfortunately, we paid a heavy price for not joining the global ethics community. Soon came the years 1952-1953, the infamous "doctors' case", the "Zionist conspiracy", as our public believed at that time. And what we are experiencing today, unfortunately, has historical roots and connections.
– And what are we experiencing?
– There is an obvious gap between the medical community and society as a whole. It began, perhaps, with the shooting of Dr. E.S. Botkin, to which no one reacted. A century of silence. But this doctor was killed along with the royal family because he did not want to leave his patients even in their dying hour. This is the service to the patient, which can never be forgotten. Today he is canonized and has entered our history as a passion-bearer. But I want to say something else. Our society needs a fundamentally different level of ethics education. There is no word "ethics" at the world level – there is the concept of "bioethics". Why? Because a person conducts a comprehensive activity, he is connected with the environment, is related to food. And if we talk about the ethical challenges of the present day, these are the problems associated with the development of artificial intelligence, editing of the human genome, new parenting. Today there are already 5 million people in the world who were born with the help of assisted reproductive technologies, and these technologies are developing. These are not only medical or technological, but also ethical challenges. Therefore, the concept of bioethics includes issues of medical ethics, the environment, gerontology and geriatrics related to the advanced age of a person, issues that are directly related to serious diseases, their terminal stages, a person's departure from life. I can talk about this topic because I have the opportunity to compare Russia and the West. And I see that we have serious problems in this regard with regard to the relevant documents and their understanding.
– What documents are we talking about?
– There are very serious fundamental documents. The very first is the Universal Declaration of Human Rights of 1948. After that, a group worked as part of UNESCO as an international structure for a considerable period of time, until 2005, which eventually wrote the document "Universal Declaration on Bioethics and Human Rights". And when we say the words "ethics", "bioethics", we must understand what human rights and his responsibility to society are. Rights are also a responsibility.
And it all started much earlier. If you go back two millennia and recall the famous meeting of Plato and Aristotle, when they are having a philosophical conversation, what is morality. Aristotle answers: the tool that is used for this concept is ethics. Strictly speaking, ethics is the quintessence of the moral system of a particular society. That's how it should be understood now.
Of course, society has developed, and today we understand that ethics is deontological: I have to do as it is accepted by the morality of my society. Ethics can be pragmatic when we set certain tasks and want to achieve them. There is also ethics based on such concepts as virtue, altruism, the desire to do good, to feel gratitude, etc. Aristotle himself emphasized that ethics is also the relationship between the older and younger generations. If this chain breaks with us, then the connection of times is interrupted. And this is one of the fundamental ethical laws of the existence of mankind.
65 years ago, Russia became a member of the international organization UNESCO.
It is a subsidiary of the United Nations. UNESCO performs certain functions at the global level. First of all, this is education, where in recent years extremely much attention has been paid to the issues of bioethics. The current Director General of UNESCO, Audrey Azoulay, demonstrates a very deep understanding of modern problems. The basic concept of her directorship is as follows: the ethical challenges that have come to the world today must necessarily preserve the moral values of our history. She pays especially much attention to the problem of artificial intelligence. In this matter, such ethical problems as the hybridization of man with a machine, the cyborgization of humanity, the so–called posthuman, are among the main ones. She also analyzed another situation: the so-called bioconservatives, people who are conservative about what is happening in our world. She answers them: the world has entered the phase of the fourth technical revolution, and we can no longer stop this process. The Internet and mobile phones are being replaced by what we call artificial intelligence. And here the leading importance is attached to education. In bioethics today, the topic of so-called deep learning sounds more acute than ever. Today's technology is aimed at looking for strong intelligence. I participated in these conferences, so I see how serious a role is assigned to these issues.
– Alexander Grigoryevich, 2019 was declared the year of the Periodic System of Chemical Elements by UNESCO decision. However, as far as I know, there is no name of D.I. Mendeleev in the wording. Is it ethical?
"Not exactly. Indeed, there are several countries in the world that claim primacy in this matter. But our country was allowed to celebrate the coming 2019 as the year of D.I. Mendeleev. Mendeleev, laying out his plates of chemical elements depending on the atomic weight and their chemical properties, showed that the second line should be occupied by gas, which determines the quality of the air environment. He didn't know the word "helium", but he drew a place for it. Then it was P.L. Kapitsa who began to deal with helium. Working in the laboratory of Ernest Rutherford in London, he discovered the phenomenon of superfluidity of helium. P.L. Kapitsa showed for the first time in the world that helium really affects oxygen, which is part of the air environment, and summed up the scientific basis for the use of helium for medical purposes. But there was no mathematical basis, and P.L. Kapitsa turned to L.D. Landau. Thus, D.I. Mendeleev predicted helium, and two of our scientists became laureates of the Nobel Prize in Helium. Foresight is the most important quality of a scientist, without it it is impossible to develop science, but so far we do not understand how insight, intuition work, what their role is in the structure of consciousness, and this is another problem on the way to the development of artificial intelligence – including ethical.
– You said that one of the directions of the development of deep learning is the search for strong intelligence. How will this happen?
– This priority should be embedded in our educational system itself. When P.L. Kapitsa created MIPT, he was doing just that – gathering talented young people. In this search he involved A.D. Sakharov, Ya.B. Zeldovich, Yu.B. Khariton, I.E. Tamm, etc. Taught himself. This has become a priority area of the famous Phys Tech system – the search for motivated, highly gifted young people. This system is still working. However, developing high technologies, we inevitably face ethical problems. That's why I started our conversation with V.V. Veresaev. It was he who first raised the question not only of the relationship between the doctor and the patient, but also of the mutual influence of all the factors of our life. There is nothing unimportant, separate – everything is interconnected. Climate, nutrition, new technologies, law – all this is bioethics. The weakest point in bioethics is precisely the legal part, which lags behind the scientific achievements present in society today.
– An event dedicated to the problems of bioethics was recently held in Moscow, and you presided there. Tell us more about it.
– It was the first UNESCO conference on bioethics in our country, the purpose of which is to bring our society closer to what is happening in the world. I must say that Russia has always been and remains to this day a country that plays a significant role in all world processes, including those related to bioethics. It has a strong staff at UNESCO headquarters. A.I. Kuznetsov, Russia's permanent representative to UNESCO, adequately represents our country. There is a large staff in various committees. This conference was held as part of the initiative of the Intergovernmental Bioethics Committee. The president of this committee is a well–known scientist working for UNESCO and the United Nations, a lawyer by education Christian Wick. I was democratically elected in September 2018 as the vice-president of this committee. In other words, I am his colleague on bioethics issues. The field he is actively developing is the ethics of scientific research. This topic is the subject of analytical reports and the preparation of a number of UNESCO documents.
– What important ideas were voiced there, what agreements were reached?
– This is a very serious question. As a result of this conference, I realized why bioethics teaching is lagging behind. The fact is that our university community does not have the relevant material, it simply does not exist in the library. Therefore, one of the outcomes of this conference, which I discussed with Christian Bick, is to create a library on bioethics in 2019. This library, as I plan, will include Aristotle's historical works on ethics, a unique work "Medicine and Philosophy" written by two professors of medicine from Sweden. They allowed the Russian version of this folio to be published, and now we are solving this issue. They didn't even ask for any fee, they are happy that their book will appear in Russian. This library will include the works of the "holy doctor" by V.F. Voino-Yasenetsky, my work about Dr. Botkin "The Passion-bearer doctor Eugene", as well as the works of V.V. Veresaev. And I want to prepare a special volume of Russian translations of all official documents on this topic. Only diplomats know all these declarations. And if you talk to professors, teachers, unfortunately, they don't know this, so they don't teach, and if they don't teach, how can our youth find out all this? Such a library is the most important outcome of the conference. And we have also scheduled the next conference. Now they will be held regularly.
– You even opened the UNESCO Chair at the N.I. Pirogov Russian National Research University.
- Yes. There was a great celebration on this occasion. On Saturday, December 1, the university welcomed Christian Bik and other distinguished guests. We had a meeting in the hall of the academic Council. Our students spoke, they were very active, asked questions to Christian Bick. It made a very good impression. The official opening ceremony of the UNESCO Chair at our university was solemn and beautiful, so we are full of hope.
– How do you imagine the work of this department? What will they teach there?
– My idea is that there should be an end-to-end program for teaching bioethics in all courses, starting with the first one. I see how it is done in universities in the UK, where there are such departments. Students of Oxford and Cambridge Universities are writing their first scientific work on ethics issues. That is, this is the most important thing for a future scientist. The Ethics Committee of Great Britain is one of the actively working ones. The American Association of Physicians has a powerful ethics website. In general, the ethics committees of these countries are very authoritative. Many of our problems are connected precisely with the fact that we do not have such committees. The same medical conflicts that are currently tearing apart our society should be dealt with by professional and authoritative ethical committees, and it is their position that should shape the attitude of society, its morality, to these situations.
– It seems to me that there is still such an ethical problem as the unwillingness and inability of doctors to convey to patients some important information - why this operation is needed, how it will take place, what the consequences may be. Because of this, many conflicts flare up that might not have been.
–That's right. The doctor should talk to the patient and his relatives, explain everything in detail, answer all questions, be attentive and patient – and this is also part of the ethics that students should be taught.
Ethics surrounds us from all sides, and ignorance of its laws, neglect of them threatens us all with serious problems. They are already happening. We all witness numerous stories when doctors are convicted, placed in pre-trial detention centers, and put on trial because of complaints from patients. Now I am experiencing events related to Krasnoyarsk. If you remember, we built a temple there with the whole world, collected money for a monument to V.F. Voino-Yasenetsky...
– I remember perfectly. What kind of events took place there?
– Krasnoyarsk was generally a city where healthcare developed well. In a short time, the medical university became one of the best in Europe. I.P. Artyukhov, the rector of this university, completely transformed it. I must say, these are places where many of our outstanding scientists have been in exile. V.F. Voino-Yasenetsky, while in these parts in GULAG camps, during the war was the chief surgeon of all hospitals in Krasnoyarsk and saved many lives. When the university was just opening. Valentin Feliksovich lectured there, became a professor, and many people remembered him. He was an outstanding man, and his famous phrase "While healing the body, do not forget about the soul" remained in the memory of Krasnoyarsk residents. Man is a spiritual–corporeal being, everything in him is one. And I.P. Artyukhov, whom I consider one of our best rectors, not only did a lot for the development of the university, but also built a church in the name of St. Luke, in the world of V.F. Voino-Yasenetsky.
– And the Medical University of Krasnoyarsk itself is named after V.F. Voino-Yasenetsky.
–That's right. A wonderful monument appeared near the university – V.F. Voino-Yasenetsky not in a cassock, but in a medical gown. This is the only monument where he is shown by a doctor, whom he has been all his life. He looks at the university, at the students who enter the temple of medical science.
It is clear that money was needed for the temple and the monument, and they were collected. Many sacrificed as much as they could. I also took part, invested my money, honestly earned, so that all this would appear on the Krasnoyarsk land.
But now the governor has changed. The new governor began his activity by closing churches. He closed the church at the agricultural academy, then – near the medical university, and the reason for this was that. that temples consume electricity and heat from state educational institutions and thus "stole" a million rubles from the state. And now the rector faces ten years in prison. Of course, we are fighting, we are writing letters to the patriarch, we will not just leave this matter. But the fact itself is very disturbing.
– But this is also an ethical issue.
– Absolutely. In general, we have implemented a number of very effective projects in the Krasnoyarsk Territory. If we talk about my native pulmonology, then in a short time we managed to launch a project to reduce mortality from pneumonia. As a result, there is now the lowest mortality rate from pneumonia in the country. Krasnoyarsk had the lowest mortality from myocardial infarction, from strokes, from road injuries and other accidents.
– Thanks to the fact that medical students were well taught?
– Including. The students studied well, there was a strong alliance between the Ministry of Health of the Krasnoyarsk Territory and the University. The teaching staff, which included many of the main specialists of the region, and the Ministry of Health developed all these projects. The new governor has ruined it all. Today Krasnoyarsk has rolled back a quarter of a century. It's very sad.
– And what inspires optimism?
– The fact that in most cases we manage to find a common language with university rectors and government representatives. The fact that we are able to develop new technologies in the fight against diseases of the respiratory system, blood circulation and in some cases implement them. The fact that our students still want to learn, are ready to absorb new things, and they are also interested in ethical issues. I want to believe that we will raise a generation of young scientists, doctors, for whom medicine is not a business, but primarily serving the patient. Ethics permeates our lives, whether we want it or not. But if we do not take into account its laws, we harm ourselves.
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