Ethics – as one of the ancient branches of philosophy –
has always been the most important problem in practical activity of doctors.
Many problems of medical ethics remain involved. At present the notion of ethics
– is the science of moral and the Law of its development, essence and
specifics. The medical ethics went through the difficult way of development. Its
history is rich with striking examples and facts. The sources of ethics go to
the antiquity.
Vavilon, Egyptian, Chinese, Russian and other ancient
manuscripts and written documents testify the searches, reflections and disputes
of doctors of many countries and nationalities. They contain the important
thoughts and opinions about traits, which are necessary for true physician.
It is necessary to point out that a doctor was surrounded
with the halo of healer who had to fight for the life of people, subjected to
different illnesses. Homer wrote in his Illiada: “One scilled physician is
worth many people. And from that period the precious and rich moral traditions
of medical profession began to develop.
The Eastern wisdom says: “The good doctor cannot be a good
doctor, if he is only a good doctor”. The following words of the outstanding
Russian writer, addressed to doctors are the confirmation of this fact: “The
doctor being the most poetic and cheerful element of society stimulate, comfort
and ennoble us.”
The physician of antiquity who left for us precious
information from the history of medicine paid much attention to the problems of
medical ethics.
The Azerbaijan Republic has a rich history of rise and
development of medical ethics.
Like many peoples of the east, Azerbaijan people from the
ancient period knew the name of famous healer Logman whose life was rich with
legends. Under this name they meant Hypocrite, Socrat, Platon, Aristotle,
Avitsena and others. Medical secrets of treatment and advice were passed from
generation to generation by the name of Logman, which were discovered
comparatively not so long ago. The first example warns about extreme use of
alcohol and food.
Don’t have too much drink
Have bread and plov moderately
So that the world in which we live
Not to be turned into cattle-shed
Another precept concerns directly to physician and perhaps
was taken from unwritten ethics code of high mean of a doctor.
All on the Earth are created kind
And where a doctor, there is a good beginning.
A lot of useful legacies were left for the descendant by
ancient memorial of Azerbaijan Literature “Dada Gorgut”, the 1300-th
anniversary of which is being celebrated nowadays. In every page of it wee see
precious opinions of thinkers how to protect out health and how it is necessary
for a man to be pure in code.
The prominent thinkers, poets and scientists of ancient land
of Azerbaijan such as Bahmanyar Ibn Mirzaban, Nizami Gyandjavi, Hatib Tabrizi,
Mahmud Shabustari, Omar Osmanogli, Seid Yahya Bakuvi, Nahchivani, Hagani,
Fizuli, Vagif and many others described in their works the hard disinterested
activity of ancient physicians and their fruitful consequences.
In the XI century there were established the first medrese
schools in Azerbaijan where religion and medicine were taught and these schools
trained religions persons and physicians, and in the XII century in Azerbaijan
there was founded a real medical school. Here under the guidance of famous
physician and pharmacentist in the East Omar Osmanogli was arranged the training
of medical personnel. Omar Osmanogli with his thorough knowledge was the active
supporter of moral principles, proclaimed by Logman and he always taught his
pupils that the doctor’s activity is based on the love to the human being. His
demands concerning the doctor’s activity went contrary to customs and
traditions. “Don’t turn you back to the enemy. Cure him.” Omar Osmanogli
educated his pupils in the spirit of moral purity, patriotism. ”Be useful to
your people even if it contradicts to ypur own interest”, “Don’t be
selfish. Don’t try to make your way to paradise and don’t be afraid of going
to hell”. Such were his slogans.
Following the traditions of Omar Osman, the famous poet
Khagani wrote: ”If you want your heart to be clean like a murror you should
throw away ten elements out of it; greediness, hypocrisy, envy, malignant,
anger, haudhtiness, breaking the laws, double face, enmity, lie.” The great
poet and writer of Azerbaijan Nizami who was one of the most educated men of his
period, highly appreciated medicine and the profession of a doctor. In his
immortal work “Leyli and Mejnun” he wrote:
There is reverence in the navel of two sciences
And this is a physician or a fakir.
In the creative activity of Nizami there are number of
scientific rules and conclusions in which there were given some characteristics
of some devices, used in people’s medicine in Azrbaijan, and also some
directions of hygiene nourishment, which in nowadays remain popular. At the end
of the XIII century Azerbaijan scientist Najmeddin Ahmad Nahchivani wrote some
commentaries to the works of Avitsena – at the period known under the pen-name
Logman, which contributed to spreading of progressive medical methods of
trearment in Azerbaijan.
It is almost unknown that in XIII century there was real
University “Dar-Ash-Shafa” – the House og Cure in Azerbaijan, in which 5-7
thousands of students got education. Many scientists from Iran, India, China,
Syria, Egypt and from central Asia visited this University with pleasure. The
ancient Azerbaijan capital attracted foreign scientists not only due to its
wealth and luxury but to possibility for scientific research work.
In many works of progressive thinkers of Azerbaijan such as:
Mirza Fatali Akhundov, Gasanbek Zardabi, Nariman Narimanov, Jalil Mamedguluzadeh
we can se progressive views on the medicine, on the role of a doctor in society.
Mirza Fatali Akhundov created the immortal works on the problems of ethics,
esthetics and policy of natural sciences and Medicine. In describing historical
events, life and manners Mirza Fatali Akhundov always focused the readers
attention on the national customs, that had negative influence on the health of
a man and on his moral qualities.
True follower of Akhundov was Gasanbek Zardabi who went
through path to form high disposition in the minds of his people. In his book
“Hygiene” he recommended the doctors to follow the rules of personal hygiene
and to be sincere and honest in society.
Numerous works of N.Narimanov were devoted to the role of
doctors in society.
He wrote: ”The doctors themselves must criticize all the
institutions and their actions in order to root out all that are against the
interests of sick people, especially if they damage them. Of course, all the
efforts must be directed in favour of patients and to meet their demands. These
and other progressive thinkers played a great role in rise and establishment of
medical ethics in Azerbaijan.
The doctors of Azerbaijan taking up their rich legacy in the
sphere of ethics continued these traditions in future. Today we can speak about
new historical situation in development of medical ethics as a branch of
medicine, in training medical personnel, in practice. It is known that in
formation of medical ethics social surroundings play a great role. The moral
traits of medical personnel is of acquisitive character and note innate. They
appear and develop in the social surroundings in which a man grew, studied and
continues to work.
During the Soviet period ethics rules were formed in
accordance with the principles of Communism morals. In this period the
outstanding scientist Zarifa Alieva played a great role in the development of
medical ethics. In her monograph she reveals the essence of moral quality of the
doctor of the XX century.
Historically the problem of doctor’s secret remains
disputable among doctors and lawyers. Obligation to keep medical secret came
through ages.
In Hippocratic oath the doctor undertakes to keep
professional secret: Ï shall never make known anything concerning to the
health of the patient, and I’ll always keep in secret all forbidden to
spread.”
The item of international code of medical ethics about
doctor’s secret emphasizes causal relations between confidence of the patient
and duty of a doctor not to make known the secret about patient’s health . We
cannot but agree to this: the patient voluntarily sacrifices his confidence, he
makes his vulnerable dignity, so that he doesn’t have absolute guarantee that
his secrets will not be made known by doctor. From the point of view of morals
it is unwilling act by a patient.
Medical ethics defends the patient’s personality by means
of protection and medical secret. But is it always so? Some young specialists
don’t exactly understand the meaning of expression “doctor’s secret”(it
is necessary to discuss to what extand it is definite) and can tell others about
the illness of the patient, about the intimate and family life. If to consider
the illness not as disgrace (for example venereal, mental and other illness) but
as a misfortune it can be true. But nobody can decide it for a patient – what
he thinks about it as a disgrace or misfortune.
In many countries the duty of a physician to keep medical
secret is distinguished as a special juridical norm. In the history of the
medical ethics there is a tradition of a new approach to medical secret, the
approach that justifies medical man, who make known the illness of the patient
in certain conditions (when it concern vital interests of others or of the
society as a whole). In many countries and in our country it is secured by
legislation. However I think that this category of medical ethics needs wide and
all round discussions.
After the collapse of the Soviet Union and proclamation of
independence Azerbaijan began to reform medical service system, to train medical
personnel, to form new medicinal market. Naturally, the main principles of
medical ethics (the doctor’s duty, responsibility of the doctor, attitude to a
patient, to colleagues) were subjected to serious corrections.
We should note that above mentioned problems remain urgent
today.
Like all other the world in our republic the medicine is very
popular among the youth and many of them want to choose the profession of a
doctor. A medical student and even a schoolboy who is going to study the
medicine must know that there are a lot of difficulties with this profession and
what spiritual qualities the patients would like to see in them.
We are convinced it is necessary to pay much attention to
reception to medical university to get rid of mediocre stale doctors and to
diminish the number of students who could be disappointed in choice of the
future profession. Nowadays the system of reception to the medical University
are guided by educational criterion ”quantity of enlisting points during
competitive examinations, reckoning of marks in the certificates. Certainly,
grade of marks of preparedness of a young man is necessary but it is not enough
for training of a medical student. It is impossible to study the medical ethics
only from the lectures and books, it is necessary to begin with strick selection
of enterers to the medical University, being sure that students have an aptitude
turn for medicine and are interested in profession of a doctor. We think that it
is necessary to introduce studies of the medical ethics in all departments and
with the reckoning of demands and specific character of the concrete profession
(surgery, therapy, oncology, pediatrics, and so on).
The main principle of the program must be differential
approach in education to problems of medical ethics. In the program must be
envisaged different methods; lectures, practical and seminar studies and also
testing interrogation for acquisition of knowledge.
The main important problem is scantiness of literature and
lack of special textbooks on medical ethics. Actually, there is not any big
monographic investigation in which there could be given detailed materials
concerning different aspects of this problem.
In modern developed society the problem of interrelations
between patient and doctor changed considerably. Today we can’t but take into
consideration the following moments.
- Nowadays the progressing process of limited specialization,
professionalism and differentiation of the medicine is taking place. But the
limited specialization, especially the technique with certain terms can
cover not only the organism but the personality of a sick man for the
doctor; this situation leads some doctor to nihilist approach to the
problems of psychotherapeutics, to the problem of medical ethics.
- With numerous narrow separated professions doctor’s responsibility for
the patient is distributed among some specialists, who examine the patient.
In such situation the moral responsibility of a doctor can be depersonalized
and humiliated.
- In the epoch of scientific-and-technical progress the number of equipment,
instruments and apparatus, used in medicine for examining of a patient,
increase. Instead of the former principle “the doctor-the patient” we
are having the principle “the doctor-the instrument-the patient”. But
this progressive tendency of development of modern medicine has some
shadowy, undesirable consequences – the instrument can cover the organism
and personality of the sick person with his complicated mental and moral
world of emotion and that was why individualized attitude of the doctor and
patient must be dominating.
The attitude of a doctor and of a patient is formed on the
mutual confidence (medical responsibility). Trusting ties are broken if there is
unfavorable end contributes to the conflict between the doctor and patient,
between the doctor and patients relatives. The reasons of unfavorable result of
treatment are different. They depend on the features of illness, on late address
to a doctor, wrong actions of the doctor, etc. Large number of these factors,
complexity of singling out of the main reason of unfavorable end of treatment
results with difficulties in juridical value. In relations between the doctor
and the patient arises a number of problems which are between the legal and
ethic principles. To these, for example, belong the case if the doctor can
artificially accelerate the death of the so-called hopeless sick person, or for
example to what extend it is permissible to inform the patient about his health.
Especially it is very complicated to define if the transplantation of organs
from one person to another is the case of law or ethics. On this respect in the
former Soviet Union in medicine existed many wrong conceptions: there was
prohibited to tell the patient diagnosis of oncology, the prognosis was not
discussed openly, the patient’s rights were not exactly formulated.
Of course, in every case these questions must be solved
individually with regard to personality of a patient, prognosis of the illness.
Undoubtedly keeping silence – is one of the serious ethological mistakes. The
patient not getting information from the doctor begins to get them in other
ways, and very often the information the patient gets are distorted and this is
dangerous mentally and badly effects on the patient’s health. It is very
important to help the patient. To tell the patient the truth or not? I think,
here any answer can be disputable. At the same time there should be
informational agreement in treatment of patients with oncology in surgical
operations and in other cases of active therapy. The doctor must obtain
patient’s consent before any diagnostic and therapeutic methods. He consent of
the patient before treatment after his getting detailed information about the
method of treatment is the basis of today’s medical ethics.
Special attention deserves the problem of incurable and dying
patients. In the history of medicine one can see two points of view on the
problem of doctor’s behavior at the bed of a badly sick patient. In the famous
Oath of Hypocrite is said “I’ll never give killing drug to anybody and never
show the way how to get it.”
Like the Oath of Hypocrite, the international Code of medical
ethics quite clearly rejects ecvtanazy making the doctors responsible to protect
human life. There is another point of view, according to which if the patient is
hopeless and suffers much physically the acceleration of his death morally
justified. A number of doctors and lawyers also admit the patient’s right to
refuse medical treatment to prolong the life. Moreover the legitimacy and
humaneness in doctor’s actions and the resolutions of courts that prohibits
evtanazy are disputed.
It is necessary to concretize the attitude to two categories
of evtanazy: active and passive evtanazies. The active evtanazy is in fact the
true one, when for acceleration or for relief of death of a sick person some
drugs or treatments are used. In case when we refuse further struggle for human
life there is a passive evtanazy.
The problem of evtanazy exists in many countries. In some
countries not only active but also passive evtanazy is penal. However, all
problems of the sick, who are in hopeless position have not already been solved.
The necessity of definite criterions medical and juristical law there scarcely
challenges doubts. The clarity in similar situation is much better, than
indefiniteness and self-confidence. Moreover it is very difficult to solve the
problem of advantage or disadvantage od evtanazy in life.
We deny the advantage of active evtanazy. According to the
laws of Islam (Koran), where it is said that while a sick person breathes-his
relation with god is not broken, and that is why, it is necessary tp fight for
his life until the last breath. It is a tradition in our country to take patient
home to die, if he is hopeless and the doctor informs about his health the
members of his family or relatives. The mentality of our nation dictates –
there must be maximum attention to the sick person and care. It is considered
that the death is taken easier in the company of family, in the warmth and care,
without of fear or sufferings (of course there assumed measures on the relief of
pain). When the doctor lets the family of sick person take him home, indeed he
agrees with passive evtanazy.
During past years there are attempts to distinguish some
boundary conception-destanazy, ortonazy and yaronazy. It will be useful to
express the attitude of participants of present seminar on this problem. The
social rights, such as health’s safeguard and allowance to the medical
services, the right to getting medical aid are provided with the constitution of
our Republic and the law “on the health of population” which was taken in
conformity on July 25, 1977.
There is the National Committee on bioethics in Azerbaijan.
The author of this bioethic the American biologist Potter explained as
connection of biological knowledge and human values. The ideology of new
biological movement is based on the General Declaration of Human’s Genom,
which was taken on November 11,1977 by General Conference of UNESCO. The
declaration is the first juridical act in this sphere. The balance between
observance of rights and human’s freedom and security (providing) freedom for
scientific investigation is indisputable virtue of the declaration.
The investigations, which are under the control of bioethical
codes are defined by Committee. Their scopes are great enough . It is necessary
to observe seven principles of bioethics during scientific investigations: first
of them – freedom for scientific search; the second – responsibility of
scientist, who must be exacting careful and objective in holding scientific
investigation then social-economic and technical type, and also in using their
results; the third – the principle surmises an active usage of results of
scientific investigations of human’s genome for health, the forth none of
medical-biological investigations, first of all genetic prevail over estimation
of human’s rights, principal freedoms and human’s merit; the fifth – this
rule is that investigations, diagnostics and treatment connected with
intervention in the genome of someone, are held after elaborate preliminary
estimation, and also in conformity with national legal system; the sixth
principle – the observance of right of each person to get the information
about the rules of genetic analysis and its consequences; the seventh –
forbidding of any practice with the purpose to renew human being as contracting
to the moral code. The Committee will analyze the condition of scientific
investigations connected with the problems of bioethics in Azerbaijan, work out
proposals on the development of more urgent and perspective directions.
At the same time in the Republic much work is to be done to
introduce modern principles of medical ethics with consideration for new
socio-economic formation, including establishment of national committees.
