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B I O E T H I C S Handout Yerevan State Medical University Ministry of Science and Education of Republic of Armenia S.H. Davtyan B I O E T H I C S Handout YEREVAN – 2013 UDC 614.253(07) The handout was guaranteed for publication by the academic council of the YSMU after M. Heratsi Editor of series: M.A. Harutyunyan PhD, Head of Chair of Philosophy of NAS of RA Official Opponents: Holder of UNESCO Chair in Bioethics, president of World Associasion of Medical Law, professor Amnon Carmi (Israel) MD, professor, founding president of Forum of Ethical Committees of CIS Countries O. I. Kubar (Saints-Petersburg) MD, Professor, Chief Editor of “Armenian Medical Journal of Abstracts”.R. A. Hovhannisyan (Yerevan) V. D. Darbinyan (Yerevan) PhD B. G. Yudin (Moscow) PhD, Academician of NAS of RF. Davtyan S.H. Bioethics, Handout, Yerevan/ Yerevan State Medical University/ 2013, 189 p. This handout is outstanding for it includes documents, declarations and resolutions on Bioethics adopted both by international organizations and the NA of RA. The handout presents thoughts and ideas of Medie- val Armenian thinkers. The theoretical topics are enriched by results of sociological surveys. Issues of applied ethics as well as analyses of spe- cific case-studies collected from the medical practice of different for- eign countries are also discussed in the handout. The book is designed for students, for PhD students and researchers as well as general public who are interested in Bioethics. The electronic version of this text is created by: A. Petrosyan, A.Balayan The book is designed by: M. Avetisyan All the rights of the author are reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the author or the publisher. ISBN 978-9939-65-057-9 ©YSMU, after M. Heratsi, 2013 2 C o n t e n t s Introduction ....................................................................................... 9 Section 1: What is Ethics and How does it Help Doctors? ............. 11 Section 2: Does Ethics Change During Time? ............................... 18 Section 3: How do Individuals Decide What is Moral? ................. 23 Section 4: The Subjects, problems and Prehistory of Bioethics ..... 30 Section 5: Theoretical Foundations and Historical Stages of Development of Bioethics .......................................................... 39 Section 6: Historical Models of Bioethics and Types of Doctor-Patient Relationships ................................................................................... 51 Section 7: Doctor’s Duties and Patient’s Rights ............................. 58 Section 8: Doctors’ Etiquette .......................................................... 63 Section 9: Involuntary Hospitalization and Sterilization of Mentally Ill People .............................................................................................. 66 Section 10: Informed consent ......................................................... 74 Section 11: Moral and Legal Issues of Abortion ............................ 76 Section 12: Ethical Issues of Genetic Engineering and Cloning .... 80 Section 13: Issues of Life and Death: Euthanasia ......................... 90 Section 14: Euthanasia. Issues of Sociology of Life ..................... 95 Section 15: Euthanasia in Armenia .............................................. 109 Section 16: Palliative Care ........................................................... 115 Section 17: Armenian Medieval Philosophy and Medical Science: Narek as a Remedy ..................................... 120 Section 18: Social Justice and Health Policy ................................ 131 Section 19: Medical Cases and Practical Solutions ...................... 139 Appendix ....................................................................................... 144 Sample Tests 144 Self Work Topics ........................................................................... 148 Glossary of Bioethical Terms ........................................................ 180 Literature 185 3 Acknowledgement I consider it my privilege to thank sincerely to all the specialists who have shared their valuable comments regarding the manuscript of this work and who have supported the publication of this book by their use- ful advices. Special thanks to: Holder of UNESCO Chair in Bioethics, President of World Associasion of Medical Law, professor Amnon Carmi (Israel) Professor of Sechenov Medical Academy M.Yu. Yarovinski Founding President of the Forum of Ethical Committees of CIS Countries Professor O. I. Kubar, M.D. (Saints-Petersburg), Professor T.V. Mishatkina (Minsk) Academician B. N. Yudin M.D (Moscow). Editor of “Journal of Armenian Medical Abstracts” professor R.A. Hovhannisyan M.D. (Yerevan), Head of the chair of Philosophy of NAS of RA M.A. Harutyunyan PhD (Yerevan). Professor M. Valton (Australia) Professor R.A. Apresyan Head of the Chair of Ethics of Institute of Philosophy of NAS, RF Professor Henk Ten Have, USA The author will be redy to accept all the comments and suggestions, which will help to elluminate the shortcomings of this work if the God permits me to republish this book again. 4 A letter of praise from UNESCO Chair in Bioethics I would like to highlight the important role of Prof. Susanna Davtyan, who functions as the Head of the Armenian Unit of the International Network of the UNESCO Chair in Bioethics, in addition to her local post as the Head of the Philosophy Chair of YSMU (2006-2009). 11 years ago the UNESCO Chair in Bioethics held its second interna- tional conference on “Ethics Education in Medical School” in Eilat (Israel). Prof. S. Davtyan took an active part in this international event, and her inter- esting report was regarded by all the participants as an important presentation. Her successful participation started an ongoing exchange of thoughts and close contact with the Directors of the UNESCO Chair. After the 7th European Academy on Bioethics in Germany, and the inter- national conference on “ Ethics Committees in Hospitals” organized by the UNESCO Chair in Bioethics ( Israel), and as a result of her hard and creative work she was appointed as a Head of the Armenian Unit of International Net- work of UNESCO Chair in Bioethics(2008). The fact that she was appointed as a Chair of Scientific Session “Teach- ing Methodology” (Israel 2010) and “Bioethics Education- Local Experience” (Singapore 2011), reflects the high appreciation shown to her by the interna- tional forum. In the international conference held 22-30, May 2011, in Singapore, prof. S. Davtyan reported on “Methodology and Methods of Investigating Bioethics (Experimental Course of Bioethics based on Basic Educational Program of UNESCO”’). Her report got high praise by well-known participants, and it was recommended to deliver it to the Headquarters of UNESCO in Paris. The UNESCO Chair is authorized to promote the study and education of bioethics in medical schools all over the world. In order to achieve this aim the 5 Chair encourages the production of books on medical ethics for the benefit of both teachers and the students. The well written book of prof. S. Davtyan is regarded by the Chair as an important contribution to the Armenian academic world. Its English translation allows readers from other countries to be ac- quainted with the ethical and legal norms that prevail in Armenia, with the thoughts, view, ideas of medieval Armenian thinkers relating to the problems of life and death, good and evil, sins and illnesses. It gives me great pleasure to express my appreciation and thanks to our Armenian colleague for excellent preparation of her report in the conference in Tiberias ( 02.09.2012) and about her report in the meeting of Heads of Na- tional Units ( 05/09/2012). I shall appreciate and be thankful if you would share with me the appreciation and will offer Prof. Davtyan your generous support in order to enable her to advance the education of bioethics in your university and throughout your country. Once again please allow me to wish you a future professional success. Prof. Amnon Carmi, Head of The UNESCO Chair in Bioethics. President of The World Association of Medical Law 6 Letter of praise from Forum of Ethical Committees of CIS Countries Following the Western and Russian example, 12 years ago YSMU started to teach Bioethics to its students. The head of the chair of Philosophy S.H. Davtyan regularly participates in activities of the committee organized under the auspices of UNESCO, reports in international conferences, cooperates with major centers of Bioethics including the centers in St. Petersburg, Moscow, Zagreb, Tartu, Haifa and corresponding chairs of other medical universities. H.S. Davtyan was invited in 2005 by UNESCO as an expert to participate in regional consultation on Bioethics and she co-chaired the fourth session of the consultation with Academician B.G. Yudin PhD, and Professor T.V. Mishatkina. I was convinced the this first manual in the national language will put a start for future publications, which will help the public to gain necessary Bio- ethical knowledge. The handout is pleasantly outstanding with the fact that it presents both international and Armenian legal acts on Bioethics. The book presents the medical thoughts of medieval Armenian thinkers (Narekatsi, Davit the Invin- cible etc.). The theoretical material is enriched by the results of sociological surveys conducted among the
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