Министерство здравоохранения Республики Беларусь УО «Витебский государственный медицинский университет» БИОМЕДИЦИНСКАЯ ЭТИКА И КОММУНИКАЦИИ В ЗДРАВООХРАНЕНИИ BIOMEDICAL ETHICS AND COMMUNICATIONS IN HEALTH SERVICE Витебск 2018 УДК 57+61[111(072)] ББК 51.1(4Беи)пя73 Б 63 Рекомендовано к изданию Центральным учебно-методическим советом ВГМУ в качестве учебно-методического пособия (дата 07.02.2018 г. протокол № 2) Рецензенты: Кафедра общественного здоровья и здравоохранения ГУО «Белорусская медицинская академия последипломного образования» (зав. кафедрой, доцент Щавелева М. В.) Профессор кафедры социально-гуманитарных наук УО «Витебский государственный университет им. П. М. Машерова», доктор философских наук, профессор Слемнев М. А. Б 63 Биомедицинская этика и коммуникации в здравоохранении= Biomedical ethics and communications in health service: учеб.-метод. пособие / Глушанко В. С., Кулик С. П., Герберг А. А., Мясоедов А. М., Михневич Е.В., Орехова Л.И., Церковский А. Л. – Витебск : ВГМУ, 2018. – 233 с. ISBN 978-985-466-907-6 Учебно-методическое пособие «Биомедицинская этика и коммуникации в здравоохранении» по дисциплине соответствует типовому учебному плану и типовой учебной программе по предмету, утвержденным Министерством здравоохранения Республики Беларусь. Пособие предназначено для студентов 1-го курса факультета подготовки иностранных граждан высших медицинских учреждений образования, изучающих биомедицинскую этику и коммуникации в здравоохранении на английском языке. УДК 57+61[111(072)] ББК 51.1(4Беи)пя73 ISBN 978-985-466-907-6 © Глушанко В. С., Кулик С. П., Герберг А. А., Мясоедов А. М., Михневич Е.В., Орехова Л.И., Церковский А. Л., 2018 © УО «Витебский государственный медицинский университет», 2018 CONTENTS CONTENTS………..……………………………………………….……3 FOREWORD ............................................................................................ 10 I.BIOMEDICAL ETHICS IN HEALTH SERVICE ......................................................................................................... 11 1. BIOMEDICAL ETHICS: ESSENCE, BASIC PRINCIPLES .......... 11 1.1. Features of the professional activities of doctor. Availability of professional ethics as a necessary factor in the regulation of medical activity. Historical stages of development of medical ethics ................... 11 1.2. Becoming and the formation of bioethics and biomedical ethics. Bioethics, biomedical and medical ethics: the status and content............ 14 1.3. Conceptual model and the problem field of biomedical ethics ......... 16 1.4. Universal principles and norms of biomedical ethics ....................... 17 1.5. Background Documents on Medical Ethics of the World Health Organization, the World Medical Association ......................................... 20 2. PROBLEMS OF BIOMEDICAL ETHICS ........................................ 22 2.1. Life is as higher value. Ethical and legal aspects of human reproduction .............................................................................................. 22 2.1.1. The phenomenon of life to bioethics position ............................. 22 2.1.2. Autonomy of an expectant mother and right of an embryo on life. Ethic of problem of artificial abortion ................................................... 24 2.1.3. The ethical dimension of control underreproduction. Moral problems of contraception ..................................................................... 28 2.1.4. Ethical issues of reproductive technologies ................................ 28 2.1.5. The problem of surrogate motherhood ........................................ 29 2.2. Bioethics of death and dying ............................................................. 34 2.2.1. The problem of death in medical and bioethical dimensions...... 35 2.2.2. The problem of euthanasia in contemporary culture: the pros and cons ........................................................................................................ 37 3 2.2.3. The problem of the relationship of physicians to the dying. Mercy from the standpoint of bioethics. The ethical foundations of modern palliative medicine. Hospice movement .................................. 38 2.2.4. Ethical-deontological principles in oncology.............................. 40 2.2.5. Deontological approach to relatives of the patient with malignant neoplasms .............................................................................................. 42 2.3. Ethical and legal aspects of transplantation ...................................... 43 2.3.1. Transplantation: past and present ................................................ 43 2.3.2. Moral and legal problems of transplantology ............................. 44 2.4. Ethical problems of medical genetics and genetic engineering ........ 46 2.4.1. Biotechnology, biosafety and genetic engineering ..................... 46 2.4.2. Specificity of moral problems of medical genetics ..................... 49 2.4.3. The problem of cloning. The moral problem of human cloning . 55 2.5. Ethical and legal regulation medical-biological experiments on animals and people ................................................................................... 56 2.5.1. Ethical and legal aspects of the regulation of biomedical research involving human subjects: international instruments ............................ 56 2.5.2. Ethical aspects of the use animals in biomedical research .......... 59 2.5.3. The role of bioethical committees in solving social and professional health problem .................................................................. 61 3. MODERN MEDICAL DEONTOLOGY ............................................ 63 3.1. The essence and problems of medical deontology ............................ 64 3.2. Basic models of relationships in the "doctor-patient" system ........... 67 3.3. Paternalistic and autonomous model of relationships. The model of "weakened paternalism." The essence of the autonomous model of relationships in the "doctor-patient" system. Priority of the autonomous model of relationships and the principle of "informed consent". The principle of "informed consent" and "cooperation" between the doctor and the patient ........................................................................................... 69 3.4. Moral climate of medical staff. Conflicts in the medical team ......... 73 4. ETHICS PROBLEMS OF MEDICAL CARE FOR PATIENTS WHO HAVE DISEASES POSING HEALTH HAZARD OF THE 4 POPULATION, HUMAN IMMUNODEFICIENCY VIRUS AND ALSO SUFFERING FROM CHRONIC ALCOHOLISM, DRUG ADDICTION AND ABUSE ...................................................................... 75 4.1. The moral foundation of medical care for people with diseases representing health hazard of the population, human immunodeficiency virus (HIV) ............................................................................................... 75 4.2. Ethical standards in the treatment of HIV-infected children............. 80 4.3. Inadmissibility of discrimination and stigmatization of people living with HIV, AIDS patients .......................................................................... 81 4.4. The problem of the fear of AIDS and the requirements of medical ethics ......................................................................................................... 82 4.5.The importance of medical confidentiality ........................................ 83 4.6. Voluntariness and anonymity of medical examination of persons for the diseases those are dangerous for public health, HIV .......................... 85 4.7. Professional risk of medical workers ................................................ 88 4.8. Legal and social protection of persons infected with HIV, AIDS patients ...................................................................................................... 89 4.9 The peculiarity of medical activity and the moral component of a modern doctor ........................................................................................... 91 4.10 Ethical and legal problems of modern psychiatry ............................ 93 4.11 Ethical problems in narcology .......................................................... 94 4.12 Conceptual model of the professional culture of the doctor at the present stage: structure, content ............................................................... 95 II. COMMUNICATIONS IN HEALTH SERVICE ......................... 100 1. COMMUNICATIONS IN THE ACTIVITIES OF MEDICAL WORKERS............................................................................................... 100 1.1. Definition of the concept of "communication" ............................... 100 1.2. Basic principles and goals of communication in health .................. 101 1.3. Scheme of communications. Communication process .................... 103 1.4. Postures, facial expressions, gestures .............................................. 104 1.5. Tactical means of communication. The art of covert influence ...... 108 5 1.6. Types of communication of medical workers. Formal communications, informal communications. Types of informal communications. ..................................................................................... 109 2. LEADERSHIP AND AUTHORITY .................................................. 114 2.1 Leader and leadership: terms and conception ............................... 114 2.2 Categories and types of leadership ............................................... 114 2.3. Scope of leadership ......................................................................