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Basic provisions of medical ethics and deontology in the work of medical personnel. Topic: “Ethics and deontology in medicine

MEDICAL ETHICS(Greek ethika, from ethos custom, disposition, character) - a variety professional ethics, specifying general ethical principles and norms in relation to the specifics medical activities.
Ethical medical principles are aimed at protecting the rights and interests of the patient, and, it would seem, they should be absolutely humane. However, in real life things are not that simple. Doctors are often put in a situation where they have to make decisions that contradict the rules of medical ethics. In this case, the doctor tries to make a decision that will cause less harm.

There are a lot of real-life examples. For example, medicine in emergency situations or military field medical care when triaging the wounded. According to the rules, all wounded are divided into three groups: light wounds, severe wounds and hopeless. The lightly wounded are bandaged and sent to the rear. The seriously wounded are first given the maximum possible assistance on the spot, and then also sent to the rear. The “hopeless” are relieved of their suffering, but are not transferred to the rear.

In fact, some of the wounded who fall into the “hopeless” category can still be saved if they are treated by highly qualified doctors with specialized medical equipment. To do this, they will urgently need to be evacuated, accompanied by medical staff. In this case, without the necessary medical care There may be lightly wounded or seriously wounded whose condition will worsen.

Here a medical ethical problem arises: on the one hand, you cannot leave a person without a chance of salvation, on the other hand, you cannot save one, forgetting about dozens of people. There is no ethically ideal way out of this situation. Therefore, each doctor takes responsibility and decides for himself what to do in this situation. Most doctors are of the opinion that it is necessary to save the lives of as many people as possible.

Also a medical ethical problem is teaching a student on living people. Students, due to their inability, may accidentally cause pain to the patient, which is contrary to medical ethics. However, how can you train a highly qualified specialist without practice on living people?! Neither dummies nor practice on corpses can prepare a specialist as well as working with a person. This ethical problem is insoluble.

On the one hand, it is quite understandable that a young doctor needs to practice on people, but few will agree to provide themselves “for experiments.” The duality of this situation is confirmed by the results of surveys in the United States, according to which more than 80% of volunteers who agreed to provide their bodies for experiments, and about 70% of donors agreed to medical manipulations, being in a difficult financial situation. Another question arises: is it ethical to take advantage of people’s financial difficulties?

The question of clinical experiments on animals remains unresolved. Hundreds and thousands of animals die during experiments in order to subsequently save human lives. Without such experiments, which entail enormous sacrifices, it is impossible to test a new technique or medicine on humans. This is another medical ethical issue.

Today, medical practice is regulated by many ethical and legal standards. The rights of volunteers are protected. Forced participation in clinical experiences considered illegal and unethical. However, society came to this relatively recently. In ancient Alexandria, it was allowed to use convicted criminals for experiments. In Germany, studies were published by Nazi doctors who conducted their experiments on prisoners in concentration camps. These are examples where a doctor rejects the principles of medical ethics.

Professional honey ethics as a set of specific norms and assessments that determine the behavior of a health worker has deep historical roots. Even 1500 BC. e. Hindu doctors took a professional oath. The basis of numerous professional oaths, which are taken by doctors in many countries of the world, is the Hippocratic Oath. The most important principles of Hippocratic ethics: “Primum non nocere” - first of all, do not harm the patient; enter the sick person’s house solely for his benefit, and in relations with him, refrain from everything malicious and immoral; consider human life as an unconditional value, never give a patient lethal means; keep medical confidentiality; do not lower the authority of the noble medical profession, etc. Since the time of Hippocrates, the mercy of medicine has been manifested primarily by the recognition of the life of each person as an unconditional and highest value, the struggle for the preservation and strengthening of health, for the longevity of people. One of the manifestations of the humanism of doctors is a compassionate attitude towards a person in pain. N.I. Pirogov, one of the first to use anesthesia in surgical practice, spoke about the obviousness of the moral influence of anesthesia on suffering humanity.

Since the middle of the 20th century. The development of electrical engineering was greatly influenced by the scientific and technological revolution and increasingly widespread honey. knowledge. The world community's campaign to condemn the crimes of fascist anti-medicine had a significant impact. During the same period, new ethical medical practices emerged. codes both in individual countries and internationally. In 1948, the World Medical Association formulated the Declaration of Geneva, and in 1949, a more detailed International Code of Medical Ethics.

In the second half of the 20th century. The humanistic mission of medicine has expanded thanks to the role played by honey. science and medicine play a role in solving problems of environmental pollution and especially in preventing global thermonuclear war (see "Physicians of the World for the Prevention of Nuclear War").

Economics in a socialist society is based on the principles of communist morality. Since 1971, in all Soviet medical centers. Universities graduates take the “Doctor’s Oath” Soviet Union", and in many medical schools graduates make a "Solemn Promise". These oaths are reflected the following requirements to a physician: constantly strive for professional improvement, observe the norms of collegiality, preserve medical care. secret. Health care workers should not disclose information about the diagnosis, the severity of the prognosis, hidden physical disabilities and mental defects, features of the patient’s medical history. In some cases, telling the patient the true diagnosis and prognosis of the disease can cause severe mental trauma. However, the need to preserve honey. secrecy does not apply to cases where there is a real threat to society or the people around the patient. When embarking on independent professional activity, a Soviet physician solemnly swears that he will work conscientiously where the interests of society require it, protect and develop the noble traditions of domestic medicine, and always remember his responsibility to the people and the Soviet state.

In socialist medical In ethics, the principle of humanism is the starting point. One of the requirements of medical humanism is that every physician must treat the patient’s personality with care and take into account the peculiarities of his mental state. The professional duty of a health worker is his moral responsibility to the patient and to society. The concept of duty is inseparable from selflessness.

Honey. ethics is a developing field of knowledge. Within its framework, the real customs existing in medicine are studied. environment, in particular the relationship of doctors with their patients, possible contradictions between them, conflicts. E. m. pays more and more attention to the study of the moral and ethical positions of patients. A modern patient is, as a rule, an active patient, whose attitude towards his health is becoming more and more responsible, he increasingly seeks to participate together with the doctor in making decisions regarding his health. At the same time, the behavior of a certain part of patients has moral deviations. All this served as a reason for raising a new question - about the “ethics of the patient.”

There is also such a thing as medical deontology:
Deontology(from Greek . δέον - due) - the doctrine of problems of morality and morality, a section of ethics. The term was introduced by Bentham to designate the theory of morality as the science of morality.

Subsequently, science narrowed down to characterizing the problems of human debt, considering debt as an internal experience of coercion given by ethical values. In an even narrower sense, deontology was designated as a science that specifically studies medical ethics, the rules and norms of interaction between a doctor and colleagues and patients.

The main issues of medical deontology are euthanasia, as well as the inevitable death of the patient. The goal of deontology is the preservation of morality and the fight against stress factors in medicine in general.

Euthanasia(or euthanasia) (Greek . ευ - “good” + θάνατος “death”) - the practice of ending (or shortening) the life of a person suffering from an incurable disease, experiencing unbearable suffering, satisfying a request without medical indications in a painless or minimally painful form in order to end the suffering.

Types of euthanasia.

In theory, there are two types of euthanasia: passive euthanasia (intentional cessation of supportive therapy by doctors for a patient) and active euthanasia (administration of medicines or other actions that entail a quick and painless death). Active euthanasia often includes medically assisted suicide (providing the patient with life-shortening drugs at his request).

In addition, it is necessary to distinguish between voluntary and involuntary euthanasia. Voluntary euthanasia is carried out at the request of the patient or with his previously expressed consent (for example, in the USA it is common practice to express one’s will in advance and in a legally reliable form in the event of an irreversible coma). Involuntary euthanasia is carried out without the consent of the patient, who is usually unconscious.

The term “euthanasia” was first used by Francis Bacon in the 16th century to define “an easy death.”

History of euthanasia.

Before the outbreak of World War II, the idea of euthanasia was widespread in a number of European countries. At that time, euthanasia and eugenics were quite popular in medical circles in European countries, but Nazi actions, such as the T-4 killing program, discredited these ideas for a long time. Among famous people Let us note S. Freud, who, due to an incurable form of cancer of the palate, with the help of Dr. Schur, performed euthanasia in his London home on September 23, 1939, having previously undergone 19 operations to remove tumors under local anesthesia ( general anesthesia was not used in such operations at that time).

Medical deontology includes:

Issues of medical confidentiality

Measures of responsibility for the life and health of patients

Relationship problems in the medical community

Problems in relationships with patients and their relatives

Rules regarding intimate relationships between physician and patient, developed by the Committee on Ethical and Legal Affairs of the American Medical Association:

intimate contacts between doctor and patient that occur during treatment are immoral;

intimate relationship with former patient may be considered unethical in certain situations;

the issue of intimate relationships between doctor and patient should be included in the training of all health care workers;

Doctors must always report violations of medical ethics by their colleagues.

Medical secret- a medical, legal, social and ethical concept that is a prohibition on a medical worker to disclose to third parties information about the patient’s health status, diagnosis, examination results, the very fact of seeking medical help and information about personal life obtained during examination and treatment. The prohibition also applies to all persons to whom this information became known in cases provided for by law.

Medical confidentiality refers to the basic principles of the Hippocratic Oath:

... Whatever during treatment - and also without treatment - I see or hear about human life that should never be disclosed, I will keep silent about it, considering such things a secret...

Fundamentals of the legislation of the Russian Federation on protecting the health of citizens dated July 22, 1993 N 5487-1 in Article 61 defines the concept of “medical confidentiality”. It also defines the circumstances under which it is permissible to transfer information constituting medical confidentiality to other citizens, including officials, with the consent of the citizen or his legal representative, as well as without such consent.

There is also legal deontology, which is a science that studies issues of morality and ethics in the field of jurisprudence (it is believed that the rules of law do not coincide with moral standards by 100%, but only by about 80%)

In connection with the development of medicine in its various fields, new ethical problems have arisen. For example, in transplantology, when transplanting a kidney from a living donor, doctors deliberately (in the name of a humane goal) violate the Hippocratic commandment “first of all, do no harm.” A heart transplant operation requires the resolution of a number of difficult ethical issues relating to both the recipient and the donor (his relatives). In transplantology, doctors often face double surgical risk. Under these conditions, the concept of “ethical risk” is becoming increasingly important.

The nursing staff conducts treatment. institutions, especially hospitals, spend significantly more time than doctors. The role of the nurse in creating an optimistic environment around the patient and belief in a favorable outcome of the disease cannot be overestimated. A modern healthcare worker must have a broad outlook, be a versatile educated and thinking specialist, who is called upon to compensate with his attentive and cordial attitude towards the patient the costs of modern “technization” of medicine.

Ethical issues for nurses

How does a nurse's approach to ethics in everyday work differ from that of a physician? Nursing ethics primarily focused on activities that involve professional patient care.

In the 19th century it was believed that the sister should be completely subordinate to the doctor, since her duties were seen as derived from the doctor’s orders. The doctor traditionally had a special place in the process of providing care to the patient; he could treat his subordinates authoritarianly. This meant that the nurse had to support the goals that the doctor was trying to achieve in treating patients. The doctor's support from the sister was seen as important factor in maintaining and strengthening the patient’s faith in the doctor. Therefore, there was a list of ethical qualities nurses which they were required to possess in both their professional and personal lives, namely: patience, trust, integrity, faith, courage, honesty, wisdom and dedication.

Such social and professional discrimination against sisters continued until the first half of the 20th century. After World War II, health care began to focus on activities such as preventive care, which had traditionally been part of nursing duties.

Over the past 20 years in nursing The level of training has increased significantly. Methods for studying research in nursing have emerged. All of this contributed to the creation of a foundation of nursing knowledge, nursing theories and nursing models.

If we make a brief review of the international literature on issues related to the sociological role and position of nurses, we can determine the following:

The responsibilities of doctors and nurses are very different: the doctor usually occupies a position that provides him with high status, and the role of nurses in the provision of health care becomes an important intermediate link;

Nurses are often faced with a huge number of orders, rules and regulations from the administration; communication channels regarding suggestions and complaints to higher hierarchical levels are limited; such a situation suppresses initiative and gives rise to feelings of inferiority and dissatisfaction;

Nurses support the scientific activities of doctors by performing additional duties;

The nurse must restrain emotions and not point out to patients the doubts, uncertainties, and mistakes that she observes in her work;

Health care is an important social ideal of the general welfare of the state, where it is located in the context of social values; on the other hand, actual physical care is usually not sufficiently valued and rewarded, which creates an unpleasant impression of nursing.

The ethical issues of nurses also receive little attention. As a result, nurses try to delegate care responsibilities to nurses.

The conclusion is that the sisters are trapped in a conflict of perspectives and hopes.

1. Relevance of the problem

The uniqueness of medical ethics lies in the fact that all norms, principles and assessments in it are focused on human health, its improvement and preservation. These norms were initially expressed in the Hippocratic Oath, which became the starting point for the creation of other professional and moral medical codes. The ethical factor is traditionally of great importance in medicine. More than eighty years ago, by analogy with the medical Hippocratic Oath, the sister Oath of Florence Nightingale was created.

2. Ethical standards and phenomena

Morality concept

There are two aspects to ethical phenomena:

1) personal moment (the autonomy of the individual and his self-conscious motivation for the rules of moral behavior and moral assessments);

2) an objective, extra-personal moment (moral views, values, mores, forms and norms of human relations that have developed in a given culture, social group, community).

The first of the noted points relates to the characteristics of morality, the second - morality.

A distinctive feature of morality is that it expresses the autonomous position of individuals, their free and self-conscious decision about what is good and evil, duty and conscience in human actions, relationships and affairs. When they talk about morality social groups, communities and society as a whole, we are essentially talking about morality (about group and general social mores, values, views, relationships, norms and institutions).

Ethics - the science of morality

Ethics as a philosophical theory of morality does not arise spontaneously, like morality, but on the basis of conscious, theoretical activity in the study of morality. Real moral phenomena and the moral activity of people arose much earlier than ethics as a science, the formation of which is associated with the emergence of a system of scientific knowledge about morality. Ethics is considered to be one of the philosophical sciences. In the history of the development of ethical views, ethics was defined as a practical philosophy that substantiates the goals of practical activity on the basis of ideas about what should and is, about good and evil, about happiness and the meaning of life. Ethics considers morality as a sphere of social life based on certain norms and values, and ethics regulates relations between people based on moral requirements and concepts. Ethics sees its tasks not only in explaining morality, but also in offering society a more perfect standard and model of behavior. Ethics describes morality, explains it, and teaches morality, explains how moral standards of behavior should be fulfilled, highlighting the specific content and form of these standards. Ethics includes both the doctrine of moral existence, the actually manifested normativity in people’s behavior, and the doctrine of moral obligation, how each person should behave in society, how he should determine his moral goals, needs and interests. Ethics studies morality from the standpoint of the principle of historicism, since each society has its own characteristics of the implementation of moral norms and requirements, its own morals and principles of behavior. Morality in the history of society evolves, improves, progresses, the features of development and normativity of different types of morality manifest themselves differently.

Professional ethics

Professional ethics is a set of moral standards that determine a person’s attitude towards his professional duty. The content of professional ethics is codes of conduct that prescribe a certain type of moral relationships between people and ways to justify these codes.

Despite the universal nature of moral requirements and the presence of a single labor morality of a class or society , There are also specific norms of behavior only for certain types of professional activities. The emergence and development of such codes represents one of the lines of moral progress humanity, since they reflect the increasing value of the individual and affirm humanity in interpersonal relationships. Consequently, the main purpose of professional ethics is that it ensures the implementation of general moral principles in the conditions of people’s professional activities and contributes to the successful implementation of professional duties. Professional ethics helps a specialist avoid mistakes and choose the most correct, highly moral line of behavior in various work situations. The task of professional ethics is not to provide ready-made recipes for all occasions, but to teach a culture of moral thinking, to provide reliable guidelines for solving specific situations, to influence the formation of moral attitudes in a specialist in accordance with the specific requirements of the profession, to explain and evaluate behavioral stereotypes developed by legal practice in areas , not regulated by law.

Code of Ethics nurses

Code of Ethics nurse Russia, developed by order of the Russian Nurses Association in 1997. It is compiled taking into account new ideas that over the past two to three decades have determined the content of medical ethics in general and the professional ethics of nurses in particular. First of all, the Code in its expanded form reflected modern ideas about the rights of the patient, which seem to dictate the content of specific responsibilities and determine the formulas for the moral duty of a nurse.

The Code also reflected the nursing reform that began in Russia (in particular, requiring the involvement of nurses in independent research activities, without which it is impossible to transform nursing into an independent science). The Code reflects those features of today's medicine that are associated with modern scientific and technological progress, for example, problems of risk, iatrogenic effects in many currently used medical interventions.

The humanity of the nursing profession.

The nurse must place compassion and respect for the patient's life above all else. The nurse must respect the patient's right to relief of suffering to the extent that the current level of medical knowledge allows. A nurse has no right to participate in torture, executions or other forms of cruel and inhumane treatment of people. A nurse has no right to assist a patient’s suicide. The nurse is responsible, within her competence, for ensuring the rights of the patient proclaimed by the World Medical Association, the World Health Organization and enshrined in the legislation of the Russian Federation.

The nurse must respect the dying person's right to humane treatment and death with dignity. The nurse is required to have necessary knowledge and skills in the field of palliative care, giving the dying person the opportunity to end his life with the maximum achievable physical, emotional and spiritual comfort. The primary moral and professional responsibilities of a nurse are: prevention and relief of suffering, usually associated with the process of dying; Providing psychological support to the dying person and his family. Euthanasia, that is, the deliberate action of a nurse to end the life of a dying patient, even at his request, is unethical and unacceptable. The nurse must treat the deceased patient with respect. Religious and cultural traditions should be taken into account when processing the body. The nurse is obliged to respect the rights of citizens regarding pathological autopsies enshrined in the legislation of the Russian Federation.

Professional competence of a nurse

A nurse must always comply with and maintain professional standards of practice determined by the Ministry of Health of the Russian Federation. Continuous improvement of special knowledge and skills, raising one's cultural level is the primary professional duty of a nurse. The nurse must be competent in relation to moral and legal rights patient. The nurse must be constantly ready to provide competent care to patients regardless of their age or gender, nature of the disease, race or national origin, religious or political beliefs, social or financial status or other differences.

Conclusion

The ethical basis of the professional activity of a nurse is humanity and mercy. The most important tasks of a nurse’s professional activity are: comprehensive comprehensive care for patients and alleviation of their suffering; health restoration and rehabilitation; promoting health and preventing disease. The Code of Ethics provides clear moral guidelines professional activity of a nurse, is designed to promote consolidation, increase the prestige and authority of the nursing profession in society, and the development of nursing in Russia.

List of used literature

1. Guseinov A.A., Apresyan R.G. Ethics. - M.: 1998.

2. Zelenkova I.L., Belyaeva E.V. Ethics: Tutorial. – Mn.: ed. V.M. Skakun, 1995.

3. Fundamentals of ethical knowledge / ed. Professor M.N. Rosenko. - M.: Publishing house. "Lan", 1998.

4. Dictionary of ethics. Ed. I.S. Kona. - M.: Politizdat, 1990.

5. Code of Ethics for Russian Nurses (adopted Russian Association nurses, 1997)

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Abstract

Topic: “Ethics and deontology of a medical worker”

Completed by: Larisa Serdyukova

Belgorod 2014

Medical ethics and deontology are features of medical activity based on mutual trust between the patient and the medical worker, to whom the patient voluntarily entrusts his health, and sometimes his life.

Medical ethics (Greek etohs - custom, custom, character) as part of general ethics considers the moral issues of a doctor, including the set of standards of his behavior and morality, a sense of professional duty and honor, conscience and dignity.

Medical ethics also covers certain standards of behavior of a medical worker in everyday life, his culture, love of humanity, physical and moral cleanliness, etc. In general, we can say that ethics is external manifestation the inner content of a person.

Medical deontology (Greek deon - due) is understood as the principles of behavior of medical workers aimed at maximum increase benefits of treatment and elimination of the consequences of inadequate medical work. Deontology is part of medical ethics, medical morality.

However, currently latest achievements medical science and technology force us to consider the traditional norms of medical deontology from a slightly different point of view. The former “doctor-patient” principle is being replaced by the new “doctor-device-patient”, and the patient’s need for the sensitive and attentive attitude of a medical worker, for his kind words that inspire hope, has not decreased, but has increased even more.

Relevance of the problem

Ethical standards and phenomena

In the process of development and formation of professional medicine, the humanistic and moral principles of the activities of medical workers were clearly formulated.

On this basis, the most generalized concepts of morality or categories were determined, reflecting moral ties between people and characterizing the attitude of health workers to the subject of their daily activities - a sick and healthy person, to society.

This is how the main categories of medical ethics were formulated and received scientific recognition: duty, conscience, honor and dignity, tact, the meaning of life and human happiness. Naturally, all ethical categories are interconnected, mutually complement and reinforce each other. As our ideas and scientific progress develop in medicine, and on this basis - further improvement of methods of examination and treatment of patients.

It is very important that nursing staff not only know, but also use the basic requirements of ethical categories in their professional activities and, on their basis, improve the quality of medical care to the population.

Conscience is an ethical category that expresses higher form the ability of an individual to exercise moral self-control, independently formulate moral duties for himself, demand that he fulfill them, and make a self-assessment of his actions. Conscience is an internal awareness of one's professional duty, professional responsibility as a personal duty and personal responsibility.

Honor and dignity are ethical categories that determine a person’s attitude, both to himself and to another person, and to society as a whole. In its content, the concept of honor is very close to the concept of “dignity”. Both of these categories regulate a person’s behavior in a certain way and determine the attitude towards him from others; they are influenced by other categories of ethics, especially duty and conscience, without which there is no personal honor and dignity.

Tact is not an innate quality, but an acquired one; it is brought up from childhood in that social environment, where it grows and is formed in the process of social and individual development.

Happiness is a sign that a person has found personal meaning in life at some specific stage of his life path.

There are two aspects to ethical phenomena:

1) personal moment (the autonomy of the individual, his motivation for the rules of moral behavior and moral assessments);

2) an objective, extra-personal moment (moral views, values, mores, forms and norms of human relations that have developed in a given culture, social group, community).

The first of the noted points relates to the characteristics of morality, the second - morality.

A distinctive feature of morality is that it expresses the autonomous position of individuals, their free and independent decision about what is good and evil, duty and conscience in human actions, relationships and affairs. When they talk about the morality of social groups, communities and society as a whole, we are essentially talking about morality (about group and general social mores, values, views, relationships, norms and institutions).

Traditional norms and rules of medical deontology

1. Hippocratic model (“do no harm”).

The principles of healing laid down by the “father of medicine” Hippocrates (460-377 BC) lie at the origins of medical ethics as such. In his famous “Oath,” Hippocrates formulated the duties of a doctor to his patient.

2. Paracelsus model (“do good”).

Another model of medical ethics developed in the Middle Ages. Its principles were most clearly outlined by Paracelsus (1493-1541). In contrast to the Hippocratic model, when the doctor wins the social trust of the patient, in the Paracelsian model, paternalism - the emotional and spiritual contact of the doctor with the patient, on the basis of which the entire treatment process is built - acquires primary importance.

In the spirit of that time, the relationship between a doctor and a patient is similar to the relationship between a spiritual mentor and a novice, since the concept of pater (Latin - father) in Christianity extends to God. The whole essence of the relationship between a doctor and a patient is determined by the good deed of the doctor; the good, in turn, is of divine origin, for all Good comes from above, from God.

3. Deontological model (the principle of “observance of duty”).

This model is based on the principle of “observance of duty” (deontos in Greek means “due”). It is based on the strictest adherence to moral requirements, compliance with a certain set of rules established by the medical community, society, as well as the doctor’s own mind and will for mandatory compliance. For each medical specialty There is a “code of honor”, non-compliance with which is fraught with disciplinary action or even exclusion from the medical profession.

4. Bioethics (the principle of “respect for human rights and dignity”).

Modern medicine, biology, genetics and corresponding biomedical technologies have come close to the problem of predicting and managing heredity, the problem of life and death of the body, control of the functions of the human body at the tissue, cellular and subcellular level. Some challenges facing modern society, were mentioned at the very beginning of this work. Therefore, the issue of respecting the rights and freedoms of the patient as an individual is more pressing than ever; compliance with the patient’s rights (the right to choice, the right to information, etc.) is entrusted to ethical committees, which have actually made bioethics a public institution.

Moral and professional qualities nurse

The role of the nurse in the process of treating a patient, especially in a hospital, is difficult to overestimate. Carrying out doctor's orders, caring for seriously ill patients, carrying out many, sometimes quite complex, manipulations - all this is the direct responsibility of the average medical personnel. The nurse also participates in examining the patient, preparing him for various surgical interventions, working in the operating room as an anesthetist or operating room nurse, monitoring the patient in intensive care units and intensive care. All this places high demands not only on the knowledge and practical skills of the nurse, but also on her moral character, ability to behave in a team, when communicating with patients and their relatives.

It is always and under all circumstances necessary to remember that a person turns to medical professionals for help due to the fact that a problem has happened to him, sometimes very serious, capable of causing loss of health, disability, and sometimes life-threatening. Only with full sympathy for the patient, with an understanding of his situation, is real contact possible between him and the medical staff, which is so necessary for successful treatment. The patient needs sensitivity, moral support, and warmth no less, and maybe more, than medications. It is not for nothing that in the recent past nurses were called “sisters of mercy”: this reflected not only the professional, but also the moral side of their work. Indifferent, unbalanced people who are incapable of empathy for a suffering person should not be allowed to work in medical institutions. When communicating with a patient and performing manipulations, often unpleasant and painful, the nurse must distract the patient from difficult thoughts, instill in him cheerfulness and faith in recovery.

Patients often ask nurses about their diagnosis and prognosis. Under no circumstances should a patient be informed that he or she has an incurable disease, especially malignant tumor. As for the prognosis, one must always express firm confidence in a favorable outcome. All information that the nurse gives to the patient must be agreed with the doctor.

A)The nurse-doctor relationship:

Rudeness and disrespectful attitude in communication are unacceptable;

Carry out medical prescriptions in a timely, accurate and professional manner;

Immediately inform your doctor about sudden changes in a sick condition;

If you have doubts in the process of carrying out medical prescriptions, tactfully clarify all the nuances with the doctor in the absence of the patient.

B)Nurse-nurse relationships:

Rudeness and disrespectful attitude towards colleagues is unacceptable;

Comments should be made tactfully and in the absence of the patient;

Experienced nurses should share their experience with young ones;

In difficult situations we must help each other.

IN)Relationships "nurse - junior medical staff":

Maintain mutual respect;

Monitor tactfully, unobtrusively the activities of junior medical staff;

Rudeness, familiarity, and arrogance are unacceptable;

It is unacceptable to make comments in the presence of patients and visitors.

Features of communication with sick children

The attitude towards children of any age should be equal and friendly. This rule must be followed from the first days of your stay in the hospital.

Medical workers who are directly among children must always take into account the psychological characteristics of patients, their experiences and feelings. Older children, especially girls, are the most sensitive and in the first days of hospital stay they often withdraw and “withdraw into themselves.” To better understand the condition of children, it is important, in addition to identifying individual psychological characteristics child, know the situation in the family, the social and status of the parents. All this is necessary for the organization proper care for a sick child in a hospital and his effective treatment.

When communicating with patients, medical workers often experience emotional stress, sometimes caused by the incorrect behavior of children, their whims, unreasonable demands of parents, etc. In these cases, it is necessary to remain calm, not to succumb to momentary moods, and to be able to suppress irritability and excessive emotionality.

It is also unacceptable to divide children into “good” and “bad,” and even more so to single out “favorites.” Children are unusually sensitive to affection and subtly sense the attitude of adults towards them. The tone of conversation with children should always be even and friendly. All this contributes to the establishment of friendly, trusting relationships between the child and the medical staff and has a positive impact on the patient.

Sensitivity is of great importance when communicating with a child, i.e. desire to understand his experiences. A patient conversation with your child allows you to identify personal characteristics, the dominant experience, helps in making a diagnosis. It is necessary not only to formally listen to the complaints of a sick child, but to show warm participation, reacting accordingly to what is heard. The patient calms down seeing the attitude of the medical worker, and the latter receives additional information about the child. On the contrary, a harsh or familiar tone in a conversation creates an obstacle to establishing a normal relationship with a sick child.

Caring for a child, in addition to professional training, requires a medical worker to have great patience and love for children. It is important to have an idea of the degree of correspondence between mental and physical development child, know his personal qualities. Frequently ill children are already early age look more infantile than their more developed healthy peers. A medical worker must be able to compensate children for the absence of parents and loved ones. Children under 5 years of age experience separation from their parents especially poorly. However, even children who are painfully experiencing a temporary separation from their parents quickly get used to the new environment and calm down. In this regard frequent visits Parents in the first days of hospitalization can traumatize the child’s psyche. It is advisable to avoid frequent visits from parents during the adaptation period (3-5 days). At the end of this period, if parents or close relatives for some reason cannot regularly visit a sick child, the nurse should recommend that they send letters more often and carry packages so that the child feels care and attention.

The medical worker has a leading role in creating a favorable psychological environment in the medical institution, reminiscent of the child home environment(organization of games, viewing television programs etc.). Walking in the fresh air brings children together, and attention and warm attitude medical personnel ensure the adaptation of sick children to new conditions.

It is necessary to maintain goodwill, unity of style and coherence in work among the staff of the medical institution, which helps to provide a high level of care and treatment for children. The nurse, being among children and observing their behavior and reactions, should see individual characteristics children, the nature of relationships, etc. By receiving this important psychological information, the attending physician can also timely change (optimize) his basic treatment tactics, which will contribute to the formation of a healthy psychological atmosphere in the medical institution and increase the efficiency of the treatment process.

Relationships between medical workers and parents of a sick child

In most cases, parents, especially mothers, have a hard time dealing with their child’s illness. And this is understandable: the mother of a seriously ill child is mentally traumatized to one degree or another and her reactions may be inadequate, since they capture the energetically very powerful sphere of “maternal instinct.” Therefore, an individual approach to the mother is necessary from all medical workers without exception. Particular attention should be paid to mothers caring for a seriously ill child in a hospital. It is important not only to reassure a woman with words, but also to create the necessary conditions for good rest, nutrition, convince her that the child is receiving correct treatment and is located in " good hands" The mother must understand the importance and correctness of the manipulations, procedures, etc. prescribed by the doctor and performed by the nurse. And if necessary, you can train the mother to perform certain manipulations, for example, injections, inhalations, etc.

Most parents treat health care workers with warmth, trust, and are grateful for their hard work. However, there are also quite “difficult” parents who try to achieve special attention hospital staff to their child. With such parents, medical workers must show internal restraint and external calm, which in itself has a positive effect on poorly educated people.

Great tact requires a conversation between a medical worker and the parents and relatives of a sick child on the days of visits and receiving packages. Despite the workload, the medical professional should find time to calmly and leisurely answer all questions. Particular difficulties may arise when parents try to find out the diagnosis of the child’s disease, clarify the correctness of the treatment, and the prescription of procedures. In these cases, the nurse’s conversation with relatives should not go beyond her competence. She has no right to talk about symptoms and possible prognosis diseases. The nurse should politely apologize, plead ignorance, and refer the relatives to the attending physician or department head who has appropriate competence in these matters.

You should not follow your parents’ lead, try to fulfill unreasonable demands, for example, stop injections prescribed by your doctor, change your regimen and diet, etc. This kind of “responsiveness” can only bring harm and has nothing to do with the principles of humane medicine and professional continuity.

In the relationship between medical workers and parents, the form of address is of no small importance. When addressing parents, medical workers should call them by name and patronymic, avoid familiarity and not use terms such as “mummy” and “daddy.”

Contacts between medical workers and parents in children's departments are usually emotionally intense, close and frequent. The correct tactics of communication between medical personnel and relatives and friends of a sick child creates proper psychological balance interpersonal relationships between a medical worker - a sick child - his parents.

Legal and moral standards of responsibility of medical workers

medical deontology moral responsibility

The multifaceted activities of paramedical workers, aimed at preserving and strengthening people's health, are also regulated by legal and moral norms, which are in a certain connection and interaction. This is due to the fact that legislative acts in a socialist society have a deep moral basis.

Consequently, the legal education of medical workers must be combined with moral education, and vice versa, moral education must be combined with legal education. Moral norms such as maintaining medical confidentiality and the obligation to provide emergency medical care to citizens on the road, on the street and in other public places have been enshrined in our country in the Fundamentals of the legislation of the USSR and union republics on healthcare.

Examples of the close connection between the moral, ethical and legal aspects of the activities of medical workers include: following situations, which often occur in life. If a medical worker clearly complies with the requirements of deontology in relationships with the patient and relatives, then, despite the possible unfavorable outcome of the disease, the relatives of the deceased come to the defense of the medical worker, because they saw that during his lifetime everything was done to the patient, both from a professional and professional point of view. and moral and ethical.

On the contrary, a conflict may occur between the relatives of the deceased and the medical worker if the latter violated the requirements of deontology, showed elements of formalism, callousness and disrespect for human dignity in the process of treating the patient.

Thus, anyone who has violated certain moral or legal norms in the course of his work will bear responsibility, the extent of which will depend on the consequences of the offense.

According to State Committee on antimonopoly policy, the number of violations of the Law "On the Protection of Consumer Rights" by medical institutions and organizations for 2000 - 2009. increased by 15.4 times. Positive trends in the fight for consumer rights often reach their opposite - consumer extremism, when rights are used for unscrupulous purposes to extract profit.

Many cases of improper provision medical services become topics of publications in the media, they receive significant public response, which was not the case in previous periods of domestic medicine. The legal basis for civil liability for causing harm due to improper provision of medical services is the norms of Chapter 59 of the Civil Code of the Russian Federation “Obligations resulting from causing harm.”

Thus, Article 1064 of the Civil Code of the Russian Federation expresses the principle of a general tort, according to which harm caused to a subject of civil law is subject to compensation in full by the person who caused the harm.

Article 1068 of the Civil Code of the Russian Federation provides for liability legal entity for harm caused by a medical worker in the performance of labor obligations (special tort). At the same time, in medical activities during diagnosis and treatment, objects and substances that represent sources of increased danger are often used. These may include, in particular, X-ray and laser devices, potent medications, some diagnostic methods, etc. If the legislator assigns individual species medical services to activities that create an increased danger to others, a medical institution or organization must bear civil liability as the owner of a source of increased danger on the basis of Article 1079 of the Civil Code of the Russian Federation.

The actual basis for the liability of a medical institution or organization is the harm caused to the life and health of the patient. The liability of medical workers may arise from a contract for the provision of paid services in cases of provision of paid medical services (Articles 778 - 783 of the Civil Code of the Russian Federation). Contractual liability for causing harm to life and health during the provision of medical services may provide for more wide range the grounds for its occurrence and the amount of compensation for damage compared to tort.

Relationships of a contractual nature are subject to the Law of the Russian Federation “On the Protection of Consumer Rights”. Thus, if the planned result of treatment is not achieved when performing a certain type of medical services, a medical institution or organization, regardless of their fault, must, at the patient’s choice, either continue treatment for free, or return the money, and if there is fault, compensate for the moral damage caused (Article 15).

The Civil Code of the Russian Federation provides for the possibility of maximum compensation for losses incurred by the victim as a result of harm to life and health, since restoring health lost in such cases can be quite difficult, and sometimes impossible. According to Article 1085 of the Civil Code of the Russian Federation, the income lost by the victim or part of it is subject to compensation, depending on the degree of loss of professional ability to work; additional expenses caused by damage to health, including costs of treatment, additional food, purchase of medicines, prosthetics, outside care, sanatorium treatment, purchase vehicles, vocational training, if the victim needs these types of assistance and is not entitled to receive them free of charge.

In addition, the victim has the right to compensation for moral damage (Article 1100), and in the event of his death, the causer of harm also bears funeral expenses and in connection with the death of the breadwinner. A prerequisite for liability is the presence of a legally significant (necessary) causal connection between the actions of the doctor and negative consequences for the patient's health. Sometimes the causal relationship is so obvious that it is easy to establish. It is more difficult to determine the existence of a causal relationship in cases where the outcome does not immediately follow illegal act or when the harm is caused not by the action of one person, but by a number of factors and circumstances that complicate the situation. It should be noted that in relation to harm caused during the provision of medical services, it can be very difficult to establish a causal relationship, despite its objective nature.

The provision of medical services is a multidimensional process, including diagnostic, therapeutic, preventive measures, and deviating from the normatively prescribed behavior of a medical worker at any stage of the process can lead to undesirable consequences for the life and health of the patient in the future.

IN in some cases with all my experience and knowledge medical experts can only state the probability of the presence or absence of a causal relationship.

To impose civil liability for harm, it is necessary to establish the guilt of medical workers. Thus, according to paragraph 2 of Article 1083 of the Civil Code of the Russian Federation, if the gross negligence of the victim himself contributed to the occurrence or increase of harm, depending on the degree of guilt of the victim and the causer of harm, the amount of compensation should be reduced (the patient refuses to take medications, drinks alcohol during treatment with antibacterial drugs, violates the bed rest prescribed by the doctor, hid information about the state of his health, which is essential when choosing a treatment method).

The guilt of the victim in the occurrence of adverse consequences for his health must be proven by the causer of the harm, i.e. medical institution, organization. From medical documents it is possible to obtain information reflecting the progress of the patient’s treatment, the procedure for prescribing certain procedures, medications, health status and the patient’s complaints about various stages treatment.

Taking into account the increase in the number statements of claim citizens regarding the inadequate provision of medical services, increased attention should be paid to the problems of legal liability of medical workers for professional offenses. The implementation of legal responsibility is achieved through the use of legal means, which allows the influence of law on public relations in the field of medical activities. As you know, not all medical interventions end well, i.e. recovery of the patient. In cases of unfavorable outcomes, when it is not possible to talk about the legality of the actions of a medical worker, there is a need for an objective assessment of the treatment performed and determination of the type and degree of responsibility of the medical worker.

The main documents that make up the legal framework defining the property liability of medical workers for committing professional offenses are the Civil Code of the Russian Federation, the Law of the Russian Federation "On the Protection of Consumer Rights" (dated January 9, 1996 N 2-FZ), Fundamentals of the legislation of the Russian Federation on health protection citizens (1993). The Law of the Russian Federation “On the Protection of Consumer Rights” regulates the property liability of medical institutions and organizations through standards on the quality of services, the consumer’s right to the safety of services, compensation for moral damage, etc. The property responsibility of medical institutions and organizations implies their greater openness, a reduction in the number of departmental and professional barriers, equal rights for patients in the provision of medical services and increased legal protection for consumers of medical services.

Currently, the medical community has recognized the study of the legal framework in the field of healthcare as a real requirement of the time. In this regard, it is necessary to instill in future doctors a high legal culture and legal awareness from the “student bench”. Legal culture and legal consciousness can arise on the basis legal knowledge when developing the skills of a future specialist practical application legal norms in professional activities, thereby proper legal training of medical workers allows for the formation of a legal culture, responsibility to the individual, society and the state. This requires instilling in medical workers the desire not only to know the laws and respect them, but also the ability to apply legal norms in practice.

Currently, the general trend in medical practice is that everyone more private issues of the provision of medical services are regulated by law, and are not left to the doctor’s conscience or moral and ethical standards, which is one of the factors of legality in the field of medicine.

Thus, knowledge by medical workers of legislation in the field of health care, an understanding of their rights, responsibilities, legal liability for various professional violations, as well as knowledge of the patient’s rights form the basis legal culture healthcare workers. Streamlining the legal knowledge of medical personnel will contribute to the most complete provision of public health protection.

Conclusion

The ethical basis of the professional activity of a nurse is humanity and mercy. The most important tasks of a nurse’s professional activity are: comprehensive comprehensive care for patients and alleviation of their suffering; health restoration and rehabilitation; promoting health and preventing disease. The Code of Ethics provides clear moral guidelines for the professional activity of a nurse and is designed to promote consolidation, increase the prestige and authority of the nursing profession in society, and the development of nursing in Russia.

References

1. Guseinov A.A., Apresyan R.G. Ethics. M.: 1998.

2. Zelenkova I.L., Belyaeva E.V. Ethics: Textbook. Mn.: ed. V.M. Skakun, 1995.

3. Fundamentals of ethical knowledge / ed. Professor M.N. Rosenko. M.: Publishing house. "Lan", 1998.

4. Dictionary of ethics. Ed. I.S. Kona. M.: Politizdat, 1990.

5. Ethical Code of Russian Nurses (adopted by the Russian Association of Nurses, 1997).

6. Akopov V.I., Maslov E.N. Law in medicine. M.: Book-service, 2002. 352 p.

7. Alexandrova O.Yu. Civil liability and its features. M.: ZAO "MCFER", 2005. P. 167 178.

8. Gerasimenko N.F., Alexandrova O.Yu., Grigoriev I.Yu. Legislation in the field of protecting citizens' health. M.: MCFR, 2005. 320 p.

9. Sergeev Yu.D. Medical law. Educational complex in 3 volumes. M.: GEOTAR-Media, 2008. 777 p.

10. Civil Code of the Russian Federation (as amended on July 29, 2004).

12. Oslopov General care for patients in a therapeutic clinic.

13. “Nurse’s Handbook of Care,” edited by Academician of the Russian Academy of Medical Sciences N.R. Paleeva. Moscow, 1993

14. Ivanyushkin A.Ya. Professional ethics in medicine. M., 1990

15. Code of Ethics for Russian Nurses.

16. International Code of Ethics for Nurses.

17. Medicine and law.

18. http://www.medpsy.ru/mprj/archiv_global/2011_4_9/nomer/nomer23.php.

19. http://www.sisterflo.ru/ethics/.

20. http://www.juristlib.ru/book_7444.html.

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Ethics

In a narrower sense, medical ethics is understood as a set of moral standards for the professional activities of medical workers. In the latter sense, medical ethics is closely related to medical deontology.

Ethics studies the relationships between people, their thoughts, feelings and deeds in the light of the categories of good, justice, duty, honor, happiness, dignity. Doctor's ethics is truly human morality and therefore only a good person can be a doctor.

Moral requirements for people involved in healing were formulated back in the slave society, when the division of labor occurred and healing became a profession. Since ancient times, medical practice has been highly revered, because it was based on the desire to save a person from suffering, to help him with illnesses and wounds.

The most ancient source in which the requirements for a doctor and his rights are formulated is considered to be dating back to the 18th century. BC "The Laws of Hammurabi" adopted in Babylon. An invaluable role in the history of medicine, including the creation of ethical standards, belongs to Hippocrates.

He owns the axioms: “Where there is love for people, there is love for one’s art,” “Do no harm,” “A physician-philosopher is like God”; he is the creator of the centuries-old “Oath” that bears his name. Hippocrates was the first to pay attention to the relationship between the doctor and the patient’s relatives, the relationship between doctors. Ethical principles, formulated by Hippocrates, received further development in the works of ancient doctors A. Celsus, C. Galen and others.

Doctors of the East (Ibn Sina, Abu Faraj, etc.) had a huge influence on the development of medical ethics. It is noteworthy that even in ancient times, the problem of the doctor’s relationship with the patient was considered in terms of their cooperation and mutual understanding.

In Russia, advanced Russian scientists have done a lot to promote the humane orientation of medical practice: S.G. Zybelin, D.S. Samoilovich, M.Ya. Mudrov, I.E. Dyadkovsky, S.P. Botkin, zemstvo doctors. Particularly noteworthy is the “Sermon on the piety and moral qualities of the Hippocratic physician”, “Sermon on the way to teach and learn practical medicine” by M.Ya. Mudrova and the works of N.I. Pirogov, representing an “alloy” of love for one’s work, high professionalism and care for a sick person. The “holy doctor” F.P. became universally famous. Haaz, whose motto was “Hurry to do good!”

The humanistic orientation of the activities of Russian doctors is described in many ways in the works of writer-doctors A.P. Chekhova, V.V. Veresaeva and others.

Morality is one of the oldest forms of social regulation of human behavior and human relationships. A person learns basic moral norms during his upbringing and perceives following them as his duty. Hegel wrote: “When a person commits this or that moral act, then by this he is not yet virtuous; he is virtuous only if this mode of behavior is a permanent feature of his character.”

On this occasion, Mark Twain noted that “we do not use our morality very well in weekdays. It always requires repairs by Sunday.”

Morally developed person has a conscience, i.e. the ability to independently judge whether his actions correspond to the moral standards accepted in society, and is guided by this judgment when choosing his actions. Moral principles are especially necessary for those specialists whose objects of communication are people.

Some authors believe that there is no special medical ethics, that there is ethics in general. However, it is wrong to deny the existence of professional ethics. Indeed, in each specific area social activities human relationships are specific.

Each type of work (doctor, lawyer, teacher, artist) leaves a professional imprint on the psychology of people, on their moral relationships. Interesting Thoughts About Communication moral education Helvetius also spoke about the professional division of labor. He said that in the process of education one must know “what talents or virtues are characteristic of a person of a particular profession.”

Professional ethics should be considered as a specific manifestation of general ethics in the special conditions of specific activities. Professional ethics is a branch of science about the role of moral principles in the activities of the corresponding specialist, including issues of humanism, problems of duty, honor and conscience. The subject of professional ethics is also the study of the psycho-emotional traits of a particular specialist, manifested in his relationships with sick people (disabled people) and with his colleagues against the background of certain social conditions.

The peculiarities of the professional activity of a doctor determine that in medical ethics there is always a comparatively greater degree, in any case, more than in ethical standards, which regulate the activities of people of other professions, express universal human norms of morality and justice.

The norms and principles of medical ethics can correctly guide a medical worker in his professional activities only if they are not arbitrary, but scientifically substantiated. This means that various recommendations regarding the behavior of doctors, developed by medical practice, need theoretical understanding.

Medical ethics should be built on a deep understanding of natural law and social life person. Without connection with science, moral standards in medicine turn into groundless compassion for people. A doctor's true compassion for a sick (disabled) person must be based on scientific knowledge. In relation to a sick (disabled) patient, doctors should not behave like inconsolable relatives. According to A.I. Herzen, doctors “can cry in their hearts, take part, but to fight the disease you need understanding, not tears.” Being humane towards sick people (disabled people) is a matter not only of the heart, but also of medical science and the medical mind.

Some of the failed doctors so skillfully coordinate their behavior with the needs of medical ethics that it is almost impossible to reproach them for not having a vocation for medicine. We are talking about “that coldly businesslike accounting, indifferent attitude towards the most acute human tragedies,” wrote the famous domestic surgeon S.S. Yudin, “when behind the guise of so-called professional restraint and restrained courage they actually hide selfish insensitivity and moral apathy, moral squalor.”

Lisovsky V.A., Evseev S.P., Golofeevsky V.Yu., Mironenko A.N.

Ethics―the doctrine of moral norms and rules that determine the relationships between people in the family, society, everyday life and work. Latin word ethics, Greek ethos(custom) - the doctrine of morality, i.e. a system of consistent judgments about the foundations, meaning and purpose of morality. When defining ethics, the words “morality” and “morality” are used.

The term “ethics” was proposed by Aristotle (384–322 BC), who believed “the goal of ethics is not knowledge, but actions; ethics is needed not in order to know what virtue is, but in order to become virtuous, otherwise there would be no use from this science...”

Medical ethics― a set of norms of behavior and morality of medical workers.

In professional medical ethics, the principle of humanism should be considered the starting point.

Humanism- this is a view that considers a person as the highest value, protecting his freedom and all-round development. The term “humanism” arose in the Renaissance, and the idea of humanity (philanthropy) was formed in the middle of the first millennium BC. e. and is found in the Bible, in Homer, in ancient Indian, ancient Chinese, and ancient Greek philosophical sources of the 6th–4th centuries. BC e. During this period, the doctors of Ancient Greece made an ethical commitment - the “Oath” of Hippocrates (460–377 BC). In Hippocrates, the idea of humanism has specific expressions: “Whatever house I enter, I will enter there for the benefit of the patient... I will direct the regime of the sick to their benefit... refraining from causing any harm and injustice...”. Manifestations of the humanism of Hippocratic ethics include the commandments about medical confidentiality and the value of any human life.

The idea of humanity is embedded in the famous “golden rule of morality”: act towards others as you would like them to act towards you.

Thus, medical humanism in its original meaning affirms human life as the highest value, defines its protection and assistance as the main social function of medicine, which must fulfill this task, guided by scientific knowledge and professional skill.

2. Historical principles and models of medical ethics

For more than 25 centuries, various moral and ethical principles, rules, and recommendations have been formed and replaced each other in European culture, which have accompanied medicine throughout its history. Medical ethics comes in several forms or models.

The Hippocratic model and the principle of “do no harm.”

The moral principles of healing were laid down by the “father of medicine” Hippocrates. In the “Oath,” Hippocrates formulated the duties of a doctor to the patient and his colleagues in the profession. One of the most important principles is “do no harm.” The Oath states: “I will direct the treatment of the sick to their benefit in accordance with my strength and my understanding, refraining from causing any harm or injustice.” The principle of “do no harm” focuses on the civil creed of the medical profession.

The Hippocratic model contains an initial professional guarantee, which is considered as a condition and basis for the recognition of the medical class not only by society as a whole, but also by every person who trusts a doctor with his life.

The norms and principles of physician behavior, defined by Hippocrates, are filled with content determined by the goals and objectives of healing, regardless of the place and time of their implementation. Having changed somewhat, they are still observed today in one or another ethical document.

An example of a document created on the basis of the “Hippocratic model” is the “Oath of the Doctor of the Republic of Belarus”.

Forms of harm from a doctor:

- harm caused by inaction, failure to provide assistance to those who need it;

- harm caused by negligence or malicious intent, for example, selfish purpose;

― harm caused by incorrect, thoughtless or unskilled actions;

- harm caused by actions objectively necessary in a given situation.

Thus, the principle of “do no harm” must be understood that the harm emanating from the doctor should only be harm that is objectively inevitable and minimal.

The Paracelsian model and the principle of “do good”― a model of medical ethics that developed in the Middle Ages. Its principles were most clearly stated by Paracelsus (Philip Aureolus Theophrastus Bombastus von Hohenheim (1493–1541). This principle is an expansion and continuation of the previous principle.

Paracelsus' principles: “a doctor should think about his patient day and night”; “a doctor does not dare to be a hypocrite, a tormentor, a liar, or a frivolous person, but must be a righteous person”; “the strength of a doctor is in his heart, his work should be illuminated by natural light and experience”; “The greatest foundation of medicine is love.”

In contrast to the Hippocratic model, when the doctor wins the social trust of the patient, in the Paracelsian model, paternalism (“pater” is the Latin concept of “father”)—the emotional and spiritual contact of the doctor with the patient, on the basis of which the entire treatment process is built—is of primary importance. The main moral principle that is formed within the boundaries of this model is the principle of “do good”, goodness or “do love”, beneficence, mercy. Healing is the organized implementation of good.

The principle of “do good” can be conveyed using words such as “mercy”, “charity”, “beneficence”.

Deontological model and the principle of “observance of duty”.

Compliance of a doctor's behavior with certain ethical standards is an essential part of medical ethics. This is its deontological level, or “deontological model.”

The term “deontology” (from the Greek deontos - due) was introduced into Soviet medical science in the 40s of the twentieth century by Professor N. N. Petrov. He used this term to designate a really existing area of medical practice - medical ethics.

The deontological model of medical ethics is a set of “proper” rules corresponding to a particular area of medical practice. An example of such a model is surgical deontology. N. N. Petrov in his work “Issues of surgical deontology” identified the following rules:

- “surgery for patients, not patients for surgery”;

- “do and advise the patient to perform only such an operation that you would agree to under the current circumstances for yourself or for the person closest to you”;

- “for peace of mind of patients, visits to the surgeon are necessary on the eve of the operation and several times on the very day of the operation, both before and after it”;

- “the ideal of major surgery is to work with a truly complete elimination of not only all physical pain, but also all mental anxiety of the patient”;

― “informing the patient,” which should include mention of the risk, the possibility of infection, and collateral damage.

From the point of view of N.N. Petrov, “informing” should include not so much “adequate information” as a suggestion “about the insignificance of the risk in comparison with the likely benefits of the operation.”

The principle of “compliance with duty” is fundamental to the deontological model. “Complying with duty” means fulfilling certain requirements. An improper act is one that contradicts the requirements presented to the doctor by the medical community, society and his own will and mind. If a person is able to act according to the unconditional requirement of “duty,” then such a person corresponds to his chosen profession; if not, then he must leave this professional community.

Sets of formulated rules of conduct are developed for each medical specialty.

Ethical committees (commissions) ― analytical, advisory, and, in some cases, regulatory bodies of various composition and status, designed to develop moral rules for the functioning of specific research and medical institutions, as well as provide ethical expertise and recommendations on conflict situations arising in biomedical research and medical practice. Ethics committees are built on an interdisciplinary basis and include, in addition to doctors and biologists, lawyers, psychologists, social workers, experts in the field of medical ethics, patients and their representatives, as well as representatives of the public.

Thus, the theoretical features and moral and ethical principles of each of the listed historical models are real elements of an integral system of professional and ethical knowledge and constitute the value-normative content of professional modern biomedical ethics.