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Development of bioethics in Russia



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DEVELOPMENT of BIOETHICS IN RUSSIA

Rem Viktorovich Petrov, Boris Grigoryevich Yudin the Russian Academy of Sciences, e-conceal: byudin@yandex.ru

Emergence of domestic bioethics can be dated the end of the 80th of last century, and it means that today we have bases to state its twentieth anniversary. At that time in the center of attention of the experts representing various areas of knowledge the ethical and legal problems arising after the latest discoveries and technological breakthroughs in biology and medicine more often began to appear.

Certainly, the numerous and quite often very substantial researches devoted to judgment of social and ethical consequences scientific and technical progressa1, on the one hand, and an ethical component of medical activity with another, were conducted in our country and earlier. However that there were two different research areas, very little connected among themselves, and their rapprochement which laid the foundation for domestic bioethics only in the late eighties began. Since then and so far the bioethics in our country developed on the basis of cross-disciplinary dialogue, cooperation of biologists, physicians, philosophers, lawyers. Shortly the Russian Orthodox Church became one of equal participants of dialogue also.

The ethical and legal questions arising in connection with organ and tissue transplantation of the person were among the most sharply discussed problems of that time. And in 1990 at the initiative of All-Union scientific center of surgery of the USSR Academy of Medical Sciences "the round table" on "People took place: transplantation

and artificial organs" in which physicians, philosophers, lawyers, priests participated. Materials of this discussion were published in the Chelovek magazine 2. It should be noted that articles on bioethical subject constantly publish in this magazine from the moment of the emergence in 1990. Soon after the discussion which took place in NCH in Moscow under the auspices of UNESCO very representative conference on bioethics within which problems of transplantology were high on the list was held. In 1992 in Russia rather qualitative Law on organ transplantation and (or) tissues of the person in whom many provisions drafted in bioethics received legal fixing was adopted.

In the same years the interaction between the Russian experts in bioethics and their foreign colleagues from the countries of Europe, Canada, Japan begins to be established by the USA. One of the first contacts was devoted to discussion of the ethical problems arising in connection with the beginning of implementation of the international project "Human genome".

In 1992 within the Russian Academy of Sciences the Russian national committee on bioethics (RNKB) was created. Organizational support of work of RNKB was undertaken by Institute of the person of RAS, in particular the sector of bioethics of this institute (the head — B.G. Yudin) which throughout all time of the existence up to the end of 2004 was one of the leading bioethical centers of Russia. Later, after transformation

1B this communication should note that a considerable part of the book by I.T. Frolov which appeared in 1986 in Politizdat publishing house, B.G. Yudina "Science ethics was devoted to bioethical problems: problems and discussions".
2 See "Take my heart. I died!" — "Person", 1991, No. 4, page 93-101.

Institute of the person in department of complex problems of studying the person of Institute of philosophy of RAS, this mission undertook the sector of bioethics and humanitarian examinations created in department (the head — dokt. philosopher. P.D. Tyshchenko's sciences).

The biologist academician A.A. Bayev and the philosopher academician I.T. Frolov became the first cochairmen of RNKB. Subsequently, when there was no A.A. Bayev, the academician R.V. Petrov who after I.T. Frolov's death in 1999 heads committee individually became the cochairman of RNKB.

The background of creation of committee is interesting. According to an initial plan this cross-disciplinary structure had to be organized at Presidium of Academy of Sciences of the USSR. However to the management of Academy of that time the term "bioethics" was unknown so the solution on creation of committee was not. Later I.T. Frolov suggested to create RNKB at office of philosophy and the right of RAS. The academician B.N. Topornin heading office supported this idea. So, in our country there was a first organization which united experts in bioethics. In the next years the committees on bioethics were created at the Russian Academy of Medical Science and at the Ministry of Health of the Russian Federation. Both of these committees were headed by the academician of the Russian Academy of Medical Science Yu.M. Lopukhin. the 90th years were celebrated by emergence of a number of medical associations, and each of them paid considerable attention to bioethics problems, and the Association of doctors of Russia even adopted the ethical code. The similar document was accepted also Russian psychiatric assotsiatsiyey3.

In 1993 at a meeting of the RNKB expanded bureau the address to scientific community was approved "And direct -

to tel of the Russian science" 4. In it it was indicated on the need of adjustment for domestic science of those mechanisms of ethical regulation of biomedical researches with participation of the person and animals who act in world science. In particular, it was talked of need of examination of requests for carrying out such works and creations for these purposes of ethical committees in all scientific institutions conducting similar researches.

Among the scientific actions organized by RNKB the big conference on ethical and legal problems of biomedical researches should note carrying out in 1994. The wide public response was caused also by at the same time organized conference devoted to problems of treatment and patient care in a terminal stage of life.

Studying the ethical and legal problems arising in connection with implementation of the International project "Human genome" became one of activities of RNKB. Since 1995 up to end of the Russian RNKB program "Human genome" took the most active part in it. The edition of the collection of analytical materials and normative documents.5 At the IX annual conference of the Human Genome-1999 program in Chernogolovka became one of results of this cooperation participants of a forum adopted the statement "Ethical principles of carrying out scientific research and medical interventions in human genome" 6.

RNKB actively participates in examination of legislative and other normative documents — both national, and international. As examples it is possible to call laws "About psikhiatri-

3 See S. Korsakov. The academician I.T. Frolov and development of bioethics in Russia//the Person. — 2008. — No. 3. — Page 27-37.
4 Published in the Chelovek magazine, 1993, No. 2, page 175 and in the Poisk newspaper, No. 7 (197), 12-18 of February, 1993 See also "Ethical and legal problems of clinical trials and scientific experiments on the person and animals. Collection of materials for a conference". — M, 1994, page 18-19.
5etiko-legal aspects of the Human genome project (international documents and analytical materials). Editors originators V.I. Ivanov, B.G. Yudin. — M, 1998.
6 See Boris G. Yudin. Human Genome Program in Russia and its Ethical Principles.//Law and the Human Genome Review, No. 12, January-June 2000, p. 237-241.

the chesky help and guarantees of the rights of citizens at its rendering" (1992), "Principles of the legislation of the Russian Federation about protection of public health" (1993), "About immunoprevention of infectious diseases" (1998), "About a temporary ban on cloning of the person" (2002). It should be noted that the law on immunoprevention included many provisions formulated in the report of RNKB7 published earlier.

The important role in development of bioethics in Russia was played by introduction in 2001 of an obligatory training course on this discipline for students of medical and pharmaceutical schools. In this regard it should be noted what on an initiative and with assistance of the Ministry of Health of the Russian Federation was held several conferences devoted to teaching bioethics. At the same time very current still is a problem of preparation and retraining of teaching personnel on this discipline. For last years it was released much educational literature on bioethics. Let's call only some textbooks and manuals: "Fundamentals of bioethics" / Under the editorship of A.N. Orlov, Krasnoyarsk, 1997; "Introduction to bioethics" / the Manual / Under the editorship of B.G. Yudin, P.D. Tyshchenko, M.,1998; V.V. Vlasov. "Fundamentals of modern bioethics" / Chosen lectures, Saratov, 2000; I.V. Siluyanova. "Bioethics in Russia: values and laws", M., 2001; E. Sgrechcha, V. Tambone "bioethics"/textbook, M., 2002; I.A. Shamov. "Bioethics", M., 2002; A. Campbell, G. Gillette, G. Jones. "Medical ethics" / Transl. from English, under the editorship of Yu.M. Lopukhin, B.G. Yudin, M., 2004; P.V. Lopatin, O.V. Kartashova. "Bioethics", M., 2005; M.Ya. Yarovinsky. "Medical ethics (bioethics)", M., 2006; N.N. Sedova. A "bioethics"/course of lectures for students and graduate students of medical schools, Volgograd, 2007. It should be noted especially such fundamental edition as "Biomedical ethics" under the editorship of V.I. Pokrovsky and Yu.M. Lopukhin

7 Vaccinal prevention and human rights. — M, 1994.

(the 1st release — the 1997, 2 — the 1999, 3 — 2002). The leading experts submitting various sections of medical science became authors of this edition.

Over the years sharp disputes raised a question of the one who exactly has to teach biomedical ethics — physicians or philosophers; in different higher education institutions this issue was resolved differently. Some time ago quite hot discussion on this subject was developed even on pages of "The medical newspaper". In our opinion, not opposition, not rivalry of physicians and philosophers on this soil, and their cooperation is represented optimum. It is pleasant to note that for today such point of view becomes prevailing.

One more problem to which it would be desirable to pay attention is teaching bioethics in higher education institutions and at faculties of a biological and biotechnological profile. It is known that the bioethical subject is often updated not only in connection with the latest technological developments in the field of medicine, but also in the context of application of biotechnologies in agricultural and industrial production, sport, space exploration and also in the context of protection of the biosphere on our planet. The border dividing bioethics and ecological ethics always was quite unsteady, and today it is especially a pronitsayema. In many educational institutions training experts in biological sciences and technologies, bioethics courses are already given. However a lot of things still should be made not only in the sense of development of courses of bioethics and coverage of all higher education institutions occupied with training on the corresponding specialties by them but also for developing the skills of the teachers capable to teach these courses.

Taking into account the cross-disciplinary nature of bioethics it must be kept in mind also its teaching for lawyers, sociologists, psychologists, journalists. Predsta-

vitel of all listed disciplines and professions more often should deal with bioethical problems and as shows, in particular, the scandal taking place a few years ago which arose in one of the Moscow hospitals in connection with removal of organs of the person for change, not always they appear at the appropriate level.

of One of characteristics of bioethics is close connection of discipline with a complex of jurisprudence. Quite often ethical judgment of the social and human problems arising in connection with emergence of new biotechnologies leads to the fact that at some stage the need of legal regulation of the corresponding field of activity begins to be realized. In each case the speech has to go about coordination of multidirectional interests of the parties entering interaction.

We will take such technology as organ transplantation of the person for an example. In this case act as the interacting parties, first, the recipient for whom change of the failed body can be in the only way to rescue (and who is often forced to wait very long for the turn); secondly, the donor (live or died) from whom this body is withdrawn and also his relatives; thirdly, the transplantologists performing organ transplantation and, therefore, guided by the interests of the recipient; fourthly, the physicians dealing with the donor and respectively guided (in case of the dying donor until the diagnosis of death of a brain is made) its interests; at last, fifthly, the physicians acting as intermediaries between the crew accompanying the donor and the crew performing transplantation. It is clear, that not in all cases the interests of each of these parties coincide, and precepts of law are designed to regulate possible cases of the conflict of interests.

The last decades are marked

rapid growth of number of the normative documents relating to biomedical and biotechnological activity. Above some domestic acts relating to this area were called. But along with them the increasing number of normative documents in the sphere of bioethics is developed and accepted by many international organizations. Among them it is necessary to call as intergovernmental (the UN, UNESCO, WHO, UNAIDS, the Council of Europe, the European Union), and non-governmental (The World Medical Association, SYuMB, the International association of bioethics, BGOSEK — network of independently created regional forums on ethical examination of biomedical researches). Regional division of BGOSEK is the Forum of ethical committees of the Commonwealth of Independent States (Federal Energy Regulatory Commission of the CIS) organized in 2001. Over the years this Forum was headed by the doctor of medical sciences O.I. Kubar (St. Petersburg); since 2006 its chairman is dokt. medical sciences A.S. Sozinov (Kazan). A number of normative documents on bioethics (model laws) was adopted by also Inter-parliamentary assembly of the CIS.

Domestic experts in bioethics play more and more noticeable role in development of the international normative documents. With their active participation work on such documents as the Universal declaration of UNESCO on human genome and human rights (1997), the Universal declaration of UNESCO on bioethics and human rights was conducted (2005). In the course of preparation of this document in Moscow in January, 2005 the regional seminar of UNESCO which number of recommendations found reflection in the final text of the Declaration was held. The Russian expert in the field of bioethics academician R.V. Petrov was over the years a part of the International bioethical committee (1BC) operating under the auspices of UNESCO — body which is formed of number of leaders

world experts in this sphere. Now the doctor of medical sciences O.I. Kubar is a part of this committee from the Russian Federation. Our country is presented also as a part of other structure operating within UNESCO — Intergovernmental bio-ethical committee (YuVS).

Since 1998 the Russian representatives began to take part in work of Steering committee on bioethics of the Council of Europe (SBV1). Within several years the representative of Russia in SBV1 of the member correspondent of RAS B.G. Yudin was a member of bureau of this committee. Besides, experts from Russia participated in activity of the working groups created under the auspices of SBV1 for preparation of separate normative documents.

Among the regulations adopted during this time by the Council of Europe it is necessary to call first of all the convention on protection of the rights and advantages of the person in connection with use of achievements of biology and medicine, the convention on human rights and biomedicine adopted in 1977 — the fundamental document covering a wide range of bioethical problems. Characteristic of the convention on bioethics (such is its widespread short name) is development and the adoption of the additional protocols in more detail regulating certain problem spheres of biomedicine. Further the convention on bioethics made new 4 documents: the additional protocol on the ban of cloning of the person (1998), the additional protocol on organ and tissue transplantation of human origin (2001), the additional protocol on biomedical researches (2004), the additional protocol on genetic testing in medical purposes (2008).

Unlike the declarations mentioned earlier, the convention on bioethics and additional protocols to it carry (for the countries which signed and ratifying them) legally binding character, i.e. the domestic legislation of the respective country has to

to be brought into accord with the norms established by the called documents. And all these norms are directed to protection of health, the rights and dignity of both patients, and participants of biomedical researches. Unfortunately, the Russian Federation still did not join neither the convention, nor one of additional protocols though the set of resolutions at different conferences and seminars was about it adopted, up to hearings in the State Duma. And the non-alignment reasons — purely bureaucratic: the convention and protocols are, in essence, documents of interdepartmental character, but any of departments does not take the responsibility for carrying out necessary coordination. However, concerning one of additional protocols concerning the ban of cloning of the person, the situation is a little differently. The position of Russia on this matter was developed at the time by the commission which is specially created at the Ministry of Industry and Science headed by the academician R.V. Petrov. The commission came to a conclusion that signing of the additional protocol forbidding cloning of the person is considered inexpedient. In exchange to refusal was decided to accept not a constant, but temporary ban (moratorium) on cloning of the person. The meaning of the offered moratorium was in that, first, it was possible to react quickly to technological innovations in the field of cloning and, secondly, to consider possible changes of positions of the Russian scientists on the matter.

Adoption in 2002 of the law which was already mentioned by us above imposing a temporary ban on cloning of the person in the Russian Federation for a period of five years became result of the recommended position. The law was highly appreciated by the Council of Europe subsequently. However, validity period it expired in 2007, and any new document concerning cloning of the person still is not accepted. The last means that for today in Dews -

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these are absent any legal restrictions for use of technologies of cloning to the person.

Life of community of bioetik in our country considerably quickened after acceptance in 2005. Universal declaration of UNESCO on bioethics and human rights. The fact is that UNESCO it was not limited to adoption of the Declaration, and put as one of the tasks assistance to performance of its principles in different countries. In particular, in Russia with assistance of UNESCO a number of the projects aimed at the development of bioethics was implemented. The first of them — the carried-out in the Moscow humanities university at the beginning of December, 2005, i.e. literally in one and a half months after adoption of the Declaration, big international conference "Social justice in health care: bioethics and human rights". The conference was convened at the initiative of department of ethics of science and technology of the sector social and the humanities of UNESCO. Results it showed that the domestic bioethics began to develop the problem field, new to itself connected with participation of society in formation, realization and assessment of policy in the field of health care as one of the most important spheres of life of modern society.8

One more project supported by UNESCO set as the purpose increase in level of training of the journalists writing on bioethics problems and development of recommendations about illumination of this perspective in media. Today our media more often address the bioethical plots attracting keen interest of reader's and spectator audience. Unfortunately, cases when interest "is warmed" by submission of bright, but not really reliable information concerning any given opportunities biomedi-are frequent

tsinsky technologies and the risk connected with their application. And meanwhile on the basis of information obtained from media, many citizens make very crucial decisions concerning the health and health of relatives. During implementation of the project supported by the Moscow bureau UNESCO and the Union of journalists of Russia, experts in bioethics P.D. Tyshchenko and B.G. Yudin held in 2006-2007 a series of seminars and master classes for journalists in Moscow, Dagomys, Barnaul, Kazan. Also two grants for the journalists lighting a bioethical perspective.9 were published

One of realities of the modern world — considerable number of natural and technogenic catastrophes which result there is a large number of victims. Very often at the same time to the aid there arrive groups of rescuers from various regions of the planet. When holding saving actions sometimes it turns out that deep cultural differences between local community and rescuers generate the difficulties and even the conflicts fraught with especially serious consequences in the conditions of emergency situation. During implementation of the project supported by the Moscow bureau UNESCO the grant including ethical principles and the recommendations of UNESCO and VMA10 was prepared, following to which will allow to avoid conflicts of this sort.

It should be noted one more project approved by UNESCO. The analysis of the existing regulatory framework designed to provide protection of the rights and dignity of the person — the participant of biomedical researches was his task. On the basis of such analysis it was supposed to reveal the disagreements and gaps existing in the domestic legislation and predlo-

8 Materials of a conference are published in the Russian and English languages: "Social justice in health care: bioethics and human rights". — M, 2006.
9P.D. Tyshchenko, B.G. Yudin. Bioethics problems in media. — M, 2006; Bioethics and media: recommendations for journalists. Editors originators P.D. Tyshchenko and B.G. Yudin. — M, 2008.
10 Ethical problems of delivery of health care in emergency situations. — M, 2007.

to live recommendations about their elimination. During implementation of the project the collection including information and analytical materials and also international (in most cases for the first time published in Russian) and the domestic normative legal acts relating to biomedical researches was prepared and published. Along with it the draft federal law "About Biomedical Researches".i Besides, with assistance of UNESCO was drafted the big project with participation of experts in bioethics of the CIS countries was implemented. The mechanisms of ethical regulation of biomedical researches which developed in these countries are presented in the project. Two books published in the Russian and English languages.12

became a result of implementation of the project

It is important to note that with assistance of UNESCO and also acting at National Institutes of health of the USA Fonda Fogarti the website of the Russian bioetik, which address of http:// www.bioethics.ru/ was created. On the website much useful information can find about the bio-ethical projects implemented in the Russian Federation, the Russian and international scientific actions, domestic experts in bioethics, the departments and the centers which are engaged in this subject.

Soon after adoption of the Universal declaration of UNESCO on bioethics and human rights in our country the preparatory work on creation of the Russian committee on bioethics (RKB) at Commission of the Russian Federation for UNESCO began. The committee was founded by the decision of a general meeting of Commission of the Russian Federation for UNESCO on April 25, 2006. The academician R.V. Petrov became its chairman. Four posts of vice-chairmen to which the academician of the Russian Academy of Medical Science Yu.M. Lopukhin (physician), the member correspondent of the Russian Academy of Medical Science Yu.D. Sergeyev (lawyer), aka-are elected are provided

demik K.G. Scriabin (biologist) and member correspondent of RAS B.G. Yudin (philosopher). Responsible secretaries of committee — dokt. philosopher. sciences L.P. Kiyashchenko (philosopher) and N.G. Stepanova (biologist). Among members of RKB there are biologists, physicians, philosophers, lawyers.

Over time RKB carried out expertize of a number of the international and Russian normative documents, formulated the position concerning need of accession of Russia to the convention on bioethics of the Council of Europe, having stated at the same time a number of reservations, prepared the conclusion about need of extension for five years of the Federal law on a temporary ban of cloning of the person, made the statement on an euthanasia problem. At RKB meeting in February, 2007 the decision on carrying out in 2008 was made. Congress "Bioethics and Human Rights".

RKB sees one of the main objectives in promoting coordination and consolidation of the Russian bioethical community which is extremely various both in disciplinary, and in the geographical relation today. Along with Moscow and St. Petersburg the bioethics intensively develops also in Volgograd, Yekaterinburg, Kazan, Krasnoyarsk, Makhachkala, Novosibirsk, Samara, Tomsk, Yakutsk and some other cities of Russia.

At quickly growing community bio-etikov many common problems, but it should be noted that the existing dissociation is a serious obstacle on the way of their judgment and the decision. Moreover, eventually the problems demanding judgment in terms of bioethics become more and more. Today, for example, it is a high time to be engaged closely in the bioethical analysis of questions which are raised for us by the latest technologies — not only actually biomedical, but also such,

11 Analytical materials on the "Analysis of a Regulatory Framework in the field of Human Rights in the context of Biomedical Researches and Development of Recommendations about Its Improvement" project. — M, 2007.
12 Ethical examination of biomedical researches in the State Parties of the CIS (social and cultural aspects). Editor-in-chief and project manager O.I. Kubar. — SPb, 2007.

© 25. "Kazan medical zh.", No. 4. 393

as nanobiotechnologies, technologies of the directed impact on a genome, the technologies which are created on a joint of cognitive sciences and neurophysiology. In all these areas so far of high expectations, than real results, but there is a sense to think of possible social and moral consequences of their application already now before these consequences, not always positive, accept irreversible character.

Once you pay attention and to such trend which is found today, use of biomedical technologies for the solution of the tasks which are beyond far medicine in her traditional understanding. The speech can go, for example, about sport of records, the aspiration to solve by means of "tablets"

personal problems to enhance mental or physical capacities, etc.

Certainly, stating need of coordination and consolidation of efforts, we do not mean creation something at all like the managing center which would begin to dictate all the principles and installations. Such plans, obviously, explicitly would contradict the essence of bioethics of which are characteristic a discussion, dialogue, ability to listen and understand various positions and the points of view. At the same time it would be desirable to hope that activity of RKB, work of the website bioethics.ru and, at last, carrying out in Kazan of the congress on bioethics will help us to know better each other, to develop new perspective contacts and to implement joint projects.

Dorothy Norris
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