Medical Ethics in the Soviet Union
It is now widely recognized that there are alternative medical ethics, including those of religious traditions, of secular philosophical systems, and those of other cultures. While our knowledge of these varied approaches is increasing, we still know almost nothing about medical ethics in the Soviet Union. We do know that what the Soviets call medical deontology has been discussed in Soviet medical schools for many years and that in 1971 an Oath for Soviet Physicians was adopted by the Presidium of the Supreme Soviet.
To begin increasing communication between Americans and Soviets in medical ethics, I, along with five other American philosophers specializing in medical ethics, recently visited the Soviet Union for nine days.(1) The explicit focus was on ethical problems of death and dying, but many other concerns in medical ethics arose during our stay. The trip was arranged by IREX (International Research and Exchanges Board, a creation of the American Council of Learned Societies and the Social Science Research Council) and the Institute of Philosophy of the Soviet Academy of Sciences. We spent most of our time in Moscow meeting with philosophers, physicians, and others interested in these issues. We also traveled to Tbilisi, the capital of the Georgian Soviet Socialist Republic, where we met with Georgian philosophers, clinicians, and researchers at the Institute of Experimental and Clinical Therapy of the Ministry of Health. All told, we met with some fifty professionals working on issues relevant to our field.
Our conversations were extremely cordial, open, frank, and collegial. as expected, discussion often referred to the key figures of dialectical materialism, especially Lenin, but in keeping with the current themes of glasnost (openness) and perestroika (restructuring)--themes that were omnipresent in our discussions--other philosophical categories emerged frequently. Even religious and quasi-religious language--references to the soul, spirituality, and immortality--surfaced from time to time without any embarrassment.
It would be a serious mistake to attempt a definitive report on Soviet medical ethics on the basis of such a brief visit. However, the developments in the Soviet Union in this area are so important and so little known to those of us in the West that a brief report offering a tentative summary of major themes is in order.
We never discussed with our Soviet colleagues the question of reporting impressions, so to respect comments that may have been offered in confidence, I will not attribute any of my observations to specific individuals. Suffice to say that some themes appeared to be so clear--in both Moscow and Tbilisi--that they must represent significant, if not unanimously held positions. Since our focus was on issues of death and dying, those concerns predominate in this report. Some topics, such as informed consent, truthtelling, and resource allocation arose frequently, while others--confidentiality and genetic engineering, for example--were hardly discussed.
Ethics and Medical Ethics
Medical ethics in the Soviet Union has not developed as an interdisciplinary specialty to the extent it has in the United States. The philosophers with whom we met were specialists in ethics, but not normally in medical ethics. They examined broad cultural themes: the problem of man; history, society, and the individual; scientific and technical progress; and the concept of health. They were much more in conversation with the continental philosophical tradition than Anglo-American analytical philosophy. With one or two exceptions, the Soviet philosophers were not in close communication with medical institutions. Indeed, Soviet clinicians were surprised that American medical ethicists were on the faculty of medical schools, understood medical terms, and could talk the language of physicians.
In what might surprise a Western medical ethicist, it was clear that the primary normative reference point for Soviet medical ethics remains the Hippocratic Oath. …