UDC 355.

40

V.Yu. Gorelov

Doctor of Law,

Associate Professor of the Department of State Law Disciplines

KROK University of Economics and Law

V.Yu. Gorelov

Candidate of Law,

Associate Professor of the Department of State Law

KROK University of Economics and Law

V. Horielova

candidate of legal sciences,

Associate Professor, Department of State Legal Sciences

University of Economics and Right «STEP»

Content of morality in medical activity

The article is devoted to the analysis of the content of norms of morality in the
activity of medical professionals of the present. Some international legal
documents related to views on morality in health care have been examined.

Keywords: morality, moral qualities, medical worker, modern society.

The question of morality in the professional activity of doctors is not a novelty of
the present, but a legal phenomenon known even before our era. As in those days
and in modern society, one of the main components of a doctor's professionalism is
his personal moral qualities, which should not go against the norms of professional
ethics. But the question arises: does the professional ethics of the physician meet
the proper level and requirements that society treats as one of the most humane
professions, and what criteria must exist to determine the completeness of a given
morality? In order to answer these questions, it is, first of all, necessary to consider
a modern international view of medical ethics.
The Geneva Declaration, adopted by the Second General Assembly of the
World Medical Association in Geneva (Switzerland, September 1948), with
subsequent amendments thereto (1968, 1983, 1994) established the solemn oath of
physicians who join the community of physicians. Thus, physicians throughout the
world swear to devote their lives to service for the benefit of man, affirming human
life from its inception as the highest value; respect and gratitude your own teachers
and respect for colleagues; in good faith and worthy to bear your professional
burden: to take care of the patient's health, to keep secrets entrusted to them even
after his death; to approve the honest and noble traditions of the profession of
doctor; no warnings related to age, health, religion, race, gender, nationality,
political beliefs, sexual orientation or social status to fulfill their duty to the
patient; not to use their knowledge of the doctor contrary to the laws of humanity
[1].
The last provision of the Geneva Declaration finds continuation and is
revealed in the following document. Thus, according to the Declaration of the
World Medical Association “Ethical Principles of Medical Research with Human
Involvement as a Object of Research”, the primary responsibility of the physician
is to protect and maintain the health of patients, including those involved in
medical research ( 3). The very participation of a person as an object of study
should be voluntary (p.22), and the study can be conducted only if the significance
of the goal outweighs the inevitable risks and difficulties for the objects of the
study (p.21) [2].
Analyzing this document, we can conclude that medical ethics, in fact,
obliges doctors to arrange certain internal documentation. From the contents of the
Declaration of Helsinki, it turns out that the medical institution must provide
anyone who agrees to be the "object of study" the following information about:
- purpose and methods of research;
- sources of research funding;
- possible conflicts of interest;
- Institutional affiliation of researchers;
- the expected benefits and potential risks of the study and the inconvenience it
may cause;
- any other aspects of the study;
- the right to refuse to participate in the study or to withdraw its consent to
participate at any time without claiming it.
The World Health Association Declaration of Helsinki also emphasized the
particular attention that needs to be given to the specific information needs of
certain potential “research objects” and to the methods of providing such
information [2]. In our opinion, the use of the phrase "object of study" to a living
person with a number of constitutional rights in any legal country is not entirely
correct in this case. In this case, the “subject of study” would be true. Also, the
believers are seen to exacerbate the obligation of the medical (research) institution
to receive from the subject of the study a written consent to carry out for each
action, and a receipt for proving information.
An important document that should be matched by the international
community of doctors is the International Code of Medical Ethics, adopted by the
Third General Assembly of the World Medical Association in England in October
1949, as amended in 1968 and 1983. The content of this Code extends the oath of
physicians that is set out in the 1948 Geneva Declaration. Thus, the moral duties of
the doctor include the provision that the doctor should not allow financial interests
to influence the free and independent execution of professional decisions in the
interests of patients, and the doctor should be honest with patients and colleagues,
and must fight with professional and personal defects other doctors, expose the
deception and fraud of other doctors.
In advance, the following actions of a doctor are recognized as unethical by
this Code: doctor's self-promotion (unless the reverse is permitted in a particular
country) and receipt of any remuneration only for the transmission of anyone's
recommendations or only for the issuance of directions and recommendations of
any nature to the patient. Important is the provision of the International Code of
Medical Ethics that a doctor must "certify only that he has checked himself" [3]. In
fact, these requirements are fully reproduced in the Moral Codes of Physicians of
Spain, USA, France, Germany, Russia, etc.
The American Code of Ethics for Healthcare Professionals, which serves as
the common moral guideline of the American NAHQ National Association for
Health Care Quality, recognizes the following ethical requirements for health care
professionals:
- work competently and impartially;
- practice only within the limits of their education and knowledge;
- treat patients with compassion and respect;
- to respect the autonomy and confidentiality of patients;

- care for patient safety;

- improve their skills and share experience with colleagues throughout their lives;
- to share their knowledge and practical experience with young specialists;
- Respect the institution where the healthcare provider works.
- maintain transparency and honesty when providing information to public
authorities, supervisory authorities and accreditation bodies ;.
- to provide information when necessary for the protection of the public interest;
- cooperate with scientists, respecting intellectual property rights.
The NAHQ American Code of Ethics for Workers also includes a section on
health care behavior. This section is often placed separately, acting as a stand-
alone document called the Code of Conduct for Health Care Professionals.
According to the latter, each member of the National Association for Quality of
Health must adhere to the following ethical rules:
- abide by the NAHQ Code of Ethics;

- Practice with honesty, integrity and responsibility to uphold public trust as

defined in the NAHQ Code of Ethics.

- refrain from indecent statements, defamation, unlawful acts and shameful

behavior that casts a shadow in honor of NAHQ and NAHQ staff;

- Respect intellectual property rights owned by NAHQ.

- avoid potential conflicts of interest;

- to maintain the confidentiality of relevant business information obtained

directly or indirectly in the course of their duties [4].
In accordance with the Code of Medical Ethics, which was adopted in
accordance with the Spanish Constitution by the Spanish Medical Association in
1978, with subsequent updates in 1990, 1999 and 2011. The purpose of this Code
is to strengthen society's commitment to the medical profession. This moral code
begins with a prayer - an appeal to God, to which I respect the creation of the Lord
- a man, gratitude for a profession from God, called to "alleviate the suffering of a
brother", a plea for God "to not thirst for profit, the desire for glory", as well as the
oath-request "let no strange thoughts distract my attention at the bedside." (p.3-4)
According to Art. 5 of the Code of Ethics of Spain, the medical profession
must serve humanity and society, and the physician must respect human life,
dignity and health care, with equal care and respect for all patients without any
discrimination. In addition, in item 3 of Art. 5 states that a physician cannot refuse
assistance to a person in the event of fear that his or her illness may cause a risk of
infection to the physician. Also, according to Article 6, doctors are not entitled to
refuse any patient in need of their care, even in situations of natural disaster or
epidemic. Of interest from the point of view of law is the requirement contained in
clause 6 of Article 6 of this Code: "doctors who legally enjoy the right to strike are
not released from the professional obligations for their patients, to whom they must
provide urgent and urgent care" .
A special requirement in the Code of Medical Ethics of Spain (Article 15) is
the duty of the doctor to inform the patient clearly, truthfully, with deliberation and
discernment about his state of health, so as not to cause harm to the patient
(paragraph 1 of Article 15). And also the doctor should respect the right of the
patient not to be informed (item 2 of article 15). In addition, in accordance with
Art. 17 "Patient complaints should not adversely affect doctor-patient relationships
or quality of care." With regard to medical secrecy, this code fully regulates this
issue, and defines a range of information that cannot be classified as confidential
(Article 30). In Art. 36 of the Code also states that the physician is obliged to try to
cure or improve the health of patients in any case, and if this is no longer possible,
With regard to the moral behavior of doctors among themselves, Art. 37 of
the Code states that doctors “must treat each other with due respect, respect,
loyalty, whatever the hierarchical relationship between them. They have an
obligation to protect the colleague who is being attacked or wronged, to refrain
from criticizing the actions of their colleagues. " It is also interesting to note in Art.
38 of the Code, according to which doctors should report breaches of medical
ethics by their colleagues.
Also important in the present world is Art. 60 of this code, according to
which "the doctor must never participate, prevent or apply torture or ill-treatment,
regardless of the arguments" and is obliged to report such negative manifestations
to the competent authority, and the doctor is not entitled to engage in any activity
which means manipulation of the mind or consciousness of man [5].
The Australian Medical Code contains similar requirements regarding the
care and respect of doctors to their patients, requirements of politeness,
compassion (p.3.2.1.) Non-discrimination or priority (including race, religion,
gender, disability) (p.2.4.1 - 2.4 .4), and requires that patients not be refused
treatment for personal or religious beliefs (clause 4.2.7), treat each patient as an
individual, (clause 3.2.2.), Respect patients' privacy and rights (clause 3.2.3), not to
exploit patients physically, emotionally, sexually or finely nso (Section 3.2.6) [6].
The Medical Code of Ethics of France contains similar requirements
regarding the respect of physicians for a patient, and also states the need to respect
a person after his or her death (Art. R.4127-2). Among other ethical requirements
for a doctor, the French Code of Ethics states that "medicine should not be
practiced as a business" and "all procedures for direct or indirect advertising are
prohibited" (Art. R.4127-19). This Code also provides a warning to physicians for
bribery: "accepting assistance in kind or in cash, in any form, directly or indirectly"
(Article R.4127-24), and the requirement "to restrain, even outside the practice of
your own profession, from any act that may discredit it ”(Art. R.4127-31) [7].
The Israeli doctor's code of ethics actually reproduces the provisions of the
World Health Association's Declaration of Helsinki and is very similar in content
to the German Moral Code of Medical Practitioner. The ethics of Israeli doctors
also highlight the concern for the status of medicine in the eyes of the public [8].
Japan has developed some of its own medical ethics, combining Buddhist
and Confucian norms with a Shinto background, with imports of Western values.
Ethical rules of a doctor in Japan assure that the doctor "will not engage in medical
activities for profit." Japanese medical ethics is also influenced by broader cultural
traditions, in this case the indigenous Shinto thought, Buddhist and Confucian
thought, inspired by China. One example of the traditional Japanese code of
medical ethics comes from the Ri-Shu School of Medical Practice, which dates
back to about the sixteenth century. The doctor's code of ethics is the seventeen
rules of Engin, which have much in common with the Hippocratic oath, including
a firm commitment to "serving the patient" and "keeping confidential all
information received from the patient.
Morality in Japan also addresses the need for medical treatment for persons
to reduce or eliminate their pain, which could lead to premature death. In Japanese
law, such precedent is considered legitimate under several conditions (Nagoya
High Court judgment, 1962):
- in cases where the patient suffers from an incurable disease;
- in cases of unbearable pain, and if he does not have any other means of relief;
- in cases where there is an agreement or agreement based on the true will of the
suffering person.
In cases where the patient's consciousness is not clear enough to express his
wishes and will, and if there is no hope of recovery for such a person, in Japanese
law, "consent or sincere request of the immediate family" is sufficient [9].
Also in Japan, the Ministry of Health and Welfare has published guides that
should help practitioners resolve complex moral dilemmas in their work. For
example, the guide lists four moral factors that should be considered by the doctor
when considering whether to disclose a cancer diagnosis to a patient: 1) the
purpose of the disclosure should be clear; 2) the patient and family members
should be able to accept the diagnosis; 3) the nature of the relationship between the
doctor and his family should be taken into account; 4) the ability to provide the
patient after the disclosure of a diagnosis of psychological support [10].
The moral tenets of Russian doctors are based on the requirements of the
International Code of Medical Ethics, the provisions of the Geneva and Helsinki
declarations. Some of the articles in the Code of Professional Ethics of the Doctor
of the Russian Federation, which was adopted by the First Congress of Doctors of
the Russian Federation on October 5, 2012, supplement the above documents.
Thus, according to Art. 7 of the Code, a physician examining or treating a person
deprived of his liberty may neither directly nor indirectly contribute to the
encroachment on the physical or psychological integrity of that person or his or her
dignity. In addition, the doctor should pay particular attention to the fact that stay
in detention facilities does not become an obstacle to receiving timely and quality
medical care. If the doctor ascertains that the person deprived of liberty has been
the victim of abuse or ill-treatment,
An interesting example is Russia's existence of the "Orthodox Moral Code
of the Doctor," which in addition to the general requirements embodies the
orthodox principles, the origin of which are the commandments of the Lord of the
New Testament. According to them, the doctor has the moral right to refuse the
operation of abortion and sterilization of patients in accordance with their religious
and moral convictions, even in the conditions of legislative authorization for such
medical interventions (clause 5.4). In addition, the Orthodox doctor has the moral
right not to participate in procedures related to artificial insemination in accordance
with his religious and moral convictions, even in the conditions of legislative
authorization for such medical interventions (p.5.5) [12].
The Russian Code of Ethics for Runet Doctors also applies in Russia,
according to which an Internet physician should not make a diagnosis over the
Internet and should not prescribe treatment via the Internet [13].
Ukraine, based on the principles of humanism and charity, in accordance
with the Declaration of the World Medical Association and the requirements of the
legislation of Ukraine on the rights of citizens to high-quality and affordable health
care, declaring the leading role of doctors in the health care system, and also taking
into account the special nature of the doctor's relationship and the patient and the
need to complement the mechanisms of legal regulation of these relationships, the
All-Ukrainian Congress of Medical Organizations adopted the Code of Ethics of
the Doctor of Ukraine on September 27, 2009. The main slogan of this Code of
Ethics is not only the principle of "do no harm", but also "bring the greatest
benefit" (clause 3.3). In this document, much attention is paid to the principles of:
respect for the honor and dignity of the patient; non-interference with the patient's
personal life; observance of professional secrecy obtained in the course of
treatment of the patient (clause 3.6);
In Section 8.1. The Code states the principle of respect for the doctor in his
profession, according to which doctors are obliged to refrain in all spheres of their
activity (professional, public, journalistic, etc.) from any actions or statements that
undermine respect for the medical profession. Also, for the sake of ensuring the
life and health of patients, physicians must actively oppose the promotion and use
of diagnostic and treatment methods and remedies not provided for by current
Ukrainian legislation (para. 7.4) [14].
 Thus, the world views on the issues of morality of the modern physician
broadly coincide in a number of developed countries. This means that morality in
most countries of the world is the same. The main requirements that apply to
doctors are not only the general requirements of morality, which are understood
and accepted in the society of each country, but also the presence of "increased
level" of morality, because the most important thing for the doctor is to ensure the
preservation of life and improve its quality.
For the health care system in countries that aim to promote human and
citizen rights, the ability to exercise the human right to health care is paramount. It
is possible to exercise this right only through a doctor who has not only relevant
medical knowledge but also possesses professional ethical (moral) qualities. Only
a high-moral physician can be fully responsible.

Literature:

1. Geneva Declaration Adopted by the 2nd General Assembly of the WMA,

Geneva, Switzerland, September
1948,https://zakon.rada.gov.ua/laws/show/990_001
2. Declaration of the World Medical Association Helsinki on "Ethical
Principles of Medical Research with Human Involvement as Object of
Research" https://zakon.rada.gov.ua/laws/show/990_005
3. International Code of Medical Ethics Adopted by the 3rd General Assembly
of the Military Medical Academy, London, England, October
1949.https://zakon.rada.gov.ua/laws/show/990_002
4. NAHQ Code of Ethics for Healthcare Quality Professionals and Code of
Conduct https://nahq.org/about/code-of-ethics/
5. Code of Medical Ethics of
Spainhttps://www.cgcom.es/sites/default/files/code_of_medical_ethics/
files/assets/common/downloads/Code%20of%20Medical%20Ethics.pdf
6. Good Medical Practice: A Code of Conduct for Doctors in Australia
https://apps.who.int/medicinedocs/documents/s17805en/s17805en.pdf
7. ODE DE DÉONTOLOGIE MÉDICALE
La France Édition Novembre
2019https://www.conseil-national.medecin.fr/sites/default/files/codedeont.p
df
8. The Ethics Board Rules and Position Papers of the country of
Israelhttps://www.ima.org.il/userfiles/image/EthicalCode2018.pdf
9. John F. Peppin. Mark J. Cherry. Regional perspectives in Bioethics. New
York.- 2017
10.Japanese Bioethics / Regional Perspectives in Bioethics: Japan, pp. 321-337
and Peppin, J. ed., Annals of Bioethics: Foundational Volume on Regional
Perspectives (Swets & Zeitlinger, 2003). Author: Darryl RJ Macer
https://www.eubios.info/Papers/japbe.htm
11. Code of Professional Ethics of the Doctor of the Russian Federation
adopted by the First Congress of Doctors of the Russian Federation October
5, 2012, Moscow http://webmed.irkutsk.ru/doc/order/kodeksetiki.pdf
12. Code of professional ethics of an Orthodox doctor
http://www.opvspb.ru/library/ofitsialnye_dokumenty/kodeks_professionalno
y_etiki_pravoslavnogo_vracha/
13. Code of Ethics for Runet Physicians
https://forumnov.com/archive/index.php/t231208.html
14.Code of Ethics of the doctor of Ukraine. Adopted and signed at the All-
Ukrainian Congress of Medical Organizations and the Xth Congress of the
All-Ukrainian Medical Society (VULT) in Evpatoria on September 27, 2009
http://www.vitapol.com.ua/user_files/pdfs/mtu/615651495680396_1401201
01907.