Chapitre 1. Medical Ethics in Russia before the october Revolution (1917)

Abstract

The evolution of medical ethics in Russia was determined by several factors. First, such Russian concepts as “obshina” (community) and “sobornost” (counciliarism) determined the supremacy of the collective body over the individual body, the state over a person etc. There is no analogue for “privacy” in the Russian language. Second, Russian medical doctors with university degrees appeared only in the 18th century after the politics of westernization by Peter the Great (1672-1725). Medical ethics probably starts from Prof. Matvei Mudrov (1776-1831) of Moscow who followed the Hippocratic credo “to treat not a disease but a patient”. Third, after serfdom had been abolished in 1861 medical care in many rural regions was provided by zemstva (local elected councils). Zemskie medical doctors had idealistic views of self-sacrificing for the service to society and to the people. On the other hand, while dealing with illiterate peasants paternalism was a necessity.
Ethical problems of healthcare and medicine were a subject of intense discussions both in professional and popular literature. A weekly periodical “Vrach” edited by V. Manassein played an important role in this discourse. Local medical societies adopted their own ethical codes but an All-Russian code of medical ethics was never formulated because the country lacked a national medical society.
“Confessions of a physician” by Vikenty Veresaev published in 1901 put problems of doctor-patient-relationship and human experimentation in the centre of public debates both nationally and internationally. Two Russian editions of “Aerztliche Ethik” by Albert Moll also contributed to the discourse on medical ethics in Russia.
Medicine as a money-making activity was criticized and ridiculed in Russian literature (see, for example, Tolstoy’s novels and Chekhov’s stories). Medical morality was generally understood as moral life in action when deeds are much more important than words (e.g. formal codes of medical ethics).