Lichterman Boleslav L, Yarovinsky Michail
Centre for the History of Medicine, Russian Academy of Medical Sciences, Moscow, Russia.
J Int Bioethique. 2005 Sep-Dec;16(3-4):17-32, 166-7.
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).
俄罗斯医学伦理的演变由多种因素决定。首先，诸如“公社”（社区）和“会议制”（集体主义）等俄罗斯概念决定了集体机构高于个体、国家高于个人等观念。俄语中没有“隐私”的对应词汇。其次，俄罗斯的大学学历医生直到18世纪彼得大帝（1672 - 1725年）推行西化政策之后才出现。医学伦理或许始于莫斯科的马特维·穆德罗夫教授（1776 - 1831年），他遵循希波克拉底信条“治疗的是人而非疾病”。第三，1861年农奴制废除后，许多农村地区的医疗服务由地方自治会（地方选举产生的议会）提供。地方自治会的医生抱有自我牺牲为社会和人民服务的理想主义观念。另一方面，在面对文盲农民时，家长式作风是必要的。医疗保健和医学的伦理问题在专业文献和大众文学中都是激烈讨论的主题。由V. 马纳塞因编辑的周刊《医生》在这场讨论中发挥了重要作用。地方医学协会采用了各自的伦理准则，但全俄罗斯的医学伦理准则从未制定出来，因为该国缺乏全国性的医学协会。1901年维肯季·韦列萨耶夫发表的《医生的自白》将医患关系和人体实验问题置于国内外公众辩论的中心。阿尔伯特·莫尔的《医学伦理》的两个俄文版本也对俄罗斯的医学伦理讨论有所贡献。医学作为一种逐利活动在俄罗斯文学中受到批评和嘲讽（例如，托尔斯泰的小说和契诃夫的故事）。医学道德通常被理解为行动中的道德生活，此时行为远比言语重要（例如医学伦理的正式准则）。
