Our time opens up interesting ethical problems that can be seen in the example of vaccination, although in reality they are much broader.
I must say that until now these problems have not been posed in this way. Medicine initially sets itself the goal of preserving the life and health of people, based on utilitarianism, albeit mild and with reservations. Yes, someone will die, but we must do our best to help as many people as possible in the best possible way.
We watch the series “Charite” close to reality and see a scene where an inept student is sent to operate on a sick boy, he safely sends the child to the next world, and this does not bother anyone at all – so what? In any case, the boy would most likely have died; few children leave the clinic alive. And so at least the student practiced.
It is clear that this was due to a high infant mortality rate and much less responsibility for the patient’s life, because the mortality rate of many diseases was very high, and nothing can be done about it.
Approximately after the 2nd World War, both in the world of victorious socialism and in the developed countries of the West, a so-called safe society was created (c)anlazz ). This meant that the life of a still not old person was quite rare and only in special cases was in danger. I think it is quite legitimate to introduce such a term, because there really was a qualitative leap: no, and in the 70s a schoolchild could die from peritonitis, say, and a man 40 years old from a heart attack, but these were really rare, exceptional cases, death ceased to surround a person everywhere. The value of human life and health has grown. A demographic transition has taken place along with urbanization – there are fewer births, the life of every child has become priceless. There was no talk of any “student exercises”, the doctors were afraid to breathe on the patient, just not to harm. All of this is certainly wonderful.
But even at that time, vaccination, for example, was widely used. No one had the slightest doubt that vaccines are a great achievement of mankind (in fact, the Charite series is partly dedicated to the invention of vaccines, in particular, anti-diphtheria). This is so, because from a number of the very diseases that mow down children and adults, humanity was saved precisely by vaccines. In 1980, the WHO declared victory over one of the most dangerous infections – smallpox, and it was achieved precisely by mass vaccination.
Meanwhile, is the smallpox vaccine completely harmless to everyone? We open the list of complications:
Complications include: autoinoculation: generalized, gangrenous (progressive) vaccination; vaccine eczema; encephalic reaction (synonyms: encephalopathy, neurotoxic syndrome, convulsive syndrome, febrile convulsions); post-vaccination encephalitis (meningoencephalitis, encephalomyelitis); polyradiculoneuritis; serous meningitis.
Yes, complications on the nervous system were rare, but they were.
What was the real death rate? Fatal post-vaccination encephalomyelitis was observed in 5-10 cases per one million vaccinated.
Smallpox Vaccination Syndrome | Research laboratory of clinical pathopsychology “SANAT” (medicus-curat.ru)
(link to work in 1972)
But you must admit that if one of these five in a million is your child, it all sounds somehow different.
Yes, there were contraindications, yes, then the child was carefully examined before vaccination, but all the same, complications could not be completely avoided.
Another question is that now about these five cases out of a million would be told on the Internet, inconsolable parents would give interviews on YouTube – and then no one knew about them. Sorry, it just so happened, we’re sorry.
This, as already mentioned, is mild utilitarianism: yes, it is known that five out of a million children will die, but otherwise, without vaccination, 400 thousand would die (mortality from smallpox reached 40%). This is the very case when “is there something more important than the tears of a child – yes, the tears of two children.”
It is not necessary to attribute such a position exclusively to Soviet medicine, at that time medicine all over the world acted in about the same way.
And in recent decades, it turns out that something has changed enormously in the world. What? After all, the safety of life, in general, has not even increased in comparison with the 80s, at least there has not been a qualitative leap (although some diseases are treated better). That is, there were no actual material, scientific, and technical changes.
Something has changed in consciousness and the humanitarian background, social ethics has changed.
First, now absolutely everyone is discussing the problems of medical ethics. It is any tabloid leaflet, any talk show and any gaming streamer or beauty blogger – everyone can make a valuable judgment on issues of medical ethics, and all these judgments are equal, and not only to each other, but also to the opinion of professionals. Undoubtedly, there is the influence of postmodernism here: the absence of truth, the presence of only “points of view”; Popper’s “open society”, where the very statement of knowledge of the truth in social matters is totalitarianism.
Since the overwhelming majority of modern (and maybe not only modern) people, in principle, are not able to grasp the concept of “society”, these points of view are mainly formed from the position “I personally, my family, my closest social circle.” No, there are smart people who are able to think on the topic of society, using statistics and public data – but after all, their point of view, as we remember, is equivalent to “opinions”. And there are more opinions.
I am amazed at the frequently heard argument, amazes because it is brought in all seriousness: “If the epidemic of covid is so terrible, why did no one die in my environment and was not seriously ill ?!” Well, really, because I am the center of the universe!
It also plays a role in the fact that the problems of medical ethics are generally posed to the broad masses of people. Yes, these masses should not solve such problems. First of all, they do not know how to do this at the moment and give rise to statements of monstrous stupidity. Secondly, there is a simple tact. We know that some people will die as a result of medical errors, as a result of complications of treatment, and this is inevitable, but what kind of monster must you be to discuss with the parents of a deceased child “ah. Your child should have died, because without these actions, statistics would have killed more children. ” And that’s what we’re doing with all these press and social media discussions.
By the way, hence the widespread hatred of “killer doctors”, equating a medical error (even inevitable, even with an experienced good doctor) downright with the usual deliberate murder. A person who has no idea at all what responsibility for someone else’s life is, and is mistaken at every step in his work, makes claims to others as to an almighty god: they say, I didn’t choose such a job, so I’m clean and good and I have the right you bastards, to judge.
But what is life there. Take a measure as simple as wearing masks. 1960th year (hypothetical), epidemic, the Ministry of Health issues an instruction: in such and such places to wear masks. All calmly put on masks and wear until the next order. Particularly violent people personally try to avoid wearing masks and in every possible way skimp, nothing terrible happens from this either. In addition to the instructions of the Ministry of Health, this is not discussed anywhere, no one writes indignant letters to the editor, everything is calm.
2020, an epidemic, an instruction to wear masks is issued. The entire press explodes with clever articles from experts on the topic of statistics, how many people die from the disease, how much it is hard to bear, how many will get sick at all, what are the predictions. These articles are overgrown with comments, opinions (which, as we remember, are all the same), bloggers, YouTubers comment on all this, and everyone is madly passionate about an interesting ethical task: why young and healthy people should experience terrible inconveniences from wearing a mask when they die from an illness in mostly old people? And they go there! (in all seriousness!) Oh, not only old people, but everyone over 50? Oh, and the chronicles in general, too? Well does not matter. we are young and not chronicles. Why We Should Sacrifice Ourselves! Citizens hysterically describe the hardest suffering, how they “almost lose consciousness” in masks, how “you enter the kindergarten and see nothing for 15 minutes. Because I have glasses!” etc.
There is a whole host of topics for discussion – and the conflict of generations, and the issue of trust in medical official institutions, and various interpretations of statistics (they are also made, as we understand it, NOT by experts in medical statistics, but by people of completely different specialties), and, finally, a worldwide conspiracy either TMP, or the pharmaceutical industry …
Actually, the same story with vaccines. A hypothetical 1960th year: a vaccine is released, citizens are vaccinated in an organized manner, everyone goes and does it calmly, the epidemic is suppressed.
Year 2020 … do you need to continue?
What is really happening: the personal has finally and irrevocably won a complete victory over the public. “The forest is being cut down – the chips are flying” – this is terrible Stalinism, totalitarianism and horror. Never again. Every particular tear of a child is important. If I personally go and get vaccinated, I may have complications, and those who consider my personal complications a necessary payment for the general immunization of the population are totalitarian killers.
Moreover, this is happening equally in the West and in the Russian Federation. Only in the Russian Federation are the authorities trying to act as if we are still in the 1980s, and citizens should, in theory, voluntarily go and do what they are told. And the citizens courageously resist the totalitarian government, fighting against anti-antiquity measures, vaccines and other “worldwide conspiracy.”
In the West, however, there are official discussions of experts in ethics, philosophy, social psychology, round tables of experts, that is, the population is being told that yes, we understand your personal concerns and are also thinking about it. Due to this, reactivity decreases, that is, the desire to “do it out of spite”, and the population becomes more loyal to antiquated measures. But at the exit – the same garbage, maybe a little better. There may be a way to solve the problem, but apparently, since in the 80s it will no longer exist.
Meanwhile, it is not only antiquarian measures that are under threat, it is still okay. Vaccines, in principle, are under threat, because the anti-vaccination movement is growing, experts are also discussing with might and main the autism allegedly caused by vaccinations and a host of other problems in children.
And this is just the beginning.
Because the antagonistic dialectical pair personal / public has many very different manifestations. Medicine is just the beginning. Our civilization is built on the interaction of these two principles, and the public has always had at least a slight priority over the personal (yes, in the West too).
The construction of, for example, any road – railroad, highway – is not complete without injuries or even deaths.
Yes, thanks to social progress, the number of these injuries has been significantly reduced. This is not the 19th century, when “you were robbed by literate foremen, your bosses were beaten, and poverty crushed,” and as a result, “brothers, you are reaping our fruits, but we are destined to rot in the earth.” Nowadays, injuries and deaths at work are rare. But they are. And are you going to explain to the wife and children of the deceased worker that, they say, it was inevitable for the sake of building a wonderful railway or bridge? Here, after all, it is not even the exchange of some lives for others – here, in general, life is given for pieces of iron.
I wonder why it hasn’t come to these discussions yet. But there is still such a “wonderful” thing. as a personal vehicle, with a huge harvest of human lives.
However, even today the inhabitants of the Internet, who tastefully talk about how the pharmaceutical industry oppresses them, forcing them to vaccinate, do not even think about the victims of children’s and adult lives, which in the peripheral countries are spent just for the manufacture of their smartphones. But this is a different topic, this is racism and the collective unconscious of the inhabitants of the imperialist centers. Since these victims – and we are separated in space, you can always pretend that we have not heard about this and do not know.
But even under communism, even with the establishment of complete social justice throughout the earth, this antagonistic pair of personal / public will not disappear anywhere. And as the value of human life, democracy, the value of the opinions of individuals grows, the same processes will be observed. It will not be possible to push them back somewhere simply by voluntaristic effort.
And if the personal continues to prevail over the public in almost everyone and everywhere, then in the end the development of civilization will become impossible. The question is not only about medicine, the loss of progress and the return of long-defeated diseases. There will be other questions, and they arise now.