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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).

Problems of ethics committees in post-communist Russia are briefly discussed. The first ethics committees were established in 1980s upon the initiative of international pharmaceutical companies involved in clinical trials. Generally, such committees exist at hospitals conducting these trials and at research institutions dealing with human experimentation. They are bureaucratic structures heavily dependent on hospital or institution administration. Publication of research results in international periodicals is the main reason for their existence. An officially recognized National Ethics Committee is non-existent although there are several competing ethics committees at a national level (at the Ministry of Health, Academy of Sciences, Academy of Medical Sciences, Russian Medical association etc.). There is no federal legislation on the structure and status of ethics committees.

The paper provides a short overview of key problems of medical ethics in the Russian and Soviet contexts--confidentiality, informed consent, human experimentation, abortion, euthanasia, organ and tissue transplantation, abuse of psychiatry. In Soviet ideology common interests were declared superior to private ones. Hence, medical confidentiality was viewed as a bourgeois survival. On the other hand, diagnosis was normally not disclosed to a patient in the case of an incurable disease (especially cancer). Due to the strong paternalistic traditions of Russian medicine the idea of informed consent is still disputed by many physicians. Abortions were first legalized in Soviet Russia in 1920. A brief history of this landmark event is provided. However, abortions were forbidden in 1936 and legalized again only in 1955. Active euthanasia was legalized in Soviet Russia in 1922 but for a short period. Federal law regulating human transplantation was adopted only in 1992 and based on the presumed consent model. Until then forensic autopsy and procurement of cadaver organs were viewed as equal procedures. In 1960s-1980s there was a practice of declaring political dissidents insane in their involuntary treatment.

Russian medical ethics bears a heavy mark of seven decades of the communist regime. In 1918 the Health Care Commissariat (ministry) was formed. It was headed by Nikolai Semashko (1874-1949) who claimed that "the ethics of the Soviet physician is an ethics of our socialist motherland, an ethics of a builder of communist society; it is equal to communist moral". "Medical ethics" had been avoided until the late 1930s when it was replaced by "medical (or surgical) deontology". This "deontological" period started with "Problems of surgical deontology" written by N. Petrov, a surgeon, and lasted for almost half a century until "medical deontology" was abandoned in favor of "bioethics" in post-communist Russia. There have been five All-Union conferences on medical deontology since 1969. The story of the emergence of "The Oath of a Soviet Physician" is briefly described. The text of this Oath was approved by a special decree of the Soviet Parliament in 1971. Each graduate of medical school in USSR was obliged to take this Oath when receiving his or her medical diploma. It is concluded that such ideas of zemstvo medicine as universal access to health care and condemnation of private practice were put into practice under the communist regime.