CC BY
4
UDK 61
Djalolidinova Sh.D.
assistant
Fergana Public Health Medical Institute
Uzbekistan, Fergana
BIOETHICAL PROBLEMS IN OBSTETRICS AND GYNECOLOGY
Annotation: Scientific and technological progress, which has affected all aspects of society, has had an impact on medicine. Under her control were the processes of human reproduction (the emergence, preservation and termination ofpregnancy), the course of embryonic and fetal development.
Key words: bioethics, obstetrics and gynecology, medicine.
Bioethics, like medical ethics, is the science of the laws, principles and rules governing the professional behavior of a medical worker, which, in the conditions of new technologies, allows not only to use the achievements of scientific and technological progress for the benefit of man, but also to warn a practicing physician, a medical scientist about the inadmissibility of harming a person, his offspring, the surrounding world, forcing them to experience involuntary "reverence for life."
Causes of bioethics:
* the emergence of high biomedical technologies;
* new understanding of human rights;
* high cost of treatment.
There is a real opportunity in the treatment of male and female infertility, prenatal diagnosis of congenital malformations and hereditary diseases, saving the lives of previously doomed children.
Contrary to expectations, new technologies that have emerged on the basis of biology and genetics, biochemistry and physics are not always perceived unambiguously by society, they cause not only admiration, but also stubborn opposition, since they do not fit into traditional ideas. Nevertheless, the expediency of using new technologies can be determined by such concepts as need, efficiency, risk, cost, morality and law.
Factors of bioethics development:
1. Rapid development of fundamental sciences in the second half of the XX century. The biggest event of the late 1990s was the decoding of the structure of the human genome. There were subsidiary sciences: genomics and proteomics. Cytology has achieved great success. It is enough to mention the discovery of the receptor apparatus, the deciphering of the structure of the cytoplasmic membrane, the phenomenon, etc. In immunology, the mechanisms of cellular cooperation, the role of cytokines, the mechanism of apoptosis, etc. have been deciphered.
2. Rapid, sometimes aggressive introduction of new theoretical discoveries into medical practice. Methods of artificial fertilization, the use of so-called surrogate mothers have been created and widely spread. Particular attention was drawn to the success in cloning warm-blooded, by transferring the nucleus of a somatic cell into an egg cell devoid of a nucleus, followed by carrying a fetus by a surrogate mother.
3. Unpredictability, or uncertainty, of the consequences of the widespread use of medical achievements. Today it is difficult to foresee what social shifts tissue cloning will lead to, which in the future will probably be available only to rich people.
4. Tragedies of humanity that occurred as a result of ignoring or underestimating the principles of humanity, ethics, morality and law in medicine.
The main principles of the European Convention on Bioethics are the autonomy of the individual; the priority of the patient's interests over the interests of science and society. It is extremely important to provide all citizens with decent medical care, regardless of their property status. The problem of informed consent is considered in detail. The main ethical positions related to organ and tissue transplantation, genetics, and research on embryos are determined.
The Convention omits such acute problems as abortion, human cloning, etc. due to the fact that some of them, in principle, do not have a satisfactory solution (in particular, abortions), while others, such as, for example, genetic identification of the entire population with the creation of a single data bank, require public discussion and decision-making.
Domestic and foreign practice has shown that any measures restricting the possibility of legal abortion lead to an increase in criminal abortions with all the ensuing consequences. At the same time, the practice of reasonable regulation of abortion in late terms always gives positive results.
Assisted reproductive technologies (ART) are developing so rapidly that in a little more than two decades, humanity has gone from the inevitability of the divine curse - infertility to almost completely taking over the sacrament of human conception. More than a million children conceived in vitro have already been born, in some countries three or four out of every hundred newborns were conceived as a result of the use of ART. But today ART is not only a way to overcome infertility, it is a basic technology for the prevention of hereditary and chromosomal diseases, cloning, etc. promising areas of biology and medicine.
The most impressive achievement of ART is preimplantation genetic diagnosis (ART). Today, ART for 18 hereditary diseases has already been performed in the world. ART can be considered as an alternative and preferred method of prenatal diagnosis, since the defective embryo is not transferred to the mother's uterus, which eliminates the need for termination of pregnancy in the future.
All the latest advances in biotechnology are based on the IVF method, since it provides access to germ cells and embryos. The idea of cloning belongs to G. Shpemann, who in 1938 for the first time proposed to transfer the nucleus of a differentiated cell into an enucleated oocyte. Technically, the process of transferring cores was carried out only 20 years later, nevertheless, G. Shpemann remains the author of the idea.
Cloning is the transfer of embryonic and somatic cell nuclei into enucleated oocytes. The cell obtained by electrofusion was called the "reconstructed oocyte". It has been shown that the potency for the development of an oocyte formed from an embryonic donor cell is 20 times higher than that of a somatic one. It also turned out that the younger the cell, the better it is cloned, in other words, the potential for cloning decreases as the body ages: embryonic cells are best cloned, then fetal, newborn cells, and only then an adult.
Transgenesis involves transferring the DNA of one animal into the adult organism of another, resulting in animals with new properties. Already today, bioreactor pets have been obtained, the milk of which contains medical preparations. Obtaining these drugs from the milk of transgenic animals is much easier and cheaper than using synthetic, bacterial or cultural bioreactors. However, the efficiency of transgenesis is still very low today - less than 1% of animals can be made transgenic. For this reason, the subsequent cloning of such animals can be considered a way out.
Embryonic stem cells (ESCs) are another aspect of cloning. The pluripotency of embryonic cells, that is, their ability to develop into any cells of the body and replace any damaged differentiated cells, made the idea of their use for therapeutic purposes invaluable. However, it is possible to obtain a sufficient number of ESCs only by cloning. Of practical interest is the cloning of a somatic, that is, a differentiated cell with known properties. Currently, clones have been obtained from somatic cells of sheep, calves, pigs, mice, etc.
Thus, ART has become not only a method of infertility treatment, but also a supplier of material for the implementation of truly fantastic biotechnologies, such as cloning, transgenesis or ESC therapy.
Information about artificial insemination and embryo implantation, as well as about the identity of the donor, is a medical secret. A woman has the right to information about the procedure of artificial insemination and embryo implantation, about the medical and legal aspects of its consequences, about the data of a medical and genetic examination, external data and the nationality of the donor provided by the doctor performing the medical intervention.
In vitro fertilization is an expensive procedure. Most patients have to experience quite severe psychological trauma due to the lack of the desired result. Negative emotions associated with the collapse of hopes naturally generate dissatisfaction. In reproductive medicine, only the quality of the procedure itself can be discussed and guaranteed.
In the course of providing any medical service, even performed at the highest professional level, one of the following results may result: complete, incomplete or no result at all. The most "bad" option is also possible - causing harm. It is impossible to give any guarantees on the outcome of treatment.
References:
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2. Radzinsky V.E. Biologically active additives in obstetrics, perinatology and gynecology. - M., 1997.
3. Samylina I.A. Basic directions of researches of herbs at the present stage // Modern aspects of studying of herbs: sci. works. - 1995. - №34. - P. 3-6.
4. Kurkin V.A. Modern aspects of chemical classification of biologically active connections of herbs / Pharmaciya. 2002. - №2. - P. 8-16.
