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МЕЖОТРАСЛЕВЫЕ ИССЛЕДОВАНИЯ
УДК 343 Виктимология 4(14) / 2017, с. 64-70
Винокурова М. А.
ИАТРОГЕННОЕ ПОРАЖЕНИЕ: ПРЕСТУПЛЕНИЕ ИЛИ ДЕЛИКТ?
Введение. Взаимодействие таких областей человеческой деятельности как медицины и права - является непрерывно меняющейся областью знаний. Следует отметить, что значение понимания ятрогенных преступлений является индикатором проблемности в обществе и импульсом изменения последнего. Проблема. В связи с этим возникает ряд вопросов о том, а как же можно эффективно противодействовать рассматриваемому виду преступлений, если еще до сих пор не разрешена проблема, касающаяся терминологического понимания данного явления, его классификации. Наличие в научной литературе, медицинского и правового характера, около 40 определений ятрогении и его производные демонстрирует разобщенность концепции. Однако, все существующие толкования не имеют юридической завершенности. Методы: сравнительный метод в области дифференциации подходов отечественной и зарубежной литературы в области материального понятия «ятрогенное поражение»; метод дедукции; анализ научной литературы в медицинских и юридическое содержание (с 90-х годов XX века по настоящее время). Результаты: для описания семантического содержания феномена «иатрогения» следует по пути via negativa (пути прямого отрицания описания), (путь отрицания), а именно, чем это суждение не является. Иатрогения это не ошибка, не случайность, не бесшабашное преступление, не умышленное преступление. Иатрогения - это деликт. Иатрогения - динамическое детерминированное явление, возникающее вследствие непреднамеренных замечаний медицинского работника (врач, медсестра и т. д.) и приводящее к изменению психического состояния пациента.
Ключевые слова: ятрогения, иатрогения, ятрогенное поражение, медицинское право, пациент, медицинский работник.
The interaction of such fields of human be noted that the importance of
activity like medicine and law is a understanding the iatrogenic crimes is an
continuously changing field of knowledge. indicator of problems in society and
Research devoted to the study of such momentum of changes.
concepts as morality, ethics and law in In this regard, a number of questions
medicine, the matter of iatrogenic «injury» about whether and how to effectively deal
in medical activities account for a significant consideration is the type of dangerous acts,
share of all scientific research. The value of if still not solved the issue regarding
iatrogenic «injury» in administrative and terminology understanding of this
criminal-legal field is one of the «core» phenomenon. For these dilemmas there is
areas of research which are interesting and no single answer, but a vector of
important for the whole society. It should development on which the right questions
can give a logical reasonable answers: what is iatrogenic, what is the nature of this phenomenon, what is the relationship with administrative and criminal-legal reality.
The presence in the scientific literature, medical and legal nature about 40 definitions of iatrogenic and its derivatives demonstrates the generality of the concept, its gomogennosti («closed»). However, all the existing interpretations have no legal finality.
The iatrogenic in Greek means «the birth of the disease from the doctor» (iatros «doctor» + genos «birth»). In the «Canon of medicine» Abu Ali Ibn Sina (Avicenna) (9801037), was reflected such a position that the practice of medicine includes not only «the action and the production of any movements, but also the part of medical science and the training which concludes with helpful advice and advice that is associated with the presentation of the essence of the procedure» [1]. Such a recommendation is useful advice, which does not injure the soul and the health of the patient. In the source, indirectly contains the essence of the phenomenon under consideration, although
terminologically this process is not indicated.
In the Russian literature of a medical nature, the term and the interpretation was made by A. R. Luria (1902 - 1977) in his book «the Inner picture of the disease and iatrogenia disease». «The best example of internal picture of the disease, - says Alexander Romanovich Luria,- is iatrogenia of the disease when the patient is under the influence of a doctor inflicted psychological trauma raises a number of new sensations»[2].
This understanding in Soviet medicine of the term «iatrogeny» was a slave, and did not require a broad interpretation. But, at the turn of XX — XXI century, in connection with the emergence of high-tech medical care, most of the provisions and methods of aiding the Soviet model was destroyed («clinical thinking of the doctor»). With all the developments affecting medical activities, scientific-technical progress has left its mark not only on methods used in medicine, (which «are becoming more invasive, and the medicine is more aggressive» [8, p.119]), but the categories and concepts of medico-legal content.
Since 1995, the term «iatrogeny» in the works of researchers of the legal and medical fields began to take on a different
meaning, different from the original:
• in the monograph by A. V. Shaposhnikov «Iatrogenic: a terminological analysis and design concept» (1998), the author defines the essence of the iatrogenic with the help of three conceptual components: 1) reflecting the system of the occurrence of iatrogenic (operation, interference, error); 2) «what happened?» (changes, disorders, diseases); 3) considering a qualitative assessment of accomplished events (adverse, negative side). Alexander Shaposhnikov reflects the term "iatrogenic" means not only «psychogenic» explanations of this phenomenon, but also includes the process of «physical negative component».
• 2000 yr. A number of scientists explore a new scientific picture as «iatrogenic crimes». So, Pristanskov Vladimir equates the concept of inadequate provision of medical care to the notion of iatrogenic. The system iatrogenic crimes included such compositions as the improper provision of medical care causing death by negligence (part 2 of article 109 of the criminal code), causing heavy or average weight of harm to health on imprudence (part 2 and part 4 of article 118 of the criminal code of the Russian Federation), causing on imprudence of harm to health or death in the illegal occupation of private medical practice or private pharmaceutical activity (article 235 of the criminal code).
• 2002 yr. In the article by V. Rykov, «On the pathology examination of the defects of medical care and their legal consequences» reflects the author's position that «medical mistakes and accidents can lead to the development of iatrogenic diseases, but to identify them with each other does not» [4, p.16].
• 2003 yr. The mechanism of iatrogenic becomes more detailed. The iatrogenic is considered as a deterministic conditional probability system [5]. 1
• 2007 yr. The iatrogenic includes both deliberate, and careless socially dangerous
5 Conditional probability: the probability of an event A causes event b, but not against - the probability of the event To determine the occurrence of the event A. From the above definitions of the phenomenon of «iatrogenic», there is such a pattern - the existence of iatrogenic disease necessarily entails a violation of the patient's health, but this should not mean that any violation of the health of the patient is iatrogenic disease.
acts of medical workers who violate provisions of medical care, and detrimental to the life and health of the patient [5, p.14].
• 2010 yr. The separation of iatrogenic diseases into two groups: 1st group -«iatrogenic, resulting from objective and/ or unforeseen circumstances». The concept of iatrogenic associated with the term «medical risk» (medical high risk activities).
2nd group - iatrogenic, resulting from inadequate medical care (defect of evacuation, diagnosis and treatment of the patient) [6, p.138].
2012 yr. V. I. Akopov in the textbook «Medical law: modern healthcare and the right of citizens to health protection» reflects the position that the iatrogenic and medical error are defects of the medical practice, but are not identical.
Then the question arises: «why is medical error, iatrogenic from, and where it ends medical error and iatrogenic begins?».
Medical error is an incorrect assessment of the patient's condition, incorrect choice of method and procedures that could cause or has caused a complication or deterioration. [8, p.278]
The iatrogenic is an additional pathological condition of the human body, which can harm the health of the patient under certain conditions (these terms were introduced by A. P. Zilber for the differentiation of the concepts of medical error and iatrogenic):
a. a person needing medical care is fully informed about the possibility of iatrogenic diseases and gave informed consent to the application of the method of diagnosis and treatment;
b. the doctor could not apply to objective reasons, a less invasive method;
c. were taken into account the individual characteristics of the patient's health;
d. "have been taken preventive measures to prevent or reduce iatrogenic pathology, carried out a rational monitoring, and applied best practices to solve iatrogenic";
e. the iatrogenic could not be predicted, but monitoring and General security measures were provided. [8, p.121]
For a proper understanding of these terms, you can submit them on the corresponding scheme (Fig.1).
latrogeniya ( 5 conditions)
Medical error
Fig. 1
This figure reflected the direct (coordinate), which is the time, reflecting the diagnosis and treatment of the patient, «beginning» medical error is an incorrect assignment of the diagnostic study or treatment, iatrogenic occurs mostly after a medical procedure (but with the 5 mandatory conditions).
— In foreign literature of the medico-legal character there is a conceptual variation of the terms "iatrogenic", "iatrogenic disease" and their different interpretations:
— Oxford Englisn Dictionary (1999): the iatrogenic is a «disease induced by word or action a health worker; and the action or word has an unintended shape» [9, p.498].
— «New Collegiate Dictionary» (2001) iatrogenic refers to as «the negligent acts of a physician or surgeon during the treatment or diagnostic procedures» [10].
— «Dictionary of molecular biology» (2004) interprets the representation as iatrogenic «disease caused by the actions of the doctor during medical therapy» [11].
— Oxford Advanced Learners Dictionary (2010): iatrogenic disease is any condition or set of symptoms that are the direct cause of the medical action, although the disease is not necessarily intentional... the Exact symptoms and causes of iatrogenic diseases can vary widely depending on the condition of the patient. Adverse reaction one known form of iatrogenic diseases. [12, p.801]
— In the «Medical dictionary» (2011) reflected that the iatrogenic «arises from the activity of a doctor; and is considered to be unintentional causing of harm to health of the patient by a medical worker by medical, surgical treatment or diagnostic procedures» [13]. For example, puerperal fever was considered iatrogenic infection in ancient times.
— «American Medical dictionary» (2015) defines iatrogenic as «the disease caused by the manner of action or therapy health care worker towards the patient; in particular, it relates to complications of treatment» [14].
From the above foreign sources, observed such a tendency that the name «iatrogenia or iatrogenous disease» include
not only mental but also physical disorders, symptoms caused by the unintended action of the doctor during diagnosis, treatment or a medical procedure. It should also be noted that in the foreign literature «iatrogenia» is not seen as a socially dangerous act (crime), but as a delict (offense). The concept of iatrogenic closely connected with another term - «standart of care» (1) and «the duty of care» (2):
(1) standart of care («breach-centred») - what you need to do person, because it requires the current situation.
The enforcement authority is obliged to determine whether my conduct in this point in time to meet the standard of medical care prescribed in the departmental legal act.
(2) duty of care («duty-centred») — what person needs to do because that's the nature of the man's work. [15, p.144]
In this case, the important point is that violating medical debt, enforcement of any link of causation comes down to a legal norm.
Conclusion: 1) in russian literature, iatrogenic regarded as the category of offences to include the deliberate or careless socially dangerous acts of medical workers who violate provisions of medical care, and detrimental to the life and health of the patient; 2) to describe the semantic content of the phenomenon of «iatrogenia» follows the path of via negativa (way of negation), namely, than this judgment is not. Iatrogenia is Not a mistake, Not an accident, Not a reckless crime, Not a premeditated crime. Iatrogenia is a delict. Iatrogenia closely associated with the concept «the duty of care». Where the Central concept in the medico-legal relations is medical debt, not the oblgation to provide a medical service. Iatrogenia — dynamic deterministic phenomenon arising from unintended remarks of a health worker (doctor, nurse, etc.) and resulting in a change of the mental state of the patient.
LITERATURE
1. Abu Ali Ibn Sina. The Canon of medicine [Electronic resource] — Mode of access: http://www.e-reading.club/ /ibn_ Sina_-_Kanon_vrachebnoii_nauki.html [accessed: 01 March 2016].
2. R. A. Luria. Internal picture of the disease and iatrogenia disease [Electronic resource] — Mode of access: http://bookap.
info/klinika/zeygarnik_hrestomatiya_ po_patopsihologii/gl5.shtm [accessed: 01 March 2016].
3. R. A. Khalfin, E. P. Kakorina, M. V. Ignatiev, V. V. Medianova. The estimation of efficiency of activity of public authorities in the sphere of healthcare of the Russian Federation / R. Khalfin, E. P. Kakorina, M. V. Ignatiev, V. V. Medianova. - M. : GEOTAR-Media, 2013. - 256 p.
4. Rykov, V. A. Postmortem examination of the defects of medical care and their legal consequences / V. A. Rykov // problems of expertise in medicine. — 2002. No. 5-1, volume 2 — p. 15-17.
5. Nikitina, I. O. Crimes in the sphere of health care:legislation, legal analysis, skills, causes and prevention// Avtoref. dis. Cand. the faculty of law. Sciences. -Specialty 12.00.08. —Nizhny Novgorod,2007. -20 p.
6. Sarkisian, B. A., Shapkina N. B., Novoselov V. P. Iatrogenic pathology in practice forensic forensics / B. A. Sargsyan, N. B. Shapkina, V. P. Novoselov // Siberian medical journal. -2010. No. 4-1, volume 25 — P. 137-141
7. Akopov V. I. Medical law: textbook / V. I. Akopov. — Rostov n/ D : Feniks, 2012. — 377 p.
8. Zilber A. P. studies of medical law and ethics / A. P. Zilber. — M.: Medpress — inform, 2008. — 848 p.: ill.
9. Oxford English Dictionary. Oxford, Great Clare 1999, p. 498.
10. New Collegiate Dictionary [Electronic resource] — Mode of access: http://en.academic.ru/dic.nsf/iatrogenic [date of access: 29 February 2016].
11. Dictionary of molecular biology [Electronic resource] — Mode of access: http://en.academic.ru/en_molecular_ biology/iatrogenic [date of access: 29 February 2016 r.].
12. Oxford Advanced Learners Dictionary. Oxford, Great Clare 2010, p.801.
13. Medical dictionary [Electronic resource] — Mode of access: http:// medicine.academic.ru/Iatrogenic [date of access: 03 March 2016 r.].
14. American Medical dictionary [Electronic resource] — Mode of access: http://www.yourmedicaldetective.com/ public [date of access: 03 March 2016 r.].
15. Francis McManus, Eleanor Russell. Delict :a comprehensive guide to
the law. John Wiley and sons, 2010. 635 p.
ПРИМЕЧАНИЕ:
1. Aбу Aли Ибн Сина. Канон врачебной науки [Электронный ресурс] — Режим доступа: http://www.e-reading.club/ /ibn_Sina_-_Kanon_vrachebnoii_nauki.html [Дата обращения: 01 марта 201б г.].
2. Р. A. Лурия. Bнутренняя картина болезни и иатрогенные заболевания [Электронный ресурс] — Режим доступа: http://bookap.info/klinika/zeygarnik_hrestomatiya_po_ patopsihologii/gl5.shtm [Дата обращения: 01 марта 201б г.].
3. РА. Хальфин, Е.П. Какорина, М^.Игнатьева, B.B. Мадьянова. Оценка эффективности деятельности органов государственной власти в сфере здравоохранения Российской Федерации / РА. Хальфина, Е.П. Какорина, M.B. Игнатьева, B.B. Мадьянова. — М. : ГЭОТAP-Mедиа, 2013. — 25б с.
4. Рыков, B.A. О Патологоанатомической экспертизе дефектов медицинской помощи и их правовые последствия / B.A. Рыков // Проблемы экспертизы в медицине. — 2002. — №5-1, Т. 2 — С.15-17.
5. Никитина, И.О. Преступления в сфере здравоохранения: законодательство, юридический анализ, квалификация, причины и меры предупреждения// Aвтореф. дис. канд. юрид. наук. - Специальность 12.00.08. —Нижний Новгород,2007. — 20 с.
6. Саркисян БА., Шапкина Н.Б., Новоселов B.^ Ятрогенная патология в практике судебно-медицинской экспертизы / БА. Саркисян, Н.Б. Шапкина, B.^ Новоселов // Сибирский медицинский журнал. — 2010. — №4-1, Т. 25 — С. 137-141.
7. Aкопов B.^ Медицинское право: учебно-практическое пособие / B.^ Aкопов. — Ростов н/ Д : Феникс, 2012. — 377 с.
8. Зильбер A.^ Этюды медицинского права и этики / A.^ Зильбер. — М.: МЕДпресс — информ, 2008. — 848 с. : ил.
9. Oxford English Dictionary. Oxford, Great Clare 1999, 498 p.
10. New Collegiate Dictionary [Электронный ресурс] — Режим доступа: http://en. academic.ru/dic.nsf/iatrogenic [Дата обращения: 29 февраля 201б г.].
11. Dictionary of molecular biology [Электронный ресурс] — Режим доступа: http://en. academic.ru/en_molecular_biology/iatrogenic [Дата обращения: 29 февраля 201б г.].
12. Oxford Advanced Learners Dictionary. Oxford, Great Clare 2010, p.801.
13. Medical dictionary [Электронный ресурс] — Режим доступа: http://medicine. academic.ru/Iatrogenic [Дата обращения: 03 марта 201б г.].
14. American Medical dictionary [Электронный ресурс] — Режим доступа: http://www. yourmedicaldetective.com/public [Дата обращения: 03 марта 201б г.].
15. Francis McManus, Eleanor Russell. Delict : comprehensive guide to the law. John Wiley and sons, 2010. б3б p.
REFERENCES:
1. Abu Ali Ibn Sina. Kanon vrachebnoy nauki [Elektronnyy resurs] — Rezhim dostupa: http://www.e-reading.club/ /ibn_Sina_-_Kanon_vrachebnoii_nauki.html [Data obrashcheniya: 01 marta 201б g.].
2. R. A. Luriya. Vnutrennyaya kartina bolezni i iatrogennyye zabolevaniya [Elektronnyy resurs] — Rezhim dostupa: http://bookap.info/klinika/zeygarnik_hrestomatiya_po_ patopsihologii/gl5.shtm [Data obrashcheniya: 01 marta 201б g.].
3. R.A. Khal'fin, Ye.P. Kakorina, M.V.Ignat'yeva, V.V. Mad'yanova. Otsenka effektivnosti deyatel'nosti organov gosudarstvennoy vlasti v sfere zdravookhraneniya Rossiyskoy Federatsii / R.A. Khal'fina, Ye.P. Kakorina, M.V. Ignat'yeva, V.V. Mad'yanova. — M. : GEOTAR-Media, 2013. — 25б s.
4. Rykov, V.A. O Patologoanatomicheskoy ekspertize defektov meditsinskoy pomoshchi i ikh pravovyye posledstviya / V.A. Rykov // Problemy ekspertizy v meditsine. — 2002. — №5-1, T. 2 — S.15-17.
5. Nikitina, I.O. Prestupleniya v sfere zdravookhraneniya: zakonodatel'stvo, yuridicheskiy analiz, kvalifikatsiya, prichiny i mery preduprezhdeniya// Avtoref. dis. kand. yurid. nauk. -Spetsial'nost' 12.00.08. —Nizhniy Novgorod,2007. — 20 s.
6. Sarkisyan B.A., Shapkina N.B., Novoselov V.P. Yatrogennaya patologiya v praktike sudebno-meditsinskoy ekspertizy / B.A. Sarkisyan, N.B. Shapkina, V.P. Novoselov // Sibirskiy meditsinskiy zhurnal. — 2010. — №4-1, T. 25 — S. 137-141.
7. Akopov V.I. Meditsinskoye pravo: uchebno-prakticheskoye posobiye / V.I. Akopov. — Rostov n/ D : Feniks, 2012. — 377 s.
8. Zil'ber A.P. Etyudy meditsinskogo prava i etiki / A.P. Zil'ber. — M.: MEDpress — inform, 2008. — 848 s. : il.
9. Oxford English Dictionary. Oxford, Great Clare 1999, 498 p.
10. New Collegiate Dictionary [Elektronnyy resurs] — Rezhim dostupa: http://en. academic.ru/dic.nsf/iatrogenic [Data obrashcheniya: 29 fevralya 2016 g.].
11. Dictionary of molecular biology [Elektronnyy resurs] — Rezhim dostupa: http://en. academic.ru/en_molecular_biology/iatrogenic [Data obrashcheniya: 29 fevralya 2016 g.].
12. Oxford Advanced Learners Dictionary. Oxford, Great Clare 2010, p.801.
13. Medical dictionary [Elektronnyy resurs] — Rezhim dostupa: http://medicine.academic. ru/Iatrogenic [Data obrashcheniya: 03 marta 2016 g.].
14. American Medical dictionary [Elektronnyy resurs] — Rezhim dostupa: http://www. yourmedicaldetective.com/public [Data obrashcheniya: 03 marta 2016 g.].
15. Francis McManus, Eleanor Russell. Delict : comprehensive guide to the law. John Wiley and sons, 2010. 636 p.
ВИНОКУРОВА Мария Александровна, аспирант Южно-Уральского Государственного Университета, ассистент кафедры отечественной истории и права, ЮжноУральский гуманитарно-педагогический университет, г.Челябинск E-mail: [email protected]
Vinokurova M. A.
IATROGENIA DAMAGE: CRIME OR DELICT?
Introduction. The interaction of such fields of human activity like medicine and law is a continuously changing field of knowledge. The value of iatrogenic «injury» in administrative and criminal-legal field is one of the "core" areas of research which are interesting and important for the whole society. It should be noted that the importance of understanding the iatrogenic crimes is an indicator of problems in society and momentum of changes. Problem. A number of questions about whether and how to effectively deal consideration is the type of dangerous acts, if still not solved the issue regarding terminology understanding of this phenomenon. The presence in the scientific literature, medical and legal nature about 40 definitions of iatrogenic and its derivatives demonstrates the generality of the concept, its gomogennosti ("closed"). However, all the existing interpretations have no legal finality. Methods: the comparative method in the field of differentiation of the approaches of domestic and foreign literature in the field of substantive concepts <iatrogenic damage»; the method of deduction; analysis of scientific literature in medical and legal content (since the 90-ies of XX century to the present). Results: to describe the semantic content of the phenomenon of "iat-rogenia" follows the path of via negativa (way of negation), namely, than this judgment is not. Iatrogenia is Not a mistake, Not an accident, Not a reckless crime, Not a premeditated crime. Iatrogenia is a delict. Iatrogenia closely associated with the concept «the duty of care». Where the Central concept in the medicolegal relations is medical debt, not the oblgation to provide a medical service. Iatrogenia - dynamic deterministic phenomenon arising from unintended remarks of a health worker (doctor, nurse, etc.) and resulting in a change of the mental state of the patient.
Keywords: iatrogenic, iatrogenic disease, medical law, patient, medical worker.
VINOKUROVA Mariya Aleksandrovna, postgraduate student South-Ural State University, assistant of department - russian history and law South Ural humanitarian-pedagogical University, Chelyabinsk, E-mail: [email protected]
