Background, initiator and participants

A debate about the rights and responsibilities of a doctor and a patient in a modern healthcare system (legal and ethical issues) was initiated in September 2018 by the Ministry of Health and Bioethics Committee of the Republic of Belarus, with participation of the Republican Bioethics Center.

The main aims of the debate were to discuss the issues of improving medical practice, exchange experiences between various hospitals and medical centers, and also to make changes and additions to new laws including the Law on Healthcare, Transplantation of Organs and Tissues, and Assisted Reproductive Technologies.

The need for debate was described as follows: In Belarus, there is a new situation where patients want more care and expect that doctors acknowledge their autonomy, where patients don’t know their rights and need skilled professional communication. There is also a new generation of doctors, whose professional skills are much more technical than communicative and ethical; these doctors need to know the laws, the elements of ethical practice, and to how to treat their patients as persons, requiring a holistic view of their health needs. For these reasons the debate needed to include all of society.

The debate was also developed to feed into later amendments to the Law of Healthcare.

Objective: To improve medical practice in healthcare, in relation to transplantations of organs and tissues and the use of assisted reproductive technologies, and to improve the understanding and collaboration in society for solving these important questions.

 The question

The debate addressed the following topics:

• the meaning of informed consent in medical practice,
• the extent of patient knowledge about their rights to choose a doctor,
• how to protect medical confidentiality in ehealth systems,
• the extent of the doctor’s duty to tell the truth about severe diagnosis for all kind of patients,
• how to arrange for family members to exercise their right to participate in the care of their relatives when the patient is in an intensive care unit

Method

Different methods were used during the organisation of the public debate, including:

• Discussion on selected topics in massmedia,
• a survey of medical professionals and medical lawyers understanding of the main topics of the conference debate,
• practical conference,
• open lecture with free discussions,
• the role of hospital ethical committees as an instrument for solving ethical problems of the treatment process.

A discussion about the rights and responsibilities of doctors and patients in the legal and ethical sphere was introduced in mass-media. The participants of the debate were medical doctors, lawyers, healthcare managers, bioethics scientists as well as members of patient organizations. The discussion was presented by different articles, and round-tables in mass-media and in scientific journals.

The Republican Bioethics Committee, The Republican Center of Bioethics and employees of the Legal Firm “JURSPECTR” started preparing the Practical Conference "Ethical and legal issues of ensuring the rights of patients and medical professionals in modern healthcare". Prior to the conference, there was a survey among medical lawyers and doctors to identify the main questions for discussion during the conference. The conference was held in March 2019, hosted by the Belarusian Ministry of Healthcare, Belarusian Medical Academy of Postgraduate Education and “JURSPECTR”. During the Conference, different speakers from the medical and legal professions participated in public discussions concerning the above-mentioned issues. Participants also included patient organisations.

The “Doctor's ethical duty” was the theme of the Orthodox Church programme for members of the society, which included:

• A lecture in ethics by a Russian Academician of the Academy of Sciences, which took place in July 2019 at the Church Seminary with free public entrance,
• a press conference entitled “The Feat of the New Martyrs in the Prism of the Ethical Duty of a Doctor".

Impact or notable features

The main ideas, the questions debated and solutions arising were taken into account by working groups during the development of new versions of Republican Laws (Laws of the Healthcare, Transplantation of Organs and Tissues, Additional Reproductive Technologies). These Laws were supplemented with articles that were discussed by the Parliament and adopted by the National Assembly of the Republic of Belarus in Summer 2019.

Basic ethical issues:

• To specify the basic concepts (informed consent, etc)
• how to satisfy the patient’s refusal to enter their data into electronic databases (according to the requirements of Healthcare system),
• to determine one of the goals of National Bioethics Committee to coordinate activity of local commissions on medical ethics,
• the proper conduct of a doctor in an emergency regarding the informed consent of the patient and their relatives, etc.

Notable features and lessons learned

The working process was founded on the main definitions of the Council of Europe’s “Draft Guide on Public Debate”. Also, our slogan was “We may say that public debate is therefore debate that is in public, with the public and for the public.”

Organisers of various public discussions were inspired by the draft Guide’s idea and based their activities on the guidance given.