Health, Ethics, and Religion:
Perceptions of Russian and American Medical Personnel
David S. Barnes
A survey conducted in 1997-98, designed by the author, focused on the perceptions of physicians, nurses, and nursing students in Novgorod, Russia, and in Novgorod's sister city, Rochester, New York, regarding aspects of health, medical ethics, and religion. Novgorod, a city of 250,000 people, is located 300 miles north of Moscow and 100 miles south of St. Petersburg.
Novgorod subjects included 25 physicians and 32 nurses and medical nurse practitioners from the Novgorod Regional Hospital and 144 nursing students from the Novgorod Medical College (NMC). Rochester subjects included 20 physicians from several hospitals; 31 nurses from Highland Hospital; 57 nursing students from Roberts Wesleyan College (an Evangelical liberal arts institution); and 73 nursing students from Genesee Community College (GCC), Batavia (metropolitan Rochester), New York. Each completed a questionnaire.
The advent of Gorbachev's glasnost and perestroika in the late 1980s opened to the West and to many Russians a clearer understanding of health care, medical ethics, and religion in the Soviet Union.
The Soviet health system theoretically provided free access to quality health care. In reality, the system was inequitable, inadequate, inefficient, and dominated by military and space priorities.1 As a two-tiered system, it provided excellent Western-style hospitals for the elite and much less for the general population. In 1990, the State Statistical Committee reported that the Soviet Union had one hospital bed per 259 people and one doctor per 72 people, double that of the U.S.2However, 24 percent of hospitals lacked plumbing, 45 percent lacked bathrooms, and 19 percent lacked central heat.3 Physicians generally had a lower level of training than those in the U.S., lacked adequate modern equipment and pharmaceuticals, and were poorly paid--less than half the salary of industrial workers.3 Health care funding received three percent of Soviet gross domestic product in 1990 versus 12 percent in the U.S.4
By 1994, with the economy in near ruin, life expectancy had dropped to 57 years for men and 71 for women, the lowest in 40 years. While life expectancy had increased in 1997 to 61 and 73 respectively, the average gap between developed countries and Russia was 15 years for men and 10 for women. The three major causes of death are cardiovascular disease, "external causes" (accidents, poisoning, suicide, and violence), and cancer.5
Soviet medical ethics are reflected in the 1991 "Oath of the Soviet Physician," including the pledge to "conduct all my actions according to the principles of Communist morality, to always keep the high calling of Soviet physicians and the high responsibility I have to my people and the Soviet government."3, 6 The duty of the Soviet physician had as its foundation obedience to the state as defined by the state--not morality as expressed in Western medicine within the context of the Hippocratic Oath and the Judeo-Christian tradition.7
Extensive studies of religious belief were conducted shortly before the fall of communism in Eastern Europe in 1989 and in the Soviet Union in 1991.8, 9 Father Andrew Greeley, a researcher at the University of Chicago, conducted an extensive study of religious belief among Russians just prior to the fall of communism in 1991. He found that 40 percent of Russians believed in God (99 percent of those were Russian Orthodox), 40 percent in miracles, 33 percent in heaven and hell, and 75 percent had a "great deal of confidence" in the Orthodox Church and its leaders.10 Whether religious belief is significant or superficial is more difficult to determine. In a 1996 study by Susan Lehmann of Columbia University, 13 percent of Russians considered themselves to be "observant believers," but of these only 13 percent attended services weekly, 13 percent monthly, and 55 percent only for religious holidays and family occasions.11
While Russian Orthodoxy generally claims 50 to 60 million adherents (33 to 40 percent of the Russian population), Anatoly Rudenko, director of the Russian Bible Society, estimates that in Moscow only one percent of Russians attend church each week, and only two percent attend biweekly. These figures are based on estimates of church attendance at the 240 functioning Russian Orthodox churches and 120 Protestant congregations in Moscow. A Ministry of the Interior report that 120,000 people (one percent of Moscow's population) attended Orthodox Easter services in 1997 supports this conclusion.12
Novgorod student responses contrasted most markedly with their American counterparts by their support of herbal medicine (96 percent), their belief that birth control pills commonly result in severe maternal or fetal problems (81 percent), and their belief that air and water pollution are major causes of disease (98 percent), perhaps reflecting, respectively, a long tradition of folk medicine, lack of extensive experience with birth control pills, and Russia's profound problems with water and air pollution. Until recently, cancer was commonly thought to be contagious among Russians, magnetic fields were ascribed special powers to increase the effectiveness of drug injections, and needed antibiotics were supposedly available and free.
Novgorod physicians, nurses, and nursing students contrasted markedly with their American counterparts on essentially all questions of medical ethics, most of which in the U.S. are commonly considered patients' rights. These rights include providing the patient a) an explanation of a potentially fatal diagnosis, b) access to test results and medical documents, c) the right to refuse treatment, d) informed consent for treatment, and e) confidentially. This contrast may reflect both the 70-year authoritarian Soviet period and the widely accepted Russian principle that physicians and nurses should not reveal to patients a diagnosis for which there is no hope of recovery.3, 7, 13
A 1993 Russian law on patient rights grants for the first time the right to confidentiality, to see test results and medical documents so as to understand the diagnosis and prognosis, to request consultation, to be informed of possible experimental treatment, to refuse treatment, and to give informed consent.3 In marked contrast to Rochester medical personnel, half of Novgorod respondents felt the state should encourage euthanasia of the elderly sick and the severely mentally handicapped. This contrast may reflect the fragile state of the present Russian economy, the general plight of the poor and handicapped, and the traditional Soviet willingness to sacrifice the individual for the apparent collective good.
In contrast to Greeley's 1991 study of religious belief10 and a 1993 study conducted by Roger Russell Research8 noted above, 95 percent of Russian students describe themselves as Russian Orthodox, 88 percent indicate a belief in God, 70 percent believe in life after death, and 90 percent know several biblical stories at least somewhat. About half stated, "I do not know if God exists, but I would like to know," suggesting interest in religious faith. Of the 80 percent of Novgorod students who have a Bible or New Testament in their home, four percent read it several times a week, and 70 percent occasionally, which is higher than Genesee Community College (GCC) students. However, fewer than 10 percent of Novgorod students, nurses, and physicians attend church weekly, compared to 31 percent of GCC, 75 percent of Roberts Wesleyan College students, and 50 percent of Rochester nurses and physicians. Of the 80 percent of Novgorod nursing students, 70 percent of nurses, and 50 percent of physicians who believe God created life, most felt God may have used evolutionary mechanisms.
Overall, the data suggest the appeal and resiliency of religious faith in Russia and in the U.S.: in Russia, despite over 70 years of official atheism, and in the U.S., despite twentieth century scientific progress and materialism.
Dr. David S. Barnes is professor of biology at Roberts
Wesleyan College, Rochester, New York. Excerpted with the author's
permission from an address at an International Conference of Christians
in Science and the American Scientific Affiliation, Churchill College,
Cambridge University, United Kingdom, 2-5 August 1998. Contact Dr.
Barnes via e-mail (firstname.lastname@example.org) to request the complete report.
Written permission is required for reprinting or electronic distribution of any portion of the East-West Church & Ministry Report.
© 1998 East-West Church and Ministry Report