The single medical space in the paradigm of ensuring the right to practice in traditional and alternative medicine

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THE SINGLE MEDICAL SPACE IN THE PARADIGM OF ENSURING THE RIGHT TO PRACTICE IN TRADITIONAL AND ALTERNATIVE MEDICINE

I.M. Sopilko, Doctor of Law, Professor

T. M. Yamnenko, Doctor of Law, Professor

National Aviation University

Objective

To define the term «traditional and alternative medicine», to explore the mechanism of legal regulation of traditional and alternative medicine. Research methods: documentary analysis and synthesis, comparative analysis, objective truth, cognitive-analytical, etc. Results: the most effective mechanisms for solving problematic issues related to the exercise of the right to practice traditional and alternative medicine are described and revealed. Also, a way to solve problems related to the formation of a single medical space, which should be carried out within the paradigm of medical law of Ukraine. This is important for the single medical space, for the practice of traditional and alternative medicine and for the formation of medical law. Discussion: the possibility of applying different doctrinal approaches to the explanation of the concepts of traditional and alternative medicine and the application of the legal mechanism to these concepts.

Key words: single medical space; medical law; patient rights; medical reform; the concept of traditional and alternative medicine; healer; doctor.

Анотація

Ірина Сопілко, Тетяна Ямненко, Національний авіаційний університет.

ЄДИНИЙ МЕДИЧНИЙ ПРОСТІР В ПАРАДИГМІ ЗАБЕЗПЕЧЕННЯ ПРАВА НА ЗАНЯТТЯ НАРОДНОЮ І НЕТРАДИЦІЙНОЮ МЕДИЦИНОЮ.

Мета: надати визначення терміну «народна та нетрадиційна медицина», дослідити механізм правового регулювання народної та нетрадиційної медицини.

Методи дослідження: документального аналізу і синтезу, порівняльного аналізу, об'єктивної істини, пізнавально-аналітичний тощо.

Результати: охарактеризовано та розкрито найбільш ефективні механізми вирішення проблемних питань, пов'язаних із реалізацією права на заняття народною і нетрадиційною медициною. Також запропоновано спосіб вирішення проблем, щодо формування єдиного медичного простору, який має здійснюватись у рамках парадигми медичного права України. Це важливо і для єдиного медичного простору, задля заняття народною і нетрадиційною медициною, і для становлення медичного права.

Обговорення: можливості застосування різних доктринальних підходів до пояснення понять народна та нетрадиційна медицина та застосування до цих понять правового механізму.

Незважаючи на динамічний розвиток медичної науки, застосування народної і нетрадиційної медицини для підтримання здоров'я є поширеним і сьогодні. Проте, українське законодавство не містить норм щодо правового регулювання таких відносин. Правова невизначеність викликає можливість реалізації прав на підставі законодавства, що не враховує особливості таких правовідносин.

В умовах бурхливого розвитку медичних знань та зростання чисельності звернень пацієнтів до народної медицини важливим є розроблення механізмів, з однієї сторони, захисту інтересів особи, що одержала дозвіл на зайняття народною медициною (цілительством).

Потреба в дослідженні надання медичної допомоги лікарем нетрадиційної та народної медицини обумовлена виникненням як етичних, так і правових проблем для пацієнта. Досягнення у медичній галузі створюють можливість запропонувати рішення майже у всіх медичних випадках, проте іноді хворі пацієнти все ж таки звертаються до лікарів нетрадиційної та народної медицини.

Ключові слова: єдиний медичний простір; медичне право; права пацієнтів; медична реформа; поняття народна та нетрадиційна медицина; цілитель; лікар.

Стаття надійшла до редакції 23.05.2022.

Problem statement and relevance

Despite the dynamic development of medical science, the use of traditional and alternative medicine to maintain health is widespread today. However, Ukrainian legislation does not contain rules on the legal regulation of such relations. Legal uncertainty causes the possibility of exercising rights on the basis of legislation that does not take into account the specifics of such legal relations.

In the conditions of rapid development of medical knowledge and increase in the number of patients' appeals to traditional medicine, it is important to develop mechanisms, on the one hand, to protect the interests of a person licensed to practice traditional medicine (healing).

The need for research into the provision of medical care by doctors of alternative and traditional medicine is driven by the emergence of both ethical and legal issues for the patient. Advances in the medical field make it possible to offer solutions in almost all medical cases, but sometimes sick patients still turn to doctors of alternative and traditional medicine.

Analysis of recent research and publications. In jurisprudence, unfortunately, there are problems with the regulation of medical care with the use of alternative medicine, because they are almost unexplored. Only certain aspects of this problem have been the subject of research by such scientists as E. Maslov, V. Akopov, M. Malein.

Presenting main material

It should be noted that one of the key standards in the field of health care should be the principle of a single medical space, which requires equal access throughout the country to state-funded health care, both territorially and economically, regardless of location, the patient's financial situation or his work. Thus, analyzing the issues of traditional and alternative medicine, it is established that traditional medicine is recognized as a set of empirical knowledge accumulated by the people, which is used to diagnose and treat diseases and passed from generation to generation in each nation. At the same time, alternative medicine is the collective name of methods that claim the ability to treat (or prevent) diseases, the effectiveness and safety of which has not been proven by scientific methods. Typical examples are homeopathy, acupuncture and naturopathy. Alternative medicine is called alternative because it is often used instead of formal medicine.

Current legislation under traditional medicine (healing) means methods of rehabilitation, prevention, diagnosis and treatment, which are based on the experience of many generations of people, based on folk traditions and do not require state registration. Whereas, the World Health Organization understands traditional and alternative medicine as «a set of knowledge, skills and practices based on theories, beliefs and experiences that are an integral part of different cultures, whether they can be explained or not. To maintain health, as well as to prevent, diagnose, alleviate or treat physical and mental illness» [1].

The permitted types of medical activities do not include: treatment of cancer patients; treatment of patients with infectious diseases, in particular, venereal and infectious skin; AIDS; treatment of drug addicts; treatment of mentally ill people who need urgent hospitalization; providing an opinion on mental health; care and treatment of pregnancy complications; surgical interventions; conducting treatment sessions designed for a wide audience with the use of hypnosis and other methods of mental or bioenergetic influence [2]. Thus, in Ukraine, a doctor of traditional and alternative medicine cannot legally treat patients with diseases from this list.

Today, officially traditional and alternative medicine can be practiced by doctors who have mastered the specialization of traditional and alternative medicine and work as a doctor of traditional and alternative medicine in licensed medical institutions, or as private entrepreneurs if they have received a license from the Ministry of Health of Ukraine. The right to practice traditional medicine (healing) have only those persons without special medical education who have received a special permit to study traditional medicine (healing), i s- sued by the Ministry of Health of Ukraine or its authorized body [3, p. 223].

Article of Art. 74-1 of the Law of Ukraine «Fundamentals of the legislation of Ukraine on health care» [2] defines the right to practice traditional medicine (healing), which belongs to persons who do not have special medical education, registered in the manner prescribed by law as natural persons-entrepreneurs and received a special permit for practicing traditional medicine (healing), issued by the Ministry of Health of Ukraine. Information on persons who have received a special permit to practice traditional medicine (healing) (phytotherapy, chiropractic, bioenergy information therapy, acupressure, etc.) is included in the register of special permits and presented on the official website of the Ministry of Health of Ukraine. folk medicine law paradigm

Thus, we note that the right to practice traditional medicine and healing can be granted to a person who is registered in accordance with the procedure established by the current legislation as a natural person-entrepreneur and who is not required to have special medical education. That is, the lack of special medical education is not an obstacle to obtaining the right to medical practice in this area, which is a key point.

But this does not mean that the issue of education in this case is closed, because in the future, namely in the process of drawing up documents for classes in traditional medicine (healing), you will need to provide copies of such documents: certificates, certificates, diplomas and other documents issued in accordance with the established procedure by higher medical educational institutions of Ukraine of different levels of accreditation, institutions of advanced training and training or equivalent, which have the right to issue state documents on the sample in accordance with current legislation. They certify the level of education required for traditional medicine, which is ai general requirement, and consist in mastering medical knowledge within the requirements, programs approved by the Ministry of Health of Ukraine, basics of medical knowledge and methods of traditional medicine, as well as improving knowledge at scientific events (conferences, symposia, etc.) and courses.

It is important that the permit for a person to practice medicine in the field of traditional medicine is not a license, but a special permit to practice traditional medicine (healing).

In general, there are three reasons for deciding to engage in the activities of a traditional healer:

1) initial inclusion in the healing tradition through place of residence or family ties. In i this case, existing techniques and skills are inherited, and obtaining additional education and state registration is often associated with the expansioniof professional activities and the need to legalize it;

2) a sharp change in worldview that occurred as a result of psychological or physical trauma, which led to a feeling of unusual abilities. On the basis of this experience, one's own health and worldview system is created, from others only methods are borrowed that are consistent with the healer's own concepts;

3) own rehabilitation and creation on this basis of a health system [4, p. 91].

Ai the same time, the legislation of Ukraine determines certain conditions for obtaining a permitito practice traditional medicine (healing).

First, the right to practice traditional medicine (healing) can be granted to a person in the case of state registration of a healer as a natural person - entrepreneur.

Secondly, the activity of a traditional healer is carried out within a specific place of practice of traditional medicine (healing) with a special arrangement of such premises and obtaining a positive conclusion of the state sanitary- epidemiological examination.

Third, access to medical practice in traditional medicine (healing) can be obtained by a person who, according to medical criteria, is able to engage in relevant health activities and has received the appropriate certificate, as well as a certificate of psychiatric examination.

Fourth, the applicant must have a sufficient level of knowledge required for practicing traditional medicine (healing), as evidenced by documents issued in courses on the basics of medical knowledge and methods of traditional medicine that meet the requirements of programs adopted by the Ministry of Health. I of Ukraine. In addition, the required level of knowledge of the applicant is established as a result of successful completion of the certification, which is the basis for further examination.

Fifth, the condition for obtaining a permit is an expert assessment of the applicant's healing abilities, depending on the method of traditional medicine used by him. In turn, the «clinical stage» of testing the applicant's abilities takes place in the clinical departments of the Institution. At this stage, the traditional healer is obliged to provide the specialist of the Institution with an explanatory note describing and explaining the method he will use [4, p. 91].

Qualification requirements for persons engaged in traditional medicine (healing), the procedure for practicing traditional medicine (healing), the procedure for issuing and revoking a special permit for practicing traditional medicine (healing) are determined by the Ministry of Health of Ukraine. A special permit for practicing traditional medicine (healing) may be revoked by a decision of the body that issued it, or by a court decision.

According to the order of the Ministry of Health of Ukraine «List of medical positions in health care institutions» from 28.10.2002 № 385, the position «doctor of traditional and alternative medicine» is included [5i]. Thus, the main purpose of postgraduate training of doctors in this specialty is the training of highly qualified personnel who can combine in their practice methods of treatment of official medicine and traditional and alternative medicine.

Doctors who have already received postgraduate training in basic medical education, with at least 3 years of practical experience after completing the relevant internship (specialty «Medical Affairs», «Pediatrics») have the right to study at the specialization courses in «Traditional and Alternative Medicine». however, with the individual permission of the Ministry of Health of Ukraine). Fori doctors who have received basic higher medicali education and postgraduate training, work experience isi not taken into account.

There are different qualification requirements for doctors of traditional and alternative medicine of different qualification categories, but common for doctors of all categories is: full higher education (specialist, master) in the field of «Medicine», specialization in internship in one of the specialties «Medical Affairs» next specialization in «Traditional and Alternative Medicine». Higher categories need more work experience and advanced training (improvement courses, internships, etc.) [3, p. 224].

Thus, significant steps have been taken in Ukraine in the field of integrationi of traditional and alternative medicine with officiali medicine. To do this, create new medicali schools with in-depth study of traditionali and alternative medicine and organize special coursesi in traditional and alternative medicine in educationali programs (homeopathy, herbal medicine, reflexology, chiropractic, iridodiagnostics, etc.).

It should be noted that thei legal regime in the field of traditionali medicine (healing) and alternative medicine should bei different, and the conditions of medical carei (rights and responsibilities of the healer andi his supervising doctor) should be reviewed byi means and methods of traditional medicine. Amongi the above, we draw attention to thei requirement that the doctor who monitors thei activities of the healer, is obliged toi use objective methods of medical control andi statistics of analysis of the effectiveness ofi medical practice in alternative and traditional (traditionali but not official) medicine [6, with. 137].

Offices and centers are being set upi in which qualified specialists use the methodsi of traditional and alternative medicine to diagnosei and treat diseases. Ukraine will remain onei of the leaders in the development ofi traditional and alternative medicine, which will increasei the level of health of the populationi and lead to further expansion of thei use of traditional and alternative medicine ini rehabilitation and complex therapy of patients [7, p. 115].

Conclusions

Summing up, we cani say that traditional medicine is recognized asi a set of accumulated empirical knowledge, whichi is used to diagnose and treat diseasesi and is passed down from generation toi generation in each nation. At the samei time, alternative medicine is the collective namei of methods that claim the ability toi treat (or prevent) diseases, the effectiveness andi safety of which has not been proveni by scientific methods. Typical examples are homeopathy, acupuncture and naturopathy. Alternative medicine is calledi alternative because it is often used insteadi of formal medicine.

Note that the regulatoryi and legal support of traditional and alternativei medicine in Ukraine includes the following legali acts: Constitution of Ukraine, Civil Code ofi Ukraine, Fundamentals of Ukrainian legislation on healthi care, Orders of the Ministry of Healthi of Ukraine «List of medical positions ini health care institutions of health» from 28.10.2002 № 385, The order of issuei of the attestation-expert conclusion confirming existencei at the person of healing abilities» fromi 23.09.2013 № 822 in edition fromi 21.05.2019, «About the organization ofi work of physical persons - businessmen who arei engaged traditional medicine (healing)» from 03.16.2016 № 189, The procedure for issuing ani attestation-expert opinion confirming the presence ofi a person's healing abilities from 23.09.2013 № 822, Qualification requirements for natural personsi-entrepreneurs engaged in traditional medicine (healing) fromi 16.03.2016 № 189, Conditions for practicing traditional medicine (healing) from 16.03.2016i № 189 and others.

It is established thati doctors who have mastered the specialization ofi traditional and alternative medicine and work asi a doctor of traditional and alternative medicinei in licensed medical institutions, or as privatei entrepreneurs, if they have received a licensei from the Ministry of Health of Ukrainei for traditional and alternative medical practice.

Reference list

1. Yevtushenko V.V. Folk medicine asi a component of traditional Ukrainian culture. NAPAi Bulletin. 2019. № 3. Pp. 91-97.

2. Fundamentals of the legislation of Ukraine oni health care: Law of Ukraine of 19.11.1992 № 2801-ХІІ (date of updatei 16.12.2021). URL: https://zakon.rada. gov.ua/laws/show/2801-12iText.

3. Pokhmur-Hudym N. Analysis of the legali mechanism of public administration of folk andi alternative medicine. Collection of scientific works «Efficiency of public administration». 2015. Vip. 43. Pp. 220-226.

4. Vorontsova K. A personi who received the right to practice folki medicine (healing) as a subject of intellectuali property rights in the field of healthi care. Theory and practice of intellectual property. 2019. № 1. Pp. 86-93.

5. Listi of medical positions in health care institutions: Order of the Ministry of Health ofi Ukraine dated 28.10.2002 № 385 (updatedi on 10.08.2021). URL: https://zakon.rada.gov.ua/laws/show/z0892-02iTexti

6. Yamnenko T.M., Zhelyak A.A. Folk andi alternative medicine in Ukraine: the mechanism ofi legal regulation. Scientific works of the Nationali Aviation University. Series «Legal Bulletin «Air andi Space Law». 2020. № 1(54). P. 135-140. DOI: https://doi.org/10.18372/2307-9061.54.14551

7. Dudka V.V. Theoretical basis ofi the problem of state regulation of folki and alternative medicine in the scientific worksi of Ukrainian and foreign authors. Investments: practicei and experience. 2012. № 4. Pp. 111-115.

References