The Moral and Ethical Foundations of Medicine Established by E.S. Botkin

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Evgeny Sergeevich Botkin's life journey began in Tsarskoye Selo, near St Petersburg, in 1865. He was born into the family of the eminent physician Sergei Petrovich Botkin, which later undoubtedly influenced his choice of profession. The family welcomed a creative atmosphere. The famous Botkin evenings were attended by the whole capital's elite: writers, artists, musicians and collectors. Communication with eminent people had an influence on the formation and shaping of the personality of the future doctor.

He graduated from St. Petersburg Gymnasium and in 1882 entered the University. At first in the physics and mathematics department, but then he drastically changed his mind and the following year he enrolled in the Imperial Military Medical Academy, which was his father's main place of work. Having graduated with flying colors, the young doctor was given limitless opportunities, but his true orthodox beliefs sent him to a hospital for the poor. There he comes to the conclusion that the clinical work of a doctor requires not only practical skills but also personal spiritual experience.

In addition to his career as a doctor, Botkin is also a professor, actively working with students and publishing works: "What it means to «pamper» the sick" and "The sick in hospital". In these he deals with issues of medical morality, paying particular attention to communication with the sick, pointing out how dialogue should be structured: "Never interrupt... the patient, let him really tell you everything..." [1] - With this statement he already emphasizes and lays the foundation of the modern principle of respect for the autonomy of the patient.  Botkin draws the attention of students to the true compassion for each patient, which is born in the depths of the soul, coming from the heart, and asks "do not be stingy with them" [2].

Having once again proved himself as a man of higher moral ideals and values, in 1904 he volunteered to the front. Most of the time Evgeny Botkin spent at the front, helping the wounded soldiers. He wrote letters to his wife from the front, which later would be compiled in the work "The Light and Shadows of the Russian-Japanese War of 1904-5". Throughout the war, faith alone was the source of E.S. Botkin's strength, for in this book he said that "unless God so wills" he would not perish [4]. His words reflect one of Socrates' virtues - courage "prudent firmness of soul", because first of all Dr. Botkin did his best to fulfil his professional duty, without fear of death.

Reflecting on the course of the war, Botkin became disillusioned with people's moral values and faith, for it was religion that occupied an important place in his work. As a deeply religious man, he perceived medicine as something higher, spiritual, compared it to "ministry", and so in his letters he notes "a whole lot of our troubles are only the result of people's lack of spirituality, of a sense of duty".

A separate page in the biography of Evgeny Sergeevich Botkin is his commitment to the Romanovs. A huge part of his life was devoted to the service of the Tsar. Evgeny Botkin faithfully kept secrets about the illness of the heir to the tsar's throne, thereby respecting the rule of confidentiality. Evgeny Sergeevich loved both his and the Tsar's children equally, and was able to protect them by pulling them out of the totally unpredictable course of the illness. When Tsesarevich Alexei was ill, Botkin asked his children to pray for the heir's health. The doctor did not leave the bed for days, using all kinds of medical remedies. Later the Tsarevich would even write to Evgeny Sergeyevich in one of his letters: "I love you with all my little heart" [4].

When the royal family is sent into exile, Botkin voluntarily refuses to leave them, thereby upholding his Hippocratic oath.

Shortly before the tragedy occurred, Dr Botkin was summoned to a talk where he was asked to renounce his oath to the Romanovs and go into private practice, to which he replied: '... But you see, I gave the Tsar my word of honour to remain with him as long as he lived. It is impossible for a man of my position not to keep such a word, nor can I leave an heir. How can I reconcile this with my conscience..." [5]. It follows that Evgeny Sergeevich was prepared for any fate awaiting the royal family; he chose to follow his oath of loyalty to the doctor to the end. In a letter to his brother Alexander, Botkin compares his decision with "Abraham's decision". A deep "faith" in God was the most important foundation of his devotion to "the cause" - professional duty. "And I firmly believe," writes Botkin in his last letter, "that, just as God saved Isaac then, he will now save my children and himself will be their father [4].

The eminent doctor, who remained faithful to his principles of medical duty to the end, was murdered together with the imperial family in 1918.

It should be noted that E.S. Botkin was awarded the title of hereditary nobleman a few years before his death. He chose the following dictum: "By faith, by faithfulness, by labour". It articulates all of Dr Botkin's values, ideals, and principles [4].

Thus, it is possible to identify the following principles of E.S. Botkin's medical ethics that characterise his absolute commitment to his profession: an attitude of service; helping no matter what; respect for colleagues; fairness; unselfishness and uncompensated service; fidelity to medical duty.

The principle of fidelity to medical duty is the most important of all, and underlies the modern principle in biomedical ethics - respect for individual autonomy [3]. Evgeny Sergeyevich Botkin remained faithful to his ideals and beliefs to the end. As Socrates said - "True morality is the knowledge of what is good and beautiful and useful for man, which helps him to achieve bliss and happiness in life".

About the authors

Sofia R. Kalinkina

Smolensk State Medical University

Email: kalinkinasofya2004@gmail.com
ORCID iD: 0009-0007-1634-6419

student of the 2nd year of the Faculty of Pediatrics

Russian Federation, 28 Krupskaya str., Smolensk, 214019, Russia

Mariya V. Barabanova

Smolensk State Medical University

Author for correspondence.
Email: mari.barabanova.04@bk.ru
ORCID iD: 0009-0006-4880-515X

student of the 2nd year of the Faculty of Pediatrics

Russian Federation, 28 Krupskaya str., Smolensk, 214019, Russia

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