By Connor Fairfield, CSEEES Autumn 2022 Intern
Dr. Nataliya Shok is a professor at the Privolzhsky Research Medical University (Nizhny Novgorod, Russia) and a public policy fellow at the Wilson Center, working on global health governance, vaccine diplomacy and health security in the context of the pandemic response. She approaches political analysis on health, medicine and biological risks using interdisciplinary methodology between social sciences, history of medicine and bioethics. In November, she attended the Association for the Study of Eastern Christian History and Culture’s conference at The Ohio State University and presented a paper “The Russian Orthodox Church and Reproduction: How the Russian Debate on IVF Transformed ‘Orthodox Bioethics’ into Biopolitics”. She kindly agreed to an interview with CSEEES intern Connor Fairfield.  

Where did you first find your passion to study bioethics and the history of medicine? 

I always liked complex subjects. Therefore, after I graduated and earned my first PhD in political science, I began teaching sociology at Mendeleev University of Chemical Technology of Russia. My first challenge as a humanities major was to make a non-STEM subject interesting for chemists. In four years, I succeeded and began understanding the advantages of the skills I had developed. My students learned to think critically, understand problems in society, and recognize their role as future scientists in preserving social stability and promoting social equality. I also began to understand their language and approach. My favorite groups were students who specialized in organic chemistry.

At the same time, my interest in the social sciences was waning. I wanted to pursue my career toward more applied and at the same time interdisciplinary research areas. I strove for an intellectual challenge and looked for adventures. This is how I ended up at Russia's oldest medical university, Sechenov University, in the History of Medicine Department. The history of the department which I found myself in was more than 100 years long—it was founded in the 19th century. I started teaching the history of medicine. In Russian medical school for more than a century, this course was a kind of "introduction to the field" for medical students. Within several years I defended my second doctoral thesis.

While in medical school, my previous experience in the social sciences inevitably led me to the social history of medicine and further into bioethics. The history of science has strong educational potential. Most existing ethical guidelines are the result of crises in science, after which scientists and society sought to minimize the risk of their recurrence. The Nuremberg Code exposed Nazi doctors, the Belmont Report exposed the cruelty of syphilis research in the United States, and the Declaration of Helsinki focused on protecting clinical trial participants. My interest in bioethics was greatly underlined by my expertise in the history of medicine.

With my growing interest in bioethics, I started to look for a mentor. I eventually became acquainted with some of the leading bioethicists from the United States. We met when they lectured at another medical university in Moscow almost 10 years ago, and later we managed to organize a few events together. As we talked and collaborated more, I saw that the most effective way for me to go into bioethics was through the history of medicine. I wanted to understand why the existence of bioethics in Russia was different from the U.S. and other countries. It was not only about the difference in health systems, but also about the history and culture of medicine. Now I can say that bioethics and its interdisciplinary nature and complex topics allowed me to successfully combine all my academic skills from social sciences, history of science, and philosophy (my deepening interest in bioethics forced me to finish an additional master’s degree in philosophy in 2018 at Sofia University in Bulgaria).

How does your educational experience in Eastern Europe compare to your experience in the United States? 

Over the past 10 years in Russia, I have mainly taught medical students. Here in the U.S., my visiting lectures are targeted towards a wide variety of educational programs. I like having students with different educational goals and topics in the audience. It makes the discussion livelier, and I find it more interesting. Plus, American students love and know how to ask good questions—I really like questions. I like the dynamics of dialogue in the classroom.

For people who may not be familiar with the concept of bioethics, why is it important for people to learn and be knowledgeable about your area of expertise? 

Bioethics is an important and fascinating interdisciplinary field of study where social sciences, humanities and life sciences work together to explore and develop knowledge aimed at maintaining essential social values like justice, safety, and equality in health, medicine, and technology. Moreover, international exchange and cross-cultural research in bioethics help us understand not only the differences in medical practice across countries, but also to develop socio-cultural and religious sensitivity that influence global health governance and security. Discussions in bioethics help understand the social meaning and implications of medicine and emerging technological advances. Medicine, as an important public activity, cannot be isolated or self-contained. Bioethics helps us hear the voice of society, which then helps us understand medicine and maintain a trustworthy public health environment.

What do you see as the biggest issue surrounding the topic of bioethics and medical research today? 

This is a great question. As with the many questions that bioethics raises, there is no single correct answer. I think, first, we must try to preserve the spirit of bioethics as it was when it first appeared as a platform of open discussion related to medical advances. The development of science and technology does not stop, and medical research is becoming more and more complex and requires the attention of bioethics. Bioethics in parallel with science has become an even more sophisticated and challenging field of study. This happened partially because of growing media and political influence in all spheres including biomedical science and technology.

I also think it is important today, given the growing geopolitical tensions and polarization of societies, to preserve the various channels of dialogue in science and medicine, where bioethics can play a positive role. The future of bioethics is continuing dialogue, not isolation, amidst diverse groups and opinions, which will help build trust in science across communities.

Considering the fact that you have spent time researching in both the United States and Russia, how does the bioethics landscape in the United States compare to that of Russia? 

My first research question in bioethics was: why doesn't Russia have as developed an infrastructure and research in bioethics as the United States? That is why I began my research in the history of Soviet medicine and worked with the archives of the Soviet Ministry of Health and the memoirs of Soviet doctors and health leaders. At first, it was surprising to me that so much interaction between doctors and scientists from the United States and the Soviet Union never led to a discussion of bioethics, especially in the 1970s. However, I realized that the Cold War was also an ideological struggle between two superpowers and bioethics therefore did not suit the goals of mutual research cooperation. At the same time, the lack of consensus on the ethical, social, and legal standards in medicine between American and Soviet physicians did not stop data-sharing for research and clinical trials. Cases of medical diplomacy like the polio vaccine and organ transplant programs on artificial hearts are even more surprising because there was a great deal of competition in public health standards. The Soviet Union actively promoted the virtues of the socialist model of health care as more accessible and equitable for the populations of decolonized countries in the global south. U.S.-developed bioethics was not presented in the USSR. When the USSR collapsed, bioethics was transplanted into the new Russian society. However, the cultural and political differences were not taken seriously. Long story short, in the U.S. the development of bioethics was linked to the growth of civil rights movements, intense discussions on moral challenges in medicine and science fueled by a long tradition of moral theology and ethical reflection in academia. Moreover, one of the key principles of American bioethics was the principle of autonomy, which can hardly be considered central to the practice of either Soviet medicine in the past or Russian medicine today. Overall, Russia has a more paternalistic model of medicine and an active role of the state in medical education (all medical universities are state-owned) and in the provision of social guarantees for medicine. To learn why Russian bioethics is different you need to understand all the factors mentioned above.

Read part 2 of the interview here.

If you find the topics discussed in this interview interesting, you can learn more about CSEEES’ dual degree in Slavic, East European and Eurasian Studies and Bioethics below.

CSEEES Dual Degree in Bioethics