HISTORICAL AND LEGAL ANALYSIS OF THE HEALTH CARE WORKERS’ LEGAL STATUS DEVELOPMENT
Authors: Kniazevych N. V. 
Published: October 2021

The administrative and legal status of a health care worker gives a possibility to determine his place and role in public administration and other public relations. The rights and responsibilities of health care workers are of great scientific and practical importance, especially in view of the ongoing health care reform processes in the country. Given this, it is important to study the peculiarities of the formation of certain rights and responsibilities of medical workers, which constitute their current legal status, over a significant period of history of the Ukrainian state.

The article provides a historical and legal analysis of the development of the legal status of a health care worker, the beginning of the establishment of the first norms of behavior and professional responsibilities of medical workers in Ukraine, as well as legal acts governing the legal regulation of the legal status of medical workers in different years of existence of the Ukrainian state. The importance of research in the context of modern health care reforms for the formation of its individual areas of implementation is emphasized.

In Ukraine, as in every country, the legal regulation of the legal status of health care workers has its own genesis. The field of health care dates back to the establishment of the statehood by East Slavic tribes in the ninth century and various subjects in the field of treatment were singled out. Thanks to the work of the first "doctors" of Kievan Rus, medical knowledge and skills were spread out, the foundations of deontological norms of behavior and professional responsibilities were formed, and the interest of the state authorities in providing medical care to the population appeared.

"Kyiv-Pechersk Paterik" contains a list of responsibilities of that time doctors that lived in monasteries, namely, they had to do menial work, caring for the sick; be tolerant in dealing with them; do not care about personal enrichment.

The first professional duties of a secular doctor were contained in the "Svyatoslav's Miscellany " in 1076, compiled for the Chernihiv prince Svyatoslav Yaroslavovich from the " Miscellany " of the Bulgarian King Simeon (X century). Among such responsibilities was the provision of surgical care - the ability to cut the skin, amputate limbs, burn wounds, fight suppuration.

The first basic act, which determined the legal status of medical workers was "Rules governing the professional work of medical staff" (hereinafter - the Rules), was approved by the SNC of the USSR on April 17, 1924. It established qualification requirements for medical positions. According to Art. 1 of this document, the medical staff included persons who had the qualifications of a doctor, dentist, obstetrician, assistant doctor, pharmacist, nurse or brother (medical), masseur. To hold the position of a doctor, it was necessary to obtain the appropriate qualification in a medical institute or university, or a higher medical school of the Union of Soviet Socialist Republics (hereinafter - the USSR) or the former Russian Empire. At the same time, such a right was granted to persons who had obtained medical education and the qualification of a doctor of medicine abroad and had passed an examination at a higher medical school in the USSR. Such professionals could engage in both medical practice and hold administrative positions in the field of medicine. Physicians, in agreement with the administration, were given the right to have a personal seal stating their qualifications.

The rules also determined the features of medical intervention (surgery, hypnosis, anesthesia, etc.). For example, a doctor had the right to use anesthesia only with the consent of the patient or in the case of his infancy or mental illness, or fainting of parents or guardians. In case of urgent surgical intervention, the doctor had to consult with a fellow surgeon. Otherwise, he had to make decisions alone. Doctors were required to report such medical interventions to health departments within 24 hours.

The health care system in 1969-1991 was based on the norms enshrined in the Fundamentals of the Legislation of the USSR and the Union Republics on Health Care (1969) and the Law of the Ukrainian SSR "On Health Care" (1971). (hereinafter - the Law), which emphasized that public health is one of the most important tasks of the Soviet state and the duty of all state bodies and public organizations. The basics of the legislation of the USSR and the Union Republics on health care served as a kind of legislative basis, on the basis of which other laws and bylaws regulating the health of citizens were subsequently adopted.

The law provided the duty to maintain medical confidentiality, which meant that doctors and other medical and pharmaceutical workers were not allowed to disclose information about illnesses, intimate and family life of citizens, which they found out as a result of their professional duties.

To sum up, we can identify the main historical stages of formation of the legal status of a health care worker:

1) IX century, the times of Kievan Rus - the first mention of the duties of that time doctors ("Kiev-Pechersk Paterik", "Svyatoslav's Miscellany " 1076);

2) The times of the USSR in 1919 - the first attempt to streamline medical activities and outline the legal status of medical workers, including the provision of certain social and material guarantees ("Rules governing the professional work of medical staff", approved by the USSR SNK April 17, 1924), Resolution of the SNC of the USSR "On Improving the Situation of Medical and Sanitary Workers" of June 10, 1920).

3) 1969-1991, Ukraine in the Soviet period - strengthening democratic principles in public and state life, a new codification of Soviet law (Fundamentals of the legislation of the USSR and the Union Republics on health care (1969), the Law of the Ukrainian SSR " On health care "(1971))

Moreover, we can identify the basic principles of health care in Ukraine, which were formed over a long period of history of the Ukrainian state, due to the different legal and economic situation of the country and, due to historical and legal development that became decisive for the current legal status of medical workers. These are such principles as: recognition of health care as a priority of society and the state, availability and free medical care, democracy, provision of state guarantees, observance of medical secrecy, etc.