State Duma lawyers criticized the bill on decriminalization of medical activities

The Legal Department of the State Duma recommended finalizing the bill on the decriminalization of medical practice, which was introduced in March by members of the United Russia party. Duma lawyers were confused by the deputies’ desire to remove medical care under the state guarantee program from the law “On the Protection of Consumer Rights” and assign it exclusively to the law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation.” The State Duma Committee on Health Protection stated that they will continue to work on the initiative. Experts interviewed by Kommersant consider a parallel legal procedure for regulating medical activities and the creation of a special status for doctors to be “more promising.”

The bill on the decriminalization of medical practice appeared after a meeting between Vladimir Putin and members of his campaign headquarters in early February 2024. The head physician of city hospital No. 52 in Moscow (and concurrently the chairman of the headquarters) Maryana Lysenko complained to the head of state about the term “medical service.” “Doctors actually provide medical care, treat patients, save lives, performing an important government function,” she recalled, asking the president to “resolve this issue” and abandon the term “service” in the field of medical activities. The head of state replied that he did not know why “our bureaucratic structures are so stubborn.” “Formally, this could be a service. But this is much broader than just taking, selling, buying, renting. Let’s do this, I’m not against it, I’m for it,” said Vladimir Putin.

On March 20, a group of senators and deputies from United Russia submitted a corresponding bill to the State Duma, developed “in order to increase the prestige of the medical profession and decriminalize the provision of medical care.” Upon examination of the document, it becomes apparent that the issue of “service” is much more complex than it seems. Parliamentarians proposed to remove relations that arise when providing medical care to citizens under the state guarantee program from the law “On the Protection of Consumer Rights” and assign their regulation exclusively to the law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation.” This, according to the authors of the initiative, will “limit the application of Art. 238 of the Criminal Code of the Russian Federation in relation to medical workers, while maintaining the responsibility of the medical organization to the patient for the fulfillment of its obligations defined by law.” As for “medical services,” this term is proposed to be used only in financial and statistical contexts, as well as in nomenclatures and standards.

The Legal Department of the State Duma drew attention precisely to the provision that the rules and conditions for the provision of medical care, as well as the rights, duties and responsibilities of medical workers should be regulated only by the norms of special legislation. Lawyers said the proposal needed clarification because it “does not meet the criteria of certainty and clarity.” In particular, it lacks “specification of legal relations that should be regulated by other legislative acts,” the types and levels of which must also be determined.

The head of the State Duma Committee on Health Protection, Badma Bashankaev (United Russia), recalled that any bill goes through several stages, including an assessment by the legal department: “This is normal parliamentary practice. Now, with the participation of lawyers and other experts, the committee will continue to work on the bill in order to prepare it for consideration in the State Duma.” The head of the committee emphasized that the bill on the decriminalization of medical practice has long been awaited in the professional medical community, and it is “of great importance for doctors, nurses, and everyone who works in the profession.”

Co-chairman of the All-Russian Patients’ Union (VSP) Yuri Zhulev believes that “the bill has a lot of room for improvement and needs legal elaboration.” “It is important to maintain a balance between the rights and responsibilities of both the doctor and the patient. Neither side should outweigh, both should be protected,” Mr. Zhulev emphasized. He noted that no system in the world is immune from medical errors. According to a representative of the VSP, in such cases it is necessary to move towards compensation for the damage caused to the patient, and not just punishment of the doctor: “If a criminal case is opened for every reason, the doctor will not think about helping the patient, but how to protect himself.” Director of the Institute of Health Economics at the Higher School of Economics Larisa Popovich previously expressed the opinion that it would be quite enough to adjust the law on the protection of consumer rights by removing the term “medical service” from its scope “in some part.”

Lawyer, managing partner of the Moscow bar association “Aronov and Partners” Alexander Aronov agrees that the bill really needs to be improved from a legal point of view. “It contains a rule on the exclusion of certain relationships from the scope of the law “On the Protection of Consumer Rights,” which in itself is impossible without determining the fate of these relationships. And if this is not a relationship between the consumer of services and the person who provides the service, then what kind of relationship is it? – the lawyer asks. – It was clear to the ancient Roman jurists that such activity of a doctor is precisely a service, since it does not have a material result and is aimed at making the greatest possible efforts to cure the patient. This is what distinguishes a service from a job. Since then, little has changed in the understanding of various legal goods—goods, work, services.”

He notes that recently, “more promising” from a legal point of view is “the creation of a parallel legal order for regulating medical activities.” Then the doctor will be granted a special status on a voluntary basis, the lawyer says: “He will become an independent subject of civil legal relations and will be able to insure his professional liability.”

Natalia Kostarnova