INTRODUCTION

This chapter addresses ethical issues concerning Communism and medicine in Eastern Europe. From the perspective of the twenty-first century, just after the turn of the millennium, one can see that the radical political changes in 1989 and 1990, including the introduction of market economy and the rise of political and moral pluralism, have not solved many of the serious problems facing Eastern Europe. The region faces high unemployment, widespread crime and corruption, environmental pollution, abuse of power, and widespread poverty. Twelve years after the disappearance of Socialism Eastern European health care systems still suffer from many serious problems. These systems are under financed, their physical infrastructure is decaying, health care professionals and nonprofessionals are dramatically underpaid, and moral dilemmas and controversies increasingly accompany the daily work of physicians and nurses. These health care systems are also badly structured and organized. Corruption, waste, and chronic bankruptcy characterize them, and the elite do little to make the necessary changes. Yet, the dramatic increase in morbidity and mortality indicates that the situation is catastrophic. Citizens can no longer trust in their health care systems and they are therefore suffering from a severe moral crisis. Throughout Central and Eastern Europe they seem to be, as a Russian author put it: “in a state of chaos and misery, in irreversible coma” (Yudin 1992, 5–6; see also Chapters 41 and 55).