THE RELATIONSHIP BETWEEN BEHAVIORAL MEDICINE AND BIOETHICS

ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-12 679 THE RELATIONSHIP BETWEEN BEHAVIORAL MEDICINE AND BIOETHICS Salimova Malika Rashidbekovna Senior Lecturer of the Department of Forensic Medicine and Medical Law of Tashkent State Medical University Abstract The primary role of behavioral medicine is to serve as an integrative foundation for the practical application of advancements in behavioral and biomedical sciences related to physical health and diseases. According to medical historians, behavioral medicine combines clinical psychology, epidemiology, medical sociology, anthropology, and bioethics with biomedical sciences such as physiology, endocrinology, immunology, pharmacology, anatomy, and dietetics, as well as certain branches of practical medicine and healthcare. Keywords: Behavioral medicine, Bioethics, Human behavior, Medical ethics, Ethical principles, Professional responsibility. Two significant scientific phenomena stand out in the history of behavioral medicine's global development. The first is the emergence of behaviorism in the early 19th century. In the USA, its founder John Watson criticized the subjectivity and mentalism of psychology at that time and believed that behaviorism could ensure objectivity in studying human behavior. Watson developed the following principles underlying this new direction: affirming the primacy of the environment, rejecting the consideration of hidden individual factors, and the thesis of the "scientific" nature of human behavior. However, at that time, his extremist position was not supported by the scientific community. As a result, new versions of behaviorism were developed. B.F. Skinner played a key role in this process. He adhered to radical behaviorism, which had a significant impact on behavioral medicine (primarily practical behavior analysis) and psychology in general. Skinner also emphasized that the only acceptable object of scientific research is specific behaviors and rejected mentalist concepts. The second historical event is associated with the emergence of experimental research in behavioral psychology. At the turn of the 20th century, Russian physiologist and Nobel laureate I.P. Pavlov laid the foundations of the theory of conditioned reflex formation. Around the same time in the USA, E.L. Thorndike conducted his innovative research in this field, focusing on the behavioral skills of animals. The clear impact of rewards and punishments on behavior was determined. From the late 1930s, B.F. Skinner also actively developed the concept of behavioral skill development. After World War II, the study of conditioned reflex formation processes and learning principles in the USA involved active experiments on animals. In these experiments, certain ethical norms established by I.P. Pavlov and B.F. Skinner were observed. In 1924, Mary Jones described the application of behavioral procedures to overcome fear in children. In 1938, O.H. Mowrer and E. Mowrer used developments in conditioned reflex formation for the treatment of enuresis. The method they created is still actively used in treating this condition. At that time, these studies did not have a significant impact on the development of psychotherapy. This is partly explained by the belief that the principles of forming conditioned reflexes in animals were too ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-12 680 primitive, and using these developments in treating complex human diseases was considered inappropriate. According to R. Corsini and A. Auerbach, behavioral medicine combines behavioral sciences and biomedical developments related to physical health and diseases. In our opinion, all work in this field should be bioethically determined. Today, behavioral medicine encompasses both fundamental and applied research. It requires mandatory bioethical assessment of available knowledge and methods of prevention, diagnosis, therapy, and rehabilitation. According to data from a recently published report by the U.S. Public Health Service, 50 percent of deaths (from the 10 most common causes) are related to lifestyle. The conclusion drawn from this is: "The main opportunity for further improving the nation's health lies in citizens changing their sometimes very unhealthy behaviors." Smoking is a persistent type of unhealthy behavior among citizens and is one of the most significant harmful lifestyle factors affecting health. Numerous studies show that smoking cigarettes leads to serious cardiovascular pathologies, oral cavity, lung and esophageal cancer, emphysema, bronchial asthma, and other lung diseases. Another common harmful habit is alcohol abuse, which often leads to liver cirrhosis, pancreatitis, accidents, murders, fires, and workplace injuries. Nutrition can also affect health. Anorexia nervosa is very dangerous for health. It is a form of voluntary starvation with extreme manifestations, most commonly found in young girls. The problem of obesity is especially serious in countries like the USA. If weight increases by 5060%, mortality increases by 150-250%. Obesity increases the risk of developing hypertension, diabetes, and heart disease. Additionally, surgical procedures are more difficult for overweight people. Non-adherence to medical instructions is another problem that behavioral medicine addresses. Following doctor's recommendations allows some groups of patients to overcome the aforementioned harmful habits. The preference for short-term results over long-term outcomes often indicates that patients do not follow medical advice. It is known that one-third to half of patients do not take their prescribed medications. In behavioral medicine, Munchausen syndrome by proxy, the effects of emotional stress, and other psychosocial factors also play important roles. Their typical consequence is an increased risk of developing a wide range of diseases: from sudden cardiac arrest to myocardial infarction, hypertension, stroke, diabetes, gastrointestinal diseases, multiple sclerosis, tuberculosis, influenza, pneumonia, headaches, insomnia, and others. Another aspect of behavioral medicine is the study of psychological problems arising from serious injuries or illnesses. Injuries or illnesses lead some people into severe depression, which is accompanied by additional negative physiological and behavioral effects that may exacerbate their painful condition. Based on the above, we emphasize that the theory of behavioral medicine cannot be formed without integrating new knowledge from bioethics, clinical psychology, medical sociology, health economics, and other fields. The role of medical professionals in solving behavioral medicine problems is crucial. An important component of doctors' professional success is their appropriate interaction (communication) with patients of different levels and healthcare organizers. Assessing the motivation behind the activities of medical institution heads, physicians performing medical services, and patients consuming these services from the perspective of bioethics and behavioral medicine is a serious challenge. Initially, the actions of all these entities are aimed at ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-12 681 ensuring and receiving high-quality medical care. However, each of them has different final indicators for evaluating medical activity. Thus, for the head of a medical institution, the main indicators of the organization's medical activity are: a) sufficient administrative control over the efficiency of internal resource use by medical staff and the professional conduct of doctors; b) conditions for the primary healthcare center to acquire quality medical resources for organizing the provision of adequate specialized medical care to consumers under certain circumstances. From the perspective of the organization's head, striving for competitive performance is an important incentive for maintaining a high level of diagnostic and treatment processes. The specific interests of healthcare providers directly serving citizens include: the doctor's satisfaction with their salary, chosen profession, working conditions, opportunities for professional and scientific growth, the presence of a certain level of social support for employees in the organization (benefits package), etc. The patient's interests primarily include the ability to access affordable and high-quality medical care in outpatient or inpatient settings. In our understanding, the concept of "behavioral medicine" reflects the existence of several additional problematic areas: a) various risks in applying new, widely untested achievements of medical science (which may threaten the patient's well-being due to insufficient study of possible complications from using new medications, technologies, and patient management protocols under certain conditions); b) the necessity for systematic internal clinical activities to prevent medical errors (arising from unqualified adherence to patient management protocols, as well as due to fundamental healthcare problems); c) the impact of additional behavioral factors on citizens' health. This includes: non-compliance by patients with the instructions of their treating physician, as well as, for example, with their personal schedule of medical examinations involving various specialists for the purpose of monitoring and improving health; conditions of hospitalization or outpatient treatment of patients; presence of socially significant and other diseases (primarily infectious) in the patient; usual methods of treatment when feeling unwell (patient's seeking help from a doctor, folk healer, self-medication, ignoring the illness, and allowing one's condition to reach a critical level); frequent unwillingness of patients to maintain good physical condition through engaging in physical culture and sports, tourism, quitting smoking, alcoholic beverages and other harmful habits, non-compliance with proper nutrition, work, and rest regimens; high levels of anxiety in most patients, uncertainty about the future; unstable family situations and difficulties associated with the birth and upbringing of their children; alcoholism, drug addiction, vagrancy, etc. All of the above aspects require additional scientific research from the perspective of medical history and the concept of bioethics. From the bioethical concept standpoint, the theoretical developments of J.T. Wilson (G.T. Wilson), Doctor of Philosophy, Professor at the Graduate School of Applied and Professional Psychology at Rutgers University, are of particular interest. In his opinion, significant changes have occurred in behavioral medicine in less than twenty years. This is ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-12 682 because this field of science actively utilizes the achievements of experimental psychology and clinical practice. Behavioral medicine has become a comprehensive, innovative, and detailed direction in medicine. The history of medicine emphasizes that behavioral medicine is characterized by diverse views and approaches. It employs a number of heterogeneous methods based on various theories. 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