In Soviet times the doctor’s ethical code emphasised the primacy of the physician’s relationship to the state. As such, remnants of these duty-focussed ethics have left a detrimental legacy to palliative care development. Cassileth writes:

Most of Russia’s bioethical standards and behaviour stem from two important features of deontology. One is the physician’s oath. In the former Soviet Union, that oath required physicians to protect first the interests of the State, not the interests of the patient. This conflict between responsibility to State and patient often worked to the patient’s detriment, and it is diametrically opposed to principals of physician responsibility in other countries.

 The second influential feature is the fundamental deontologic principle that obliged Russian doctors to protect patients from knowledge of potentially fatal diagnoses. This rule required that physicians not reveal diagnoses such as cancer, and it had the further effect of quelling communication with patients generally. ⁴³