Failure to render medical aid to the patient (Article 124 of the Criminal Code of the Russian Federation) as an intended crime: a concurring opinion

Berchanskiy Kirill Alekseevich Postgraduate student, the department of Criminal Law, Criminology and Penal Law, Saint Petersburg Law Institue (branch) of the University of Prosecutor's Office of the Russian Federation 191014, Russia, Sankt-Peterburg, gorod Sankt-Peterburg, Liteinyi prospekt, 44 cyrillbears@gmail.com Other publications by this author

Introduction. We have already mentioned elsewhere the heterogeneity of judicial practice in crimes committed by medical professionals as a result of them being an extremely small share in the practice of Russian courts, their high workload, and the resulting lack of interest in forming a unified and solid understanding of the specifics inherent in such crimes ^[1].

While the difficulties in understanding the category of causality, given the lack of its legal definition and the existence of contradictory concepts in the doctrine ^[2], are relatively understandable, the differences in understanding the content of their mental element might baffle.

It would seem that when the whole Chapter 5 of the Criminal Code of the Russian Federation ^[3] (hereinafter – the Criminal Code or the Code) is dedicated to the issues of subjective element, and Part 2 of Article 24 does not provide any alternatives for it in any particular offence ^[4] (while some states of the Civil Law system are deprived of the statutory definition to even intent and negligence ^{[5, с. 233]}), such problems can occur only as isolated cases.

Nevertheless, as the analysis of judicial practice on Article 124 of the Criminal Code in the period from 2010 to 2020 shows, the Russian judicial community is far from being united on the mens rea in iatrogenic crimes.

The purpose of this study is to clarify the reasons for courts deeming offences by Article 124 of the Criminal Code as intentional crimes or as having double mens rea, while the generally accepted understanding of such crimes does not allow it. And although the arguments of those law enforcers and scholars, who insist on the opposite, are based on wrong understanding of Russian law, their conclusions may have an alternative confirmation. The result of this inquiry was the formation of a concurring opinion: we do not agree with their reasoning, but partially agree with their conclusions.

Judicial practice. Part 2 of Article 26 of the Criminal Code establishes that the act committed only negligently is considered a criminal offense only when it is specifically provided by the relevant article of the Code.

Although, according to the author of this article – Ninel. F. Kuznetsova, it supports only one interpretation: in the absence of indication of particular form of mens rea in the article of the Criminal Code, it provides for negligence or intention ^{[6, с. 34-35]}, the practice of the Higher Courts of the Russian Federation suggests otherwise.

Thus, in the above-mentioned decision № 3-P of March 31, 2011, the Constitutional Court, when deciding on the constitutionality of Article 138 of the Criminal Code, indicated that since this article does not indicate negligence, it provides only for intent.

Due to the fact that Article 124 of the Criminal Code of the Russian Federation indicates omission, which inadvertently entails the occurrence of socially dangerous consequences, such an act in the light of the above mentioned position of the Constitutional Court should be qualified as a negligent crime. Nevertheless, the Russian courts show a striking diversity of opinions on this issue^[1].

While in a number of decisions the courts justifiably point to negligence when passing a sentence ^[7-9], in some they directly refer to intent as a necessary element of such crimes.

The sentence passed by the Chernyshkovskiy District Court on June 25, 2019 indicated that a doctor, who had not supervised the implementation of the assigned diagnostic procedures (ultrasound of the abdominal cavity, probing and irrigation of the stomach) and by that caused the patient's death from a massive peptic ulcer bleeding, acted negligently, while Part 2 of Article 124 of the Code provides intent as its mandatory element. By this court changed the initial indictment to Part 2 of Article 109 of the Criminal Code («Negligent causing of death while performing professional duties») ^[10].

According to the verdict of Ilovlinsky District Court of Volgograd Region on August 17, 2015 a surgeon had been convicted of committing a crime under Part 2 of Article 124 of the Code for, despite the symptoms of severe injuries, not providing a patient with care for at least 20 minutes while he was lying on a stretcher in the emergency room.

The court rejected the defense's request to dismiss the case on the basis of Sub-paragraph 2, Paragraph 6 of the Resolution of the State Duma of the Russian Federation of April 24, 2015 «On declaring an amnesty in connection with the 70th anniversary of the Victory in the Great Patriotic War of 1941-1945» ^[11]. According to the court, this crime was «classified by the law as intentional one» (which was not covered by the amnesty)^[12].

The appeal decision of the Volgograd Regional Court found this to be incorrect, and the criminal case was dismissed by applying the amnesty act ^[13].

The verdict of the Ikryansky District Court of the Astrakhan Region on July 25, 2012 convicted an ambulance paramedic who, after a superficial examination of the patient, refused to hospitalize him, causing his death. The court stated that «The culpability of P. in commiting an intentional crime is confirmed by the following evidence: ( ... )», and although the court imposed a sentence of 1 year in a penitentiary settlement and banned her for 3 years from medical profession, this decision became final and was not appealed ^[14].

Also, by the verdict of the Magistrates' Court of the judicial district № 1, Zlatoust City of the Chelyabinsk Region of September 28, 2010, a surgeon, who ignored a preliminary diagnosis of «a perforated ulcer? Peritonitis? Intestinal obstruction?» and without further examination diagnosed «an alcoholic gastroduodenitis, dehydration», causing patient to die, was acquitted of a crime under Part 2 of Article 124 of the Criminal Code. The court justified this decision by indicating that this article provides for intention, while such an attitude on the part of the defendant was not proved by the prosecution ^[15].

The most significant thing in this case is that the Zlatoust City Court of the Chelyabinsk region overturned this decision and passed the appeal verdict of April 19, 2011, by which found the doctor guilty. However, this decision was motivated by the fact that the medic allegedly acted with intent ^[16].

In a number of decisions, law enforcement officers and courts allow extremely vague and contradictory wording, indicating at the same time the intentional and negligent attitude of the convicted, without determining which category (intentional or negligent) the act belongs to as a whole.

Thus, in the verdict of December 18, 2017, the Kirovsky District Court of Kazan City indicated that the mental element of this category of crimes is characterized by direct intent aimed at not providing care, and negligence in relation to the consequences. Based on this, the court changed the indictment supported by the prosecutor from Part 2 of Article 124 of the Criminal Code to Part 2 of Article 109 ^[17].

Investigators, indicating both intention and negligence in the initial indictment, caused the return of the criminal case to the district attorney by the decision of the Prokhladnensky District Court of the Kabardino-Balkar Republic of March 1, 2013 ^[18]. The appeal ruling of the Supreme Court of the Kabardino-Balkar Republic of April 19, 2013 upheld this decision ^[19].

In a number of cases, the courts generally avoided determining the form of mens rea, not specifying it in the decision ^[20].

Unfortunately, differences in doctrinal research only support this practice. If we turn to the most accessible and «ready – to-use» for law enforcement sources of scholarly interpretation – to the commentaries on the Criminal Code, the reason for such discrepancies in investigative and judicial practice becomes somewhat more clear.

Commentaries and problem statement. So, the group of authors under the leadership of N. Gromov uses the already mentioned wording «intent to act, negligence to consequences». They consider Article 124 of the Code to be a crime with a double mens rea (which will be described later) by the provisions of Article 27 of the Criminal Code, that is, intentional as a whole ^{[21, с. 184]}.

A number of researchers, in particular: the groups under the leadership of Vladimir I. Radchenko ^{[22, с. 100]} and Alexander. I. Chuchaev ^{[23, с. 520-521]}, formulate the mental element of this crime in the same way, but without indicating the double mens rea.

Collectives of Gennadiy A. Esakov ^{[24, с. 218-219]} and Oksana. S. Kapinus ^{[25, с. 431-432]} limit themselves to pointing negligence in relation to the consequences in the form of bodily injury.

Of all the works studied, only the researchers under the leaderships of Alexey. I. Rarog ^{[26, с. 260-261]} and Aleksandr V. Brilliantov ^{[27, с. 437-438]} directly and unambiguously point to negligence in offences described in Part 2 of Article 124 of the Criminal Code.

Such discrepancies and unfortunate wordings in theoretical understandings of the law may well have an impact on law enforcement practice, or at least exacerbate its heterogeneity.

In order to establish a valid configuration of the mental element in Article 124 of the Code, first, we need to turn to the the dedicated research on this crime and iatrogenic crimes in general.

Mens rea in Article 124 of the Criminal Code in the dedicated studies. Unfortunately, the opinions of experts in the study of the corresponding category of crimes are as diverse as the positions of law enforcement officers and scientists of a broader specialty.

Svetlana V. Zamaleeva directly refers Article 124 of the Code to crimes with a double mens rea, pointing to negligence in relation to the consequences as the only characteristic of the subjective element ^{[28, с.16] [29, с. 14-15] [30, с. 15, 31]}.

The same point of view is shared by the authors of the «Iatrogenic crimes: legal, criminological and forensic view», who refer Article 124 of the Criminal Code to the category of generally intentional iatrogenic crimes ^{[31, с. 31]}.

Olga S. Lavrikova and Ekaterina E. Kochanova also state that the mental element of this crime is characterized by direct intent in relation to the failure to provide care and negligence (in the form of negligence in se or recklessness)^[2] in relation to the consequences ^{[32, с.34]}.

The opinion that Article 124 is characterized by a double mens rea is held by Arkadi N. Krasikov and Nadezhda V. Miroshnichenko, who allow the combination of any forms of intent and negligence in it ^{[33, с. 89] [34, с. 93-98]}.

Nadezhda V. Miroshnichenko at the same time states that the subjective element of this act is expressed in the awareness of the possible occurrence of dangerous consequences and in the conscious assumption of a criminal result. N. Alexandrova allows any kind of intent in combination with recklessness ^{[35, с. 106-107]}, and N. Medvedeva – direct intent and negligence in se ^{[36, с. 167]}.

Aleksandr G. Blinov, criticizing a similar point of view of Eduard F. Pobeghailo ^{[37, с. 105-106]} and Konstantine L. Akoev ^{[38, с. 74]}, points out that the double mens rea occurs only in qualified aggravated offences, in which the legislator legally combines two independent crimes that separately entail criminal consequences ^{[39, с. 97-98]}. Alexander N. Varygin and Ekaterina K. Chervonnih agree with this opinion, refering this offence to negligent crimes ^{[40, с. 52]}.

Marina A. Garbatova, basing her reasoning on the provisions of Part 2 of Article 24 and Article 27 of the Code, insists that Article 124 is characterized only by negligence, both in the form of recklessness and negligence in se, but the latter in practice is practically non-existent ^{[41, с. 299-300]}.

Tatiana N. Petrova, in turn, refers Article 124 to a category, which is characterized by either negligence or a «mixed form of mens rea» – the intention to act and negligence to the consequences, separating them from purely intentional offences (Article 235 and 238 of the Criminal Code) ^{[42, с. 8]}.

Vladimir D. Pristanskov refers offences under Article 124 of the Criminal Code to crimes that are characterized by negligent in se or reckless form of mens rea ^{[43, с. 8]}.

Eugenius P. Grigonis and Oleg V. Leontiev do not pay attention to the subjective element of this crime, limiting their analysis to only the most problematic issues of actus reus: the essence of the statutory element «with no relevant excuse» and the status of medical professional ^{[44, с. 92-95]}.

Also Oleg V. Leontiev indicates that «passive euthanasia» – failure to assist a patient out of compassion, might be qualified under this article, while committing acts aimed at causing death falls under Article 105 of the Criminal Code («Mudrer») ^{[45, с. 17-27]}.

It is obvious that the notion of Article 124 of the Criminal Code being characterized by double mens rea among researchers of the criminal dimension of healthcare is the rule rather than the exception. This situation, even for people only nominally familiar with the concept of double mens rea in Russian criminal law, is intuitively aversive, since any textbook cites as an example of double mens rea Part 4 of Article 111 of the Criminal Code («Part 1. Intentional causing of grave bodily injury. Part 4. The same offence causing death by negligence»), which is a compound aggravated offence and Article 124 is not. In light of this, to understand the subjective element of similar offences, it is necessary to turn to the definition of a double mens rea.

Anticipating the subsequent conclusions, it should be noted that this situation – an almost parallel divergence of opinions about the subjective element of offences under Article 124 of the Criminal Code, is due to many factors. In part, to the misinterpretation of the provisions of Article 27 of the Criminal Code («Double mens rea») by some researchers, in part – to the anachronisms of criminal doctrine of the Soviet and pre-Soviet period, sneaking into the modern discourse, the desire of some researchers to convey their work in simple language, losing some of its essence in the process, and finally – the real mistakes on the part of the legislator.

Double and «mixed» subjective element in the criminal doctrine. Article 27 of the Criminal Code («Double mens rea») states that if, in commiting an intentional crime, the more serious consequences are caused by negligence, and law provides for them a more severe punishment, then this crime as a whole is considered intentional.

This rule first appeared in the history of Russian criminal law in 1996 and has no analogy in domestic criminal legislation.

Its origin – whether it was borrowed directly from the legislation of other countries, or was devised by Russian scholars, who independently came to similar conclusions, is hardly possible to establish because of the extremely complicated history of the new Code coming into existence.

The idea of a new criminal code came a very long way from individual proposals for reform in the 60s and 70s, through the creation of the «Theoretical model of a Penal Code (General part)» (analogous to the US Model Penal Code) in 1985, proposal in October 1992 of the first «presidential» draft, introduction of an alternative project on behalf of the Legislation Committee of the Supreme Council, their merger in July 1994, and finally – to the adoption of the current Code in July 1996. ^{[46] [47, с. 669-675] [48]}.

In this situation, separate articles has long lost their authorship and live their own lives, which is demonstrated by the above mentioned example with the inconsistent interpretation of Article 26 of the Code by its author and the Constitutional Court.

Nevertheless, for reasons that will become clear later, we consider it necessary to turn to the understanding of double mens rea by scholars who stood at the origins of the Code – this will allow us to form, albeit limited, but understanding of the initial legislational logic in the creation of Article 27.

Professor Victor V. Luneev, in a team of authors under the leadership of Vladimir N. Kudryavtsev and Anatoly V. Naumov, cites as an example of such a crime Part 4 of Article 111 of the Criminal Code, which is represented by a compound aggravated offence, where liability for an intentional crime is provided by the main offence («Part 1. Intentional causing of grave bodily injury») and for negligent causing of consequences – by the aggravating one («Part 4. The same offence causing death by negligence») ^{[49, с. 217-220]}.

Yuriy. A. Krasikov, which should be noted, calls such offences «acts with a double (complex) mens rea», while Victor V. Luneev emphasizes that Article 27 of the Criminal Code does not describe any new form of mens rea – only the presence of its separate forms in relation to the main offence and the aggravating one. He also points out that since such a «form» is characterized by a different attitude to the act and to its consequence, it can only be observed in material offences (those which require an onslaught of socially dangerous consequences to be qualified as a crime). At the same time, in formal offences, the consequence is «inseparable from the act» and merged with it, and therefore the attitude to both the act and the consequence will be the same ^{[50, с. 117]}.

Anatoly. V. Naumov also points out that crimes with two forms of mens rea are characterized by intention to the act and a negligence to the consequences. However, he also notes that the application of this rule is limited only to intentional offences, the composition of which provides for an aggravating circumstance in the form of negligent consequences as a separate offence ^{[51, с. 95-96]}. Moreover, in his later writings Naumov states directly that the offences with double mens rea are specially designed by the legislator, again citing the example of Part 4 of Article 111 of the Criminal Code ^{[52, с. 426-427]}.

Irina M. Tiazhkova, under the leadership of Ninel F. Kuznetsova, believed that two forms of mens rea are possible only in compound aggravated offences, directly warning against mistaking them with negligent violations of special rules, for those offences are not compound but simple – they provide for one consequence and one negligent form of mens rea.

The author also draws attention to the doctrinal origins of this rule, which she sees in the Soviet legal doctrine of the 60s. At that time, a number of researchers insisted that there is a «mixed form of mens rea», which is characterized by intention to the act and negligence to the consequences.

This point of view did not receive practical application and was reasonably criticized by contemporaries: first, this way a single offence was broken into two for no good reason, second, the legislation did not allow to establish an attitude to the act – only to the consequences, and third, the proponents of this theory confused intent with awareness of violation of special rules ^{[53, с. 290-292]}.

As will be shown later, much of this criticism is still relevant today.

Alexei I. Rarog, who is generally considered to be the creator of the modern domestic understanding of the subjective element, under the leadership of Alexander I. Korobeev criticized positions of Y. A. Krasikov, Vladimir D. Ivanov, and S. Mazukov ^{[54, с. 23-24]}, as well as Vladimir V. Lukyanov ^[55] on different attitudes of the perpetrator to the act and to the consequences in crimes with double mens rea, interpreting them as a return to the concept of «mixed» mental element.

The author points out that the essence of crimes with two forms of mens rea lies in different mental attitudes to different characteristics of the objective element: the mandatory feature of the main offence and the aggravating consequence. The offences that include two forms of mens rea are specially envisioned by the legislator in the form of compound aggravated offences ^{[56, с. 354-358]}.

It should be noted separately, that when discussing offences, where the main one is formal, Alexander I. Rarog has to temporary fall to the position of his opponents. Thus, when describing them, he points out that they are characterized by a heterogeneous mental attitude to the act and the aggravating consequence, but adds that such an offence is criminal, regardless of the consequences. This nuance distinguishes his position from the views of Yuriy. A. Krasikov, who considers the consequences in such crimes to be identical to the act itself ^{[57, с. 57-61]}.

Naturally, an appeal to authority cannot be considered evidence in itself in the doctrine of criminal law, even if said authority is directly involved in the formation of it. However, as a basis for further reasoning, preliminary conclusions can be drawn from the arguments of these researchers.

All of them believe that the double mens rea is possible only in specially designed by the legislator compound aggravated offences.

Researchers consider deeming simple offences expressed in violation of special rules as crimes with two forms of mens rea to be inconsistent with the law and the legacy of the unsuccessful theory of a «mixed» form of mens rea.

Also, there is no unity among them on the presence of double mens rea in compound aggravated offences, in which the main offence is formal. The root of these differences lies in the different understanding of the consequences of such crimes.

We fully agree that considering violations of special rules (which includes Article 124 of the Criminal Code ) as having double mens rea only on the basis of «intentional attitude to the act and negligent – to the consequences» is not correct. It has been already wrong 60 years ago, under the concept of «mixed» mens rea.

A rule, similar to Article 27 of the Criminal Code has been proposed in the domestic legal doctrine as early as 1985. Thus, Article 31 of the «Theoretical Model of a Penal Code (General Part)» already contained this idea, being formulated as follows: «Article 31. Complex mental element. If, in committing an intentional crime, a person inadvertently causes other socially dangerous consequences, with which the law associates increased criminal liability, this crime is recognized as committed intentionally as a whole» ^{[58, с. 22]}.

Even its superficial comparison with the current rule shows that their meaning are generally identical.

Despite the fact that its author – Mindia G. Ugrekhelidze named such a configuration of the subjective part a «complex mental element» (which may indicate some form of guilt, separate from intent and negligence), his own attitude to this idea was far from unambiguous.

The first observation of the author points to the essence of the problem, which is the misconception that the perceived and foreseen circumstances of the crime constitute intention, and not negligence.

Mindia G. Ugrekhelidze drew attention to the fact, that the Soviet criminal law did not provide for a separate assessment of the relationship to the act and to the consequence in simple unaggravated material offences (which today include Article 124 of the Criminal Code). Even if a criminal committed the act consciously (for example, violated the requirements of fire safety, being aware of their content), but this awareness was not enough to anticipate the consequences, he still acted with negligence.

This observation is extremely valuable for our study, although it seems that the author did not develop his idea further enough. The Criminal Code of the Russian Soviet Federative Socialist Republic of 1960 (hereinafter – the Criminal Code of the RSFSR) ^[59] did not provide for the realization of public danger of the act itself as one of the elements of mens rea in Articles 8 and 9 («Intentional crimes» and «Negligent crimes», respectively). The presence or absence of criminal mens rea had to be decided on the attitude to the socially dangerous consequences alone: their anticipation or unawareness of them, desire of them to occur of absence of it ^{[60, с. 86-99]}.

Article 25 of the Criminal Code («Intention») similarly provides anticipation of socially dangerous consequences as a characteristic of intention. However, Article 26 («Negligence») provides for this element as a characteristic of recklessness. The distinction lies in the attitude to the consequences: the desire of them or conscious concession to their occurrence for intent, and misplaced hope of their prevention for recklessness. In other words, intent and recklessness are distinguished by the volitional part of mens rea.

In an effort to escape the cumbersome analysis of the subjective part by discerning the volitional and intellectual elements adopted in the Romano-German legal systems and which has become the main framework for understanding the concept of mens rea in Russia, some researchers «dumb it down» to a simple and clear formula «intent/negligence to the act/consequence». In the process, they either lose their understanding of the issue or confuse their readers.

Defining intent through a single attribute – through anticipation of possible socially dangerous consequences (that is, through the intellectual element), they lose both its second component – the awareness of the social danger of the act itself, and part of the volitional element – the attitude to the consequences.

From the arguments of Mindia G. Ugrekhelidze, both then and in modern Russia, inevitably follows the conclusion: even awareness, which is sufficient to foresee socially dangerous consequences, is not enough to establish intent. In addition to such awareness – awareness of the possibility of the occurrence of socially dangerous consequences, it is also necessary to have the second part of the intellectual element – awareness of the social danger of the act itself, as well as one of the variants of the volitional part – the desire for their occurrence, their acceptance or indifference to them.

It seems most likely that researchers who do not insist on the presence of a double mens rea in Article 124 of the Criminal Code, but use the formula «intent/negligence to the act/consequence», are trying to describe recklessness .

It is recklessness that is characterized by this configuration of the volitional and intellectual elements: the awareness of possible socially dangerous consequences (for which they use the word «intent»), the aversion to their occurrence (for which they use «negligence»), but the unbased expectation of their prevention. However, the statement that Article 124 of the Criminal Code is characterized only by recklessness is also not correct.

It seems that those researchers, who do not allow negligence in se as a form of mens rea in Article 124 of the Code, do that due to incorrect understanding of the mandatory feature of its objective element – «with no relevant excuse».

One of the most striking examples of such an eclectic approach to the analysis of the subjective element of Article 124 of the Criminal Code is the commentary by Yuriy. E. Pudovochkin, compiled under the direction of Aleksandr.V. Brilliantov.

The author points out that this offence is characterized by negligence both in the form of negligence in se and recklessness. However, he further explains: «Due to the special character of the perpetrator, the content of mens rea includes their awareness of the public danger and illegality of their own behavior» ^[27]. We doubt that one of the most prominent scholars in Russia allowed such a description out of misunderstanding the essence of mens rea. Nevertheless, the chosen wording misleads the reader, since the awareness of the public danger of the act itself is a characteristic of intention, while in negligence it is the anticipation of socially dangerous consequences. However, even if the author had in mind socially dangerous consequences, such a conclusion does not follow from the text of the law.

The liability for the offence under Article 124 of the Criminal Code comes for failure to provide care to a patient by a person obliged to provide it without a relevant excuse.

It is generally accepted that this article describes inaction – a complete refusal to implement measures aimed at providing care ^[61]. Some researchers point to the possibility of it in the event, where the amount of care was deliberately incomplete ^[62].

In this context, the interpretation of the requirement «with no relevant excuse» is of particular interest. Extensive lists of possible justifiable reasons that may exclude responsibility of a physician for not providing assistance to a patient are given in most special studies on this topic ^[63-65], which is not the subject of this research. It seems that scholars who hold the same opinion as Yuriy E. Pudovochkin, see in it something similar to the requirment of «deliberate» in Article 125 of the Criminal Code («Abandonment»).

This attribute establishes a mandatory requirement for the intellectual component of mens rea in this offence: the perpetrator must be aware of the existence of danger to the life or health of the person left to it. Such a feature actually excludes negligence in se in the event of dangerous consequences occurring. However, Article 124 of the Criminal Code does not contain it.

Citing as an example of valid excuses the unability to get to the patient on time, the lack of necessary equipment or medicines, the false medical history provided by the patient, authors expectedly do not indicate as such the forgetfulness of the doctor, inattention, or unshakeable confidence in their own unfailability.

It was the doctor forgetting about the patient that could well have taken place in the case decided by the Ilovlinsky District Court, where he left a patient injured in a traffic accident for 20 minutes in the emergency room.

Even if we take into account the fact established by the investigators: a paramedic bringing to his attention drop in patient's blood pressure and the general deterioration of his condition, this does not automatically indicate the awareness of possible consequences. The doctor could, as a result of insufficient education, be absolutely sure that it did not require his immediate attention.

A similar situation was described in the verdict of the Michurinsky City Court of the Tambov Region on April 14, 2016. During the proceeding, it was found that two surgeons on duty did not conduct the necessary examination of a patient, who was taken to the department with a preliminary diagnosis of «Intoxication, general hypothermia», leaving him in the emergency room under the supervision of nurses. After the deterioration of his condition and the establishment of bilateral pelvic fractures, ruptures of internal organs, complicated by hemorrhagic and traumatic shock, the patient died ^[66].

The content of the criminal case does not contain any information on the doctors suspecting these injuries, but counting on them not being present, or on the delay in providing medical care not worsening his condition. Needless to say, there was no evidence that they were aware of the danger and desired him to die, or treated it indifferently. However, this did not prevent the court from classifying this crime as intentional and refusing to apply the amnesty act, which the court of appeal upheld ^[67].

This situation is more likely to be characterized as negligence in se: medical care was not provided due to the failure to foresee the socially dangerous consequences, which, with the necessary care and foresight, was possible ^[17].

Cases of forgetfulness and absent-mindedness should also be deemed as such: where the doctor does not realize that the patient needs help and failure to provide it may lead to socially dangerous consequences, but must and has the ability to.

Simply put, contrary to the arguments of some scholars and courts, a criterion to distinguish between Article 124 of the Code and other offences of negligent harm (Article 109 («Negligent manslaughter») and 118 («Negligent causing of grave bodily injury») of the Criminal Code), is not the mental element, but the form of an act – omission.

Returning to the question of crimes with a double mens rea, we consider it necessary to once again turn to the arguments of Mindia G. Ugrekhelidze.

As it has already been established, the most prominent Russian researchers believe that the double mens rea is present only in compound aggravated offences, where the aggravated circumstance is the onset of serious consequences due to negligence.

This is confirmed by the text of Article 27 of the Criminal Code, which indicates the commission of an intentional crime, entailing grave consequences by negligence. Due to Article 14 of the Code defining a crime as a guiltily committed socially dangerous act prohibited by the Code under the threat of punishment, for the purposes of Article 27 this act must lead to criminal liability by itself.

Despite the fact that this rule became a novelty of the 1996 Code, similar acts were prohibited by the Soviet criminal legislation.

So, M. G. Ugrekhelidze, pointing out that «mixed» mens rea cannot take place in offences associated with the violation of special rules, observes its counterpart in «offences aggravated by consequence» ^[60].

As an example of such a crime, the author cited an analogous to modern Part 4 of Article 111 of the Criminal Code, Part 2 of Article 110 of the Criminal Code of the Georgian Soviet Socialist Republic ^[68] (hereinafter – the Criminal Code of the GSSR) (and analogous to Part 2 of Article 108 of the Criminal Code of the RSFSR) – intentional grievous bodily harm that resulted in death. Since by Article 11 of the Criminal Code of the GSSR, which allowed charging aggravating consequences if at least negligent attitude toward them was proved, this offence required negligence toward its aggravated circumstance, it contained two forms of mens rea.

The author notes that such offences were a special case of an ideal merger –commission of a single act containing, qualifying features of two or more offences. In the absence of such an article in the law, the responsibility would have come under Article 110 – intentional grave bodily injury (analogous to Part 1 of Article 111 of the Criminal Code) and Article 108 of the Criminal Code of the GSSR – negligent manslaughter (analogous to Part 1 of Article 109 of the Criminal Code). However, the legislator, due to the occurrence of more serious consequences being especially predictable in the commission of certain intentional crimes, took a different path and combined them into one offence, which they formed «in their original ontological form without any changes». In other words, both an intentional act and causing consequences through negligence separately include sets of objective and subjective elements that qualify each of them as an independent crime.

This position is also held by Alexei I. Rarog, who indicates the independence of each part of the offence qualified by negligent consequences, where different forms of mens rea are determined on the basis of different attitudes to different features of the objective element. In offences, where the main one is material, this attitude is determined in relation to two different consequences ^{[69, с. 727-730]}.

At the same time, supporters of the «mixed» mens rea theory break a single simple offence related to violation of special rules, determining forms of mens rea separately in relation to the act and the consequence, which is another argument against such reasoning towards non-assistance to the patient.

Based on all the above, we can conclude: first, the design of Article 124 of the Criminal Code itself does not provide for qualifying it as the offence with two forms mens rea. Secondly, the legislator provided for such a combination only in offences aggravated by a negligent consequence.

We fully agree that logic of researchers who insist that Article 124 of the Criminal Code contains double mens rea is baseless. We also agree with the second conclusion, but it is important to note that the intention of the legislator, as a result, in particular, of their shortcomings, may differ from the actual text of the law. The final part of this study is devoted to this question.

Conflict as a justification for double mens rea in Article 124 of the Criminal Code. As already mentioned above, there are certain differences among Russian legal scholars regarding the existence of double mens rea in compound aggravated offences, in which the main one is formal, due to the lack of indication of consequences as their mandatory elements.

The question of any consequences within simple formal offences is one of the most controversial in the national legal doctrine, especially due to the fact that Article 25 of the Criminal Code requires to establish a perpetrator's attitude both to socially dangerous act and to consequence in determining the form of mens rea.

For this reason, scholars are divided into two camps. The first equate the term «consequence», used in Chapter 5, to «causing harm» and declare formal offences to be «with no consequence», in which public danger is dictated solely by the danger of the act itself. It allows them to proclaim rules of Article 25 of the Criminal Code as an error of the legislator and offer to provide law enforcement with the possibility to evaluate separately the attitude to the act and to its effects ^{[70, с. 174] [71, с.247]}.

The second group say that there are no «consequence-less» crimes, and introduction of formal offences is dictated by the logic that such acts either entail consequences, precise determination of which is not necessary because of its difficulty: in the case of non-material consequences, such as violations of relevant personal rights, the established governmental procedures, or they create a real possibility of the onset of material consequences ^[72-74].

In recent years, the High Courts of the Russian Federation have tried to put an end to these disputes.

So, the Supreme court in the judicial review on application of Article 76.2 of the Criminal Code («Forgoing the sentence with application of a judicial fine») pointed out that absence of socially dangerous consequences as a qualifying feature of an offence does not mean that such crimes do not involve harm or actual threat of it, linking specific characteristics of said harm with the specific elements of its actus reus ^[75].

The same position was previously stated by the Constitutional Court of the Russian Federation ^[76], linking its arguments with the opinions of the Supreme Court, indicating that the harm caused by a crime can be expressed in violation of victim's personal rights, other legitimate interests of the individual, society and the state ^[77].

Thus, the consequences of a formal offence are expressed not in the occurrence of clearly identified harm, but in more abstract violations of rights, established order of governance, its prestige, etc., which cannot be formally defined and reflected in a statutory rule.

This approach might be considered valid in terms of the cumulative interpretation of the Russian Constitution, Part 3 of Article 55 of which indicates restriction of personal rights (and criminal liability is a form of such a restriction) to be allowed by federal law to protect the rights and interests of other people, and of Part 1 of Article 2 of the Criminal Code, which proclaims protection of the rights and freedoms as a separate function of the criminal law.

Consequently, the violation of personal rights and freedoms can be an independent consequence of a criminal act, regardless of any material damage.

As an example of a formal offence with a double mens rea, it is most logical to demonstrate Article 238 of the Criminal Code, which in recent years has become the most relevant in the topic of iatrogenic crime.

Part 1 of this article provides liability for the production, storage, transportation or sale of goods and products, the performance of works or the provision of services that do not meet safety requirements.

The specified offence is formal and does not require establishing any consequence as a result of the act. It belongs to the group of crimes against public security and order (Section IX of the Criminal Code), and the subgroup of crimes against public health and morality (Chapter 25 of the Criminal Code).

Thus, it can be concluded that the consequence of this crime is a violation of the public interest and rights of an individual to provision of services and purchase of goods of appropriate quality and safety.

Also, due to the intentional nature of this crime, it logically follows from the text of the article, that its commission creates a risk of certain consequences – since the awareness of non-compliance with safety requirements inevitably means the awareness of danger. Accordingly, the consequence of this offence is also the creation of danger, which the Higher Courts also regard as an independent consequence.

In the event of serious consequences in the form of negligent grave bodily harm or death, liability follows in accordance with Parts 2 and 3 of Article 238 of the Criminal Code, respectively. And this, in our opinion, allows to interpret this rule as follows.

Part 1 of Article 238 implies the possibility of several consequences occurring simultaneously, in particular: violation of the right to safety of the consumer and the environment, provided for in Part 1 of Article 7 of the Federal Law «On the Protection of Consumer Rights» ^[78], and at the same time creating a risk of serious harm. This configuration of objects of criminal legal protection allows us to deem the occurrence of negligent consequences in course of committing this offence as a crime with two forms of mens rea.

Since, as was shown above, the double mens rea requires separate determination of its forms both in relation to the consequences in the main offence, and in relation to those caused by negligence, the configuration of the volitional and intellectual elements would look like this:t

• the perpetrator is aware of the social danger of their actions, aware of the possibility or inevitability of the occurrence of socially dangerous consequences in the form of violations of personal rights and the creation of real danger, desires them to occur, consciously allows it or treats it indifferently;
• the perpetrator does not realize the possibility of socially dangerous consequences in the form of death or serious harm to health, does not want them to occur, although with due care they could and should have, or are aware of them, but presumptuously hope for their prevention.

In this case, there are two independent forms of mens rea towards two different consequences, which allows us to apply the provisions of Article 27 of the Criminal Code.

And finally, proceeding to the final part of the study, we should note that the current criminal law contains a partial intersection of the corpus delicti of Article 124 of the Criminal Code with another offence – Article 125 («Abandonment»).

This provision criminalizes the deliberate failure to assist a person a in life- or health-threatening condition and deprived of opportunities for self-preservation, if the offender had the opportunity to help that person, and was obliged to take care of them or put them in this condition.

This offence is formal in a sense that it does not require occurrence of socially dangerous consequences in the form of death or harm to health.

One of the mandatory element of its actus reus is inaction – not performing certain actions prescribed by law or contract. Here we observe the first intersection of this offence with Article 124 of the Criminal Code, which also provides for inaction as a mandatory element of the offence ^[79].

The perpetrator of this crime, as well as in the case of Article 124 of the Criminal Code, is a specially devised one, but formulated more broadly. If the latter is a representative of medical profession, who is obliged to provide medical care (because a victim is indicated there as a «patient»), in Article 125 they are also other persons who are required to provide other types of care. However, it is quite obvious that the term «care» or «assistance» is also applicable to «providing health care», and the mandatory status of the offender in these articles may also coincide.

The subjective element, due to the requirement of «deliberate» and the intentional nature of the offence under Article 125, is in the awareness of the socially dangerous nature of the act and the possibility or inevitability of the occurrence of socially dangerous consequences, the desire for their occurrence, their conscious assumption or indifference to them.

As for the consequences, they are, within the meaning of the law, are the violation of the right to assistance by law or contract, as well as creation of risk. Also, due to the peculiarities of the objective element of this offence, the consequence may also be the infliction of physical and moral suffering. Despite the fact that Section 16 of the Criminal Code contains crimes against life and health, some of the offences under it do not require any injury or death (Articles 116 («Battery»), 116.1 («Repeated battery»), 117 («Cruelty») of the Code), requiring infliction of physical or mental suffering.

In the event of consequences in the form of harm to health or death, liability will occur in accordance with the relevant Articles of the Special Part of the Code. So, in case of awareness of the possibility of them and the desire for them to take place, this act should be qualified according to the articles on intentional infliction of harm: Article 105 in case of death, Article 111, 112 in case of harm to health, as well as with the application of the provisions of Part 3 of Article 30 («Attempt»), if the consequences did not occur due to circumstances beyond the control of the offender ^[80].

If the offender did not want such consequences to take place, but deliberately allowed them or treated them indifferently (Part 2 Article 25. «Indirect intent»), then the same principle applies in case of them coming into place. However, if such effects do not occur, for example – assistance was provided by third parties despite the will and understanding of the offender, the liability for an attempt for intentional causing of harm cannot be established ^[81] and, therefore, such features of the subjective element will not affect the liability and it will come according to Article 125 of the Criminal Code.

The requirement of knowing that there is a danger to life and health dictates the need to be aware of the possibility of corresponding consequences, and, therefore, excludes negligent in se attitude to them, while leaving the possibility for recklessness. In the event of such consequences, the liability will come in accordance with the articles on negligent harm, in particular – Article 124 of the Criminal Code, regardless of the form of negligence.

For a clear comparison of objective and subjective elements of Articles 124 and 125, we have placed them in the following table. For the purposes of this study, we have identified only possible consequences in the form of death or injury.

It is easy to see that at a certain combination of offender's disposition to the consequences, that is – one characteristic to recklessness, the same offence under Article 125 of the Criminal Code will entail liability in accordance with Article 124 upon the occurrence of serious consequences. In other words, Article 124 will be a special rule in relation to Article 125, on the basis of the occurrence of moderate or grave injury or death.

And this situation is paradoxical. From it follows that the commission of a crime under Article 125 of the Criminal Code will entail liability under Part 2 of Article 124 if the consequences occur. At the same time, Article 125 describes an intentional offence, and Article 124 of the Criminal Code – a negligent one, and, moreover, entails more severe punishment than Article 125 – imprisonment for up to 3 years against 1 year.

And here it is necessary to refer back to Article 27 of the Criminal Code, which defines crimes with two forms of mens rea as intentional crimes, which cause serious consequences not covered by the intent of the offender, and which law punishes more severely.

Despite the fact that the consensus of scholars, and, apparently, the intention of the legislator, dictate the existence of such crimes only within the framework of compound aggravated offences, Article 27 of the Criminal Code of the Russian Federation itself does not contain such a requirement. It provides only for indication of such consequences in the law and a more severe punishment for them, and not for their existence as an aggravating circumstance of the same article. Thus, the combination of these features falls under the statutory definition of a crime with a double mens rea.

The first question that arises when this fact is discovered is whether rules on ideal merger apply, which would remove the contradiction? It seems that the answer to this question is negative, as Part 3 of Article 17 of the Criminal Code dictates in case of conflict on general and special rules to apply special ones.

We have already established that the difference between these rules in the event of a conflict is the occurrence of socially dangerous consequences, which means that the offence under Article 125 will be completely absorbed by Part 2 of Article 124.

Thus, such an offence should be qualified in accordance with Part 2 of Article 124 of the Criminal Code. Moreover, the law does not explicitly prohibit classifying such a crime as committed with double mens rea.

Naturally, this situation was not intended by the legislator. This conclusion is supported by influential scholars, one way or another involved in the formation of domestic criminal law, by the author of the first iteration of Article 27 of the Criminal Code himself, and the general logic of the law, in which special rules go after general ones, but not vice versa. It is most likely that the legislator did not see these articles as linked when they were adopted, and when forming Article 27 they were guided by the desire to ensure the accessibility of the text and its wording. Indeed, the terms «compound aggravated offences» and «formal crimes» are purely doctrinal, and different scholars may give them different interpretations.

Based on the above, we come to the conclusion that with a combination of relatively unlikely, but still possible factors, the offence prohibited by Part 2 of Article 124 of the Criminal Code can be qualified as a crime with double mens rea, but this situation is the result of shortcomings in legal technique.

Solutions. Taking into account the relative conservatism of the Criminal Code, especially in relation to its General Part, as well as the possibility of a «cascade» of contradictions that often arises with fundamental changes, we prefer to distinguish two solutions to this issue – rational and realistic.

The most realistic – simple and possible soon, we consider the elimination of this contradiction through an official interpretation by the Plenum of the Supreme Court of the Russian Federation.

So, either the text of the current resolution of the Plenum of the Supreme Court of 27 January 1999 № 1 «On court practice in cases of murder (Article 105 of the Criminal Code)» (as containing some questions of qualification of negligent causing of death), or a new resolution on negligent crimes, should contain the following: «If results of an offence qualified under Article 125 of the Criminal Code are grave bodily injury or death caused by negligence, the offense should be charged under an appropriate norm of the Special Part of the Criminal Code, that provides liability for reckless infliction of harm as a generally negligent crime. If the danger to life and health of the victim specified in Article 125 arose as a result of the commission of an intentional crime, the offence must be qualified according to the relevant article, which provides for two forms of mens rea».

It would also be useful to supplement the text with explanations on the nature of the compound offences aggravated by negligent result, and their differences from offences of negligent infliction of harm associated with violation of special rules.

However, such an outcome will only be a legal analogue of the «Solomon's decision», since it does not eliminate the contradictions in the law. It also does not eliminate the problem of the need for the actual qualification of an intentional crime that entailed the onset of serious consequences through negligence, as generally negligent.

Another solution, as part of a more comprehensive reform, would be to amend the provisions of Article 27 of the Criminal Code. Some provisions from criminal legislations of other nations can be cited as examples.

In Common Law countries there are no clear parallels with the domestic understanding of crimes with double mens rea. The doctrine of «transferred intent», which is available in American, Canadian, British and Australian doctrines, dictates deeming negligent infliction of harm in the commission of an intentional crime as intentional (or, alternatively, an attempt to commit an intentional crime and intentional infliction of harm), but it applies only to cases of factual mistake ^[82-86].

Also inapplicable is the doctrine of «felony-murder rule», which dictates the qualification of negligent causing of death in the course of committing certain intentional crimes that the legislator or court consider to be of increased public danger (armed robbery, reckless driving, and so on), as murder ^[87-89].

Moreover, such a legislative approach was found by the Supreme Court of Canada to be inconsistent with the Constitutional Act of 1982, and the legislator was ordered to introduce a separate rule on negligent infliction of harm as a result of the commission of an intentional crime ^{[5, с. 550-551]}.

In the criminal doctrines of Italy, Bolivia, Peru, Ecuador and a number of other countries, there is a concept of «preterintenzionale» – «beyond intent», which, however, is more similar to the doctrine of «felony-murder rule» and is criticized by many scholars as allowing strict liability ^[90-91]. The same applies to the French «le delit praeterintentionel» and «le dol indetermine» ^[92].

The most interesting, in our opinion, are the provisions of German criminal law.

Thus, § 11 (2) of the Criminal code of the Federal Republic of Germany (hereinafter – the German Criminal Code) states: «An act is also deemed intentional for the purposes of this law, if it fulfils the statutory elements of an offence, which requires intent in relation to the offender’s conduct but lets negligence suffice as to a specific result caused thereby». ^{[93, с. 39]}.

Direct adoption of this rule is not possible, because German understanding of forms of mens rea does not fully comply with the Russian one – the German Criminal Code lacks definitions of intent and negligence altogether, and they are not divided into specific types ^{[94, с. 69]}. Also, this rule contains the wording «intent to act, negligence to consequences», which we criticize, although, there is some rationality to it, which consists in a clear indication of existence of an aggravating negligent result in the same article as the intentional offence. Moreover, the German doctrine has developed frameworks for double mens rea, in particular – for complicity and attempted crimes ^{[95, с. 297, 477]}, which cause fierce disputes among Russian scholars ^[96].

In this regard, we propose to summarize Article 27 of the Criminal Code as follows: «If the result of an intentional crime is a more serious consequence caused by negligence, which is provided by the same article of the Special Part and punished more severely...».

Such an approach will allow to eliminate misconceptions in understanding the concept of double mens rea. However, the problem of Articles 125 and 124 of the Criminal Code conflicting remains.

To solve this issue, we can also turn to the already developed and tested achievements of the German criminal doctrine.

Thus, Article 221 of the German Criminal Code (1) («Abandonment») states: «If anyone: 1. places a person in a helpless situation, or 2. abandons a person in a helpless situation although he gives him shelter or is otherwise obliged to care for him, and thereby exposes him to a danger of death or serious injury (...)». Paragraph 2 of Part (2) of the same article provides for a more severe penalty for causing injury in the commission of this act, and Paragraph (3) – for causing death ^[93].

So, similar to Article 125 of the Criminal Code offence in the German Criminal Code is designed as a compound and aggravated by consequences offence, similar to those characterised by double mens rea in the domestic criminal law.

If we are to eliminate Article 124 from the Criminal Code at all, and introduce into Article 125 aggravating consequences caused by negligence, then we can potentially solve several problems at once.

First, since Article 125 requires understanding danger of causing harm, the requirments of «causing grave injury death by negligence» will exclude negligence in se as a possible form of mens rea, leaving only recklessness.

This approach is generally in the wake of foreign scholarship, where for many years common criticism of the prosecution of medical professionals for negligent harm has been the call to abandon the objective (not requiring the establishment of a mental attitude toward possible consequences) standard of negligence and transition to the standard of recklessness. Some of the arguments for this approach are not applicable to domestic realities, since they are based on the shortcomings of the division of types of negligence in the Common Law into simple «negligence» and «gross negligence», where the first does not entail criminal liability, and distinguishing them is solely at the discretion of a jury ^[97-100].

However, the argument that reckless harm should entail more severe punishment than negligent one is not devoid of logic, since it provides for a more reprehensible attitude to the consequences, in which the possibility of their occurrence is recognized, but partially ignored. That is why, unlike the Russian and the German law, the Model Penal Code as a «default» form of mens rea, in articles where it is not mentioned, provides recklessness ^{[101, с. 55]}.

In this case, liability for negligent in se failure to provide assistance, both for doctors and for other offenders, will occur according to the general provisions for causing harm by negligence (Articles 118 and 109 of the Criminal Code) and entail less severe criminal liability.

Secondly, by simultaneously excluding liability for negligent infliction of moderate bodily injury in not providing medical care, it is possible to answer fair arguments of some representatives of the medical profession. For example, the president of the National Medical Chamber, Leonid M. Roshal, points out the unreasonableness of criminally charging medical workers for causing moderate injury in the absence of medical care, in a situation where such responsibility is excluded for representatives of other professions, similarly associated with the risk of harm ^[102].

^[1] The following examples from the practice of domestic courts are intended to demonstrate only the logic of their decision-making regarding the mental element of the relevant crimes. The issues of inconsistency of the court's conclusions with the actual circumstances of the case, in particular, when qualifying under Article 124 improper provision of medical care, will not be covered.

^[2] The Criminal Code provides negligence («неосторожность» where «не-» means «not» and «-осторожность» – «caution») as a general term, which is subdivided into «небрежность» (where «-б(е)режность» means «care», and as a whole could be translated as «carelessness») and «легкомыслие» (where «легко-» means «light, easy» and «мыслие» is «mind, thought»), which generally corresponds to the Common Law notion of recklessness. There is no common subdivision of mens rea of the same kind in the comparative frameworks that we could find, and the term «carelessness» is not used much, so in order to differentiate between negligence as a general term and negligence as «carelessness» we use «negligence» for the first and «negligence in se» for the latter.