Ideas and Ideals

The subject of the research is the philosophical (ontological, epistemological, philosophical-anthropological and social-philosophical) foundations of personalized medicine, the biomedical foundations of which are methods of therapy and prevention of diseases based on the individual characteristics of the patient. The authors highlight the preventive nature of personalized medicine - to prevent the patient's diseases based on certain diagnostic methods and using a system of preventive measures, as well as its focus on improving the effectiveness of treatment for a specific patient. The value of personalized medicine is that it allows to determine precisely the causes of a particular disease or to assess a person's predisposition to certain diseases, to apply preventive measures to minimize the risks of diseases; to use personalized methods of treatment and correction of the conditions of a particular patient, as well as biomarkers for monitoring the effectiveness of therapy.

The philosophical foundations of personalized medicine, on the one hand, contain certain philosophical attitudes related to medicine in general, and on the other hand, reflect specific features determined by new technologies that modern medicine possesses. In particular, the article points to a change in the concept of personalization in connection with the disclosure of its content at the genomic level. The authors emphasize that personalized medicine raises a number of new problems of a philosophical nature: the approach to a person as a set of data about his or her body, the possible increase in social inequality due to the lack of general availability of the results of personalized medicine, and so on. The article substantiates the idea that improving and reducing the cost of sequencing technologies will help make new methods of treating diseases more accessible to the general population. Further personification of medicine will occur due to obtaining more and more objective information about patients, increasing the number of subgroups in the typology of patients, offering them variable methods of treatment, as well as due to the increasing involvement of a patient in the treatment processes, based on a better understanding of his/her “existential presence analytics”.

The signifi cance of the analysis of medical narrative is determined by its dissemination in recent decades in the context of humanization and individualization of medicine. Comparative content analysis of the texts shows that ‘subjective understanding’ (F. Schleiermacher), ‘inner experience’ and methods of descriptive psychology (W. Dilthey) are essential components of contemporary narrative analysis. The ‘narrative turn’ in socio-humanitarian knowledge became possible only after the questions about the genuine existence of man and the ways of understanding his individuality were worked out in various directions of the continental philosophy of the twentieth century.

The growing popularity of the narrative approach in the fi eld of medicine is due to theoretical, methodological, and practical changes that occurred in medicine: the rejection of the priority of the biomedical model of health, the principle of paternalism, objectifi cation of the patient and disease. Changes in the structure of diseases also played an important role in its spread. However, as the analysis of the content and methodological foundations of the medical narrative has shown, one should not absolutize its possibilities in solving the problems of patient individualization, preserving his/her identity and, ultimately, in optimizing the treatment process.

In the article the author describes the transformations provoked by the transition from politics and economics to biopolitics and bioeconomics. The author notes the impact of these changes on the development of modern scientific knowledge (commercialization of science, commodification of the results of scientific research, dehumanization of knowledge in general). One of the article points concerns the ambivalence of the consequences caused by modern trends in the production and use of scientific knowledge. The key contradictions are: the contradiction between the price and value of the human body and life of the individual as such; the contradictions related to the attitude to human and non-human entities. The possibilities of a positive response to new challenges in the development of science and the application of its results are in the field of humanization of scientific knowledge, which is interpreted as strengthening the axiological and ethical components of modern science, overcoming the technocratic and highly professional style of thinking of scientists and specialists. The article gives the assessment of difficulties in solving the problem of humanization of scientific knowledge from the standpoint of classical humanism. The author provides the overview of concepts that are based on criticism of traditional humanism and that let develop ethical answers to modern challenges in the field of humanization of knowledge and practice of its use in conditions of biocapitalism and growing progress in the field of biotechnological development. In particular, the principles of approaches methodologically proceeding from the following orientations, are analyzed: first, based on the denial or preservation of the key pathos of humanism and its principles; second, bringing out the “new” humanism from theistic or secular foundations. Theistic and non-theistic versions of “renewed” humanism, posthumanism and transhumanism are analyzed. The author describes essential difference between posthumanistic and transhumanistic orientation. The author draws a conclusion about the prospects of using these approaches to solve the problem of humanization of scientific knowledge.

The development of new biomedical technologies has contributed to changing, blurring the boundaries between the norm and pathology of a human being. It is about a gap in the notions of norm and pathology, illness and treatment that are accepted in scientific communities. As a framework of the emerging humanistic scientific paradigm the principles of a subject-oriented approach to the patient are being developed, aimed at maintaining the patient's control over the recovery process, at developing his/her subject position, which implies his/her active and responsible participation in the treatment process and in medical decision-making. Formation of the considered approach in medical institutions is connected with the development of new institutions and practices.

The author shows that the procedural model of the institute of medical cases ethical expertise is aimed at developing a subject-oriented approach in clinical practice.  At the same time, the patient, as a participant of ethical expertise, acquires the experience of reflexive reasoning and, thus, enabling the possibility and capability for a patient to be involved in the process of treatment management on a new basis. The article presents some results of the author's study of the procedural model of ethical expertise in German medical settings in the context of describing the main gaps and problems associated with the implementation of the subject-oriented approach.  The research was conducted using the methods of semi- formalized interview, substantial analysis of research and methodological literature. As the study has shown, the main problems of the subject-oriented approach implementation in the practice of ethical expertise are related to the trends of bureaucratization and commercialization of this practice in the hospital environment. It seems that the issue of developing an appropriate language ensuring equal participation of the subjects of the expertise is important. Prospects for humanization of this practice are seen to be connected with the inclusion of representatives of patient communities and self-help groups of patients in this practice.