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Development of Patients’ Subject-Oriented Approach Through Practices of Their Participation in Ethical Expertise of Medical Cases

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.