A Human in Modern Medicine: From the Restoration of Health to Improve

The article analyzes the dynamics of the development of medical models of treatment of deviations from the health norm, discusses the issue of changing ideas about the human health in medicine. It is shown that as a result of changes in the conceptual understanding of health and the process of its restoration, the principle of achieving a commercially profitable, fast and controlled result is introduced into modern medicine, as a result of that the process of medical treatment is standardized and regulated. But the preservation of object optics of views in the medical industry, as shown in the article, becomes ineffective, moreover, risky in a situation of moving boundaries of the human health norm. To overcome the existing risks, new institutes and practices of ethical examination of health standards are being introduced into medicine. It is shown that the accepted deliberative practices of ethical expertise only introduce a procedure for taking into account the patient’s position regarding the boundaries of their health standards and the limits of medical intervention. At the same time, the patient’s position is considered as something ready, initially given, in other words, the classic “human project” continues to be defended in medicine.

HUMAN BEING IN NORM AND PATHOLOGY: TOWARDS THE QUESTION OF EXPERTISE IN MEDICINE

The article discusses a problem of a change in habitual paradigms of human being understanding in medicine within the progress of medical science and practice. The prevalence of natural scientific principles in medical expertise is becoming ineffective; medicine is losing its subject – a human being in norm and pathology. The awareness of the consequences of an object-oriented attitude contributed to the development of new notions about the subject of medicine, fixed in a socio-cultural and, later, person-oriented approaches in scientific understanding of human being in norm and pathology, as well as the development of practices aimed at protecting humans from interference. As a result, a new form of expertise is emerging in medicine – ethical expertise, aimed at protecting a human being. However, in the process of ethical expertise evolution, as the author shows, a shift has taken place towards bureaucratic management, oriented to proceduralism and efficiency. Moreover, ethical expertise continues to use socio-cultural approach as its methodological basis, which is not sufficient within the new situation of blurring boundary between norm and pathology. A human being himself as an object of expertise is disappearing.

How to Do What Is Right, Not What Is Easy: Requirements for Assessment of Genome-Edited and Genetically Modified Organisms under Ethical Guidelines

Summary/AbstractAn ethical assessment is a complex, dynamic and comprehensive process that requires both ethical expertise and practical knowledge. An ethical assessment of a genetically modified organism (GMO, including genome edited organisms) must follow accepted and transparent methods and be based in relevant considerations. In addition, the Ethical guidelines must include a broad and adequate range of values, so that no groups, stakeholders, agents or areas are left out.

Humans and Technologies: Assemblage Modes

The article deals with the field of techno-somatic interaction modes and ongoing human biology transformations beyond the conventional biotechnological manipulations. There are three broad trends in dealing with the interface of the human body and technology: 1) "technicalization" of the body; 2) "somatization" of technical appliances and infrastructures in viewing them as "external organs"; 3) synthetic view on "humanity cum technical milieu" as a fundamental unit in human evolution, the unique way of being human. These trends are illustrated by the relevant positions of such philosophers of technology and body as Ernst Kapp, Alfred Espinas, Maurice Merleau-Ponty, and Bernard Stiegler, as well asof sociologists and anthropologists (Marcel Mauss, André Leroi-Gourhan). It is argued that the intrinsic technicity of humans is corroborated by the current evidence of the human body and technology continuing co-evolution that necessitates ethical expertise of all technical innovations as essentially "bio-technological".

The Council of the President of the Russian Federation on Ethics

The paper is devoted to investigating the main problems caused by the development of ethical regulation in various fields of professional activity. In the opinion of the author, the problem of ethical regulation is particularly acute in the field of science and innovation, which requires the development of such a direction as ethics of high technologies. The ethics development requires: to elaborate common approaches to ethical regulation, ethical responsibility, ethical expertise; to revise, systematise ethics legislation; to prepare scientifically justified ethics recommendations; to respond timely to ethical problems caused by the emergence and implementation of high technologies. In view of the scope of the tasks that need to be solved, the author believes it is necessary to start the elaboration and implementation of the Ethical Concept of the Russian Federation. This work can be carried out by the Presidential Council on Ethics created by the Decree of the President of the Russian Federation of the same name. According to the author, possible tasks of the Council under the President of the Russian Federation on Ethics, requiring independent discussion, could include: resolution of issues related to the resolution of individual ethical conflicts (e.g., in the field of high technology and other areas where ethical standards are still developing); appeal against holding individual categories of persons ethically responsible (highest ethical authority).

Core competencies for ethics experts in health technology assessment

ObjectivesThere is no consensus on who might be qualified to conduct ethical analysis in the field of health technology assessment (HTA). Is there a specific expertise or skill set for doing this work? The aim of this article is to (i) clarify the concept of ethics expertise and, based on this, (ii) describe and specify the characteristics of ethics expertise in HTA.MethodsBased on the current literature and experiences in conducting ethical analysis in HTA, a group of members of the Health Technology Assessment International (HTAi) Interest Group on Ethical Issues in HTA critically analyzed the collected information during two face-to-face workshops. On the basis of the analysis, working definitions of “ethics expertise” and “core competencies” of ethics experts in HTA were developed. This paper reports the output of the workshop and subsequent revisions and discussions online among the authors.ResultsExpertise in a domain consists of both explicit and tacit knowledge and is acquired by formal training and social learning. There is a ubiquitous ethical expertise shared by most people in society; nevertheless, some people acquire specialist ethical expertise. To become an ethics expert in the field of HTA, one needs to acquire general knowledge about ethical issues as well as specific knowledge of the ethical domain in HTA. The core competencies of ethics experts in HTA consist of three fundamental elements: knowledge, skills, and attitudes.ConclusionsThe competencies described here can be used by HTA agencies and others involved in HTA to call attention to and strengthen ethical analysis in HTA.

IV—Two Puzzles in The Early Christian Constitution Of The Self: Reflections on Agency in Foucault’s Interpretation of Cassian

I tease out two early Christian puzzles about agency: (a) agential control: how can agents self-constitute if their primary experience of themselves is not one of control, as in Greek antiquity, but of relative powerlessness? And (b) ethical expertise: how can agents constitute themselves as ethical agents if they cannot trust themselves to recognize, and act in the light of, the good? I argue, first, that Foucault saw the importance of these puzzles and focused on extreme obedience as affording a possible resolution; second, that he failed to resolve the puzzles because of his reliance on an overly voluntarist and reflective understanding of obedience as an exercise of will; and finally, that turning to Cassian’s own thoughts on the relation between extreme obedience and humility as kenosis affords us a way out of the puzzles.

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.