Health as a realization of patient social subjectivity

author: Svitlana Pustovit 

Urgency of the research. The medical reform that is being implemented in Ukraine and the experience of the fight against the COVID-19 pandemic have actualised the review of patient's rights and obligations scope in the field of medical provision, the urgency of a new patient subjectivity forming, and the development of modern health concepts in a globalised and medicalised society. In this context, it is important to further study of philosophical,  methodological, and sociological approaches for understanding of health and illness through the prism of interpersonal space and various social relations, which are the basis of the patient social subjectivity.

Target setting. The social subjectivity of the patient, his active participation in social relations in order to preserve and strengthen his health, is one of the important criteria for the success of medical services in a single medical space. Patient-centered medicine, providing patients with medical care that meets individual needs and values, are based on preserving the patient social subjectivity in making decisions related to his health. The contradiction between social and individual good in healthcare can be significantly weakened/removed by a new understanding of patient social subjectivity, who shapes his/her health as a certain interpersonal space, life world. Social practices influence ethical and legal, normative structures, create a new environment for individual activity. It is through the expansion of social relations, through the acquisition of common everyday experience it is possible to implement and affirm modern holistic ideas about health as both an individual and a social value.

Actual scientific researches and issues analysis. The historicaland philosophical, bioethical and valeological foundations of medicine are considered in the works of G. L. Apanasenko, R. M. Veatch, G. Canguilhem, T. Kielanowski, V. L. Kulinichenko, М. Lalond, S. V. Pustovit & L. A. Paliei, H. Sigerist, I. Mortimer, A. A. Shevchenko & A. D. Sokolov, M. Fuko, J. Halasz and others. The mechanisms of interpersonal space formation, social relations and subjectivity are highlighted in the sociological studies of G. Boomer, I. Hoffman, N. Elias, A. D. Collins, J. Mead, J. Turner, P. Stompka, A. Schütz & T. Luckmann. The works of G. L. Apanasenko, K. Bursa, K. Holstein, J. Engel, B. Jolstad, V. L. Kulinichenko, A. Maslow, A. Meneghetti, O. P. Mintser & A. M. Novak, H. Allport, L. Nordenfelt, S. V. Pustovit, V. R. Potter, K. Rogers, H. Sigerist, F. Svenaus, E. Fromm, B. Hoffman, and others are devoted to analysis and justification of different approaches to the health phenomenon and theoretical models of health.

The research objective. To investigate the regularities of the patient's social subjectivity development in the process of the scientific medicine formation and on the example of modern health models.

The statement of basic materials. The historical-philosophical, philosophical-methodological and sociological aspects of interpersonal relations of  patient as a social subject in the process of receiving medical services are considered. An analysis of modern concepts of health in terms patient's social subjectivity, different types and forms of relations between the patient and other social subjects is carried out.

Conclusions. The philosophical and sociological aspects of patient subjectivity in different health models are analyzed. The historical-philosophical, philosophical-methodological and sociological analysis of modern health models:  biomedical, biopsychosocial, psychosomatic, adaptive, bioethical, valeological, etc. is conducted from the point of view of interpersonal space, various types and forms of relationships between patient and other social subjects. It was demonstrated that sociological measurements of medicine and patient social subjectivity are updated in the 20th century. It was concluded that the development of patient social subjectivity contributes the enrichment of his social and psychophysical experience, the increasing his knowledge about the nature of illness and health. The patient's ability to actualize his external and internal potential, actively build social relations and use interpersonal relations contributes the resolution of contradictions between social and individual benefits and the formation of a single medical space. It was found that the introduction of psychosomatic, adaptive, bioethical, valeological health model, model of health as a life world into practice affects the expansion of patient  social subjectivity and interpersonal space, structured by ethical principles of personal autonomy and dignity, integrity, beneficence, avoidance of harm, vulnerability, justice, responsibility, solidarity, tolerance, etc.

Key words: patient social subjectivity, social relations,  interpersonal space, provision of medical services, health models, ethical principles

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