The article examines the contradiction between the biopsychosocial approach and evidence-based medicine. The traditional biomedical model, that has been dominating since the 17th century, focuses on pathophysiology and ignores the psychological and social factors. The alternative biopsychosocial model, offered by Engel G (1970–1990), treats a disease as a result of interacting biological, psychological and social factors. It corresponds to the definition of health provided by the WHO. The approach is, however, limited due to highly personalized nature, complex objective assessment of factors and risk of subjectivism. As evidence-based medicine became widespread, clinical focus transitioned toward statistically average patient populations. Consequently, this standardization minimized the individual differences, particularly psychosocial factors. The doctor-patient relationship becomes mechanistic. The authors stress that the biopsychosocial and evidence-based approaches cannot be opposed. Their synthesis is perspective. They rely on evidence-based data taking into account psychosocial characteristics of a patient. They include various integration options from the way the multidisciplinary team functions to the formation of the basis of patient’s profiles indicating psychosocial features. The central idea that unites three groups of factors as viewed by the patients includes the internal picture of illness. The complex approach is taken as an essential element of modern clinical thinking and medical culture.
VIEWS 229
This study is relevant due to the need to balance child protection and respect for the family, while mitigating the risks of stigmatization and confidentiality breaches during cooperation between agencies. This study aims to identify the ethical dilemmas that arise while supporting children at risk of social orphanhood and to provide recommendations for improving these support tendencies. The research methods include analyzing regional practices, algorithms of interaction between agencies, the work of specialized commissions and councils, and the legal and regulatory framework, which includes the Convention on the Rights of the Child and Russian social service standards. According to the results, the most ethical and effective methods rely on minimal intervention, family partnership, and transparent communication. Collaborative visits by specialists and parents, interdisciplinary consultations, and adapted methodologies for considering the child’s views are effective. Researchers used data from the Yaroslavl region to find the major ethical issues such as treating informed consent as a mere formality, risk of data leakage in central databases, ignoring the life experience of families, and treating a child’s opinion without deep care.
VIEWS 268