Introducing two journal special issues and a conference
Written by Alberto Giubilini
Two special issues of the journals Bioethics and Monash Bioethics Review will be devoted to, respectively, “New (Bio)technology and Human Identity” and “Medical Humanities in the 21st Century” (academic readers, please consider submitting an article). Here I would like to briefly explain why those topics matter beyond strictly academic discussion.
The first issue is, broadly, about our relationship with new technologies, particularly within healthcare, medicine, and the biosciences. A lot has been written and said about genome editing, artificial intelligence in medicine and, in a more futuristic fashion, human-computer interfaces (Saha et al 2021), human-animal chimeras for autologous organ transplantation (Lu et al 2019), or human brain organoids (Kim and Chang 2023). While some such technologies have broader areas of potential applications, they are typically developed in view of improving medicine and healthcare. In fact, it is hard to read anything about any of these technologies that does not refer to their potential for ‘revolutionizing’ healthcare and medicine.
New (bio)technologies often come with the promise of revolutions, partly because promising revolutions attracts attention and funding and partly because, every now and then, such revolutions actually happen. Even when they don’t happen, the mere prospect of adopting such technologies can have important implications. Not revolutions, but opportunities for reflection. Many of these technologies prompt us to ask questions about some of our fundamentally human dimensions, such as trust, responsibility, autonomy, and so on. As I have also suggested in a previous blogpost, when we ask certain questions about (bio)technologies we are really asking fundamental questions about ourselves.
For instance, a lot of the discussion around AI and medicine concerns whether AI is trustworthy (see e.g. Kerasidou et al 2022) or whether AI generates responsibility gaps in healthcare (see e.g. Danaher 2022, Di Nucci 2021, Lang et al 2023). For example, who is responsible for a misdiagnosis by an autonomous artificial agent? Algorithms’ workings are often ‘opaque’, that is, we cannot explain why a certain output is produced by the machine (the so-called black box problem). As a consequence, we have no way of foreseeing, identifying, and preventing the error. Can we, humans, be held responsible for the misdiagnosis? How can we trust the machine in any given situation? I don’t know the answers, but these questions raise more fundamental, and philosophically interesting, questions. Whether artificial agents are autonomous depends on what autonomy is, whether they are trustworthy depends on what trust and trustworthiness are, whether there is a responsibility gap depends on what kind of responsibility we attribute to human doctors, and so on. We need to understand what these concepts mean in the first place before asking questions about how they do or don’t apply to discourse around (bio)technologies. And in the first place, these are concepts that describe human dimensions.
More broadly, whether advances like germline genome editing, human-animal chimeras, brain-computer interfaces entail substantial modification of our eminently human nature depends on what it is that makes us human in the first place. Whether they will actually be able to bring about revolutions is, in a way, a less interesting question from a philosophical point of view: that might or might not happen and it is an empirical matter. But the philosophical questions they raise, they raise regardless of what is going to happen.
The special issue of Bioethics aims at addressing these types of problems, especially within medicine and healthcare. The inspiration for it comes from a conference that TORCH Medical Humanities, the Oxford Uehiro Centre, and the Stanford Boundaries of Humanities Project are organizing for October this year (everyone welcome).
This is part of a broader series of events and other activities within the Medical Humanities program at Oxford that aim at placing science, medicine, and healthcare in their context of human values, histories, cultures. The second aforementioned special issue in the Monash Bioethics Review on the meaning and value of Medical Humanities is, thus, in an important sense thematically connected to the first one.
It is difficult to define what exactly the Medical Humanities are as an academic discipline (see e.g. Cole et al 2015), but perhaps easier to understand what they are as a general approach to science and medicine.
As an academic discipline, “Medical Humanities” is a relatively recent area of inquiry. It originated in the 1960s in the US, mostly thanks to the Society for Health and Human Values and the work of scholars like medical doctor and philosopher Edmund Pellegrino. It aimed to reform medical education by giving proper recognition to human values and cultures in a field until then dominated by a mechanistic approach to medicine (Fox 1985). While the original focus was mostly on theology, it soon expanded to include a wide range of approaches within the Humanities. Questions around our relationship with medicine and healthcare that require a Humanities-focused perspective have since then become increasingly more salient in academic and in societal discussion.
Why different individuals and communities trust some health institutions or some medical interventions but not others, how different people or communities conceptualize health, healthcare, and their place in the broader system of values are examples of questions that a Medical Humanities approach can help answer. They are questions about the values, histories, and practices around health and medicine that escape the scientific approach. In fact, science and medicine themselves are embedded in such values, histories, and practices. Their proper place and function in society can only be grasped from a perspective that places the complexity of the human being at the centre.
In an article published in the Lancet in 1995, geneticist and neuropsychologist Chris McManus cast some doubts on the actual utility of Medical Humanities in medical school curricula. As he wrote, “any serious evaluation of the humanities in medicine must […] bite the bullet of definition and measurement”, and he called for an “empirical evaluation” of the contribution of the Medical Humanities to improving health care (McManus 1985). This sounds a lot like a call for the application of the scientific method to an evaluation of medical humanities’ contribution to healthcare. One question here is whether there is some scope for approaching the whole issue from a different perspective. For instance, one where the scientific and medical approach are assessed through the methodologies and lenses of Medical Humanities.
Or perhaps, more interestingly and more challengingly, whether some third approach is possible that turns the antagonism implicit in the preceding two into mutually beneficial dialogue. Easier said than done, of course.
(please check out the (soon to be renewed) website of TORCH Medical Humanities at Oxford and follow the new X account for updates on events and how to get involved, including by attending the aforementioned conference or submitting to either (or both) of the aforementioned special issues)
References:
Cole, T. R., Carlin, N. S., & Carson, R. A. (2015). Medical Humanities: an Introduction. Cambridge University Press
Danaher, J. (2022). Tragic choices and the virtue of techno-responsibility gaps. Philosophy & Technology, 35(2), 26.
Fox, D.M.(1985) Who we are: The political origins of the medical humanities. Theoretical Medicine and Bioethics 6, 327–341 (1985)
Kim, S. H., & Chang, M. Y. (2023). Application of Human Brain Organoids-Opportunities and Challenges in Modeling Human Brain Development and Neurodevelopmental Diseases. International journal of molecular sciences, 24(15), 12528. https://doi.org/10.3390/ijms241512528
Kerasidou, C. X., Kerasidou, A., Buscher, M., & Wilkinson, S. (2022). Before and beyond trust: reliance in medical AI. Journal of Medical Ethics, 48(11), 852-856
Lang, B.H., Nyholm, S. & Blumenthal-Barby, J. (2023), Responsibility Gaps and Black Box Healthcare AI: Shared Responsibilization as a Solution. DISO 2, 52
Lu, Y., Zhou, Y., Ju, R., & Chen, J. (2019). Human-animal chimeras for autologous organ transplantation: technological advances and future perspectives. Annals of translational medicine, 7(20), 576. https://doi.org/10.21037/atm.2019.10.13
McManus, C. (1995). Humanity and the medical humanities. Lancet, 346, 1143-45.
Saha S, Mamun KA, Ahmed K, Mostafa R, Naik GR, Darvishi S, Khandoker AH and Baumert M (2021) Progress in Brain Computer Interface: Challenges and Opportunities. Frontiers in Systems Neuroscience. 15:578