MEDICAL HUMANITIES AND ITS ROLE IN SHAPING ETHICS IN MEDICAL GRADUATES

Medicine as a field is unique in the sense that the skill to relate to people weighs heavier on the doctor than the skill required to practise it. Medical humanities is an interdisciplinary field that considers issues of health in the context of history, philosophy, social studies, and anthropology among others, enabling students to change their practice from “looking” to “seeing” the patient as a whole. Unfortunately, current medical training is focused on academics with students left on their own to acquire communication and ancillary skills. In the core medical curriculum, a structured training in medical humanities remains lacking. Herein, we discuss the need, student’s perspectives, and the approach going forward in the inculcation of medical humanities in the medical training with a particular focus on medical ethics.

Historicity, Historiography, and Hope

Historicity is a key epistemological component of the definition of “science” proposed by authors such as Gaston Bachelard, Georges Canguilhem and Michel Foucault, and partially accepted by the Brazilian Collective Health builders. What we call the “historicity awareness” of Collective Health is the field’s recognition that there is no knowledge of health without history and that its history interferes with its results, with the conceptualization of its objects, its cognitive and technological practices, and the feasibility of its promises of enhancing the quality of life towards an equal society. This helps explain why Humanities in general and History, in particular, are ubiquitous to Health Education, where they are known as Health and Medical Humanities or, as is more usual in Brazil, Human and Social Sciences in Health. They helped to imagine an equitable health care system of which the concrete manifestation, however imperfect, is the Brazilian Unified National Health System, the SUS. Health Humanities, Medical Humanities, and History of Science and Technology are all interdisciplinary fields that challenge historiography and theory of history to look beyond the borders of our normative understanding of the historian’s professional identity – which legitimacy is achieved through specific academic training – to properly evaluate the multiple expressions of society’s relationships and engagements with history and time.

A Study of Differences in Compulsory Courses Offering Medicine Humanization and Medical Communication in Polish Medical Schools: Content Analysis of Secondary Data

Medical humanity is an essential element of medical education, and the respective courses are introduced to the curricula of medical schools worldwide. However, significant differences in this type of medical education were identified in Italy, Spain, and the UK. In Poland, this issue was not yet analyzed. The classes offered on a compulsory and not elective basis secure the uniform skills of future physicians. Therefore, we were prompted to ask a question: do Polish medical students receive equal compulsory education in medical humanities? To answer that question, we performed a content analysis of mandatory classes’ frequency, types, and content on medical humanization and communication in Polish medical schools. The study used publicly available information provided on the home pages of the universities to perform content and comparative analyses. Of 22 identified universities, 15 had publicly listed teaching programs, and nine had freely available syllabi. The names and types of courses varied from school to school. The number of hours the courses offered throughout medical education ranged from 15 to 216. In some medical schools, the classes were scheduled during the early, pre-clinical part of the study, whereas in other schools they were offered each year. The content of the courses always covered the topics of physician–patient communication but rarely offered protocols, such as the Calgary Cambridge guide. We conclude that the medical humanities represented by medical humanization and communication courses are included in the publicly available compulsory curriculum of most Polish medical schools. However, to secure equal education of future Polish physicians, there is a need to unify the medical humanities program.

The Application of the Philosophical Thinking of “Three” From I Ching to Medical Education

Since ancient times, the Chinese have had a special understanding of the “Three”. Chinese philosophy originates from the I Ching, and the philosophical concept of “Three” is the core of the I Ching. The philosophical thinking about “Three” entails a complete dialectical thinking method that is consistent with the Western philosophical concept of “One Dividing into Three”. In this paper, we explain the philosophical concept of “Three” and suggest its application to medical education, including the learning and application of new technology, shared decision making between doctors and patients, and integration of medical humanities and medical science.

”Den här kroppen som lämnat mig i sticket”

”This body that has forsaken me.” Breast cancer, bodies, and recovery in Kristina Sandberg’s "En ensam plats" and Yvonne Hirdman’s "Behandlingen" This article studies autobiographical accounts of breast cancer, so called pathographies, analysing how the body and the illness are portrayed. The article has a special focus on the experiences of the lived body, relating it to the psychological concept resilience as well as to the sense of estrangement of the body in illness and the socially situated body. The focus of the study is two autobiographical Swedish accounts of breast cancer: Kristina Sandbergs’ En ensam plats (‘A lonely place’, 2021) and Yvonne Hirdman’s Behandlingen. 205 dagar i kräftrike (‘The treatment. 205 days in the kingdom of cancer’, 2019). The article is located in the field of medical humanities and the authors aim to bring out aspects relevant to both the literary understanding of pathographies and the medical understanding of individual experiences of illness.

Affect Theory and Breast Cancer Memoirs: Rescripting Fears of Death and Dying in the Anthropocene

Re-evaluating dominant cultural narratives around dying and death is central to new critiques of individualism and human exceptionalism. As conceptual tools for theorizing the end of the individual proliferate, the affective dimensions of this project are often overlooked, especially as they pertain to individual subjects. In contrast, a significant number of iconic queer and feminist thinkers have suffered breast cancer and written memoirs representing the subjective experience of confronting mortality. This article identifies the affective orientations towards one’s own mortality as missing from queer and feminist thinking on embodiment in the Anthropocene. As a remedy, the article reads several iconic feminist breast cancer memoirs – Sontag, Lorde, Sedgwick, Jain and Boyer – for their complex representations of affect, in particular fear, in relation to dying and death. Using the affect theory of Silvan Tomkins, this analysis contributes to critiques of cancer culture in medical humanities and of mortality and embodiment in feminist environmental humanities.

Medical Humanism or Scientia Sexualis? Building a Sexological Concept in Fécondité

This article argues that Zola's late novel Fécondité, while on the surface a transparently didactic roman à thèse articulating populationist concerns, is in fact at the same time a roman de mœurs implicated genealogically in a broader range of issues than pro-natalist ethics and various behavioural and therapeutic bêtes noires, containing identifiable traces of other contemporary pathological concerns, contingently marshalled for pro-natalist ends. Exploiting the terminological flexibility of what Peter Cryle and Alison Moore have referred to as a long-established ‘constellation of themes’ constituted by ‘impotence, frigidity and sterility’, Fécondité participates in the fin-de-siècle production of a key sexological concept. It does so through relentless deployment of the malleable motif of female sexual coldness – a signifier of pathological conditions named in contemporary medical and pseudo-medical literature as ‘frigidité’, ‘froideur’, and so on – and its polyvalent application to distinct pathologies manifesting in a variety of its female characters, in particular inabilities to desire, to conceive, and, significantly, to climax. Zola's novel appears at a moment where women's sexual pleasure was becoming normalised, to the extent that its absence now counted as a pathological disorder; Fécondité deploys tropes of coldness – consequential upon anti-reproductive practices – to suggest that it is attempted disruption of the natural reproductive order that ensures such disordered absence. Ultimately, while Fécondité is readable as didactic expression of a ‘humanitarian’ natalist ethics and representation of doctor-patient encounters, treatment, experience of illness and other ‘medical humanities’ concerns, it is however important not to overlook this representation's discursive contingencies, particularly the coalescence of sexological and populationist concerns at a moment when both were of considerable significance. Fécondité in this sense straddles two major fin-de-siècle discursive economies, offering an ideal object for a critical medical humanities valuing the pathological as well as the pathographical.

When numbers eclipse narratives: a cultural-political critique of the ‘ethical’ impacts of short-term experiences in global health in Dominican Republic bateyes

With the rising demand for short-term experiences in global health (STEGH) is an ever-increasing volume of literature that focuses attention on ethics and ethical concerns, such as the effects of STEGH on host populations. Such concerns have driven the development of ethical principles and guidelines, with discussions and debates largely centred around normative questions of positive/negative and benefit/harm for us/them. Using a critical medical humanities lens, this paper blurs these dichotomous framings and offers a more complex understanding of the effects and effectiveness of STEGH on hosts. I explore STEGH that send volunteers from North American universities to the Dominican Republic to participate in service-learning activities aimed at improving the lives of impoverished Haitian migrants living in bateyes. I address the following questions: What perspectives about the impacts of interventions on host communities manifest through STEGH? What tensions emerge through interactions among diverse stakeholders related to those perspectives, and with what effects? Drawing together critical theory and ethnography, I examined the perspectives of three stakeholder groups: student and faculty volunteers, host organisation staff, and hosts in batey communities. Data collected from observations and interviews were counterposed; I analysed interactions and interplay between stakeholders. My findings revealed conflicts around an emergent theme: counting efforts, or volunteers’ proclivity for numerical evidence of impactful STEGH for hosts. With attention on power relations, I argue that a preoccupation with quantifiable evidence eclipsed and erased the lived realities of hosts, thereby blocking a fully ethical engagement. These sociopolitical effects, often overlooked in conventional ethics assessments, are no less harmful and may reinforce rather than reduce inequalities that the global health movement seeks to eliminate. My study offers a compelling case for how the critical medical humanities lend critical insights in the name of improving global health.