Notes from a Family Meeting is a newsletter where I hope to join the curious conversations that hang about the intersections of health and the human condition. Poems and medical journals alike will join us in our explorations. If you want to come along with me, subscribe and every new edition of the newsletter goes directly to your inbox.
Every so often, I’ll share things I’ve been reading with a few words of mine scribbled in the margins. If you have something to share, please do! The comment section is open.
GeriPal Podcast: Ambivalence in Decision-making
For much of my young career, I hadn’t given much thought to what happens when clinical decision-making stalls out. After I completed fellowship in hospice and palliative care, I had a better understanding of how emotions impacted decision-making (and that was after a combined residency in internal medicine and psychiatry!). But it wasn’t until I read a paper on ambivalence by Bryanna Moore, Ryan Nelson, Peter Abel, and Jennifer Blumenthal-Barby that I realized just how deep the rabbit hole can go. It was a paradigm shift for me, as I came to appreciate that it was important to diagnose the reason why decision-making stalls out and respond accordingly. Not everyone needs more information. This was a fun conversation, and I highly recommend the paper. I wrote more on ambivalence here.
French governments gives go-ahead to voluntary assisted dying
France has approved what seems to be both assisted suicide. The law avoids the word “euthanasia,” but allows someone, medical or not, to assist the person in administering the fatal drug. I haven’t been tracking this conversation in France, but it appears, unsurprisingly, that this is controversial and that medical professionals have been asking for increased palliative care services. However, in other countries where assisted suicide or euthanasia are legal, it seems that access to hospice and palliative care isn’t a driver for using ASE. Existential reasons are usually the most common and not relieved by those services.
GeriPal Podcast: Promises and Pitfalls of AI in Medicine
Bob Wachter discusses artificial intelligence (AI) in medicine. He brings along another guest - GPT-4! He speaks a prompt to the machine in a very casual voice, identifying a newly diagnosed woman with cancer to whom he now needs to deliver the news. He asks that GPT-4 also be sensitive to the fact that she has young children. GPT-4 responds audibly; I’ll let you listen to judge for yourself how things go. While the conversation does touch on the concern about “de-skilling,” most of these types of conversations, including this one, overlook the deeper, formative (or malformative) aspects of relying too heavily on our tools (“if you give a mouse a cookie…”). For example, even if everyone thinks a machine appears more empathic, it is not actually more empathic. Are we satisfied with the lack of human presence if we’re just tricked into believing it’s there?
Language in Bioethics: Beyond the Representational View
Hidden underneath an opaque title is a profound article examining how we use language in medicine. Most clinical communication hinges on the belief that language is representational: the words I speak say symbolize reality and are meant to act in the world (e.g., to motivate you to do something). This leads clinicians to narrowly focus on the moment of decision. These authors argue that this neglects the broader context surrounding language use: who is speaking and what are they implying? If we take this into account, a new landscape of pitfalls (and opportunities).