Notes in the Margin - 3 January 2025
AI, Health Freedom, Surrogate Decision-Making, and more...
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.
The Danger of Superhuman AI Is Not What You Think
Shannon Vallor interrogates this term of “superhuman.” Why would anyone claim something like AI is “superhuman” when really it only does one human task quickly? Certain assumptions about what it means to be human, and what we value in our humanity, are smuggled into this claim of superhuman.
reflects on the words of Lewis Mumford about how we can sometimes try to give over agency we’d rather not have to our machines. But that would be unwise, according to both men. “...with regard to the principle that life cannot be delegated, we might helpfully ask, 'What are the thresholds of delegation beyond which what we are left with is no longer life in its fullness and wholeness?'" Of course, the question presumes two things: First, you can identify those thresholds before you cross them. Second, you'll retain the agency to return if you cross a threshold. I find clinicians simultaneously decry the burdens of the electronic medical record while at the same time placing more and more hope in technical fixes. Their imaginations are total enthralled to a technical way of thinking. I’m not sure, then, that either those questions have positive responses, at least when it comes to the use of technology in medicine.“How ‘Health Freedom’ Became a Winning Rallying Cry”
There’s growing popularity mounting behind a concept known as “health freedom.” As I understand the concept, it’s the well-accepted right that people cannot have medical interventions forced on them. Traditionally viewed in narrow terms regarding medical interventions for individual patients (e.g., surgery), the movement is now broadening to include things like fluoride in the water and vaccine mandates for children. As the article indicates, some of this flows from mistrust exacerbated by how the COVID pandemic was handled (upon which I reflected in 2021). It seems that some clinicians are starting to grapple with the fact that it hasn’t been great to ground our entire system of bioethics for the past 50 years on “respect for autonomy.” A better society would consider how to love its neighbors well. The irony is that “freedom” and “autonomy” cannot flourish without commitments that boundary and limit those very ideals.
Authoritarian and Democratic Technics
Lewis Mumford, writing in the 1960s, provides a perspective even more relevant today. Insofar as this short essay applies to my neck of the woods in medicine, I see authoritarian technics at work, squeezing our humanity, through the metastatic expansion of the electronic medical record (EMR) to burden all hours of the workday. This is purportedly in service to better patient care, but carries with it an enormous bureaucratic weight. Through quantification, mechanization, and standardization, the hope is we can remove the unreliable human element and rely entirely on the cool, objective care afforded by the machine. But of course that’s not care at all.
reflects on what imbibing AI-generated summaries might do to our capacities for reasoning (not to mention our capacities for wonder, curiosity, and attention). The Machine will shape the questions we ask and how we ask them, even as we think we’re shaping the Machine.Autumn Fiester argues that clinicians subtly (and not-so-subtly) impose their values on patients under the guise of “best interests,” particularly those patients and surrogates with “life-continuation values.” These people believe life should be sustained at nearly any cost, and don’t allow value judgments about functional status to influence their medical decision-making. She ultimately recommends trying to shift the locus of decision-making back to something less biased - e.g., relying on committees made up of members who don’t work for the hospital.
Where The Magic Doesn’t Happen
Andy Crouch writing for
warns against the allure of instant, effortless, impersonal power. This isn’t how we become the people we’re meant to be. People are formed much more slowly, painstakingly, and personally. I’ve shared these same concerns here, here, and several other places in Notes.From the Archives
Here's something, only a little dusty, that new readers may not have seen.
Everything in medicine comes with a trade-off. Sometimes these are minor, sometimes major; sometimes temporary, sometimes permanent. But trade-offs there will be. Realizing that medical intervention is a pharmakon can help us begin to reckon with it more wisely.
