UCI Podcast: At the intersection of nursing and philosophy

Thank you.

Thank you for having us.

Dean Lazenby, let’s start with you. You have a rather unique background. You’ve been a professor of both nursing and philosophy. You’ve also written a trilogy of books about the spiritual, social and ethical significance of nursing. How would you describe the intersection of nursing and philosophy?

Thank you, Cara. Very much. Well, first off – nurses are there at the big events of life: at birth, at death and all that goes between that. You know, a child’s first well visit, to someone being diagnosed with a life-limiting disease. Philosophy asks the big questions of life. What is the meaning of life? Is there life after death? Is there a God? All these big questions. And nurses are there when people ask these big questions in these big events of life. I can’t tell you how many times I’ve been with someone who is newly diagnosed with cancer, asking me, “why did God allow this to happen?” That’s a common question. And so, nurses are there being philosophers for people who need nursing care.

My own background is, yes, I’m a philosopher first. And I was very happy teaching philosophy – I had my first book out in it – when my parents died of chronic illness, fairly close to each other. And it was really a nurse who helped us with our mother’s care, helped us understand what was going on, helped us understand the future and what it would mean to provide a peaceful death for her. I took some time to evaluate what that meant for me and my family, and what it also meant as a philosopher – to be with people, not just to ask the questions and to answer them in my own little books. And I decided to go back to school and become a nurse. Really following in the footsteps of the philosopher I work on – Ludwig Wittgenstein – who, in the second World War, became a nurse. So, it was a way to work with my hands as a philosopher in those big moments that people encounter when they need nursing care.

And I’m sure that the people that needed you at that moment really leaned on that expertise and that background.

Not that I had any answers, but I certainly could help them work through their questions, as a philosopher is trained to do.

Sometimes a conversation is enough. Dean Miller, along with a Center for Nursing Philosophy, UCI also has a Center for Medical Humanities. Now as the dean of the School of Humanities, I’m certain you’re asked about this from time to time. How do you explain what the “health humanities” are?

Let me start, actually, by saying something about the center. It is a collaborative effort, not just with the School of Humanities, but also with the medical school and with the School of the Arts. And, in the School of Humanities, we have a minor in medical humanities that students primarily from outside of the humanities take. They’re often pre-med or nursing/public health students, who are interested in getting a broader background in the humanities related to what they’re going to be doing. So, in terms of what the medical humanities are, I would say that there are probably three major areas that I would signal.

One is the history of medicine and medicine has a history. It goes back. I mean, as long as we were humans, we were experiencing aging sickness, death, birth, and so forth. And we know all the way back to very archaic societies, there were specialists who were involved in those processes. Obviously in more modern and contemporary times, we’ve had an incredible development of medicine. So, one aspect of the medical humanities really is helping us to understand that long history – that long human history of health and healing and curing and caring.

A second dimension – and this is very closely related to what Dean Lazenby has talked about – is the philosophical dimensions. Obviously, those kinds of fundamental questions of life and death, the meaning of one’s life, what it means to live a good life and die a good death are key, but there are other areas of philosophy as well. For instance, there’s a field of philosophy called phenomenology, and it’s very much related to how we experience our bodies, how our senses work. And clearly that has important applications for the experience of sickness or aging or healing.

And then a third dimension of this really is the imaginative engagement with these experiences. So, there’s a tremendous amount of literature, film, art that relates to the experience of health and sickness – and the medical humanities also investigate those. I’ll remind you that there were many writers – important writers – who were doctors and nurses, but I’ll just point to Walt Whitman, who during the Civil War was a nurse caring for Union soldiers.

And on that note, nurses often do research in phenomenology. So – patient experience – and are really there to describe the person’s sense of their body or their experience of symptoms. And they do use the tools of the philosopher – the phenomenologist, in particular – Heidegger and Husserl and others like that, to help us understand what’s going on for people who are in need of healthcare.

Well, and that really is what it’s about, right? I mean, conversations between humanists and scientists – I’m having one right now – how do those in the end, Dean Miller, really help to serve our community and the healthcare consumers?

Well, I think of this as a matter of partially where health has gone for some important reasons – but very strongly towards technology, very strongly towards big data. Obviously pharmaceutical chemicals are a very important part of our healthcare system, and we wouldn’t want to do without them, but very often what gets alighted is that there’s a human being in the center of that. There’s a person – a person who also can ask questions, can resist, has agency in the process of their healing. It’s not simply an object that you apply technology to, or you feed with pharmaceuticals. And to really engage with that person, we need to understand what their culture is, what their identity is, understand what they mean when they may be speaking inarticulately or ambivalently – or in other ways, or that they’re actually utilizing cultural codes in their own language, in their own culture that may be different than the doctor or the nurse. It helps us to understand that holistic situation in which a patient is at the center of this – a human being who can speak and who comes with a history and a culture.

That’s absolutely right. This bit of agency – that people have a will and the ability to determine what they want done to their bodies is very key and certainly is central in nurses’ work in the space of the health humanities. So often – and this is even true for me – I go see my primary care provider and they say, “you need to do ‘X.’” And I’m like, “why should I do ‘X?’” Right? “Let’s have a conversation about ‘X.’” And it may seem rather facile, but to educate healthcare providers in culture, in beliefs, in personhood – and being able to engage others through their culture, through their beliefs and who they identify as – is one key aspect for me of educating future healthcare providers in the humanities.

And I think, Dean Lazenby, along those lines – the “language of healthcare” can be deeply scientific and sometimes phrased in terms that are inaccessible to the community. What changes can we make to make the language of healthcare easier for all of us to understand?

Yeah, it’s so true. And, you know, I, laugh about this because it even happens, you know, to me. Like, I get my cholesterol checked and I know what all the various types of cholesterol are, et cetera, but my provider speaks to me as if I should know them. In that moment, when I’m looking at lab results, I don’t interpret them with a scientific mind. I interpret them with the mind of Mark Lazenby, right? Father, husband, professional… help me understand what this means for me. And I think we have to personalize the language of healthcare – and not just getting beyond jargon – but help people understand what test results or what even such phrases as “targeted therapies” – what does this mean for you?

So, for example, I had a patient – I’m an oncology nurse practitioner, as a nurse – I had a patient who the oncologist said was eligible for a “targeted therapy.” The patient came in and said, “do you mean that it’s gonna really go just straight to the cancer cell and target it like a missile, right?” They couldn’t interpret the language of “targeted therapies” in their embodied experience. And it really was just sort of breaking it down and not using technical terms, but just describe that it’s going to target this gene that has this alteration on it and use pictures and diagrams and simple things. Like, “tell me how you understand it now.” Motivational interviewing techniques, as it were, that you can learn from the humanities. But also, how does this fit in with what you want out of life? Right? These are the side effects that are going to happen. Is this consistent with what you want? What do you want? Right? And it really comes down from moving away from the technical to the personal, and to do that, I think you have to have some awareness of the broad questions that humans ask themselves in those key moments.

And I could just pick up on one term that you were using, and that’s the idea of the personalized. There’s a very significant kind of build-up around the notion of personalized medicine. And very often the notion of the person that is being personalized is a very thin notion. Now, people talk about the humanities often as having a big dimension that’s critical. And that’s true, but this is an instance in which “critical” means let’s sort out the kind of limits of the way that we use terms and also to clarify them. So, when we talk about personalized medicine, very often, we’re talking about the application of big data techniques to understand a set of correlations that will then allow you to target a therapy or understand why something has emerged within a particular patient. But it leaves aside the whole question of, “is there a universal person that lies behind this? Does this person have a gender? You know, what kinds of background and culture do they bring to the encounter with the therapies?” Those are all dimensions of personhood that we in the humanities really want to make sure is part of the conversation about personalized medicine, so that we can actually realize, you know, what might be a truly – if not miraculous – certainly very impressive, you know, improvement in how we understand, you know, healthcare and the delivery of therapies. But let’s not leave out that human dimension because I think it’s actually essential to our being successful in that dream of, of personalized medicine.

Dean Miller, you’re absolutely right. We use “personalized medicine.” We use “targeted therapies”, “precision medicine.” “Targeted” and “precision” are almost militaristic in their tone. Like, “we’re going to go in there for a clean strike” and it doesn’t involve the person who may have hopes and dreams, and also who may not want it. And I have a specific example of a woman who had a melanoma. And melanoma back in the day used to be very lethal. But now, because of immunotherapies and very targeted treatments, can sometimes be cured. Even when it’s at advanced stages. She didn’t want any of this treatment. And I was called in to find out why she didn’t want it. And she said, “I’m 85 years old. I’ve led a good life. I don’t want to go through the treatment and the side effects.” No one thought to ask the person behind the personalized techniques. Right? And so, that’s some of the language of healthcare that sometimes we have to hold intention with the language of the humanities, the human behind all of this.

You’re both philosophers. So, Dean Miller, I’ll start with you. What are some of the tools in a philosopher’s toolbox that would be very useful in the field of nursing to a nurse? I mean, we just had a great example there from Dean Lazenby about, “let’s just talk about it.” That’s one tool: conversation.

Yeah. I mean, I do think that this close attention to language and how we use language and various ways in which language means is one of the key topics of philosophy. It’s one of the topics that Ludwig Wittgenstein, that you’ve studied, you know, really called our attention to. But I think that there are other traditions. I mentioned phenomenology – really understanding kind of the way in which sickness or healing might engage new experiences of the body, even innovative and creative experiences of the body that wouldn’t be accessible to us, except by going that journey through sickness. I think there are also things in the traditions of ethics that are very important in terms of understanding. Well, I mean, it kind of boils down to the question of, “We can do this. Should we do this? And under what circumstances should we do this with what level of understanding and consent from the patient should we do it?” Those are very significant ethical questions that I think come up in very everyday ways in the healthcare setting.

Bioethics, as it’s called is, is, is one of the significant ways philosophy has really contributed to modern healthcare. We still are grappling with what is informed consent. How do you know a person has really understood the information and when is it truly consent? And oftentimes it, you know, we have it built in now into some of our structures, but consent is a continual thing, right? And even in treatment of disease and disorder, when do you have the right to opt out because you’ve opted in, right? When can you say enough? These are still ongoing fundamental questions that philosophers work in the ethics space.

I would just add one other thing. It’s kind of, you know, pulling back to a bit of an aerial view, but it’s asking philosophers who have asked the question, “What is the role of healthcare or health in the larger social and political sphere?” And there are philosophers, like Michel Foucault, who talk about the “biopolitical,” basically that our society is increasingly structured around these kinds of very basic questions of life, death, birth, sickness, health, and so forth, and the various kinds of structures that we have for managing it – insurance, risk, healthcare systems, government programs. And if you think about what are the key, you know, what are some of the major political issues that we’ve struggled with in the last 10, 15 years: government health insurance, abortion, you know, the various kinds of levels of care for people, health inequalities, those are really big political issues. And I think not accidentally. And that’s kind of what Foucault and others have really identified.

And lest we forget the end-of-life conversations. Could they even be covered by your insurance or by Medicare?

Mental health?

And yeah, mental health? Absolutely. And as one who works within what something many call – and I, myself, call – the “healthcare industrial complex,” it is a big business. And, in many ways, society more and more is becoming structured around it. So, this biopolitical, Foucaultian viewpoint is critical.

Is there anything that we haven’t talked about that was something that you wanted to make sure that we brought up in our conversation today – this unique space where you’re both together to talk about these very vast, important topics?

Well, I think for me, it’s important to say that I don’t view that there’s a divide between the people who study healthcare and the humanities. And it is a tragic consequence of the modern university when we have to work at integrating because – as we’ve illustrated here today – the questions are no less human than they are scientific. I want us to think not of integrating, but of it is one piece.

The other thing for me is that nursing, itself, as one of the healthcare professions, perhaps provides a fairly unique lens in that we are right there with the human, right? We touch the human more than any other profession. It’s not lost on me that the American public – for however many years Gallup has been polling, “which is the most trusted profession?” Nursing comes out on top and has come out on top every single year, except 2001 when firefighters came out on top. So, what’s going on there? I think part of it is that people know that nurses are there for them in the most intimate of times, the most human of times. And so, that there is a Center for Nursing Philosophy at UCI and that we work closely with the School of Humanities is very much what should be happening.

And I’ll just agree with that and say, you know, a bit more generally on the one hand, we see some of the incredible things on the campus as taking place in the health space and science and technology and engineering. And in many ways, there are new problems and new questions that are being posed for the humanities by the remarkable developments in those fields. At the same time, despite all we hear about STEM and non-STEM and so forth, for us, it really is also we’re very confident that we have significant contributions to make to many of the kind of grand challenge discussions that are going on around healthcare, around climate change, around the effects of technology. And, you know, we want to really make sure that the artificial divides don’t keep us from making that contribution and having those substantive conversations. So, I’ve really welcomed the opportunity to collaborate with the nursing school. And earlier in the quarter, we had a banner up that had the medical humanities center and the Center for Nursing Philosophy together on the banner for people to see about the human side of health. And I think it’s just, you know, an example of a place that we can continue to develop those sorts of collaborations.

And to your point, sometimes it’s just as simple as a conversation in an interdisciplinary basis like we had today. Thank you both for your time.

You’re welcome.

Thanks so much.

Thank you.

The UCI Podcast is a production of Strategic Communications and Public Affairs at the University of California. Irvine. Please subscribe to the UCI Podcast wherever you listen.