Revisiting "patient career"

Almost a decade ago I posted:

Medical Sociology: The Importance of 1894....2015 patient career - health career

- which was prompted by:

McKinlay, J.B. (1971) The concept “patient career” as a heuristic device for making medical sociology relevant to medical students. Social Science and Medicine, 5(5), 441-460.

https://pubmed.ncbi.nlm.nih.gov/5160599/

McKinlay's abstract reads:

Abstract

Increasingly it is being suggested that the behavioural sciences can contribute to medical education and should be incorporated into the medical curriculum. Evidence for the development of this view in Great Britain can be found in the recommendations of the recent Royal Commission on Medical Education and the submissions of various bodies to it. Given that the behavioural sciences in general and medical sociology in particular, can contribute in a positive way to the medical curriculum this paper attempts to: (a) draw together and crystallize some of the major problems inherent in past attempts to organize and include the behavioural sciences in the medical curriculum; (b) devise some criteria for determining the behavioural science content of the medical curriculum; (c) outline and discuss one possible course in medical sociology utilizing, as an organizing framework, the concept “patient career”.

Brian Hodges created his eponymous model with curriculum planning, design and development as a key purpose. In the early-mid 1980s nursing was looking forward to becoming a degree, undergraduate course of study.

McKinlay's use of 'patient career' (and others) can obviously be associated with the impact of life chances upon a person's health career. 

Individual

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

'While discussing the relationship between the medical and social sciences, and the role of the social scientist in teaching and research in medicine, Butler groups the range of medical topics which have been studied sociologically into four main categories [l4]. These are, the sociology of illness, the sociology of health, the sociology of medical care and the sociology of healing.' p.443.^

McKinlay sees these categories as too comprehensive. Although within the SOCIOLOGICAL domain of Hodges' model this is a 'start'? McKinlay proceeds to identify specific difficulties presented to educators, which include (in summary and with my emphasis):

'(a) The failure to identify needs, specify objectives and devise criteria

(b) The failure to distinguish between perspectives

'Very generally, the behavioural sciences can be said to be conccrned with the description and explanation of the health and illness behaviour of groups and social categories, whilst medicine (especially clinical medicine) aims at the understanding and successful treatment of individual patient cases. By working exclusively on the basis of (or failing to take account of) these separate perspectives, meaningful dialogue between behavioural scientists and medical students has been made extremely difficult.'

(c) The failure to distinguish the audience

(d) The failure to take account of temporal location

(e) The failure to provide a conceptual framework

Most courses in the behavioural sciences either offered or proposed, to a greater or lesser extent, tend to ressemble a sort of shopping list. For example, the courses offered by Badgley, Martin et al., and those proposed by the Society for Social Medicine and the Royal Commission all reflect this "'shopping list" charactcristic. After working down the list it is assumed that students will have the technical goods required. It is, of course, difficult for students undertaking these "shopping list" courses to reflect on where they have been, appraise their current position, or consider where they may be going.

Two further general problems seem to be inherent in many of the attempts to systematize the field of medical sociology, and to some extent are associated with some of the problems already outlined. 

(f) The problem of trying to cover too much [Which lists 18 topics for 2nd year students.]
 (g) The problem of omitting important areas' pp.443-445.

McKinlay then, is similarly preoccupied with the curriculum (for medical students):

'This section is concerned primarily with devising criteria which, given the finite amount of teaching time available, will offer some guidance in determining what aspects or areas of medical sociology should be given priority for teaching in the medical curriculum.' p.445.

This work from the 1970s surely invites reflection upon the meaning of 'progress'? 

^My formatting.

More to follow...?

Paper - (finally!) "A generic model and conceptual framework to prime curiosity across health and social care ..."

 It has been over a decade but at last the second* paper has been published in Journal of Evaluation in Clinical Practice:

Jones, P. (2025), A Generic Model and Conceptual Framework to Prime Curiosity Across Health and Social Care Disciplines to Facilitate Lifelong Learning. Journal of Evaluation in Clinical Practice, 31: e70252. https://doi.org/10.1111/jep.70252

ABSTRACT 

Rationale: The Corona virus pandemic highlighted the importance in continuity of the physical and emotional labour across all care sectors. Synergy between healthcare in hospitals, and community services must be allied with social care; and be central to integrated and efficient policy and service delivery. Services were found wanting in the pandemic and in recurring winter crises. The politics of funding for care delivered in rest and nursing homes remains contested, awaiting long‐promised governmental action. The workforce is recognised as dedicated, skilled, compassionate and yet under‐valued and under‐paid; managers face ongoing recruitment challenges, with a national shortage of staff, and high turnover of personnel. A National Care Service is awaited in England and Wales. 

Aims and Objectives: This study explores the ongoing care crisis, using the educational lens of threshold concepts, projected, analysed and synthesised of a generic conceptual framework, known as Hodges' model. Readers will understand Hodges' model and threshold concepts being equipped to explain both. 

Methods: The study is descriptive and uses a conceptual mapping approach supported by discussion and literature. Additional resources and avenues for ongoing study are also provided. 

Conclusion: In conclusion, Hodges' model is a pragmatic, practice‐based tool, that can support and sustain curiosity for workforce learning and development. 

Acknowledgements I would like to thank Messrs Mark Bird and Matthew Graham and the journal's reviewers for comments on drafts of this study; and acknowledge the effort of Dr Michael T. Flanagan in creating the informative threshold concepts resource (referred to above). 

https://onlinelibrary.wiley.com/share/author/IRPNBR2KHJNYJK8XUAW6?target=10.1111/jep.70252

*This paper was originally the first of a two-part work. Feedback from reviewers suggested the papers be standalone. United now, in one journal.

Many thanks to the reviewers, editor, editorial and publications team at JECP.

This paper has been added to bibliography in the blog's sidebar.

You say Hodges' model is a map. What's the scale?

"That's another thing we've learned from your Nation," said Mein Herr, "map-making. But we've carried it much further than you. What do you consider the largest map that would be really useful?"

"About six inches to the mile."

""Only six inches!"exclaimed Mein Herr. "We very soon got to six yards to the mile. Then we tried a hundred yards to the mile. And then came the grandest idea of all! We actually made a map of the country, on the scale of a mile to the mile!"

"Have you used it much?" I enquired.

"It has never been spread out, yet," said Mein Herr: "the farmers objected: they said it would cover the whole country, and shut out the sunlight! So we now use the country itself, as its own map, and I assure you it does nearly as well."

        Lewis Carroll - The Complete Illustrated Works. Gramercy Books, New York (1982). Page 727.

My source
Text: https://people.duke.edu/~ng46/topics/lewis-carroll.htm

Plus a letter in FTWeekend: by Prof. R.T. Harrison. 'Country as its own map served as well' https://www.ft.com/content/2ad8ea16-d27d-11e1-abe7-00144feabdc0 1 Sept. 2012.

Book review: #5 - Handbook on the Ethics of AI

If there is an overall theme to the book it is - rather inevitably -   anthropomorphism. Some argue it is consequential in nature due to the risks we are running. Sandry's chapter 10 Anthropomorphism and its Discontents begins by highlighting duality, dichotomies, and  oppositions that instantly come into effect in this emerging  theoretical, practical and policy field. If a term anthropomorphic can be 'loaded' this one carries extra baggage: history, religion, natural, aesthetic, philosophy, physical, existential. The dual issue of making a machine that looks human; versus, machines that could deceive humans (used remotely today and in situ in the future?) is considered. In our interacting with AI Tech, I found intention (and attention) of specific interest. Sandry seeks definitions, starting with dictionaries, the discussion is helpful across arts too. The reader is left well briefed and technically too: intrinsic and extrinsic forms, the role of the intentional stance, 3-factors. ...

Health is not a primary focus of the book. The index does not list health, medicine, nursing, at least not where they may be expected. The index is comprehensive but I wonder if it could be improved. Care is suggested through social robotics (p.147). Design figures again, anthropomorphically of course (p.147). Specific attention to ethics and Taking Care With Language are given (sections 6-7). I scribbled! again about care for tech - in the material, energy, and production 'costs' in an ecological sense. SUVs annoy me (sorry!) are they all necessary? On language, I thought back to McDermott D (1985) Artificial Intelligence Meets Natural Stupidity, In MIND DESIGN, Haugeland J (Ed), MIT Press, London, p.144-145:

Naive holism, Hodges' model and a lesson from NeuroLinguistic Programming

Balance in subjectivity and objectivity of stances and resulting content / conclusions can be difficult to achieve and represent. The latter section prompts respond to frustration with the term anthropomorphism. I found myself in a couple's lounge, as a community mental health nurse, acutely aware of the role of proxies in dementia care; as Sandry described Paula Sweeney's 'fictional dualism' (8, 150). Hodges' model fits well here too, regards anxiety. To socialbots, I added carebots. There seems potential in sociomorphing.

As noted previously, reflection and relation-al points litter the text. In Jecker's chapter 11 A Relational Approach to Moral Standing for Robots and AI this is more explicit. Jecker refers to care of others - as animals too. In computer science and seeking to retain a socio-technical perspective, I've seen potential in capability and maturity frameworks. Section 2 provides some discussion of the former. One of the first words I looked up in the index was isomorphic. It wasn't listed but I found reference to it on page 157: '... a community of robots psychologically isomorphic to to human beings that share our psychology ...'. Maths is a focus here, even though I must try to utilise AI to aid my learning and understanding. This is - must be an outcome of reading HEoAI.

The section on (self-)counsciousness is engaging and not limited (again) to machine intelligence. Subjectivity arises again. I wrote a note re. the precautionary principle, my 'prompt' the ethical principle. A gift was dicovered in 3. A CONCEPTUAL REFLECTION and within 3.2 Relational Ethics, preceded by the potential of Kant, utilitarian and vurtue ethics. While not wishing to virtue signal I've long speculated on how other cultures could inform nursing theory and models of care. Jecker incorporates the African philosophy of ubuntu in relational ethics. Student's would enjoy this, especially as Jecker (Source: Author) provides tables laying out the ethical approaches and robot & AI capabilities. This can also encompass older adults and care contexts with social robots. Nussbaum's capabilities applied to human development is also adopted here - another useful reminder:

Hodges' model: axes and care domains

Hodges' model - as 'a' philosophy c/o TPM

(And, once again I recall Nussbaum's talk on Aristotle.) In post #4 I wrote of the rubbish scene in the film A.I. Artificial Intelligence, but it's here (p.166) that I wrote the note. There is so much I'm skimming over - believe it not.

The conclusion in mentioning a hybrid future consisting of both humanistic and mechanistic agents appears to find an additional theoretical and practical ally in Hodges' model?

Chapter 12 by Navas is AI Ethics, Aesthetics, Art and Artistry visits the history and philosophy of this subject too, esp. from 1700s. With Žižek and Deleuze there is much prepatory reading for would-be undergrads - and general readers keen to have an awareness of contemporary issues. There is quite a triad here - disassembled - across several sections. I have quoted from the volume many times, but p.179 concerns empathy: 

'Empathy challenges the ongoing optimization of technology, because it takes time to exercise it. A person needs time to think about whatever issue, situation, thing, or person they may empathize with. In other words, empathy is essential for humans to understand and figure their relation to others and their surroundings. Empathy, if practiced reflexively, can lead to critical thinking. which may not lead to clear results but the activity may and often does end in "wasted" time if framed under the drive for efficiency, which is clearly something Al is designed to achieve. And lastly, empathy, because it has been foundational to art, is also part of art's long-term resistance against capitalism's exponential dependence on speed of production. At the core of AI ethics, then, we find speed of production and consumption coming in conflict with human existence itself. Humans are proving to be inefficient actors in the very system they built for their own benefit, which obsessively demands faster cultural activity from people, which (to be blunt) translates to an unapologetic and incessant desire for profit.' pp.179-180.

Section 6 on creativity AND speed is fascinating, especially as human-machine (brain) interfaces develop apace. Concerned as I am with what is a metacognitive tool, 8 Metacreativity formed the conclusion of chapter 12. The notes refer to generative coding which has come up in various webinars.

Silent Running: Film

Briefly, chapter 13 covers AI and the Environment. It is amazing (or not) how in a few sentences your mind can be changed? From "Really!" upon reading 'species culling', to this being explained in the crown-of-thorns starfish (hence COTSbot) and the toll on coral in Queensland. There are robots-for-ecology. I smiled returning to Silent Running's Dewey, Huey, and Louie becoming reality. Facinating point in: what is collective must be recognised in terms of causation. Appropriatly, PEAS is an acronym: probalistic weather event attribution studies are a reality in conjunction with remote sensing and tracking.

Drones are also developing apace, and applied robotics - tree-climbing. Less reassuring (adding to nature's precarity?) are artificial insects to undertake pollination; more positively reducing the impact of chemical and toxic spills. Simulation for training is well established in medicine and nursing; section 2.3 addresses this were PEAS form super-ensembles of data (I like that). PEAS can also have a role in determining an evidence-base and demonstrating it is hoped provenance for that evidence in the movement of populations, for example, climate refugees. In conflicts, human rights and justice, forensic architecture is of course well established: Forensic Architecture (Care Forensics?)

The summative nature in closing chapter 13 is a helpful approach which I will possibly try to duplicate.

Socio-technical approaches are found in chapter 14 Uses and Abuses of AI Ethics by Frank & Klincewicz. Understandably, boundaries play a large role, as you would expect in deliberating value and values, moral patients and agents. The Collingridge dilemma is discussed, regards putting in place controls for a technology while it is still in development, otherwise control may be lost (p.213). Diversity, a story of the moment - closes out this chapter. There is a 'nice' continuity across chapters to
15 The (Un)bearable Whiteness of AI Ethics by Syed Mustafa Ali et al. (the first note highlights the format is a dialogue). The (colonial) politics of north-SOUTH are duly noted and Africa (section 4). Section 8 points to technological (and health) colonialism. I take as a positive that the 'hyphen' also has a place (S.10).

The Savage Mind

Again related, as per the book's structured parts, chapter 16 Ethics beyond Ethics: AI, Power, and Colonialism by Kim prompts the reader to revisit the concepts of 'other', alterity even if 'understood'. I pencilled 'Savage Mind' here. Machines are posited as the colonial other. There will be a repeated argument as in response to humankind's going back to the moon (to stay) and on to Mars. We should sort Earth out first. So too for inclusion and the machines. What about the people who are excluded, disenfranchised and increasingly so? I wondered (previously) if (even) more could be made a transparency? Noting the word subaltern, it appears this has suddenly been attributed to Ukraine? On disability and ableism reminded also of radio history and 'Does He Take Sugar?'

The statement: 'Machines are perceived as distant - temporally, spatially, or socially - and different from human culture.' p.234. Is, so true.

INDIVIDUAL

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

GROUP

cognitive - conceptual 'spaces'	distance: time, space
human cultures societies	difference

'Binary-opposition' and the need to think outside of this is acknowledged. And as if (perhaps) to stress both distance and proximity, I wrote 'mobius' in the margin (p.238). Hutchings (2015) sounds a valuable reference: 'Ethical Encounters - Encountering Ethics'. The books I've read contribute to evidence to revalidate my nurse registration. I realise I've sold-myself short in listing the book's titles. Although not discussed here the remaining chapters are excellent critical reading at a time when diversity, equality and inclusion policies are being rolled-back and undone. I will highlight these:

• 17 Disabling AI: Biases and Values Embedded in Artificial Intelligence (quoted in 'Do you fit the description?')
• 18 The AI Imaginary: AI, Ethics and Communication
• 19 Feminist Ethics and AI: A Subfield of Feminist Philosophy of Technology
• 20 Buddhism and the Ethics of Artificial Intelligence
• 21 Queering the Ethics of AI

In chapter 16 'Ethics beyond Ethics...' just before the conclusion I will carry forward a sentence -

'Forming an identity requires that "I identify something or someone beyond me" - with one or more categories persons, non-human others, acts, ideals, values, or social systems' (p.243).

- and the points following, and end there.

Many thanks to David J. Gunkel (Editor), the many contributors, and Edward Elgar Publishing Ltd for my copy. I have greatly enjoyed and learned much from reading this book.

Handbook on the Ethics of Artificial Intelligence. David J. Gunkel (ed.). Cheltenham, UK: Edward Elgar Publishing Ltd. ISBN: 978 1 80392 671 1245
https://www.e-elgar.com/shop/gbp/handbook-on-the-ethics-of-artificial-intelligence-9781803926711.html

Book review: Handbook on the Ethics of AI #1

Book review: Handbook on the Ethics of AI #2

Book review #3: Handbook on the Ethics of AI

Book review: #4 - Handbook on the Ethics of AI

Images:

Silent Running 
https://cdna.artstation.com/p/assets/images/images/016/839/904/large/david-eagan-screenshot001.jpg?1553673214
The Savage Mind
https://en.wikipedia.org/wiki/File:The_Savage_Mind_(first_edition).jpg

Related previous posts: 'general + AI'

*That early streak of competitiveness was clearly educated out of me.

Book review: #4 - Handbook on the Ethics of AI

Chapter 7 is no doubt one of the engine rooms of this book. In AI Ethics and Machine Ethics, John-Stewart Gordon follows preceding authors citing Nyholm and others. This probably helps the overall coherence of the book, and underlines what is a dynamic and emerging field. Reading 'What is AI ethics?' (p.98), I made a note about our humanity's cognitive house-keeping (and other life-forms?) executed through sleep, the ability to unlearn, and forget. Efforts to mitigate machine bias are provided in a list 1-5 (p.100). As observed previously, this author is also thinking on their feet (and very well too) with 'Source: Author's own' in a figure for the systemic place of machine ethics and another (table) 7.1 'Four approaches to machine ethics'.

3.4 considers the challenges involved in developing ethical AI systems. As in healthcare, we see where the (problem of) 'many hands' emerges from:

'Developing ethical AI systems requires collaboration between computer scientists, ethicists, and other stakeholders, which can be challenging due to differences in expertise, terminology, and perspectives. Computer scientists bring technical expertise to the table, while ethicists provide insights on moral principles and values that should guide AI behavior. However, these experts often operate within their own domains and may lack a common language to effectively communicate and collaborate. 

Other stakeholders, such as policymakers, industry professionals, and end-users, also play vital roles in shaping the ethical development of AI systems. They bring diverse perspectives, needs and expectations that need to be considered and balanced during the design, implementation, and regulation of AI technologies. For instance, policymakers are responsible for creating guidelines and regulations that ensure the safe and responsible use of AI, while industry professionals must adhere to these standards and navigate the practical challenges of integrating ethical considerations into their AI-driven products and services.' p.104.

The solution includes having interdisciplinary and ethnically diverse teams, cross-disciplinary training, and a more holistic and comprehensive approach to AI development. Unintended consequences (a news item today (13th Feb 2025) are discussed, the dual-use nature of AI and technological 'delivery' surveillance acting for good and potentially ill (China's - Social Credit Point System).

AI ethics is also itself apparently a conceptual framework (p. 99,107).

What is permitted by law in a State clearly varies. Chapter 8 deals with From Ethics to Law: Why, When, and How to Regulate AI. Collingridge is another recurring citation, and presents a dilemma no-less (Section 3. p.116); one to follow up  (Coeckelbergh too, chap 9). I've always felt that some knowledge of social and economic history is a good foundation. History is reflected here in resort to 'masterly inactivity' (p.118) and regulatory approaches - as debated this past week at an AI Action Summit in France. 

I can still recall the sense of competition in having time in the sandpit at infants school.* Software developers will use sandboxes to develop and revise code in an isolated environment, before it goes live, or wild. With AI the book refers to mishaps, projects that have gone wrong. We need to take care regards the nature of the 'sandboxes' that are used. In a way this speaks to the utility of Hodges' model as a resource for lifelong learning, a learner being fully socialised into a profession and its evolving disciplines:

INDIVIDUAL

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

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GROUP

box	sand-
box	box

I had to look up the CREEPER (Curbing Realistic Exploitative Electronic Pedophilic Robots) ACT (p.121). We are accustomed to outsourcing, and its perverse effects facilitated through globalisation, with nations transferring their pollution - plastics, and e-wastes. There are efforts as Chesterman writes to limit outsourcing to AI in terms of the decisions (pp.122-123). I enjoyed the nods to Isaac Asimov too. 

Gellers in chapter 9 AI, Design, and More-than-Human Justice provides another cylinder to drive the text not just forward but acknowledges the future for all: organic and inorganic. Gellers is argues for attention to AI and justice, not merely the moral and legal status of AI. Reading of  'communities of justice' (p.128) the established notion of 'communities of practice' or the collective of users - socio-technically. Gellers highlights our being in the anthropocene and how the environment and nature is figuring in law. So, not just legal questions for humans but natural 'things' and entities also (posted previously: Person & Sense of Place: A River runs through it ...).

INDIVIDUAL

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

GROUP

person- [what >] 'Who'	-hood (p.129) algorithmic
collective communities of practice	justice communities of justice

I don't think we are there yet? Even, accepting that built-in obsolescence is an established and legal thing. But AI could turn materialism on its head. Looking at the materials, metals, rare earth elements ... that goes in how long do they last and how are the materials recovered? AI, computing desperately needs the doughnut economy, must epitomize the doughnut. Looking for a place to live, you notice the way probably quite serviceable bathrooms and kitchens are ripped out. The suites on a skip. That is quite a scene on the rubbish tip in the film: 'A.I. Artificial Intelligence'. The amount of energy in total production and materials is still not wholly valued, even before other values are 'added'? The focus on design here is integral to such questions. It has brought me to care design, and care architecture. Socio-technical aspects are highlighted again by Gellers (for me, as noted on W2tQ, that hyphen matters). 

Unsurprisingly, Descartes also figures in this chapter, section -Technology in the anthropocene:

'First, for philosophers of technology, the Anthropocene obliterates the nature/culture divide intrinsic to Cartesian thinking (Conty, 2017) that altered the course of history by rebranding technical objects as artificial and thus divorced from nature (Hui, 2017).' p.131.

It is encouraging that there is now recognition that 'we are nature too'. While we can record thought - brain activity on an EEG, from the outset (school studies of biology, then human biology) I've always associated intelligence, mind, thought, emotion, hope, dreams and cognition .. with the intra- interpersonal domain. If you adopt a socio-technical approach (overview - mindset) then invariably the technosphere will straddle the HUMANISTIC <-> MECHANISTIC axis of Hodges' model:

'So far, I hope to have established that technology plays a prominent, if complicated, role in the Anthropocene. But how does this relate to justice? Technology's relationship to ecological systems holds important implications for determining who belongs to communities of justice. To begin, the Earth system consists of interrelated biological, physical, and mental "worlds" (Kotzé, 2020, p. 80). The mental world, also referred to as the "technosphere," is an autonomous amalgamation of energy, communication, transportation, and financial systems, along with cities, governments, factories, farms, and other built systems and their constituent parts (Haff, 2014, P. 127). Technological artifacts such as AI are therefore part of the technosphere.' p.132.

Hodges' model: axes and care domains

We read of robots-in-ecology and robots-for-ecology. I was reminded of the SF film 'Silent Running' here. The real merit and encouragement for me in Geller's contribution, is section 4 which compares how we can approach more-than-human justice. Total eclipses are supposed to be rare, irrespective of what they might portend, now AI, the climate and life on Earth keep eclipsing each other: thus far partially. 4.1 Multispecies justice - Peter Singer really is ahead of his time (chapter 11 - here!); following socio-ecological justice 4.2, we arrive at planetary justice. Note (in Hodges' model) the 'distance' of what is generally deemed social and where the ecological in reality - physically resides. In the margin I'd scribbled 'Less a case of "take me to your leader" and more a case of "show me all your cards!"'. The synthesis and closing section on the design of robots specifically for more-than-human-justice helps here by including relationality, intersectionality and and contexts. 'Design justice' is something the book prompts me to carry forward (p.137).

Handbook on the Ethics of AI

One final post on HEoAI to follow ...

Handbook on the Ethics of Artificial Intelligence. David J. Gunkel (ed.). Cheltenham, UK: Edward Elgar Publishing Ltd. ISBN: 978 1 80392 671 1245
https://www.e-elgar.com/shop/gbp/handbook-on-the-ethics-of-artificial-intelligence-9781803926711.html

Book review: Handbook on the Ethics of AI #1

Book review: Handbook on the Ethics of AI #2

Book review #3: Handbook on the Ethics of AI

Related previous posts: 'general + AI'

*That early streak of competitiveness was clearly educated out of me.

ii Comparison and Contrasting the Meikirch Model and Hodges' model

Meikirch Model

Quite some time has passed since June 1st and part 1. I don't think this post can wait 18 years like that preceding! It is good to see '(Biologically given) potential' emphasized in the Meikirch Model; and the arrows which refer to:

'Whenever the five components and the ten complex interactions (double arrows) cooperate in a purposeful way, health may result. More specifically, a person is healthy, if by the two potentials she or he is in a position to respond satisfactorily to the demands of life.'

The interactions are explained in more detail. Mental health (illness) is there in 'personally acquired potential', but I wonder if it needs to be more explicit? Although, is this a welcome 'break' from the mind-BODY Cartesian divide and its legacy? A shift that enables a more constructive (less stigmatizing) formulation?

Given the climate crisis and experience of COVID, we can hopefully retain a sense of our individual proximity to the environment and green spaces. The importance of access to 'green spaces' seems to be sustained, even if action on air quality (and plastics in the environment) is still playing catch up with WHO air quality recommendations. The interdependence of nations and geography crystallizes more each month. The need for international cooperation apparent in cities, such as Lahore (1). Pollution and smog in Pakistan depends on what happens in India. Water flows, the how, when and whether is noted as a potential trigger for future conflicts.

Both models, the Meikirch, and Hodges' are of course idealizations. As such there are inevitable limitations, assumptions, pros and cons. Like many concepts, environment is a compound or expansive term. Simultaneously, from a primary meaning, we can proceed from the physical environment, to the social, political and the mental environment that these invoke or foster. 

In the SCIENCES domain of Hodges' model we are in 'a' - the environment. Physical reality presents itself in raw and fundamental terms. Across the world climate change is threatening many homes and places a stress the importance of 'shelter' and the homeless. Natural disasters, and acute local weather events which are now repetitive disrupt life and population. Conflicts continue to displace people, climate refugees will follow: (https://www.unhcr.org/refugee-statistics). Contrast this with the ideals of housing design that is sustainable and also enables occupants and communities to feel the environment. 

'Ecosystem' is being applied in ways beyond its original articulation. This past N. summer-autumn reading and reviewing -

Capra and Luisi's (2014) The Systems View of Life - A Unifying Vision.

(i) https://hodges-model.blogspot.com/2024/09/i-systems-view-life.html

- there was much emphasis on complexity, ecosystems, emergence, education, and obviously systems.

In their model, Bircher and Hahn incorporate Complex Adaptive Systems (CAS).

https://meikirch-modell.ch/wp-content/uploads/2017/12/Health-and-diease-as-CAS.pdf

This is helpful as the ecosystem is transformed, before our eyes. Clearly, there isn't one ecosystem, but several and they are all dynami: even if, outdoor clothing and car manufacturers want us to believe that we can create our own private ecosystem that is trans-portable. Systems are like the whirls in moving water, they come and go. Ironically there are now more opportunities to study them - if we so choose. Now weather events reveal the risks of people trying to sustain these mindsets when a local catastrophe strikes. The website for the Meikirch Model includes the table below. 

Theories Concerning
Health and Disease

Type of thinking	Epistemology	Means for comprehension
Prescientific	Personal experience	Intuition
Scientific: Meikirch-Model	Scientific argumentation	Rational mind

This is constructive as models should encompass what can be presented as 'knowledge' and from there: data, information, facts, myth, wisdom and folk theory. Intuition is listed as a prescientific 'means for comprehension'. Intuition is highly subjective, in contrast to the (supposed) objectivity of the sciences. Intuition is nonetheless significant in mental health care - psychotherapy, and in truth more generally (interpersonal skills); even if it remains 'unscientific' and an enigmatic phenomena. 

On twi/X and here on W2tQ, I've suggested that the bio-medical, and the biopsychosocial models are inadequate as conceptualisations for healthcare and education. We need to fully encompass the subjective and humanistic dimensions of health care and lived experience, giving more attention, if not credence to 'personal experience'. In England and Wales these past months and to follow our parliament has been debating assisted dying for people with terminal illness. Both sides acknowledge the sorry state of palliative care. Policy and ethics - hence the politics of health needs to be explicit in a model of/for healthcare.

Working in mental health you quickly understand how critical it is being able to relate to others, and  develop therapeutic relationships. Get this wrong, and problems may follow. If interpersonal - communication are essential to a health professional's knowledge then awareness and competence in relational skills are also key. In the past two years or so, I've realised the importance of this for Hodges' model and trying to develop a theory to underpin Hodges' model. I believe that this is a strength of Hodges' model. So we need to extend the table above. 

Individual
   |

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :   POLITICAL 

|

Group

choice - life style reasoning - rationality my literacy - responsibility mental illness - fear of stigma intuition / subjectivity	geography - environment air pollution - smog & plastics traffic regulation - metrics Planetary health 'truth' objectivity
community - relationships culture social systems family social (all) determinants	international cooperation transparency / accountability policies - funding determinants of health reporting - citizen science

As part 1 started, I will finish with the title of the paper that prompted these reflections:

Bircher J. und Hahn E. G., (2017). Will the Meikirch Model, a New Framework for Health, Induce a Paradigm Shift in Healthcare? Cureus 9(3): e1081. DOI 10.7759/cureus.1081 

The Meikrich model is not alone in seeking to facilitate and deliver a paradigm shift in healthcare; and, at individual, collective, planetary levels, across social care and education and the disciplines - old and new.

 

(1) https://www.independent.co.uk/climate-change/news/pakistan-lahore-air-pollution-schools-shut-aqi-b2640783.html

i Comparison and contrasting the Meikirch Model and Hodges' model

Comparison and contrasting the Meikirch Model and Hodges' model

Learning of another conceptual framework, which helpfully is also described as a model, there is a website, publications and illustrations (well executed PNGs). Enter, the Meikirch Model:

Bircher J. und Hahn E. G., Will the Meikirch Model, a New Framework for Health, Induce a Paradigm Shift in Healthcare? Cureus 9(3): e1081. DOI 10.7759/cureus.1081

The title of the paper is impressive, and on reflection worthy because we really do need a paradigm shift in healthcare. 

How to achieve universal health coverage and do so sustainably? In turn, how to realise the Sustainable Development Goals, while having regards the dependencies, determinants of health? For Hodges' model this is factored in by Brian (Hodges') recognising the political in situations including health. (So, I would argue that the required paradigm shift extends much further, but more on that to follow.)

Below I will review some of the main arguments, facets, and principles of the Meikirch Model, drawing from their website: https://meikirch-modell.ch

 
Meikirch Model: Overview

The Meikirch begins with 'demands of life':

"Each living creature has to fulfill the demands life puts on him or her. In man these demands include biological, psychosocial and environmental shares."

From the outset the INDIVIDUAL being - as a living creature (hence animals, flora too?) is highlighted - as per the individual - self, in Hodges' model. Maslow's hierarchy is presented too in stressing the need for shelter to counter the demands of the environment.

I like the way the individual draws upon 'biological given' and 'personally acquired' "potentials". In Hodges' model the individual's interpersonal development, their intellectual abilities, motivation, attitude, personality and more all contribute to a person's self-actualisation.

Demands of life provides the basis for the Individual in the Meikirch model, as per the figure. In the notes the responsibility of the individual in the extent to which they achieve their potential appears to be emphasized. Responsibility extends to:

• how he or she cultivates the relationship to other human beings.
• how she or he participates with the life of the society.
• how he or she deals with the natural environment.

There is acknowledgement of how the biologically given potential can be reduced, and so:

"may compensate their defects to a large part by further developing their personally acquired potential. "

The Meikirch model is "A new concept of health based on science".

For the Individual, an example is given of type 1 diabetes were the person is able to become an proficient in management of their condition, possibly even an expert - and most likely the expert barring complications (infection ...).

I've blogged (I think!)* and Twi/Xed about the old joke (of course, it is not) of the N.H.S. being a misnomer. It really stands for the "National Ill-Health Service". Since drafting this in February, I'm sure I've heard this again on the radio, amid the ongoing UK election process. The website notes how generally:

"The health care system is 'sick'

This sickness results from a concept of health that is blind itself."

It is also not just just the need for change, as stressed by Meikirch; but how to make the transition to health education, promotion and prevention? Meikirch is a marvellous addition to the argument.

Moving further another common component with Hodges' model is the SOCIETY and social determinants in the Meikirch model, Sociology in Hodges' model. As Profs Bircher and Hahn note, relationships are key:

"The social context of a person encompasses the family, friends, acquaintances, schools, employers, including political institutions. Good lively personal relationships in family and social settings promote health. In contrast, burdensome relationships may compromise health. Whoever damages human relationships, exacerbates the development of the personally acquired potential of affected persons including his own."

The role of the law in the social framework is acknowledged, and how anxiety, greed and abuse can obviously impact on an individual's health. This extends from within the family, community, to the workplace; relationships between employees and managers for example.

Helpfully, society is also responsible for the health of (its) individuals. But this also relies upon mutuality with individuals:

"each individual must also contribute his or her part for a proper functioning of the society."

A reference that links the collaborative nature of society with public health:

Johannes Bircher, Shyama Kuruvilla, Defining health by addressing individual, social, and environmental determinants: New opportunities for health care and public health. Journal of Public Health Policy (2014) 35,363-368. (with link).

The ENVIRONMENT makes up the outer-most ring in the diagram. The Meikirch author's connection with Switzerland is evident in the protective examples of avalanche barriers and a natural deficiency of iodine and fluorine. 

"iodization of cooking and table salt and fluoridation of tooth pastes to prevent thyroid diseases and dental caries. Construction of avalanche barriers and of houses resistant to earthquakes also protects health."

Sadly we have seen backward steps in dental services provision in the UK; and recent earthquakes have demonstrated the tragic consequences of lapse building regulation when buildings 'pancake' in a progressive collapse. 

I contacted the authors https://meikirch-modell.ch/en/authors/ but no response has been received.

I will reflect further - adding a table with concepts related to Hodges' model and discuss the table at: https://meikirch-modell.ch/en/model/

Theories Concerning Health and Disease

Type of thinking

Epistemology

Means for comprehension

Prescientific

Personal experience

Intuition

Scientific: Meikirch-Model

Scientific argumentation

Rational mind

*Salutogenic Perspectives and Supertankers - Public Health

Whether, wherever, whatever you shave - you need Occam's razor

Can Hodges' model be honed by students from day #1 - 'Intro lecture 101',
 across all curricula to function as a form of Occam's razor -
a reflective and critical thinking tool
to last a lifetime's learning (and unlearning)?
 

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

Occam's razor: "entities should not be multiplied beyond necessity". "It urges us to choose the simplest explanations or models for any phenomenon we observe." William of Ockham, born around 1285.	"It has been a tool for scientific progress, not to mention a guiding principle for our thoughts, right up to the present day."
Hodges' model: a tool for individual learners and communities of practice.	"He was, I believe, the first person to so clearly separate science from its religious tethers, a move crucial to science's subsequent secular development."

McFadden, J. (2021) Razor sharp, New Scientist, 18-25 December. 252:3365/66. pp.70-71.

Nursing care of the patient - 1976 and Earth Day . . .

Moidel, H.C., Giblin, E.C., Wagner, B.M. (Eds) (1976) Nursing care of the patient with medical-surgical disorders. New York: McGraw-Hill,  ISBN 10: 0070426554 / ISBN 13: 9780070426559

"The process of nursing assessment is a deliberate and systematic analysis of the patient and his environment with the purpose of gathering data about the patient's health-illness status and resources. A systematic and recorded assessment also provides (1) a baseline measure for identifying change over a period of time; (2) a foundation for the nursing-care plan, giving direction to nursing interventions; (3) a means for evaluating the effectiveness of nursing care." p.8.

"The nurse's major tools for obtaining data regarding a patient's health-illness status and resources include communication (with the patient, his family, health team, and nursing-team members), direct observation and examination (through the use of all sensory channels and technological adjuncts), consultation, and review of the literature. The use of these tools, which is amplified in chap. 7, should be in accordance with some organized, systematic, valid, and reliable framework." p.9.

The need for systematic and deliberative approach remains, despite the passing decades. Whatever 'system' is adopted it needs, as per 1-3 to be dynamic, act as a substrate; that is also neutral - non-prescriptive (apart from); facilitating the flow of assessment, planning, interventions and evaluations, and what used to measure effectiveness, outcomes, quality and safety. As an American text, chapter 7 is also concerned with 'nursing diagnosis' and Orem is referenced.

Nursing care of the patient
with medical-surgical disorders

 

Nursing Management

"Nursing management is based upon and follows assessment. It is the process of determining and initiating goal-directed nursing action in relation to the patient problems diagnosed during assessment. Without assessment, nursing management becomes mechanical, dependent on physician's orders, and detached from the ultimate goal of wholeness for the patient." p.9.

We still need balance in humanistic-mechanistic care delivery. Paying attention and due regard to the interpersonal detail and needs, while also seeing the whole.

"Delong studied the impact of preoperative information on recovery from surgery. In general, individuals who were given specific detailed information regarding the surgery and postoperative care had a less complicated recovery and were discharged earlier than those who received general nonspecific information. When coping styles were considered, it was found that those who exhibited flexible patterns of coping with general stress in their lives recovered well regardless of the type of information they received. Copers, who were defined as individuals who seek out information regarding potential threat, recovered better if they were given specific information before surgery. Avoiders typically showed slow, complicated recoveries, regardless of specific or nonspecific information; however, those who received specific information had more postoperative complications than those who heard only the general information." pp.38-39.

Now in healthcare, we are concerned with Health Information for All, and Health Literacy. I wonder what the informational nuances are in 2023 bio-psycho-socio-politically: and of course spiritually?

"All the disease and illness concepts cited above have reshaped society's thinking and practices about health, maintenance of health, and treatment of disease when it appears. But each emphasizes specific aspects of the totality of interwoven dynamics that constitute disease and illness, leaving us with cumbersome vocabularies and classifications that are partial and imprecise. Theoreticians, endowed as they are with a sense of order and logic, will most assuredly seek to bring the various viewpoints together into new conceptual frameworks." p.51.

Now our 'new' conceptual frameworks must incorporate nursing, patient-nurse relationship, the 'team', society, research and evidence-based care, policy - local, national, and global, plus technical and climate change all amid the politics of health and the informational milieu - or melee?

Also of note (Chap. 1):

Section headings: Care as a Nursing Function, with Cure, and Coordination as Nursing Functions.

Ecologic Orientation, Part 2.

Individual differences in patterns of anxiety arousal, stress-relevant information and recovery from surgery. Delong, R. D., University of California, Los Angeles ProQuest Dissertations Publishing, 1970. 7116307. https://www.proquest.com/openview/0d64def524b9e5845b7e168aa4cc5876

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As I continue to sort through 'old' books and papers, on Earth Day we are (duty) bound to reflect on the future. As my grandson was on the post-school play ground this week, I noticed the infants and those at risk of walking into the merry-go-round. I wondered whether in their senior years, will the ice be returning, the sea-levels stabilise, and will the CO² in the atmosphere be reducing? 

What of - Nursing care in 2076? We need a conceptual framework that can project the care of the past and now, into the future. For those who are not yet here.

Previously:

'Planetary Health'

Gaia

'climate change', 'ecology' . . .

Report: "Developing learning health systems in the UK: Priorities for action"

Developing learning health
systems in the UK:
Priorities for action

"Importantly, many of the issues discussed above highlight how successful learning communities – and successful LHSs – require effective leadership. In particular, effective leadership is a critical facilitator for:

• aligning the activities of the LHS with wider operational and strategic priorities
• securing resources and organisational support
• gaining the buy-in of staff and teams across an organisation
• creating a healthy improvement culture.144

In this context, effective leadership includes behaviours such as being ‘problem framers’ rather than ‘problem solvers’, listening and observing, and stimulating reflection and critical thinking within teams.145 (While a detailed exploration of leadership is beyond the scope of this report, it is worth emphasising that this includes clinical leadership, which can have a significant impact on organisational performance.146)" pp.49-50.

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC   

SOCIOLOGY  :   POLITICAL 

|

GROUP

See also: Thiscovery

Being situated, Hodges' model can also 'frame' - strengths, staying well, relapse prevention, weaknesses, opportunities, threats, recovery, prevention...