Wednesday 15 May 2024

Project launch for EPIC!

On Monday 13th May, we celebrated the launch of Project EPIC in Bristol. The launch was held at a beautiful and unique historic venue in Bristol, The Mount Without. We welcomed colleagues from the Universities of Bristol, Nottingham, and Birmingham, as well as representatives from our funder, Wellcome, friends and colleagues from other Universities, doctors, local art therapists and more. 

The evening began with an introductory address from the Principal Investigator, Professor Havi Carel, who introduced the topic of epistemic injustice in healthcare and why it matters. This was followed by short, three-minute snap-shot talks from each of the project's researchers summarising what interests them about the project. 

We heard from Lisa Bortolotti, Matthew Broome, Ian James Kidd, Michael Larkin, Michael Bresalier, Ellie Byrne, Fred Cooper, Dan Degerman and Kathleen Murphy-Hollies on a range of topics, including how epistemic injustice in healthcare relates to intersectionality and wider socio-political structures, phenomenology, emotional dysregulation, self-understanding, loneliness, and silence.

The EPIC project team 

The first part of the evening was closed by the Bristol University Singers, conducted by Elinor Cooper. The choir first sang an excerpt from ‘under the surface’ composed 2015, called ‘We measure time in breath’, followed by 'Bawo Thixo Somandla - Sidumo Nyamezele’ - a protest song widely sung during the apartheid period - and ‘We are’ by Ysaye M Barnwell.

The final of four pieces was composed by Toby Young, with lyrics by Jennifer Thorp. It was commissioned specially for Project EPIC. An excerpt as follows:

    What I keep is vigil

    What I pray is mute

    What I breathe is secret

    What I know is brute

The musical composition will grow as the project progresses, and we can't wait to see what themes emerge from the research that we'll do together.

The University Singers

The remainder of the event was spent networking and mingling with our guests. Bringing together researchers, healthcare practitioners, patients, and their advocates, clearly demonstrated the scope and the potential of the project to better understand, and ameliorate, epistemic injustices in healthcare. 

Recordings of our talks and the musical composition will be made available in due course. 

Watch this space!

Wednesday 8 May 2024

Automated epistemic objectification in healthcare

The provision of healthcare is an intrinsically cooperative enterprise in which patients’ active engagement is crucial. It is paramount to recognize the value of patients' epistemic offerings in medical encounters and that their testimony is central to providing healthcare professionals epistemic access to their health state. These are fundamental preconditions to finding the most suitable course of medical action tailored to patients' needs in their singularity. 

However, the ever-growing body of literature tackling epistemic injustice in medicine and healthcare shows that identity prejudices often diminish patients’ credibility, thus hampering their possibility to play their role as epistemic subjects in medical encounters. Often, this leads to misrecognition of patients' epistemic status by, among others, hastily dismissing their testimony as irrelevant, thus leading to epistemic and practical harm. These situations are already highly problematic in healthcare encounters among human patients and physicians.

The introduction of artificial intelligence-based systems, such as machine learning (ML), in medical practice shows that medical care is no longer an exclusively human domain. So, what happens when an ML system, as an allegedly objective epistemic authority and powerful knowledge-generating entity, enters the picture by considerably influencing central medical procedures? As we argue in a recently published paper, we must be wary of ML systems' roles in crucial medical practices, such as providing treatment recommendations and diagnoses. More precisely, we advance the claim that ML systems can epistemically objectify patients in subtle but potentially extremely harmful ways that must be treated in their own right. In fact, these harms are not to be subsumed under other ethical concerns currently receiving extensive attention in the AI Ethics debate. 

Robot typing

Our paper discusses the hypothetical case of an ML system generating a treatment recommendation that goes against a patient's values. In similar situations, the patient is confronted with an unsuitable course of action. We argue that the patient risks being epistemically objectified if the system cannot pick up on their values and produce a new recommendation aligned with their expectations. This is the case because, crucially, when the patient needs to actively provide a piece of information relevant to further course of action, they are prevented from effectively doing so due to the system's setup. The bottom line is that the patient's status in this knowledge-producing endeavor may be degraded to merely being an object of medical action. 

Against these considerations, one could argue that a human physician could simply neutralize the recommendation produced by ML if it goes against the patient's values. However, we see this move as too simplistic for two main reasons. First, physicians may be epistemically dependent on an ML system and de facto unable to override it. Even though this is a surely undesirable scenario, it is recognizable in systems currently deployed. Second, disregarding ML systems' recommendations does not guarantee that physicians can readily find a further, more appropriate course of action. Rather, they might benefit from an ML system supporting their decision-making.

Overall, our general plea in the paper is thus to show the need for a flexible ML epistemology that can incorporate and adapt to newly acquired and ethically relevant information that patients can actively provide. This is key to avoid objectifying patients in morally salient medical interactions. 

Dr. Giorgia Pozzi is a postdoctoral researcher at Delft University of Technology (The Netherlands), working on the intersection between the ethics and epistemology of artificial intelligence (AI) in medicine and healthcare. She has a particular interest in tackling forms of epistemic injustice emerging due to the integration of AI systems in medical practice.

Wednesday 1 May 2024

Stereotypes about young people who hear voices

Negative stereotypes associated with people who report unusual experiences and beliefs cause lasting harm and often undermine agency. In a series of workshops with the young people of the Voice Collective, facilitated by Fiona Malpass (Mind in Camden) and designed by Lisa Bortolotti and Kathleen Murphy-Hollis, we discussed the challenges that hearing voices poses for young people, at home, at school, and in healthcare settings.

The result of our conversations was a script created by the young people who participated in the workshops, where they described three forms of negative stereotyping that cause harm: 

  • perceived dangerousness, leading to the thought that the young person poses a threat; 
  • perceived lack of capacity or incompetence, leading to the thought that the young people cannot achieve anything valuable or challenging; 
  • perceived difference or weakness, leading to social exclusion.
The script was turned into an animated video, produced by Squideo (click below to watch).

Snake or dangerousness


Perceived dangerousness is represented by Snake, who does not really pose a threat to humans but is feared and kept at a distance. Contrary to popular belief, most snakes are neither venomous nor dangerous. Snakes defend themselves if someone disturbs or attacks them but are not aggressive towards humans. Yet, many people make assumptions about their being dangerous. So, Snake in the video is right that his bad reputation is undeserved.

Butterfly or incompetence


Perceived lack of capacity is represented by Butterfly. Although she is an active pollinator contributing to the life of the garden, Bee teases her and suggests that she is lazy and useless, based on her past as a caterpillar, when she was seen eating all day long. Seeing a chewed leaf might make us think that caterpillars are good for nothing but destroying plants. However, caterpillars are actually very important to their environment even before they become pollinators. They prevent vegetation from growing too quickly and depleting nutrients in the soil. So Bee's attitude towards caterpillars and butterflies in our video is unjustified.

Wolf or exclusion


Perceived difference or weakness is represented by Wolf. Wolf got an injury and because of that he was left behind by his pack. The other wolves assumed he would be a burden, unable to keep up and hunt for himself. But there is no reason that his small, temporary injury would have made his contributions to the pack less valuable in the long term. He would have probably needed some support until the injury was healed, and then he would have been in a position to run and hunt as fast as the other members of the pack.

A safe space

Snake, Wolf and Butterfly in the clearing

Being treated as dangerous for no good reason, being considered as a burden and nothing else, and being excluded by shared decision-making, are all harmful (and sadly common) experiences for young people who hear voices. Young people struggling with their mental health have a lot to contribute and with some support they can continue to pursue the projects that are important to them.

In the video, Snake, Wolf and Butterfly meet in the clearing to share their experiences and support each other. What happens in the clearing, sharing experiences in an environment that is safe and non-judgemental, is what happens in the Voice Collective. Young people who hear voices and have other unusual experiences or beliefs come together and connect with people who are in a similar situation. 

The video is an invitation to go beyond the stereotypes and see the person, not the label. To learn more about myths and truths about hearing voices, visit The Voice Collective website.

You find The Wolf, the Snake and the Butterfly and other animated videos introducing philosophical issues in The Philosophy Garden, a virtual philosophy museum gathering and producing resources for young people, educators, and the general public. 

The Philosophy Garden is a project run by EPIC co-investigator Lisa Bortolotti, with the collaboration of Kathleen Murphy-Hollies, Anna Ichino, and Fer Zambra.