by Deborah Franklin, DDS, MA, LPC and Nathan Carlin, PhD
What is health humanities? Why is it important? How is it different from medical humanities? And where does dentistry fit in health humanities? In this blog post, we will attempt to offer brief answers to these questions.
The term “health humanities” is usually meant to be an alternative to “medical humanities.” Health humanities is intended to be inclusive of all health professions (nursing, dentistry, public health, etc.), and it relativizes the importance of medicine such that medicine is not dominant. As a point of comparison, what was once called medical ethics is now referred to as clinical ethics (to be inclusive of nursing ethics, dental ethics, etc.) or health professional ethics (to be inclusive of non-clinicians such as public health professionals). Also, health humanities rejects points-of-view that are medicine-centric and hierarchal. In Teaching Health Humanities, Olivia Banner suggests, for example, that disability studies should enjoy a central role in health humanities because disability studies disrupt assumptions about normalcy that medicine often assumes.
There is an organizational rationale for health humanities as well, because the closely-related field of bioethics often overshadows both medical humanities and health humanities. This is evident in the programming of the American Society for Humanities and Bioethics, which focuses mainly on issues of ethics. Likewise, medical schools and hospital systems employ clinical ethicists to a much greater extent than they employ medical humanists or health humanities scholars. For these reasons, some prominent scholars left (or reduced their time with) the American Society for Humanities and Bioethics to form the Health Humanities Consortium so as to foreground humanities perspectives in matters related to health, illness, and healthcare.
In Medical Humanities Thomas Cole, Nathan Carlin, and Ronald Carson define medical humanities as “an inter- and multidisciplinary field that explores the contexts, experiences, and critical and conceptional issues in medicine and healthcare, while supporting professional identity formation.” They note that not every piece of scholarship or work fulfills each component of their definition but that, taken together, these activities constitute the field of medical humanities, achieving a basic coherence.
What is the relationship between medical humanities and health humanities? Our view is that we see medical humanities as a part of health humanities, along with nursing humanities, dental humanities, public health humanities, etc. Consistent with the definition of medical humanities in Medical Humanities, medical ethics is a part of medical humanities, dental ethics is a part of dental humanities, and so forth. While we support Banner in particular and the health humanities movement more broadly, we also want to retain the term “medical humanities” because we do not see the term “health humanities” as a replacement for “medical humanities.” We think all of the health professions have particular perspectives, each of which is valuable. If terms such as “medical humanities,” “dental humanities,” and “nursing humanities” are not retained, their uniqueness is obscured when they are conflated under the umbrella of “health humanities.”
We now would like to turn our focus to dentistry, because it is so often ignored by humanities scholars. In a very real way, the divide between medical and dental professionals is artificial, for the earliest dentists were referred to as “dentist surgeons.” Dental treatment is similar to surgical treatment in many respects, as both dentists and surgeons employ highly technical procedures for replacing body parts (e.g., teeth, knees, organs). But a key difference between dentists and surgeons is that the great majority of dental procedures are done while the patient is awake. Therefore, humanistic skills are important in dental practice in a way that is different than for surgeons.
The traditional four-year dental school curriculum includes some teaching of the commonly referred to “soft skills” of dentistry, such as communication and teamwork. These skills are usually included in the practice management curriculum. Ethics is often presented in a first-year course that deals with professional obligations as set forth in the American Dental Association Principles of Ethics and Code of Professional Conduct.
Because of the central role of disability studies in health humanities, we want to point out that a recent change to the American Dental Association Principles of Ethics and Code of Professional Conduct better reflects the rights of patients with disabilities by prohibiting dentists from denying treatment to patients because of their disability (such as a mental illness). It also specifies that, if the dentist does not feel confident in treating patients with disabilities, they should refer them to dentists who are able to provide the necessary care. This accompanies a change to the Accreditation Standards for Dental Education Programs that guide dental school curricula: “graduates must be competent in assessing and managing the treatment of patients with special needs.” As dental schools adapt their curricula to address these changes, we hope that discussions of humanistic care will flourish.
In 2015, the UTHealth School of Dentistry (with support from the McGovern Center for Humanities and Ethics) launched a dental humanities program, which is the first of its kind in any United States dental school. Since the first class was admitted, twenty-three students have graduated from the program. It is a four-year program with learning opportunities that allow students to reflect, share, and work together to enhance their individual and collective capacities to care for patients in humanistic ways. The basic requirements of the program include:
- attendance at program meetings and at events related to humanities or ethics in the Houston community
- completion of interprofessional elective courses on topics such art
- ethics, literature, and history
- reflective journaling
- service learning
- a final project
We have found working with dental students in the area of dental humanities to be very meaningful. People sometimes assume that in dentistry there are not existential issues as there are in medicine, but the students in this program have shown us that this is just not true. This became apparent to us a few years ago when we led a writing workshop with dental students, asking them to write about a patient’s suffering that had moved them. To our surprise, out of a group of about fifteen students, three of them wrote about the same type of patient encounter: a young woman presenting to the clinic missing teeth because of domestic violence. Much of one’s identity is connected to the appearance of one’s teeth, perhaps especially for young women. In any case, the students were troubled by these encounters, feeling a sense of moral distress for attending to the mouths of these women without being able to attend to their home life.
So, there really are deep and complex issues to deal with in dental humanities. We hope that we have made the case that dentistry does fit in health humanities in its own unique way. We also hope that when people invoke the term “health humanities,” they recognize the place of dental humanities within this framework.
Conflict of Interest Declaration
Nathan Carlin receives royalties for Medical Humanities and Teaching Health Humanities.