Impersonal Operators? Challenges in the Doctor-Patient Experience in Relation to Artificial Intelligence.

by Pinto Bustamante, Boris Julián

Universidad El Bosque / Universidad del Rosario, Colombia

This article is a preview of the work presented by Dr. Boris Pinto at the World Conference of the International Chair in Bioethics (ICB) that took place in Porto in October 2023. This online version includes the fragment of Truffaut’s film screened on that occasion and the reference to the complete text in English, published on the 70th anniversary of Ray Bradbury’s famous novel. We appreciate the collaboration of Susan Miller, whose valuable suggestions were incorporated into the final version of this article. [1]

The synergy between AI and human intelligence promises various applications in healthcare, such as precision medicine, drug discovery, analysis of large datasets, optimization of diagnostic processes, and clinical decision-making. Applications of AI in medical education have also been explored, to perhaps facilitate student’s understanding of complex concepts. However, all these potential benefits must be approached with caution due to the concerns and risks associated with the use of large language models (LLMs), such as the generation of inaccurate content, inaccessibility of relevant content, the risks of bias and discrimination, lack of transparency and reliability, inaccurate predictive algorithms, cybersecurity issues, ethical consequences, privacy, confidentiality, patient consent, and social implications. There are currently no international guidelines for the shared use of this data.

Beyond the concerns and expectations suggested, I will address some specific issues from the novel Fahrenheit 451, a provocative, dystopian novel written by Ray Bradbury in 1953, which was adapted into a film in 1966, directed by François Truffaut.

The plot of the novel is set in a bleak future where books are considered dangerous and their possession is forbidden. Firefighters, instead of extinguishing fires, are tasked with burning any books they find to eliminate any traces of knowledge and critical thinking.

The protagonist of the story is Guy Montag, an exemplary firefighter who, in his monotonous routine, begins to question the reason behind the book ban. As his curiosity grows, he meets Clarisse, a young woman unusually fascinated by the past and literature. Conversations with Clarisse awaken in Montag a desire to understand the value of books and the importance of freedom of thought.

As the plot unfolds, Montag becomes involved in an underground world of people who refuse to give up their books and memorize their contents to preserve their content. This transformative experience leads Montag to confront the tyranny and censorship of the government, risking his life to protect knowledge and to free society from totalitarian control.

In summary, Fahrenheit 451 is a captivating reflection on the importance of literature, the pursuit of truth, and the struggle for intellectual freedom in an oppressive world where information is restricted and manipulated.

In one scene of the story, Mildred, Guy Montag’s wife, loses consciousness due to an overdose of sleeping pills. Throughout the novel, Mildred is portrayed as a shallow, alienated woman completely immersed in the "parlor walls" (giant televisions in homes that broadcast interactive shows) and her superficial and disconnected life. She represents a dehumanized society obsessed with trivial entertainment, with no interest in literature or critical thinking. As a tribute to the patience and reflection required for reading and to contrast this conscious process with current day threats of automatic thinking, I propose to review the narrative sequence described in Bradbury’s novel:

They had this machine. They had two machines, really. One of them slid down into your stomach like a black cobra down an echoing well looking for all the old water and the old time gathered there. It drank up the green matter that flowed to the top in a slow boil. Did it drink of the darkness? Did it suck out all the poisons accumulated with the years? It fed in silence with an occasional sound of inner suffocation and blind searching. It had an Eye. The impersonal operator of the machine could, by wearing a special optical helmet, gaze into the soul of the person whom he was pumping out. What did the Eye see? He did not say. He saw but did not see what the Eye saw. The entire operation was not unlike the digging of a trench in one’s yard. The woman on the bed was no more than a hard stratum of marble they had reached. Go on, anyway, shove the bore down, slush up the emptiness, if such a thing could be brought out in the throb of the suction snake. The operator stood smoking a cigarette. The other machine was working too. The other machine was red. It was like a red honeycomb that stood in the sun. It was a house of fabulous bees that murmured their gratitude to the stranger who filled the hive with honey. It was a comforting thing to see them, all small, shiny-walled, warm and soft, with their silver blurs and the tiny, dead white queen all surrounded by her fauns. The operator looked down at Montag. "Now," he said, "we’re going to have you hold your hand under this chin. That’s it, now the breath, sir, if you’ll just take a deep one. That’s right. Inhale. Lots of it. No hurry. Breathe deeply. How do you feel?" "I feel fine." "He’s got a healthy color," he was speaking directly to Montag. "How do you feel?" "Fine. I feel-" He finished it for her. "I feel like I’ve just been born." (Bradbury, 2006)

From this passage, I ask the reader to reflect on two specific issues: the dystopian impact on the doctor-patient experience and the role of education to mitigate this influence.

In this segment of the novel, the portrayed nonprofessionalism of the two cavalier ambulance personnel attending to Mildred after her suicide attempt is striking. When Montag complains, "None of you is a doctor!" the two personnel, while finishing their cigarettes, pack up their things, make inappropriate innuendos about her recovery, and charge $50 for their service, responding, "A doctor is not needed."

What moral qualities and virtues are required of doctors and healthcare professionals? In a broader sense, what attributes define us as human beings? At what point does a healthcare professional lose their professional norms and react with automatic, psychologically-unconscious responses to vulnerable patients? How does the profession mitigate repetitive robotic behaviors which dehumanize the physician-patient relationship? For example, is it appropriate for surgeons to merely perform interventional procedures as if the body of the patient was a hard strata of stone to be penetrated? At what point do we become unfeeling actors who go through the motions in each interaction? What implications does this lack of empathy have on a relationship-based profession of medicine and health care? In contrast, what type of society creates virtual realities where the population has to self-medicate with psychotropic drugs to further cope with their ennui? How is it normative for anyone to respond to fifty drug overdoses in their daily work? [2]

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