Daniel García Abiétar is a medical doctor specialized in Preventive Medicine and Public Health. He works at the Catalan Health Institute (ICS) as a public health officer and is a researcher at IDIAPJGol. He is currently pursuing a degree in Philosophy and is working to apply the humanities to both the healthcare model and research. He discusses the need to create a space –the format is not yet defined, but it would involve research and include IDIAPJGol and ICS– to promote humanistic reflection in the organization of healthcare practice at ICS, incorporating the perspectives of academic disciplines traditionally distant from healthcare. We spoke with him about how to make the approach to health more humane.
How did the idea of creating this space focused on humanizing healthcare come about, and what will it involve?
We are identifying a community of interest within ICS to work on these issues from the perspective of the humanities. My background is mixed. I’m a medical doctor specialized in public health, and I’m currently studying Philosophy. The humanities include a wide range of disciplines: philosophy, of course, but also history, literature, the arts… And also, medical anthropology, which has been close to healthcare practice, though mainly in research. We want this joint space between IDIAP and ICS to open more opportunities to academic disciplines typically seen as unrelated to healthcare and research, because right now everything is based on a very biomedical view. At IDIAPJGol, we’ve begun to explore this idea by involving Francesc Borrell, a physician renowned in the field of medical ethics, and in the future, other professionals from ICS and IDIAPJGol from various disciplines could join.
This space could help break with the dominant logic, which prioritizes scientific and technical advances over care. People cannot be reduced to their biological dimension –we are primarily our history, our narrative, the way we live health and illness in everyday life, the influence of our environment… Our aim is to question how we are doing things, and to offer a cross-cutting vision that permeates the way we approach health in healthcare services.
“We want this joint space between IDIAP and ICS to open more opportunities to academic disciplines typically seen as unrelated to healthcare and research”
How does this translate into research? What research lines reflect this approach?
On one hand, we have contributions from professionals in bioethics, such as Professor Francesc Borrell, focused on the relationship between professionals and patients. This has implications, for example, in euthanasia, mechanical restraint in mental health or prisons, and the use of artificial intelligence in clinical decision-making processes. My background is in public health, and one of the key branches is good governance of health systems –how institutions are organized to make sound decisions, and how deliberation within health and research institutions can be democratic. This is especially important at a time when democracy and democratic systems are being questioned. We need to incorporate this approach as well.
Some of your discourse echoes nursing care, which emerged from the Florence Nightingale model.
Historical contributions from nursing are very relevant. It’s a central part that must be present. For instance, we have nursing leaders here like Montserrat Busquets. But it’s also important to bring in all the contributions from the humanities. Philosophy, in connection with feminism, has made notable efforts to integrate the ethics of justice with the ethics of care. Authors such as Paul B. Preciado, Paul Ricœur, Nancy Fraser… have developed this vision extensively. There’s also the contribution of philosophical anthropology from the Madrid School, which has reflected on what it means to be human and the ethical and political implications of that.
For years, we’ve heard that the person should be at the centre of the healthcare system, and periodically projects on humanizing care have been launched at ICS and the Department of Health –yet few have borne fruit or had continuity. How can we truly put the person at the centre of the system?
It’s a complex issue that must be addressed on several levels. There’s a professional level, related to skills acquired through socialization and training, but also individual attitudes. There’s an organizational level, involving team dynamics and workflows in primary care and hospitals. Then there’s an institutional level involving decision-making and democratization processes. And beyond that, a broader level concerning the socio-economic system in which these institutions operate. We can’t assume that the healthcare system can change everything outside of it, as if it were impervious to what’s happening.
At the root of our system lies a techno-optimism that turns technologies –which should be means– into ends. This shift from means to ends is linked to capitalist social development, where the goal of accumulation places technology ahead of what should be the real goal –not just in healthcare, but in society at large: the human being integrated sustainably within the nature they belong to. This issue is closely tied to health inequalities and a healthcare system that is not person-centred. The question we must ask is: “What must we do to resist?” How can we improve our institutional and care processes to be more democratic, to fully pursue the health of individuals and their social and environmental surroundings? We will always be limited, since the healthcare system depends on other institutions. That’s why it’s essential to include all perspectives, not just those of professionals. From a health policy perspective –which I work on through the European Observatory on Health Systems and Policies–, this reflective space is closely linked to the concept of integrated care, which involves incorporating health into all policies.
“At the root of our system lies a techno-optimism that turns technologies –which should be means– into ends”
How did the COVID-19 pandemic influence the over-technification of the healthcare system?
It had a big impact. The pandemic accelerated many processes that already existed in our society. A lot of financial resources were allocated to boost telemedicine and digitalization. That was very useful during that period, and it’s good that we have it, but it also contributed to the dehumanization of care. We still need efforts to ensure these initiatives don’t become a long-term replacement for human relationships, and to ensure equitable access.
Could efforts to humanize healthcare often end up increasing bureaucracy, through procedures that require professionals to adopt certain practices?
Francesc Borrell points out that there are indicators that can describe the quality of care, such as the average consultation time. For example, the percentage of medical visits with no physical examination. Or whether the patient’s perspective, narrative, and socioeconomic context are recorded in their medical file. Another indicator might be how often cases are discussed with other professionals, which reflects collective deliberation and dedication. There are many indicators that could show whether a humanizing perspective is being applied in care.
But, of course, a quantitative view is not enough. We need to be present in the workplace and understand firsthand the difficulties professionals face in offering humane care. Neoinstitutionalism –the theory focused on the economic and sociological study of institutions– has much to contribute here, as does the comprehensive assessment of the care reality, which goes beyond research and uses listening and observation as methods. This helps us deliberate with professionals and make good joint decisions to improve resource allocation and training, apply hiring policies that favour professionals with certain qualities, and establish procedures that ensure listening. In other words, we cannot stay at an individual intervention level, putting all the responsibility on professionals, because institutional organization also shapes the behaviour and identity of the people who work within it.
“We need to be present in the workplace and understand firsthand the difficulties professionals face in offering humane care”
Currently, there’s a growing tendency to discredit science. The pandemic was a trigger, and so was the backlash against the technification you mention –the worship of technology. How can we counter this without claiming that technology is the solution to all problems?
Science has taken a place that does not belong to it; it is not a single truth. We need to be more critical of the social and political implications of science. That said, it would be very naïve to criticize science while failing to recognize that many anti-science stances are also anti-democratic. My critique is of scientism. I want a science that contributes where it should –in the physical and biological domains– but does not try to dominate other realms that are not its own, as philosophy has long pointed out. Still, just as those who believe science is the answer to everything are misguided, those who criticize science from authoritarian or anti-democratic positions are also not placing science where it belongs.
I don’t believe science seeks truth, but rather the transformation of reality, whether through quantitative or qualitative techniques. Scientific knowledge brings us closer to reality, but it never fully captures it. Truth is the object of philosophical inquiry, and it’s a very complex concept. Its complexity and ambiguity can only be resolved temporarily through dialogue, through deliberative respect –which is tied to participatory equity, and to social and political representation.
“it would be very naïve to criticize science while failing to recognize that many anti-science stances are also anti-democratic”
What role do you see for artificial intelligence? Could it help humanize healthcare or is it more likely to be an obstacle?
I have many doubts. I think we need to consider how AI has developed. It’s conceived as a kind of anarchic reappropriation of knowledge, accumulating information and generating answers to certain questions, aimed at transforming reality. But while AI is framed by its use and potential –and carries an ideological backdrop– it’s up to us, as institutions, to define its goals. I see it as a very powerful tool, but in today’s context, which leans heavily toward a dominant technological logic, we must be cautious and reflective. So, could AI help humanize processes and the healthcare system? That depends on how the system is organized, and whether we put these tools in service of humanization. We need to consider how we use them. It depends on work organization, decision-making, and the boundaries we set around their use.
