How Sci-Fi Creates Better Doctors
One bioethicist at UTHealth uses science fiction to educate medical students about racial bias
A philosopher by training, Keisha Ray, who now researches racial disparity in health care, has never been scared to ask big, bold questions about humanity.
Having grown up in a medical family (her mom and grandma were both nurses and operated a nursing home), “I was always interested in medicine, but I knew I didn’t want to be a clinician,” she says. “My interest in medicine has always been the philosophical questions: What do we owe people, and why do we treat some people different than others?”
Focusing on the field of bioethics while pursuing her philosophy degree felt like a match made in heaven: She could contribute to justice in medicine in her own way, by addressing questions about how to treat people when they’re at their most physically vulnerable. Now, as an assistant professor and bioethicist with the Center for Humanities and Ethics at UTHealth in Houston, Ray adds another personal interest to her work: science fiction.
This year, Ray launched her bioethics and science fiction elective at the McGovern Medical School, using a mix of essays, TV episodes, and a film from 2000 — Flowers for Algernon — to prompt discussions on ethics in healthcare.
So far, the course has received rave reviews, and Ray is hopeful that as more students learn about health care through sci-fi, they’ll have the tools they need to dismantle issues contributing to racial disparity in their own practice.
Elemental talked to Ray about why sci-fi works, how her curriculum shapes medical students’ perspectives, and, of course, aliens.
This interview has been edited and condensed.
Elemental: Why are medical schools such an important pipeline for preventing racial disparity in health care?
Keisha Ray: Racial disparity in health care is one of the most pressing topics facing medicine right now. We have a lot of research that says certain races get less health care or lesser quality health care than other races, and it’s usually people of color. In my work, I focus on the racial disparities between black and white patients. We have a lot of data showing that black people have less access to health care, and when they do see a provider, the quality of that care is a lot lower than of their white counterparts.
One way to remedy this problem is to educate students in medical school on how social factors contribute to racial disparities in health. It’s not that black people have something in their DNA that causes them to have worse outcomes. It’s that they have lower income, and less access to care, nutritious food, and good neighborhoods, and that they are often subject to things like medical racism and decision bias.
To help my students understand their role in overcoming these disparities, I have them read an article about “visionary medicine” on the first day of class. Visionary medicine is the idea that you contribute to what you want medicine to be. You can pinpoint what’s wrong with healthcare, imagine the future, and ask “what’s my role in creating change?” I want that to be the backdrop to all of our science fiction reading. For many of my students, affecting this change is part of how they want to advocate for their patients.
What is it about science fiction, specifically, that opens up this discussion?
There’s literature out there about using science fiction to teach different topics to medical students. A lot of it has to do with the idea that in the world of science fiction, anything can happen. When we look at utopian novels, for example, we can see how worlds should be. We can use the idealistic world to discuss what’s ideal about how that society works, and how our society matches up. What’s missing, and what do we want to be better? On the other hand, in a dystopian setting where a huge event has ruined the world, we can use that as a lesson about what didn’t work.
Sci-fi can be a powerful mirror to our society: how it should be and could be if we take the right steps. X-Men is a great example. You have one group that could parallel people of color — the mutants are outcasts, fighting to be heard. They may be oppressed, or they may have a traumatic past with their government or society. Then you have the ruling class, the people that want the other group to conform. So in the case of X-Men, we would talk about who is marginalized in our society and who is not. We would use these stories to identify our own injustices, and then talk about what we can do to rectify them and become part of a machine that brings about justice.
Can you share any other examples of the media you use and the conversations it starts?
We watch an episode of Star Trek: The Next Generation called “Ethics.” The main storyline is about a person of an alien race wanting to be euthanized after being injured in an accident. According to his people’s code of ethics, if he is disabled, then life isn’t worth living. His human friends don’t believe disability warrants euthanasia, so they refuse his requests.
I use this episode to talk about the differences in race and culture. We discuss how different racial groups have different ideas related to illness and death and how to respond to them. Racial disparities in health care can develop from a lack of understanding. Physicians may not understand why patients want or do not want certain interventions, which can be frustrating and encourage a lack of communication, not explaining interventions well enough for patients to understand, or passing patients off to other doctors, all of which can contribute to lesser quality of care and lower patient satisfaction. So this Star Trek episode puts students in a “what would you do?” scenario and asks them how they would treat a patient who asks for care inspired by their cultural beliefs, even if they don’t agree.
Do you find that students are more willing to engage with these issues in the context of something they might enjoy, like sci-fi?
Sci-fi is a really good way to make the topic of race abstract enough that students want to talk about it, and then take a step back and see how this reflects our real life and society. Students are able to talk about things more than they would if I just said “Let’s talk about how we’re all racist.” We use this fantasy canvas to talk about real-life issues. For instance, sometimes science fiction can be off the wall: In Octavia Butler’s novelette Blood Child, men can have children. On the one hand, students know this is something that won’t happen in real life. Cisgender men probably aren’t going to start having children tomorrow. But we can use that far-off world as a backdrop to start a conversation about how we would want our society to work if there were no bounds.
What is your hope for how this discussion and your class will empower your students and shift the world of medicine?
First, I hope the class helps more of my students read for fun. A lot of times medical students don’t have time to read a non-medical textbook, but it’s so important to encourage imagination and shape how they think about people. When you read sci-fi, since it’s filled with all kinds of people (and aliens), you get a sense of the differences around you and how they deserve to be respected.
I also hope my students can see that differences don’t have to lead to value claims of good or bad, but that differences deserve respect. Just because you’re different doesn’t mean you aren’t due justice. I definitely hope science fiction allows my students to see different kinds of people and worlds, but also, I hope it helps them see their place in this world and how they can contribute to making sure people’s needs are met, that they can get the care they need.