Reading Between the Lines: Using Alice Munro's Fiction to Explore Physician-Assisted Suicide with Medical Students

Abstract: Artificial intelligence promises innovation in medicine, but human connection at the bedside will remain a cornerstone of care delivery. Although experts in medical education cite the humanities as an important tool in honing empathy at the bedside, there is scant literature investigating how the humanities are used to teach bioethics, a field that necessarily encompasses the most nuanced aspects of the human condition. Using broad terms including “fiction” and “medical education,” we conducted a literature search across PubMed, ERIC, and Web of Science. Of 390 articles from 1987, only 25 studies investigated how fiction is used to teach bioethics, and only 40% of these studies included medical students. With the aim of exploring how fiction can be introduced in the bioethics classroom, we conducted a feasibility trial in which 11 first-year medical students read the short story “Comfort” by Alice Munro, a work of fiction exploring the social impact of physician-assisted suicide, and subsequently participated in a semi-structured discussion-based seminar guided by pre-formulated questions and close reading of key passages. Students found the session “lively and stimulated,” reporting greater engagement compared to conventional coursework. Half the students reported that they directly learned from peers’ perspectives and were able to “multiply [their] understanding” as a result. Our data suggest the need for future studies directly comparing standard bioethics instruction with fiction-augmented curricula, assessing short-term outcomes like comprehension of bioethical issues and self-reported levels of comfort, as well as longer-term outcomes like ambiguity tolerance in the clinical setting.

Ben Martin, MD – University of Virginia; Jacob Ujhazy – University of Pittsburgh