Introduction

In the last few decades, the development of life sciences has been characterized by a paradigm shift that calls for rethinking the contribution of humanities to medicine. This is mainly due to two reasons: 1) the rise of molecular explanations of illness and disease has changed the way in which diagnosis, prognosis and therapy are understood; 2) theoretical reflections on medicine are lagging behind the advancements of biomedical sciences. Within this context, academics, practitioners and citizens alike have raised many concerns regarding the overall direction and shortcomings of medicine and healthcare. Clinical medicine, they argue, ought to be considered as standing along a continuum in which molecular explanations, diagnostic tools, therapeutic approaches and patient care all interact for the purpose of exploring and making sense of the human experience of disease and illness (Brody 1985; Boniolo 2011).

The promise of the discipline that goes by the name of Medical Humanities (henceforth MHs) is to vindicate the fundamental importance of this broader understanding of medicine. MHs’ aim, in fact, is the opening up medicine and healthcare to different educational and cultural opportunities for the purpose of producing some benefits that are both intrinsic and instrumental (Evans and Greaves 2002). Respectively, MHs are expected to (i) enable practitioners to plunge into the numerous perspectives within the humanities (literature, history, philosophy, sociology, etc.) that can foster a deeper understanding of what medicine is and attempts to, and (ii) to improve the quality of the humane relationship among doctors, clinical professionals and patients. The advancement of this field has prompted many initiatives in most of medical schools both in the US and in Europe and is gradually gathering momentum in clinical research and practice. Nevertheless, immediately after its rise in the 1960s, many controversies have arisen about the way in which MHs should be understood and characterised as a recognised discipline (Evans and Greaves 2010).

Our contribution aims at bringing into question different conceptions of MHs proposed thus far. By doing so, our work aims also at providing a clearer understanding of what MHs are and why they matter. While this will not close the discussion about their identity, nonetheless, we will defend an approach to MHs that might be considered a step further in the process of clarifying its status. In particular, we discuss three main conceptual issues regarding the overall nature of MHs: (i) a problem-driven approach to MHs; (ii) the need for an integration of MHs into medicine; (iii) the methodological requirements that could render MHs an effective framework for medical decision-making.

Arranging the space for different disciplines within MHs

A cursory analysis of the literature on MHs shows a substantial lack of consensus as to their aims and scope as a discipline. Within this state of affairs, however, it is generally agreed that MHs are expected to (i) embrace all the disciplines contributing to the conceptual analysis of medicine (MHs as a multi-faceted conceptual framework), and (ii) to foster a depth of human and humane understanding of the professional-patient relationship (MHs as an existential framework). Many of the controversies arising from the analysis of MHs as a discipline are currently framed in terms of finding a common balance between the two distinct purposes just sketched. On the one hand, some authors ascribe to the two-fold nature of MHs the unique capacity of dealing with the all-embracing nature of medicine (Meites et al. 2003, Ahlzén 2007, Crawford et al. 2010). Under this interpretation, different disciplines - from history and philosophy of medicine, bioethics, psychology and sociology to arts, poetry and literature - are in fact wrapped up together in the light of fostering a significant understanding of the human experience of illness. On the other hand, other authors prefer to see MHs as consisting of different movements, “which may overlap, but are distinct in their aims, methodologies and participants” (Downie 2003, 37). These different strands of MHs, they argue, are hardly reconcilable within a unified conception that is actually compelling (Campo 2005).

Unsurprisingly, many scholars have emphasized the need of harmonizing these contrasting ‘modes of understanding’ MHs (Puustinen et al. 2003, Ahlzén 2007). For instance, one way of reconciling the interaction between conceptual and existential reflections on medicine has been found in the dichotomy between ‘multidisciplinarity’ and ‘interdisciplinarity’ (Evans and Macnaughton 2004) – i.e. the way in which different disciplines should interact with regard both to the cross-border issues pertaining to MHs and the preservation of distinct scientific and academic expertise. While the dichotomy between conceptual and existential approaches to MHs has to be thought as an epistemic dichotomy, the one between ‘multidisciplinarity’ and ‘interdisciplinarity’ seems to point to the methodological criteria necessary for reconciling different disciplines within MHs. Problems arise in fact as to the way in which the interaction of experts and competencies from different fields should be conceived. Those who describe the interplay of expertise at the basis of MHs as multidisciplinary put a strong emphasis on the idea that their most effective contribution to knowledge can be gained only by preserving specific disciplinary identities. Every individual discipline participating in MHs is seen, under this interpretation, as a self-contained domain with its own distinguishable subjects, questions and methods. Though this is not meant to deny that any discipline includes some questions that can be better answered through the awareness coming from different disciplines, supporters of the multidisciplinarity view maintain that looking for the continuities between fields is likely to result in an endless and conflict-ridden process that might waste the potential of independent and recognised disciplines within the humanities (Pattison 2003). On the contrary, different authors have argued that the general purpose of MHs supports a rather diverse view (Evans and Macnaughton 2004). Namely, the view that interdisciplinarity - the search for possible interactions between expertise as to relevant subject matters that cut across different disciplines - represents the best way to foster a humanistic contribution to medicine both at the theoretical and the practical level. Interdisciplinarity, according to these authors, concerns a deeper engagement among disciplines, and more particularly “with subject matter that somehow both straddles the disciplines and falls between them – aspects of a question which [any discipline] neither might pursue, or even recognise, in isolation” (Evans and Macnaughton 2004, 2).

In principle, we agree with Evans and Macnaughton (2004) as to the general need of abandoning stiff disciplinary boundaries within MHs and of embracing an approach where scholars coming from different disciplines can make their ideas, competences and experiences interact profitably. Nevertheless, interdisciplinarity also has its own weaknesses. Arguably, it would entail the necessity to engage with the search for common dictionaries, subjects and methods in order to avoid ambiguities and confusions stemming both from the different meanings of some terms in different disciplines and from the different methods that characterize them. Though such a goal might be highly desirable, we think that it is virtually impossible to achieve due to the specialisation that different fields within the humanities have undergone in the past and are currently undergoing. This is what makes interdisciplinary approaches to MHs unlikely to be successful at the academic and the educational level. In addition, considering the task of a mutual agreement on fundamental issues as necessary in light of such a variegated community of experts, would have to be grounded on better reasons than the mere potential academic recognition of the field (Evans and Macnaughton 2004).

In the light of the methodological issues arising from different ways of making sense of the interaction among disciplines within MHs, we suggest abandoning the dispute between multidisciplinarity versus interdisciplinarity. What appears to be relevant is neither the language deployed by disciplines to answer some questions nor the search for an agreement on core issues between experts. Rather, as argued by Popper (1963) while discussing the status of scientific disciplines, what counts as necessary is the capacity to deal with problems under analysis. In other words, though resolving an issue might imply the need to resort to competencies coming from different fields, this does not seem sufficient ground for the construction of cross-disciplinary knowledge and expertise. This appears to be especially true in the case of MHs whose questions usually cross the borders of many disciplines but are nevertheless solvable notwithstanding the lack of agreement on disciplinary boundaries at the academic level. Therefore, we argue, a problem-based approach that preserves distinct expertise and competencies, while at the same time looking for successful cooperation in the light of the outcome might be much more likely to produce better results than the attempt to create a sort of hybrid knowledge within MHs. Whatever problems medical professionals are confronted with, MHs can provide them with more thorough conceptual and existential understandings of the situation, resorting to different contributions coming from a variety of disciplines. In this respect, their role appears to be fundamental. Under the problem-based approach, professionals should in fact (i) collect all the stimuli coming from several disciplines participating in MHs; (ii) tailor such knowledge as taught at medical school in the process of seeking a solution to a particular issue; and, thus, (iii) produce an interlock between distinct disciplinary perspectives, depending on what the problem within a context demands them.

The problem-driven approach to MHs just sketched should not be seen as something to be established once and for all. Rather, it is precisely conceived as a revisable and flexible framework for different modes of interaction between medicine and humanities within clinical practice. The search for interdisciplinarity has raised many concerns due to the expected difficulties faced in the process of harmonizing distinct academic expertises. This search, we argue, has diverted the attention of scholars in the field from the fact that there exist ways of reconciling diverse perspectives, abandoning the goal of creating common languages and methods. A problem-based approach, on the contrary, seems to point to revisable and provisional ways of making this interaction practically possible - something, we argue, that could serve better the purpose of solving the difficulties arising from medical decision-making. However, the capacity required of practitioners in making such interactions possible needs to be better examined if we want to seriously take up the challenge of providing them with useful resources coming from MHs. Abandoning discipline-based perspectives, while looking for the contribution that any of them can bring to problems in clinical practice seems to be a process much more complex than the mere exposition of humanities during medical education. We will turn to this issue later in our work. Before trying to make sense of it, however, we wish to continue our discussion of current understandings of what MHs are.

Arranging the role for MHs within the practice of medicine

Besides the issues presented above, a further layer of analysis concerning the identity of MHs deals with their implications in the study and practice of medicine. As to the former, many authors (e.g. Grant 2002) have stressed the relevance of the educational role of humanistic reflections on medicine. MHs ought to play, on this view, an active role in the educational curriculum of medical practitioners in order to ensure the centrality of conceptual and existential understandings along with biomedical ones in their profession. As to the latter, however, different scholars have underlined the importance of the assimilation of a humanistic conception in the practice of medicine. Under this interpretation, MHs should be conceived as a benign form of self-ruled governance to which every professional subscribes (Evans 2008). This understanding of MHs’ practical role sheds light on the fact that the impulse to heal, palliate, comfort, and console cannot be externally imposed through education. Quite the contrary, MHs can contribute to medical practice only if practitioners authentically assume the relevance of humanizing the delivery of care.

Then how should the relationship between humanities and medical practice be conceived? With regard to this point, Evans and Greaves (1999) have summarized the debate into two main positions: (i) the additive view, according to which medical practice should be ‘softened’ by sensitive practitioners who have had training in the humanities and (ii) the integrative view, according to which the status, goals, methods and procedures of clinical medicine should be reshaped by the broader understanding of a patient’s condition that, coming both from existential and conceptual reflections within MHs, is authentically endorsed by professionals. In keeping with this distinction, it is our intention to point out the second as the necessary, though more ambitious, way to conceive MHs. On the one hand, the integrative approach would bestow on MHs the capacity to make medical practitioners more aware of several conceptual and existential implications that their role entails. The search for integration of humanistic and scientific knowledge on medicine is, in fact, likely to produce, through education, the extended understanding of medicine voiced by scholars within MHs. By reuniting technical and humanistic perspectives within medical training, an integrative approach aims at fundamentally refocusing medicine both at the level of its understanding and its practice. In doing so, this view is meant to compel professionals to bring within the models of illness’ explanation the experiential nature of suffering. On the other hand, a merely additive conception is undesirable for at least two reasons. First, it could leave fundamentally unchanged current understandings of the condition of being sick as a mere biological phenomenon. The addition of training in the humanities within medical curricula would not, in fact, make necessary any reappraisal of medicine’s explanatory models. Otherwise stated, the additive view is merely concerned with complementing medical education with the conceptual apparatus of the arts and humanities. The sole exposure of future professionals to these alternative perspectives of medicine, however, is likely to produce only a contrast between ‘humanistic’ and ‘evidence-based’ approaches to medicine rather than a thorough reconsideration of medicine’s objectives. Second, such an additive approach to medical education would ascribe to individual responsiveness to academic stimuli the fulfilment of MHs potential to ameliorate medicine and its practice (e.g. the practitioner-patient relationship). These are the main reasons why we hold the view that the engagement with MHs should be deeply integrated within medical education and, by result, form and transform the clinical encounter. The realisation of an integrative approach, we argue, could embed the humanae litterae within the knowledge base of medicine, hence vindicating the idea that medicine has risen as the science for suffering humans, keeping material and experiential natures irreducibly fused (Evans and Greaves 1999).

Framing different conceptions of MHs

What, then, are MHs? To sum up, there seems to be a two-dimensional space - call it MHspace - that covers different formulations of MHs. As far as we know, all authors working in the field of MHs could find their own position in such a space. The MHspace appears to be constrained by two main dimensions concerning: 1) the aims and scope of MHs as an academic enterprise dealing with conceptual and/or existential understandings of medicine and the methodological issues arising from their interaction - i.e. MHs as an interdisciplinary or multidisciplinary endeavour; 2) the specific impact that MHs should have on medical education and the governance of healthcare - i.e. should MHs be merely supplemental to the so-called “medical gaze” (Foucault 2010), or should they be expected to integrate with medicine and reshape its nature? Generally speaking, therefore, MHs seem to gather all those conceptual and existential approaches that, starting from the perspective of humanities, aim at having a bearing on the study and practice of medicine.

As to the attempt at making sense of MHs according to this two-dimensional characterization, our opinion is that a comprehensive and conclusive definition of MHs is neither possible nor desirable. We believe, in fact, that the search for conclusive conceptions of the interaction between expertise standing behind MHs would not settle all the issues arising from the use of such a distinctive label. Accordingly, we claim that MHs should be differently characterised if analysed within the context of medical education, academic debates, or healthcare practice. However, we suggest that MHs could generally profit from an approach that is oriented to the way in which inputs coming from different fields can act together in the light of a concrete problem that has to be solved. It is not of course within the scope of our work to reconcile all the expected instantiations of any humanistic approach to medicine. We believe that, for the aims of this work, the recognition that MHs occupy a multidimensional space rather than being a homogeneous academic and practical endeavour is enough. One of the promises of MHs lies precisely in their capacity to encompass different objectives and yield lots of different benefits. As summarized by Pattison (2003, 36), MHs can, in fact, simultaneously aim (i) at opening up medical and healthcare education, (ii) at establishing a counterculture protesting against the exclusion of certain bits of knowledge from medicine, (iii) at transforming the nature and practice of medicine, and finally (iv) at providing some academic and funding opportunities to under recognised disciplines.

Although there exists no definite answer to the question regarding which of these objectives should be given a priority, we want to follow the suggestion made by Ahlzén (2007) about what the task of medicine is and how the humanities should primarily contribute to its fulfilment. Medicine, according to the author, is the “activity that aims at healing and ameliorating suffering due to disease and at the prevention of this suffering” (388). Integrating the humanities into its understanding and practice should therefore aim at compensating the weaknesses and shortcomings that, within current developments of medicine, make the activity of mitigating suffering mistaken or unsatisfactory. This approach, the author concludes, would immediately reveal the deeply positive influence that MHs could have on medicine. Otherwise stated, Ahlzén (2007) argues that MHs should concentrate “on core issues like the disease concept, the diagnostic process, and the idea of treatment” (388) if they want their contribution to be rapidly acknowledged as valuable. With a conceptual apparatus strongly relying on biomedical sciences at its core, the development of medicine has thus far overlooked all the existential dimensions of medicine that concur to the shaping of its nature and, consequently, of its practice. Our contribution wants to take up the challenge of providing MHs with a stricter characterization of their potential to transform the nature and practice of medicine. Nevertheless, we believe that rather than focusing on the wide conceptual apparatus that forges the nature of medicine, one should primarily focus on how its practice is actually mediated by the very same concepts and value-choices at its core. Knowledge that helps us to understand a complicated situation and can guide us in decision-making by evoking insights from experience, does not automatically flow from conceptual reflections into practice.

The remainder of our work will accordingly explore further the contribution of humanities to medicine with a particular focus on how MHs can ameliorate the practice of medicine. In order to achieve this goal, we will focus on the potential bearing that humanistic approaches to medicine might have on the fundamental locus where all the grounding concepts and assumptions in medicine are instantiated in the form of structural constraints of a practical activity. Otherwise stated, the last part of our work will analyse, through the lens of the humanities, the doctor-patient relationship as the crucial encounter where biomedical knowledge, conceptions of medicine, and individual values all contribute to the decision-making process aiming at promoting and fulfilling the tasks of medicine as a human activity.

Methodological foundations and medical decision-making

In this section of our paper, we propose a characterization of MHs as a tool for deliberation encompassing all the approaches that, coming from the humanities, could contribute to the improvement of the interaction between practitioners and patients. The widespread appeal and desire to promote the importance of humanizing medicine poses, in fact, an important question about how to conceive decision-making under the banner of MHs. By making reference to deliberation, our work aims at specifying the widespread appeal within MHs to an idea of medical decision-making that we shall call alliance between clinicians and patients. This approach, we argue, is likely to produce the benefit of enabling individuals to make choices that are informed by their experiences, values and beliefs. Creating such alliance, however, entails the elaboration of viable methods and strategies for the engagement of patients, which have been so far overlooked by scholars in the field of MHs. Achieving the goal of constructing such an environment for patients’ decisions lacks a methodological outline of MHs as a tool for deliberation in healthcare. To this issue we now turn.

As showed above, we defend a notion of MHs as a humanistic problem-based approach to medicine aiming at influencing its nature and practice. In this section, we specify further this perspective by analysing some methodological requirements that MHs should meet when conceived, in particular, as a full-fledged framework for medical deliberation. In a recent paper, Barilan and Brusa (2012) have suggested a model for ethical deliberation that builds upon Rawls’ (2005) Reflective Equilibrium (henceforth RE). Famously, RE has been conceived as “a deliberative process in which we reflect on and revise our beliefs about an area of inquiry, moral or non-moral” (Daniels 2011, 1).1 The use of RE might be as specific as the moral question, “What is the right thing to do in this case?” or the logical question, “Is this the correct inference to make?” Alternatively, the inquiry might be much more general, asking which theory or account of justice or right action we should accept, or which principles of inductive reasoning we should use. This is the main reason why the expression ‘method of RE’ refers both to the process of making an inference or a decision and the method itself. Barilan and Brusa (2012) propose a modified version of RE called Triangular Reflective Equilibrium (henceforth TRE) that could allow for the interaction in medicine of inputs coming from conceptual and existential reflections. In particular, the authors direct their attention to the possibility of reshaping RE in a way that could better accommodate medical decision-making in socio-psychological as well as narrative and rational terms. For this reason, they characterize TRE as a threefold method (and process) grounded on (i) descriptive narratives, (ii) considered judgements, and (iii) rational arguments.

According to this model, deliberation starts with a descriptive narrative of a situation. This individual ‘construction of reality’ is the underlying substratum that shapes and gives rise to beliefs and value-laden judgements that then are consolidated in the form of considered judgements - i.e. the initial responses to a problem that are the “product of intuition, cultural background, personal or professional experiences or some other conscious or subconscious psychosocial mechanism” (Barilan and Brusa 2012, 306). At this stage of deliberation, the individual narrative is immediately subjected to the criticism coming from rational argumentation. This phase of TRE is expected to make deliberation as fruitful as possible, since deliberants are engaged in a discussion that aims at improving, refining and purging from errors their beliefs and judgments. This is not meant of course to conform the uniqueness and irreplaceability of individual narratives to any superimposed way of experiencing disease and illness. Rather, as the authors explicitly claim: “TRE produces awareness of diverse narratives while pursuing the level of integration necessary for critical reflection” on a medical decision (Barilan and Brusa 2012, 313). In other words, TRE is expected to exert every effort to facilitate the interaction between inputs coming from individual narratives of a situation and the critical reflection upon it that the deliberant can gather from the interaction with other people.

Arguably, TRE addresses some of the central issues pertaining to how deliberation in medicine could be actually improved by an analysis of its method. In particular, it sheds light on the necessity to open clinical decision-making to humanistic reflections on medicine that go beyond mainstream bioethical reflections. Nevertheless, we believe that their contribution only partially succeeds in achieving this goal. As argued by Boniolo (2012), one central question that remains to be answered in current general debates on deliberation pertains to the different ways in which deliberative rules and methods should be practically instantiated (see also Boniolo and Di Fiore 2010). In particular, deliberation requires participants to be “quasi-peers,” meaning that a minimum sufficient common knowledge is necessary for models of deliberation to fruitfully foster an alliance between its members. If this condition is not met, the whole process of deliberation might be impaired by unbalanced degrees of knowledge. In other words, under Boniolo’s view, deliberation entails ideally that a minimum of shared knowledge is correctly delivered to all deliberants. In the case of the doctor-patient relationship, we argue that this could imply communication of information to the patient, as well as the careful consideration of the ways in which different patients might dissimilarly make sense of and act upon the same information.

In the light of this, we maintain that the approach based on TRE should be modified in order to have what we might call TRE+ (TRE plus). After descriptive narratives are taken into account and considered judgments are subjected to rational scrutiny, the deliberative canon defended by Boniolo (2012) can suitably contribute to tackling any potential imbalance of knowledge in the process of deliberation. His canon is mainly divided into two parts: the presentation of the status quaestionis, and the construction of a justification for choosing what is considered best by deliberants. In the case of medical practice, the status quaestionis might amount to an initial phase in which the decisional landscape is presented by the physician in a form that is as much as possible neutral (note that the display of patient’s individual narrative and the scrutiny of considered judgements have already been undergone). This stage could be then followed by the disambiguation of the terms used in which patient’s inquiry and questions, encouraged by the physician, play a central role. Finally, different solutions are presented by the practitioner and justified to the patient. At this point, the clinical pathway preferred by the professional is presented. This line of action is then subjected to rational argumentation and critical reflection by the patient (as in the TRE model) who engages with the physician in concluding the deliberative process. We argue that the outcome of this renewed version of TRE is indeed a valuable one. Whether the patient decides to conform to the suggestion of the professional or not, his/her choice for any clinical course seems to have been enriched by the engagement in this open-ended dialogue.

How does all of this relate to MHs? As shown above, TRE+ could be considered a suitable method both for medical deliberation and for the individual process of making sense of the experience of illness. In the previous section we have also argued that one of the main purposes of MHs is the construction of a supportive framework in which medical decision-making is enriched by conceptual and existential understandings of medicine. Apart from the impact that bioethical reflections have had in the last 40 years (Brody 1985), however, humanistic approaches to medicine are somewhat lagging behind in the process of providing practitioners with an expanded perspective on their professional activity. Whether patients are confronted with choices that have ethical implications or not, their moral and cultural background always plays a pivotal role in informing the decisions they are about to make (e.g. the decision to undergo a treatment rather than another, the decision to comply with medical prescriptions, etc.). The individual description of a situation ought to be, in fact, considered as the value-laden narrative – encompassing a set of moral values as well as a spectrum of beliefs about the world – that predetermines opinions, judgments and understanding alike. If MHs want to be acknowledged as an established supportive framework for decision-making in healthcare, actually reshaping and improving the nature and practice of medicine, the methodological analysis presented in our work appears to be essential. This is the main reason why we put forward TRE+ as a method that could accommodate the different perspectives characterizing MHs as an academic enterprise within medical practice. TRE+, we argue, could constitute the common methodological domain in which the different disciplines contributing to MHs could finally explore the “potentially synergistic character” (Ahlzén 2007, 386) of their contribution to medicine. TRE+ is likely to produce an expanded awareness of the human condition within the doctor-patient relationship, resulting from the engagement with all the different disciplines participating to MHs. This is what we might deem to be a first step towards the problem-driven approach to MHs. With such a methodological view in mind, in fact, MHs could really enhance physicians’ capacity to deal with (i) the individual understanding of disease and illness as a contextualized and self-construed phenomenon, and (ii) the rational discernment of the subjective perception of a situation to better support medically relevant decision-making.

There exist similarities between our model for patients’ engagement in medical deliberation and what is currently presented under the general title of “shared decision-making” between the professional and the patient. By looking at a systematic review of intervention for its implementation (see Légaré et al. 2012), one might in fact easily conclude that our way of characterising MHs as a framework for medical deliberation shares the same objectives of the shared decision-making endeavour. We maintain that our proposal should not be understood in opposition or as an alternative to this approach. We rather suggest our contribution as affirming the potential for MHs to enhance strategies for shared decision-making. In particular, we believe that canons of deliberation like the one presented in our work might answer some of the questions about methods and procedures (Stiggelbout et al. 2012) for clinicians and patients to make decisions together, hence fostering the emergence of better practices of shared decision-making.

In conclusion, we argue that the method of TRE+ could enable MHs (interpreted as a humanistic problem-driven approach to medicine aiming at influencing its nature and practice) to be a full-fledged background framework for decision-making in clinical practice. On the grounds of the fruitful combination between a canon of deliberation and a renewed version of RE, TRE+ could map the team effort that characterizes MHs (as an academic endeavour) by providing medical deliberants (i.e. patients and professionals) with a common scheme of reasoning to resolve problems with they are daily confronted. This, we maintain, is likely to produce an interaction and integration between humanistic gazes and medicine that scholars in the field of MHs are currently seeking (Annoni et al. 2013).

Conclusion

Our proposal has referred to current understandings of Medical Humanities as incomplete attempts to re-make sense of medicine from the perspective of humanities. If we analyse medicine as a human activity, humanities appear to play a crucial role. This, we argued, makes MHs – conceived in many possible different ways, according to the context – a promising field of study that could produce significant benefits for the practice of healthcare (Petersen et al. 2008). By incorporating and promoting the adoption of a shared method within a particular instantiation of this approach, however, our work has been also intended to shed new light on the persistent uncertainty surrounding the contribution of humanities to medicine. MHs are currently facing the challenge to turn into a full-fledged discipline. There may be many issues arising from medical decision-making that might not be resolved through an approach that focuses narrowly on disciplinary boundaries. In the light of this, we argued, a straightforward approach to the capacity of finding solutions to particular problems could result in a more immediate improvement of medicine from the perspective of humanities. In some cases, such strictness might be particularly desirable on the grounds of the importance of preserving distinct scientific and academic expertise. MHs entails grappling with such methodological issues arising from the purpose of combining ‘humane and humanizing’ reflections on medicine with the daily course of healthcare delivery. In the case of medical decision-making, we argued, this goal could be achieved through the employment of TRE+, as a shared standard of reflection and deliberation at the level of the patient-professional relationship.

Of all kinds of relationships, the ones between patients, doctors and all the different agents involved in medicine are those that we value the most. The rationale behind the approach of MHs to healthcare is (among other things) that of fostering a renewed understanding of this relationship, which ought to be capable of re-making sense of it in more humane terms. Our opinion is that achieving such an ambitious goal entails the construction of a methodological domain in which different people can practically interact and produce valuable outcomes that discipline-based approaches would not be otherwise able to bring forth. Our work aimed, accordingly, at taking a step forward in the process of investigating the nature and potential of the interlocking of disciplines that goes by the name of Medical Humanities, in order to provide them with the minimal coherence that is required to a full-fledged theoretical framework for medical decision-making. There may be many controversies at the academic level, arising from a sharp methodological approach to MHs. Some people might welcome such an attempt; others might feel uncomfortable with it. Nevertheless we believe that, despite this risk, the potential of TRE+ for the practical implementation of MHs within medicine is very significant and that such opportunity should not be squandered.

Endnote

  1. 1.

    It is worth mentioning that Rawls intended RE as the theoretical movement of ‘going back and forth’ from judgements and ‘contractual circumstances’ to our principles of justice for the aim of tailoring the latter to match our considered judgments ‘duly pruned and adjusted’ (Rawls 2005, 20). Otherwise stated, in Rawls’ original intentions RE is a method for the assessment of the validity of a theoretical framework, such as his theory of justice, and not as a means to make practical, concrete decisions.