Medical Humanities at the University ofWales SwanseaMartyn Evans and David Greaves University of Wales Swansea

AbstractThe UK’s first taught master’s degree in medicalhumanities involves a field of inquiry that is frequentlyphilosophical, pursuing interests and questionstraditionally arising in medical philosophy and ethics,but on a larger interdisciplinary canvas, drawing uponliterature and the visual arts, sociology andanthropology, social history and politics, andtheological and religious perspectives.(J Med Ethics: Medical Humanities 2001;27:51–52)

Keywords: Medical humanities; postgraduate education;philosophy; medical ethics; medical sciences; medical soci-ology; literature; theology; history

One of the questions at issue in determining thescope and identity of the medical humanitiesconcerns its position in relation to both medicalethics and philosophy of medicine. At the Univer-sity of Wales Swansea our postgraduate and, morerecently, undergraduate, teaching in medical hu-manities has developed organically out of our post-graduate teaching in ethics and philosophy ofhealth care. By implication therefore our concep-tion of the medical humanities—for the purposes ofboth teaching and research—is of a field of inquirythat is frequently philosophical in flavour, and thatcarries forward many of the interests and questionstraditionally arising in medical ethics, but on alarger canvas.

For us, the ethical questions in health care prac-tice have always seemed to be penetrated by “con-ceptual”, epistemic or philosophical questions to dowith the central ideas in medical practice andtheory—how one should understand the ideas ofhealth, illness, disease, normality, abnormality,human needs and interests, the boundaries ofhuman life and death, and so forth.1 These ideas arecentral, too, to the medical humanities—how it isthat a rehumanised conception of medicine can andshould be distinguished and explored, includingthose critical areas of medical theory and practicewhich the natural sciences cannot reach unaided.

Equally, ethics and philosophy of medicine notonly supply part of the content of the medicalhumanities but also contribute to its “methods”,belonging as they do centrally among thosehumanities perspectives whose rightful place is atthe core of clinical medicine, alongside the naturalsciences and integrated with them.

For these reasons then it was perhaps inevitablethat in developing the UK’s first postgraduatedegree in medical humanities in the mid-1990s weshould build upon our experience in, and ourunderstanding of, ethics and philosophy of healthcare, and embody this in developing what we havecalled the “integrated” conception of the medicalhumanities.2 We set out to harness the characteris-tic insights and perspectives of a number ofhumanities disciplines (“humanities” here includ-ing representation from the social sciences) as thesebear upon clinical medicine—but to harness themin a way which could lead to a sustained and inte-grated view of medicine’s nature and goals.

To achieve this we considered the “contributory”humanities perspectives themselves from a further,overarching perspective, that of philosophicalinquiry and reflection. We did this in terms of bothconceiving and delivering the teaching of thedegree. In a sense, our medical humanities teachinginvolves “philosophy looking at humanities disci-plines looking at medicine”. The idea is to considerfrom a philosophical standpoint what it is thatdrives these disciplines’ interest in medicine, andhow their perspectives characteristically illuminateour understanding of clinical medicine.

The general disciplinary areas which we fastenedupon as embodying central humanities perspectiveson medicine were history, medical anthropologyand sociology, literature, the visual arts, politics andsocial policy, and theology. (In each case the suYx“and medicine” could usefully be applied to specifytheir scope.) This is necessarily a selection from awider range of potential areas (obvious omissionsinclude law, psychology and music); regrettablethough this is, it is clearly necessary, given the con-strants of a master’s degree, if we are to have ameaningful yet still practicable syllabus. Havingsaid this, the choice of disciplinary areas is as mucha matter for continual review as is the precise selec-tion of topics within those areas in year-on-yearteaching.

In each general disciplinary area we attempt todistinguish and explore a group of characteristicideas or questions which that particular perspec-tive’s gaze upon medicine may embody. Forinstance, one might consider the ideas of plot andcharacter in the way that literature engages withmedicine, or the ideas of role and group identity insociology or anthropology, or the evolution anddevelopment of styles of thought in historicalperspectives, or the notions of suVering and

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salvation in theological accounts—always with theaim of considering how such ideas might illuminatethe patient’s (and the clinician’s) experience ofillness, suVering, disability, and the search forstructured explanations and responses in profes-sional health care. The syllabus that was developedreflects these aims at the level of the degree as awhole and in individual modules; from a broadlyphilosophical perspective it embraces topics asdiverse as the distinction between biological andbiographical life; the history and politics of theNational Health Service (NHS); the relationshipbetween religion and psychiatry; visual images,medicine and the body, and ethnography andqualitative method.

Thus the MA (Wales) in Medical Humanitieswas launched in Spring 1997. It was from the out-set available primarily as a part-time taught course(part one) lasting two years, with up to a furthertwo years available to complete the master’s disser-tation (part two). The first cohort of part-time stu-dents are therefore completing their dissertations inthe Spring of 2001.

Both parts of the scheme are separately examinedand must be passed in order to obtain the degree.Part one is examined by means of five writtenassignments, one related to each of the five modulesof the taught course. Whilst a restricted choice oftitles is given for each assignment in order to obtaina reasonable comparison of students’ attainments,the scope for individual students’ choice is greatlyincreased at the dissertation stage. Dissertations arecurrently being completed on topics ranging fromthe role of narrative and myth in healing to anexploration of cultural shifts in the rising incidenceof caesarean section.

One member of the first cohort pursued thedegree full-time (the only full-time candidate so faradmitted), and he successfully completed hisdissertation prior to being awarded the MA inDecember 1998. It is interesting to note that whatwas therefore the very first UK postgraduate degreeawarded in medical humanities is held by an over-seas student; Dr Shinik Kang is a university teacherand practitioner in dentistry in South Korea, whobrought his family with him to live in Swansea forthe period of his studies. We have been delighted towelcome both Dr Kang and other overseas studentsfrom, so far, Finland, Portugal and Israel.

Students otherwise come from a wide variety ofUK locations, and from an interesting array ofprofessional clinical disciplines. Perhaps unsurpris-ingly, medical general practitioners are the moststrongly represented group, coming as they do fromwhat might be called one of medicine’s most “nar-rative” specialisms—that is, specialisms in whichthe patients’ wider life stories are of clearest clinicalrelevance. (Of eighteen current part one students,nine are GPs.) The second most strongly repre-sented specialism is midwifery—again having astrongly “narrative” flavour albeit over a shortertimescale for most patients than is the case withgeneral practice. Other clinical backgrounds in-clude public health, chronic pain management,

intensive therapy anaesthesia, palliative nursing,hospital chaplaincy, chiropractic and health serv-ices management.

It is too early to judge the impact of medicalhumanities study upon the professional practice ofour students in general terms, although we havebeen gratified by individual reports. At some stage,with suYcient numbers of successful medicalhumanities graduates, a suitably designed and con-ducted evaluation of such impact will be desirable,for the benefit of all those involved in teaching orstudying on existing and planned postgraduateschemes in medical humanities.

Alongside the question of impact upon qualifiedprofessionals, the question also arises of the value ofmedical humanities study for those undertaking orpreparing for medical education as such. At theUniversity of Wales Swansea we have more recently(1999/2000) introduced another novel scheme ofstudy, the BSc in medical sciences and humanities.In this scheme, prospective graduate entrants tomedical school undertake a preparative degreewhich diVers from a number of existing combinedmedical sciences degrees available in the UK in thatit incorporates an equal measure of humanitiesstudies (50% of the scheme’s assessed content).

A substantial proportion of the humanities study,specifically concerning the bringing to bear uponmedicine of sociology, philosophy, literature andhistory, is strongly influenced by our experience inexploring these perspectives at postgraduate level,as we have described. Necessarily the correspond-ing undergraduate teaching is pitched at an appro-priately less ambitious academic level than thepostgraduate, but it does benefit from the long termstudent-teacher contact over the compass of threeyears’ full-time study. This degree, which has beendeveloped in collaboration with the University ofWales College of Medicine in CardiV, is intended toprovide intending medical students with a roundedpreparative education which will serve them wellthrough their experience of medical training andeducation, and contribute to their readiness tobecome sensitive and engaged clinicians uponqualifying. We hope to be able to report in moredepth on this undergraduate teaching in a futureissue of Medical Humanities. In the meantime,further information on both our postgraduate andundergraduate schemes of study can be obtainedfrom the authors; the undergraduate scheme has adedicated website at: www.swansea.ac.uk/medical-sci-hums/

Martyn Evans, BA, PhD, is Senior Lecturer in theCentre for Philosophy and Health Care, School ofHealth Science, University of Wales Swansea. DavidGreaves MB, ChB, MLitt, PhD, is Senior Lecturer inthe Centre for Philosophy and Health Care, School ofHealth Science, University of Wales Swansea.

References and notes1 Greaves D, Upton H. Philosophical problems in health care.

Aldershot: Avebury, 1996.2 Evans M, Greaves D. Conceptions of medical humanities [edi-

torial]. Medical Humanities 2000;26:65.

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