“Lethal, this becoming and being a doctor! Denying hope and fear, ritualized defenses pulled up around ears like turtlenecks, these doctors, to survive, had become machines, sealed off from humans—from wives, kids, parents—from the warmth of compassion and the thrill of love.” Samuel Shem, The House of God
Viewers of the recent movie The Imitation Game will be familiar with the Turing test, perhaps the best-known thought experiment in 20th century computer science. Named after the British mathematician and code breaker Alan Turing, the test asks whether observers, communicating with an unseen entity by computer keyboard, can determine if they are conversing with another human being or a computer. If judges cannot reliably tell the difference between the human and the machine, the machine would be said to pass the test and to possess the appearance of intelligence or capacity for thinking.
Thinking, speaking, and acting—nowadays, these very human activities may be simulated by machines to a remarkable degree. It is hard to watch IBM’s Watson trounce other contestants on Jeopardy without feeling that the computer’s wires and hard drives constitute some profound form of intelligence, eerily similar, and perhaps even superior, to our own. The Turing test sidesteps the issue of whether this kind of algorithmic intelligence is fundamentally the same as our inner life; if the machine seems like it can think, then by definition it can think. Yet many of us still struggle with the sense that Watson’s intelligence and our own are somehow different, clinging to the idea that humans possess something unique that can never be etched in silicon.
The question of what defines thinking is becoming increasingly relevant in a world of burgeoning medical automation that includes electronic medical records, decision-support software, computer-aided detection, robotic surgery, and algorithmic diagnosis and treatment. The health care industry has begun to abandon the model of decision making by an individual physician and patient and is migrating to an institutional model in which many medical decisions are preordained by policy. Such technologies and institutions are tempting to us because they offer efficiency with the promise of objectivity and uniformity.
In this sea of preprogrammed health care delivery, some providers see themselves as islands of humanity, bravely maintaining the “human face” of medicine. Others have discarded this notion as potentially detracting from otherwise efficient, accurate, and dispassionate care. Many of us fall in between these two extremes and are not sure where to draw the line between the cold of rationality and warmth of empathy. How can we know whether we are maintaining our greatest powers of thought while still promoting the most important “added value” we offer–namely, our humanity? In short, we need to be mindful of intention.
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