Undisciplinary
Undisciplinary
Philosophy of Food: Discussing food restrictions, identity, and care with Dr Megan Dean Pt1
Philosopher Megan Dean joins us to explore the complex ethics of food restrictions, from hospital feeding tubes to revealing how deeply our identity and relationships are intertwined with what and how we eat.
In this episode we discuss
- Case of mushroom attempted mushroom poisoning - Ask Polly: My In-Laws are careless about my deadly food allergy!
- Smuggled Doughnuts and Forbidden Fried Chicken: Addressing Tensions around Family and Food Restrictions in Hospitals by Megan A. Dean, Laura Guidry-Grimes
- The Culinary Mind - Center for the Philosophy of Food
Undisciplinary - a podcast that talks across the boundaries of history, ethics, and the politics of health.
Follow us on Twitter @undisciplinary_ or email questions for "mailbag episodes" undisciplinarypod@gmail.com
Undisciplinary, is recorded on the unceded lands of the Wadawurrung peoples of the Kulin Nation in Geelong and the Gadigal peoples of the Eora Nation in Sydney. We pay our respects to Elders, past and present. The world's first high-strung plant has been performed.
Speaker 2:Medical history has been made in South Africa, reports of systemic racism in the healthcare system and COVID-19 has made the issue even more urgent.
Speaker 3:Characterised as a pandemic.
Speaker 1:Welcome to Undisciplinary, a podcast where we're talking across the boundaries of history, ethics and the politics of health, co-hosted by Chris Mays and Jane Williams. Okay so, jane, welcome to another episode of Undisciplinary. How are you going?
Speaker 2:I'm going pretty well, Chris. Thank you very much.
Speaker 1:Any good food lately, any good meals or any problematic meals, oh, look, I've got to say.
Speaker 2:my son is upstairs at the moment with food poisoning you want me to discuss that.
Speaker 1:That's quite timely.
Speaker 2:Yeah no, so that's a real pity.
Speaker 1:Do you know how he may have been poisoned?
Speaker 2:We believe so and you know, maybe he's got a virus, but it's easy to blame the very authentic takeaway that we had the other night, uh-huh.
Speaker 1:Yeah, yes.
Speaker 2:But I had really nice peanut butter toast for breakfast, Just you know.
Speaker 1:Well, the food poisoning is actually more relevant. I'm surprised you didn't alert me to this earlier, because what we're partly going to be talking about today is sort of some of the ethics of being a host and a guest and sharing meals, food ethics, the ideas behind or not really an idea.
Speaker 1:An anecdote that I've heard many years ago and dug up to read to you, jane, is about food allergies and how to be I guess in this case it's how to be a very bad host, and that's what we're going to be talking. We've got a guest who has written on this topic, which I'm looking forward to introducing in a moment, but firstly, I wanted to read you this. It's like a Dear Polly. It actually is literally a Dear Polly letter. I think it's from the New York magazine and it was written in 2019. And it's this person writing in the title is my in-laws are careless about my deadly food allergy. Um. So here we go, dear holly.
Speaker 1:I have a very severe allergy to mushrooms. I carry an epi pen and I have been hospitalized multiple times because of exposure to this food. One time, I began convulsing in the ambulance on the way to hospital. My husband politely explained this to his parents when we started dating and I was invited to family meals. Since then, most meals we have shared at my in-laws house have had very limited options for me.
Speaker 1:Somehow, they managed to find a way to add mushrooms to almost everything. They managed to find a way to add mushrooms to almost everything. One time they made a point to make a special plate of mushrooms and pass it around. My mother-in-law said very rudely I would have liked to add mushrooms directly to the salad, but somebody has a problem with it. Then they even added mushroom powder to mashed potatoes at one holiday dinner. My mother-in-law claimed it was a new recipe she'd found. I even added mushroom powder to mashed potatoes at one holiday dinner. My mother-in-law claimed it was a new recipe she'd found. I literally held my breath as the mushrooms passed in front of me at the table that day. That was extremely dangerous for me. That food could kill me. What's worse is my husband told me that mushrooms were not a common dish served by his parents before he started dating me. When I was pregnant, my husband told them we would not take part in any family meals if they didn't promise to keep the meals allergy free. His dad said quote we can't promise that everyone except your wife likes mushrooms and we're not changing what we eat for one person. My husband's sister even called me up angry about the fact that we would not be attending a party at her parents' house, yelling I was overreacting and that mushrooms are not a poison.
Speaker 1:This has caused a huge wedge between my husband's family and us. We no longer spend holidays with them and rarely speak. They don't get to see their grandkids, even though they live very close by. His stepsisters stop talking to us. He has a brother who still reaches out and is kind to us, but he acts as though his parents are just set in their ways and we should forgive them and move on. Short of taking them a doctor's note telling them my allergy is real, I'm not sure what to do. My husband supports me 100% and he's very angry and hurt by their actions, but at times I feel terrible and I that I'm the cause of this rift and I just want a happy family. Help, disrespected daughter-in-law. Now I won't go on long with the response, but the person responds polly responds by saying dear disrespected daughter-in-law, you are not the cause of this rift. The cause of this rift is truly terrible human beings. Your letter is a pitch for a dark comedy on premium cable I wish I could follow these people around with cameras all day.
Speaker 1:I want to know everything about them. I want to know what they do every day, how they talk to each other, how they spend their free time, where they vacation. I want to know what kinds of human beings are comfortable behaving this monstrously. Do they like monsters? It's hard not to picture them as monsters. Your in-laws are next level off the charts batshit, and then they go on.
Speaker 2:So, josh, how would you describe those in-laws? Yeah, oh my God, they sound evil. They also sound like they're totally angling to not have that person in their lives, right, not by killing it through mushroom consumption, but by making it untenable for it to be there.
Speaker 2:Here's an admission, though. When she said, short of showing them a doctor's note, my first thought was show them a damn doctor's note. But then like, why? Why would you want a relationship with those people except for that? You know, I do generally feel like kids should be able to have a relationship with their grandparents, but that goes to something we're going to talk about later on in the show, the Doctor's Note. Should we introduce Megan?
Speaker 1:We should.
Speaker 2:Because Megan is sitting here quietly and politely. We're super excited to have Megan with us today. Megan Dean is an assistant professor of philosophy at Michigan State University. She works in feminist philosophy, bioethics and science and values, as well as 20th century European philosophy, especially Foucault, and phenomenology. Her current research is in the ethics of food and eating. She received her PhD in philosophy from Georgetown University in 2019, and she has an MA in philosophy from the University of Alberta Prior to joining.
Speaker 3:MSU Dean was the Chauncey.
Speaker 2:Truax exactly the way it's written. Postdoctoral fellow and visiting assistant professor at Hamilton College, her work has appeared in journals including Feminist Philosophy Quarterly Journal of Medical Ethics and the Hastings Centre Report. Megan's the North American coordinator for Culinary Mind Centre for the Philosophy of Food and we're so happy to have you here today, megan.
Speaker 3:Thank you for having me.
Speaker 1:I'm so excited to be here. Um, I mean, I think I imagine you've got some responses to that mushroom story and you've no doubt thought about them before. We might hold them off, unless there's anything itching to say, until we get to your paper, because you discussed this in. Well, not the mushroom case exactly, but you know a lot of these different themes of medical authority how to be a good host. The difference mushroom case, exactly, but a lot of these different themes of medical authority how to be a good host. The difference between, say, food allergies and gut issues.
Speaker 1:Yeah, in a really interesting paper that we'll be discussing later on about the worst dinner guest ever. But before we get into that, something we like to do in reflection of the title of this podcast Undisciplinary. We are interested and it'll be great in reflection of the title of this podcast Undisciplinary. You know we are interested and it'll be great to talk about the discipline of philosophy and what that can bring to the study of food. But it would be also interesting to hear from you about how you ended up doing the kind of research that you do and any kind of disciplinary boundaries that you traversed along the way.
Speaker 3:Yeah, sure, well, I guess. So I didn't grow up knowing what philosophy was. I had never heard of it until I went to university undergrad. I'm originally from Nova Scotia, canada, so east coast of Canada, and I grew up near Halifax, where there are a lot of universities and it was kind of always expected like you're going to go to university. But I didn't really know what I wanted to study.
Speaker 3:I really liked reading, I really liked history. So I signed up for what's basically like a great books program at University of King's College it's called the Foundation Year Program and so we read, you know, literature, history, along with philosophy, and that was the first time I, you know, encountered that and I loved it. It was like these big questions, you know, like the pre-Socratics what is everything? Is it water, is it air? I never really had thought about those questions before. I had people to talk with about them. And so after that year of the sort of great books, I started taking some philosophy classes at Dalhousie University, which is affiliated with King's, and some of them I loved. I took some feminist philosophy classes which I was really excited about, and I also took some classes which I found very technical and analytic and I wasn't very good at that and I didn't find it very interesting. So I actually tried to jump ship and take French instead of philosophy. But I guess luckily, because I am very happy to be doing it now I stumbled onto some work in feminist philosophy that looked at weight loss, dieting and critiques of weight loss dieting.
Speaker 3:So, like Susan Bordeaux's work, sandra Barkey and Cressida Hayes and as a person who had very much like grown up with diet culture, sort of went on my first diet when I was in grade five, you know. So, like 12 years old, had always sort of struggled with that. This was like life changing for me, you know, just to be able to sort of think critically about why, why do people think that thinness is so valuable, why do people feel that it's a failure of the self not to be thin and not to be able to regulate your diet. Those things were really eye opening for me and I thought, okay, I could do philosophy about this, like this is amazing, um. So that kind of pulled me back into it and I decided, um, I didn't really have anyone in my family who had done, you know, was in academia. But uh, you know, I went to a little workshop, like, are you thinking about grad school? And uh, somebody recommended working with Cressida Hayes, actually at the University of Alberta. So that's where I ended up.
Speaker 3:I did a master's there. I don't know what's common in Australia, but in Canada at least at the time, people did master's degrees separately from their PhD. Here in the States they kind of combine them a lot of the time. But so I did that master's degree and I wrote a thesis about these critiques of weight loss dieting and my frustration that I found them so powerful. But also I still felt really bad about my body. Why didn't philosophy just fix all my problems? For me? That was sort of thing about what counts as a good body and that sort of thing. So yeah, so while I was there I sort of I worked with Quill Kukla and who had written some stuff about diet and eating and health, and I kind of got into thinking about eating in a broader sense instead of just weight loss dieting.
Speaker 3:There's a lot of literature, especially in the 90s and early aughts, about weight loss, dieting and feminist philosophy and eating disorders, but I noticed there's not a lot about like taking the insights in that literature, about like what dieting can do to subjectivity and and that sort of thing, and taking that outside of the context of weight loss dieting, because it seemed like, well, if that way of eating can do those things, surely other ways of eating might also have those sorts of effects, or you know, um, and there just wasn't that much on it at the time.
Speaker 3:So, um, I ended up writing my dissertation on, on, um, healthist eating. So you know, the assumption that good eating is is healthy eating and um, yeah, and I've just continued, I'm not tired of the topic yet I'm still really interested in eating and there's lots, lots of angles um, to you know you can think about eating from and and lots of disciplinary resources within philosophy but also outside, outside of philosophy. So I, I really um, I mean you know, engaging with food studies, um, folks and research and social science stuff on eating, and um recently just published a paper in the fat studies journal, so also kind of thinking about it from that interdisciplinary angle. Uh, so I, so I definitely bring like philosophical tools and perspective to eating, but I don't think eating should be contained to that disciplinary perspective.
Speaker 1:Yeah, I mean thank you for that. That's a really great overview and introduction to your background and interests. And just on, I guess that final point about philosophy and that eating and food studies draws on a lot of disciplines. But, yeah, what do you see as something that philosophy brings to it? And perhaps, in the context of talking about that, you're involved with the Culinary Mind, which is a group. Perhaps, in the context of talking about that, you're involved with the culinary mind, which is a group, looking at the philosophy of food. Um, so yeah, what, what do you see is, you know, does philosophy contribute to that? I guess interdisciplinary analysis of food yeah, so I mean eating.
Speaker 3:There's obviously a lot of research on eating from a lot of different disciplinary perspectives. A lot of that makes certain assumptions about eating and food, about what counts as good eating, what counts as a good eater, eater, and similarly, like in everyday life, a lot of assumptions about that. A lot of assumptions about who's a good eater, who isn't, what it means if you eat this way, blah, blah, blah. And I think philosophy has so many great tools for one, like identifying assumptions behind the way that people are talking and thinking and acting, and then also critiquing them. So I think some of these assumptions like both in the research and in everyday life, you know they're justified or they're plausible and maybe they fit with our values, but a lot of them don't. A lot of them are are pretty poor assumptions. They're not well founded and they're actually quite harmful. They cause a lot of suffering. They're not well-founded and they're actually quite harmful. They cause a lot of suffering. And so I think philosophy really has, philosophy is really valuable in being able to okay, let's figure, why are you? You know, why are you making that assumption? Should we buy that assumption? Is that a good assumption to make? You know, and then you can kind of go from there.
Speaker 3:So, just as one example, I have a paper about mindless eating. So for a while mindless eating there was in the news a lot. There were some social scientists who were doing a lot of research on mindless eating and how harmful it was and how we should stop it. You know and I'm not saying that mindful eating isn't valuable, so let's put that to the side but there's sort of like this boogeyman of mindless eating like oh, everybody, everybody's doing it, so much it's it's terrible, we have to stop this. And I just think like, well, what's behind that?
Speaker 3:I I think it's some sort of like latent dualism here where we think that if you're not consciously in control of yourself, it's some sort of like latent dualism here where we think that if you're not consciously in control of yourself, it's like your animal spirits kind of taking control and making you do things that you don't endorse, that are bad for you, and like you know, that's that's a view that people have had, but it's not a view that many people would defend anymore because it's not very plausible. And also there are other views about you know agency and how our agency actually, a lot of the time it's working under the surface. We're not super conscious, like when we're driving a car or when we're doing things that we're habituated to. It doesn't mean we're not being agential. When we drive the car and get home successfully, we just we don't have to consciously be paying attention to it all the time. It's not a bad thing. It's actually great that we can do that.
Speaker 3:So that's just one example of you know I think, um, kind of like demonizing mindless eating in that way makes a lot of people feel like I'm a bad eater. Oh my god, like I need to do something about this. It's like, well, do you maybe, maybe, because maybe you're not happy with you? Know how much sodium you eat when you minus eat a whole bag of chips or something like. Ok, but let's not like over exaggerate what's going on here. So, and then, yeah, the culinary mind group is. It's based at University of Milan.
Speaker 3:Andrea Borghini is the sort of founder of it. Andrea Borghini is the sort of founder of it. So there's no real philosophical association for philosophy of food or food ethics here, at least in North America and Europe, and so Andrea sort of started this as a way to build community and connect people who are working on food and, um, you know, centered in philosophy, but we also engage with a lot of people who are doing philosophical critiques or philosophy curious, but are working in social sciences and, um, things like that. So, um, it's great. You know, we have a lot of online events, um, people are interested the the information's at our website um, culinary mindorg. I have to plug it?
Speaker 3:yeah, we'll provide a link yeah, um, but yeah, I mean, there's just such a variety of a philosophical work on food. Not all of it is ethics either. A lot of people are working in sort of metaphysics of food. What is food, what counts as food, how do we know? So? Epistemological questions, um aesthetics also. So there are a lot of different angles you can think about um food. I tend to focus on the ethical questions, but yeah, there's, there's a lot going on.
Speaker 2:I was super interested, megan, to just reflect for a second there on the idea of good eating, and I know we're going to get into your papers that you've written. But I guess, chris, as parents it's very interesting to me the amount of, I guess, credit or censure that people get for whether or not their children are good eaters there's. You know, my children have always just eaten whatever and I get so much. Oh my God, your kids are amazing. They're older now so it's not a thing, but you know and have food poisoning. But the thing about, oh, your kids are really good eaters, you've done a great job, as if something about me did something to them. It's so tied up with parenting, the idea of children being good eaters. I don't know if that resonates with you, chris.
Speaker 1:Well, I was thinking about that, the idea of shame parents' shame if you have a picky eater and the apologies, the kind of yeah apologeticness that goes along with that well, I was thinking about that just in the context of the, the um, mindless eating, and I think that's a good example as well of sort of what you were saying, uh, megan, about the philosophy of food, but yeah, focusing, I guess, on the phenomenology of eating.
Speaker 1:But then also it has sort of good ethical and social implications of that research. Because, yeah, that idea of mindless eating in parenting, you know there's a lot of stuff about, yeah, you shouldn't let your kids eat in front of screens because they're not being, yeah, a gentle and intentional, you know. Know, I'm not sure how many sort of under seven year olds are too intentional about things anyway, but you know, that's maybe a different matter, um, but yeah, certainly, like, yeah, my daughter, she would go into the supermarket and pull a capsicum off the uh thing and eat into it and people would say, oh, wow, what an amazing child. And then she would, you know, go home and just demand chocolates or something like that.
Speaker 1:So yeah, people see snippets of what people eat. But yeah, they certainly give you that credit as if you've done something Well. Let's move on and talk about some of Megan's work Particularly. We'll start off with Smuggled Donuts and Forbidden Fried Chicken, addressing tensions around family and food restrictions in hospitals, and that is a great title. I must say you got lots of good titles with your work.
Speaker 1:Yeah, when I saw that, I immediately wanted to read it and this is just. I'll give a, you know, very brief, I guess overview, but you feel free to expand or correct anything. But you know, this was published in the Hastings Centre Report and we will provide a link to these articles in 2023. It's co-authored with Laura Girdry-Grimes.
Speaker 3:Girdry-Grimes, yeah.
Speaker 1:I hope I pronounced that correctly. Clinical setting where a patient is on a PEG which stands for percutaneous endoscopic gastronomy.
Speaker 3:Basically a feeding tube. It's a feeding tube.
Speaker 1:feeding tube. It's a feeding tube, um and uh, a family member has come in and put a um, a spinach smoothie um, into this feeding tube because this is a food that the their, their family member enjoys or likes and they saw it as connected to their, their treatment, that they had been doing at home prior to coming into the clinical context, and the medical staff are outraged at this and feel that the person is willfully doing them harm or you know that there's a bad intent there as well as just not being.
Speaker 1:you know appropriate medical procedure and you're looking at and you've got this sort of pull out question which I think sort of gets to the issue is you know, how should food values be weighed against health values, especially if a patient is medically frail and family is serving in a care giving and decision making role, and looking at this sort of shared decision or the possibility of shared decision making in the context of food and seeing food as being part of holding someone's identity the family member.
Speaker 1:You know we hold people's identity by connecting them to favourite foods and as well as care for them by providing foods. But that comes into conflict with medical authority who may say well, under these conditions, we don't want you eating any of those foods, and family members, you just sit over by the bedside and say kind words but don't get involved in this treatment aspect side of things. And so you're investigating, you know what are some of the ethical implications of this and you know what is a potential way forward for families to, I guess, be involved in that decision-making, because they are involved in many other areas of decision-making and this, I think is another good, nice example of the way food is kind of neglected as just this other thing that's sort of not essential part of life. So yeah, I enjoyed reading this paper and found it very insightful and I guess it'd be just as a. You know what was the origin of this like? How did you get to be writing this paper?
Speaker 3:yeah, so my co-author, laura. We went to grad school together at georgetown but, um, she went on to clinical ethics. So she now works as a clinical ethicist and this is a case you know that that came up for her and we were sort of chatting about it and the sort of ethical complexity and richness of food and eating, especially eating with family or feeding family, the sort of ethical complexity of that could really help in this situation to sort of like recontextualize what this in the case, what the family member, the partner of the patient, was doing, so sort of like. I guess one of the things I'm interested in is thinking about figures of, like bad eaters, or you know people who are bad eating and you were kind of talking about this. When it comes to parents whose kids are picky, you know the parent sort of comes across as the bad feeder in that context, right, and so it's very similar situation here where, like the family members, kind of framed as this, like bad, they're doing something very bad by, in this case, bringing in the smoothie. But you know, in other cases, including in my own family, you know sneaking in the donuts to someone who's in the hospital after a heart procedure. They're not supposed to have that but it's their favorite. You know they always have it in the morning and you know, instead of just having this sort of like, understandably the staff is frustrated and concerned. But the sort of easy read of like this person's irresponsible. This person doesn't understand what's at stake here. This person can't be trusted to care properly for this patient. We really wanted to kind of provide a reframing, using some of these ethical tools to say well, actually you know, when people are feeding their family they're doing really morally important work. They're showing care. You know they're providing care morally important work, they're showing care. You know they're providing care like physical care, emotional care and in a hospital.
Speaker 3:Usually when someone's in a hospital it's because the family can't care at home for that person anymore, right? So a lot of the care responsibilities have been shifted onto professionals, but families still feel this responsibility and in fact you know healthcare systems rely heavily still on families to do a lot of this unpaid care, like wouldn't function without that. So you know, by by bringing in the food sometimes it's like one of the only ways that families can kind of show their care for somebody. That's in this hospital context. And then also the identity piece which you mentioned, like that's in this hospital context, and then also the identity piece which you mentioned like being in the hospital.
Speaker 3:If anyone that's been in the hospital, you know, probably has had this experience very disorienting. You know you're not on your routine, you don't have access to your, your things, um, you're taken out of your uh, you know your work context, your relational context, you don't get to choose what schedule you're on and just being ill or being injured is also can be very disorienting. And you know, I think in general we often use food to kind of comfort ourselves, orient ourselves, say like this is who I am, you know whether it's like a culturally important food, or even just like I'm the kind of person who always eats this for breakfast. Like this is who I am, you know whether it's like a culturally important food, or even just like I'm the kind of person who always eats this for breakfast, like, and it's sort of like a grounding thing.
Speaker 3:And I think I think that's another thing that family can be doing when they're bringing people food is just saying I see you, like this is who you are, this is important to you, these are the things you like and we care.
Speaker 3:You know that we care about you and we care about who you are and you know so, even in cases where, yeah, it's very it's dangerous for the that to them or might want to bring that to them. Let's acknowledge that and not just say, oh, you're irresponsible, you're untrustworthy. If we can kind of engage in the shared decision-making, even if ultimately it's like, well, the providers are going to have to make the call, these foods are off limits, these foods are off limits, at least acknowledging the important work the family's doing, acknowledging that maybe we need to help the family find other ways to connect with this person, orient this person, care for this person if we can't use food, and so, you know, kind of re-inscribing the person within the family unit in other ways. So, yeah, the shared decision-making thing is that at least opening up this conversation and saying we need to make sure everybody is taking eating seriously here and in participating in these conversations, so we can all sort of hopefully be more on the same page about what it does mean to care for this person.
Speaker 2:Well, in this context, was reflecting on some work that I've been part of and also my own personal experience around food in hospital and family bringing food to hospital when you're not ill, but when you have given birth right. So, food and birth well, there are a lot of cultural practices around birth. Birth in hospitals tends to be fairly same same. I was involved in a study in the Illawarra near Wollongong in New South Wales of Australia and it was led by Delia Ramble-Denny Gooding and Chris. We can link to the paper that's just been published about this, because it's about the experiences of refugee and migrant women giving birth in hospitals in the Illawarra and quite a few of them talking about how they felt that they had to sort of hide, I guess, their cultural practices after birth. A lot of that was around food, but not all of it. Some of it was around other things that were culturally important and culturally normal for them, but they didn't feel that they could practice those kind of cultural norms in the Australian, in the Australian context, essentially because they thought that people thought they were weird or smelly, their food was smelly and so on.
Speaker 2:As we were doing this data collection, I was really reflecting on my own experience of having babies in a hospital in Singapore, and after the second one I was so hungry like unbelievably hungry, and there are, of course, a whole lot of cultural practices around postpartum eating in Singapore, but they weren't my practices, right?
Speaker 2:So my husband brought me in a pizza which I felt no need at all to smuggle and pizzas are smelly I did not even give that a second thought, right? So my relative privilege in that situation where I just did my thing and I honestly just didn't give it a second thought, contrasted with the experiences of the refugee and migrant communities in hospital in Australia and how hidden I guess a lot of their food practices had to be in that postpartum day or two, was really striking to me. And so I was thinking, you know, as I was reading your paper, about the power dynamics of who the patient is, I guess, what they're sick with, what the family, you know, I guess how the family members are, how they're able to communicate or not with the hospital staff, is probably also really relevant here. I just made that all about me, but I was thinking about it a lot as I was reading your paper was thinking about it a lot as I was reading your paper.
Speaker 3:Yeah, I think that's a great example, and I think that's partly why there's no sort of like easy takeaway from this, except that it should be part of a shared decision making process, and part of that process is trying to take all of those sort of things into account. Okay, well, like, what are the foods that we're talking about? What is the meaning of them? Why are they ethically important right to? Is it because it's a part of the culture that they feel alienated from? Because they're away from you know where they grew up? They're, they're immigrants, they're so, um, and it.
Speaker 3:it really also depends on you know some, these sort of these sort of normal, I guess or usual things that we want to think about in medical ethics, like power dynamics, who feels comfortable expressing their questions, even not even like demands, issues with translation. You know things like that, um, issues with translation. You know, um, things like that, and you know, hopefully that would all be sort of part of the shared decision making process and kind of go into um, go into how the decision gets made about what foods might be permitted or who gets to make the call and who doesn't, um, but yeah, it's not really separable from all of these other issues. I think it's, um, it's, it's just sort of like, uh, I don't know, a little. Thinking about the eating is like a little uh, I don't know what metaphor to use, but you can kind of focus on it and it brings all of these other complex ethical questions into view.
Speaker 1:Um, which is yeah, I mean, it's as well just in what you're saying there.
Speaker 1:You touched on it and you draw this out in the paper that food is also one of those things. In an environment where you don't have much control, food is something that you can have some control over and the family can, in a way that you know they might not be able to take you out of this environment and take you to a place where you do feel at home, where you have your routines. But food can, with the smells and the tastes and the textures, can do some of that and it's seemingly relatively easy and, one would think, uncontroversial, until you bring in the donuts or you bring in the smoothie and attach it to the PEG or those sorts of things. So yeah, I thought that was quite interesting.
Speaker 1:I'd be also interested to know if at all you in the reviews of this, like if anyone sort of kind of didn't get it like you know whether they were just like yeah, of course people shouldn't be bringing that kind of stuff in, of course people shouldn't be fiddling around with the PEG. Have you had any of that kind of? Or did people sort of did reviewers or people who presented this to sort of see the significance of it.
Speaker 3:We didn't have any reviewers say that, but I will say that I I do want to emphasize how understandable it is for staff to get frustrated with with families and patients that they feel you know are are kind of compromising their ability to help the person get better or to take good care of them. You know I especially because I don't work in clinical ethics I always, you know I I always want to be very respectful of people's clinical expertise and I don't, I don't want to say, like people are wrong to feel frustrated when somebody's you know they believe someone's health is is at risk there. I will say that most of the feedback we've gotten for this is like oh my gosh, yes, that has been such a huge problem in where I work and I'm so happy that we have like we can think about it together, because this happens all the time and we were just like not really sure what to do.
Speaker 3:We did consult with a dietitian, a registered dietitian who is one of Laura's colleagues as we were putting this together, just to see you know what her take was on it or if she had any sort of advice about you know what, because in clinical ethics papers like this, they always want you to have some concrete takeaways.
Speaker 3:You know, and it seemed to me really that registered dietitians are maybe an untapped resource in some institutions, because at the Cleveland Clinic they do get called for situations like this or situations where there's some conflict over diet or eating, or situations where there's some conflict over diet or eating. It seems that that's a regular part of the process. But in other institutions that sort of expertise might not be part of the care team all the time, and so you know, I think there are some clinical experts who who not only have the expertise about what what food is actually safe, what food is could be okay under certain circumstances, that sort of thing but also who are really trained in having conversations with people about food and thinking carefully about, like how, how to talk about diet and you know so I I think that's. Another recommendation I think we make in the paper is is if you have access to a registered dietitian and you're having these sorts of issues like, call them, call them um.
Speaker 1:They will likely be very helpful, um, for this sort of situation yeah, so I mean that sort of covers really another question that I was going to have, but I'll ask it anyway and maybe we'll get to it so, to recognise the sort of the values associated with family provision of food, with then also this sort of medical necessity of dietary restrictions. Yeah, what I guess some and this comes into some of those conversations about medical authority, because, because, like, in what sense I guess there's also and this I guess is part of the broader shared decision making thing where the medical team are needing to relinquish some of the decision making and does releasing that control maybe feel uncomfortable and they're jeopardizing the care of the patient. I mean, you can't know, the insights of healthcare workers, but yeah, I guess, is the role of the are there other things other than the sort of, I guess, registered dietician?
Speaker 1:I mean, that's a good example of another medical professional who's perhaps thought more about that balance between but, you can also have dieticians who can also be quite ruthless is the word that came to mind, strict maybe is another word Sure, sure, and also wanting to sort of maintain their control over diet. Interested to further your thoughts about this shared decision-making process and particular, that sort of, also that particular dimension that food brings, that, on the one hand, some people say, well, who cares what people eat, in the sense that they should just eat what we tell them to eat because it's for the best of their care, rather than, as you nicely articulate, that family providing food is an important part of care as well.
Speaker 3:Yeah, I mean, I think some of this is just really going to depend on the context, but I guess I'll say the way we understand shared decision making is sort of on a continuum or a spectrum. So at one end you have patient-led decisions, so very little input from anybody else, patients just gonna make the call. The other end, provider led decisions, very little input from anyone else involved, and in the middle you have so much scope for, you know, collaboration, input from different parties, that sort of thing. And I think our suggestion to you know, our concern, was that people were defaulting to provider-led decisions on diet and not even asking the question okay, where should we be on this continuum of shared decision-making in this case? And then, once we decide where we should be, who should we be on this continuum of shared decision-making in this case? And then once we decide where we should be, who should be making the call, who should have input, who should be collaborating then what will the decision be? You know, that's the second step after, like, who gets to make the decision. We're just worried that the default was just providers get to make the call, and then that was sort of leading to this conflict and tension and real problems.
Speaker 3:So the suggestion is let's assume it should be a shared decision. The question is, where along that continuum should we be? Maybe it will be close to the provider end, because maybe there are very good medical reasons why there can be no wiggle room on certain dietary restrictions. You know some people are like choking hazards, something like that. You know this can be very strong reason. But you know you have to be able to articulate that it can't just be the assumption, like in the case we discussed in the paper. There was an assumption that wasn't really based on any empirical literature, that the smoothie was causing malnutrition or, you know, it was not providing adequate nutrition to the patient and so, or it was dangerous in some other way, and you know Laura looked into this. There actually isn't really good data on this.
Speaker 3:So that was just sort of an assumption that was made. So, you know, shifting to this question of okay, it's shared decision maybe where should we be on this line, requires people to articulate the reasons for well, you know, I think it should be just provider, and here's why significant health safety reasons, or should be somewhere else on there. So you know, we suggested that a lot of times, when it comes to diet, it's probably OK for it to be more in the middle, closer to the patient-led. Or, you know, in the case of people who are incapacitated, it's going to be family whoever's their surrogate decision-maker proxy is going to be involved in that. And then, because family is often the caregiver, you know, doing this care work, either when the person's discharged or during their stay. Even, too, they might be involved, where you know, in the collaborative process of decision-making. You know, kind of regardless of where we end up on that sliding scale, because we need them on board, you know like you need them on board to do this unpaid labor of care that keeps the medical system running.
Speaker 2:However, however well it runs.
Speaker 3:But you, you know, just acknowledging that, even if people think like, oh, who cares about food? Just eat. You know, I could just live off of soylent or whatever people, people like, some people feel like that, you know, but for many people they don't. And also, having the family like, these conflicts with family and having this tension with family is not helpful to any good care outcome. You know, I don't think it's something that people, people want, and so, you know, our hope is that if we can kind of lower the tension, lower the possibility of conflict, through this shared decision-making process, it's just going to have. It's not just that. Okay, now people get to eat things that have meaning for them and their family gets to show care. But also, you know, we're getting family on the side. We're reducing conflict between family and the care team, which can distract from all kinds of other things. You know there are lots of different benefits that I think, even if you are skeptical of the value of food and eating, maybe you would be persuaded by those positives. Yeah.
Speaker 1:I'm glad you brought up the evidence, because that's something that I did have highlighted in your paper, that, yeah, it didn't turn out that there was evidence. There's heaps of things. I would like to talk more about this paper, but we should probably move on to the next one. One of the things I'll just say in the transition is I used to work in a hospital in the catering area and it was like a sort of fancy, high-end hospital and it's interesting, I'd say that you know you could look also at the sort of class and, I guess, dimensions of the care, because they sort of prided themselves on, you know, not having stereotypical hospital food that's. You know everyone thinks, oh, gross hospital food. But you know would try to give choice to these sort of high-end private patients, particularly in the maternity wards. You know where they would give them, because they recognise that people don't just want to have Soylent, they want to have something fancy, which I guess is part of being a good host which takes us to this.
Speaker 2:There you go, nice segue, chris. So, Megan's written another paper that we wanted to talk about today, and it's called the Worst Dinner Guest Ever.
Speaker 1:And with that cliffhanging end, we are going to split this episode. So part two will be coming shortly, where we will discuss uh megan's article the worst dinner guest ever on gut issues and epistemic injustice at the dinner table uh which was published in gastronomica in 2022. So we will be providing links to this article so you can read it before we release the second part of this if you are eager. Otherwise, tune in when it drops To be continued. Thank you, you.