Hi! My name is Leah Eisenberg. As a bioethicist, I am involved with the ethics of both clinical care and biomedical research. In all that I do, I am thinking about how to make healthcare and research equitable as well as accessible via understandable, inclusive policies, interdisciplinary collaborations, and approachable education.
Everyone is touched by illness, so every type of person is found in these settings, from the person with an advanced degree who has been researching illness for decades to the child apprehensive about what all the white coats and strange smells mean. It is difficult to present ethical concepts to such a diverse group of people, especially since healthcare involves many unseen barriers: complex power dynamics, time limitations, differing levels of educational attainment, and the decreased ability to digest information that can accompany illness or overwork.
I can’t improve ethics anywhere unless I can foster an environment that meets individuals where they are and makes learning and questioning feel safe and interesting. Study after study shows that many people don’t understand the medical information the are offered yet will not ask for clarification. Furthermore, even those who are well-versed in medicine may have little knowledge of bioethics.
I see comics as an excellent vehicle for bridging gaps between the diverse people ethics touches and brings into common spaces. A comic draws people in from the moment they see it, because it looks different from what they are used to seeing at a hospital, clinic, or lab. My experience has been that even people who say they typically just sign whatever they are given pause for a moment in the presence of something unique and eye-catching. That engagement provides a chance to draw them in further, to hopefully teach them something they didn’t know or misunderstood. A comic can convey high-level information, but to do it well, the information must be distilled down to a clear and succinct message, which serves everyone best. Even someone who is a comfortable reader and learns well from printed material should not object to direct, understandable communication. Producing clear messages forces authors and illustrators to really think about what they are saying and the goal of their document. What’s more, a narrative can provide another avenue for reaching people and providing context that even illustrations alone cannot offer.
So much of what happens in medical care is conveyed via the written word. Sure, a physician should explain things to their patients, but by nature of them being humans, and busy humans at that, they sometimes leave things out, or think patients understand more than they do. I see a comic as a way to help the physician communicate, and perhaps more importantly, to help empower patients to take an active role in their care: to know that asking questions is acceptable, and to help them learn how to ask. I have also seen healthcare providers become more comfortable opening up hard conversations with patients when they have a tool like a comic that opens the door and gives them a common language to share. So many ethical problems arise in healthcare due to poor communication, so something that opens up communication while providing a shared experience, like a comic, benefits all.
How to get started:
Bioethics is a relatively small field, and graphic medicine is perhaps even smaller, so it is not easy to naturally encounter someone doing this type of border crossing work. That’s an issue I hope to address in my new role the bioethics liaison to graphic medicine! You will almost certainly need to be proactive in determining what you need and who can help you, and then putting that support in place for yourself. Luckily, both fields are filled with approachable people who are happy to share their knowledge with you, and the amount of online resources grow daily.
I recommend starting by acquainting yourself with what graphic medicine is, how is can reach people in different ways than text-only materials, and what resources already exist. The National Library of Medicine curated the “Ill Conceived and Well Drawn” exhibit to achieve just this goal. Additionally, this lecture by Michael Green, a physician and bioethicist, and MK Czerwiec, a nurse and cartoonist, is a great place to start.
The Graphic Medicine webpage would be a great next step. Poke around, search for topics that interest you. The team at the website is always open to answering questions, as am I. You can check out ethicist Craig Klugman’s blog for more bioethics-specific content. Does something speak to an ethical issue you already encounter in your work? Is someone working on a project that overlaps with an area of interest for you? I was wrestling with how to make informed consent for DNA biobanking easy to understand when I first encountered graphic medicine, and I immediately began thinking about how to use comics on consent and other medical forms, and that remains my primary research focus to this day. That focus led me to PubMed, and what research already exists on this topic. For example, MK Czerwiec, a former hospice nurse, cartoonist, and ethicist, has been working with colleagues to explore how comics can help facilitate end-of-life care conversations. She details some of this work on the HealthCetera blog here, and posted an update on the graphic medicine blog as well.
Once you have done some research and identified the area of your work in which comics might be helpful, you need to build your project team. I have had great collaborations with people from all kinds of disciplines. What matters more than a common background is a common goal. If you are all committed to answering a specific need, and getting there with comics, you can learn together, and pull in experts as needed. I don’t produce my own illustrations, so getting a comic artist involved early on is helpful, because – and here is perhaps the #1 piece of advice I have to share- it is much easier to convince people that using comics is a great idea when you can show them an example. Without an example, you are not sharing a common vision with your audience, and people who haven’t done the research you have might be thinking Archie and Jughead rather than Brian Fies. I have worked with cartoonists who are familiar with GM and some who are not- both are great, but the former can help you recognize your own blind spots more. For more on integrating GM into your institution, read Alice Jaggers’s great series of blog posts on this topic: How do you integrate graphic medicine in the workplace?.
As I’ve expanded my work as a bioethicist to include comics, I have grown to appreciate how comics can engage people. I see so many places in health and research where I now think, “they should use a comic.”
Key texts, reading suggestions, and resources:
“Comic assent/informed consent for biobanking is accessible.” IRB Advisor. March 1, 2015. Found at Comic assent/informed consent for biobanking is accessible | 2015-03-04 | AHC Media: Continuing Medical Education Publishing (reliasmedia.com).
“HIPAA and informed consent forms get the comic book treatment.” IRB Advisor. Feb. 1, 2014. Found at HIPAA and informed consent forms get the comic book treatment | 2014-02-01 | AHC Media: Continuing Medical Education Publishing (reliasmedia.com)
Bio: Leah Eisenberg (leah.eisenberg@yahoo.com) is a clinical and research ethicist, the Director of the Clinical Ethics Consultation Service at University of Illinois Health and a Visiting Associate Professor in the Department of Medical Education at the University of Illinois at Chicago. She has training in law and ethics, and is a Healthcare Ethics Consultant-Certified. She became interested in graphic medicine as a way to make medical and legal forms more accessible to patients, their families, and clinicians, particularly those who are not native English speakers and/or have low health literacy. Part of her interest in the use of comics on official forms stems from her legal training, and the idea many circulate that legal forms cannot be made understandable and accessible. Therefore, her entry into graphic medicine involved developing graphic translations and related research pertaining to the HIPAA Notice of Privacy Practices, consent forms, and assent for children. During the COVID-19 pandemic, she has also collaborated with a group of other ethicists on an open-source comic about triage during a pandemic, and is working on a series about vaccine myths. She has given multiple presentations about the intersections of medicine, ethics, and comics:
Presentations:
- Paper Presentation, American Society for Bioethics and Humanities Annual Meeting, Virtual Meeting. Oct. 15, 2020. “No Laughing Matter: Using comics to explain allocation of scarce resources during COVID-19.” Leah Eisenberg, Joan Henriksen, Anita Tarzian, Felicia Cohn, Theresa Drought, Heather Fitzgerald.
- Lightning Presentation, Comics & Medicine: The Ways We Work. Hanover, NH. August 17, 2018. “‘Comics? Like Superman?’ Introducing a hospital community to graphic medicine through the work of MK Czerwiec.”
- Paper Presentation, American Society for Bioethics and Humanities Annual Meeting. Kansas City, MO. Oct. 22, 2017. Leah Eisenberg, Angela Scott, Alex Thomas, Gary Ashwal. “A (graphic) novel approach to assent for clinical research.”
- Panel Presentation, Comics & Medicine: Access Points. Seattle, WA. June 15th – 17th, 2017. Leah Eisenberg, Alex Thomas, Gary Ashwal. “Basketball and biobanks: Comic book assent through narrative and metaphor.”
- Lecture, Cook Children’s Hospital IRB and Ethics Committee. Ft. Worth, TX. May 11, 2016. “Drawing patients in: Consent, assent, and the role of comics in improving understanding.”
- Grand Rounds, Cook Children’s Hospital. Ft. Worth, TX. May 10, 2016.“Visualizing assent.”
- Lecture, Comics & Medicine: Spaces of Care. Riverside, CA. July 17, 2015. Leah Eisenberg and J. Rose Anderson.”Visualizing biobank consent.” (HEAR THE PRESENTAION HERE: Leah Eisenberg and Visualizing Biobanking | Graphic Medicine)
- Panel and Poster Presentation, PRIM&R’s 2014 Advancing Ethical Research Conference. Baltimore, MD. Dec. 5-7, 2014. Leah Eisenberg and J. Rose Anderson.“No laughing matter: Comic assent for biobanking.”
- Panel Presentation, Comics & Medicine: From Private Lives to Public Health. Baltimore, MD. June 26-28, 2014. Gary Ashwal, Alex Thomas, Leah Eisenberg, J. Rose Anderson, MK Czerwiec, Laura Ruth Venable.“Research outcomes when the intervention is a comic.”
- Panel and Poster Presentation, PRIM&R’s 2013 Advancing Ethical Research Conference. Boston, MA. November 7-9, 2013. Leah Eisenberg, Jim Pringnitz, Linda Hasadsri, W. Edward Highsmith Jr., Devin Oglesbee, J. R Anderson. “Drawing patients in with HIPAA in comic form”
- Panel Presentation, American Society for Bioethics and Humanities Annual Meeting. Atlanta, GA. October 26, 2013. MK Czerwiec, Leah Eisenberg, Alex Thomas, and Catherine Belling. “Graphic medicine at work: Research outcomes when the intervention is a comic.”
- Invited Presentation, Transform Symposium 2013. Rochester, MN. Sept. 10, 2013. MK Czerwiec, Michael Green, Leah Eisenberg, J. Rose Anderson. “How can comics help us understand health?”
- Lecture, Comics & Medicine: Navigating the Margins. Toronto, ON. July 22-24, 2012. Leah Eisenberg and J. Rose Anderson.“A form of comic relief: HIPAA in graphic detail.”
Publications:
LR Eisenberg, JM Henriksen, FG Cohn, AJ Tarzian, TS Drought, and H Fitzgerald, Explaining pandemic triage: When a picture is worth 3000 word, American Journal of Bioethics Blog, Jue 1, 2020. Explaining pandemic triage: When a picture is worth 3000 words | Bioethics.net
LR Eisenberg and JR Anderson, Picture This: Illustrating the Future of HIPAA Documents, Atrium: The Report of the Northwestern Medical Humanities & Bioethics Program, Issue 10, Spring 2012 265014AtriumNews (northwestern.edu)
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