Paul Scherz is the Our Lady of Guadalupe Professor of Theology at the University of Notre Dame. He is the author and editor of several books, including The Evening of Life: The Challenges of Aging and Dying Well. The University of Notre Dame Press is thrilled to publish his newest book, The Ethics of Precision Medicine: The Problems of Prevention in Healthcare (October 2024). He recently answered some of our questions about his research and writing processes.
When did you first get the idea to write a book about the intersection of medicine and theology?
The book emerged from questions I had during my scientific career. Before I pursued my doctorate in moral theology, I was a doctoral and postdoctoral researcher in genetics. Over the course of my ten years in genetics, I saw the field gradually shifting away from seeking basic biological mechanisms that might lead to cures toward a focus on predicting people’s risk of disease. For an example of this risk prediction, if you think of results people receive from direct-to-consumer genetic testing like 23andMe, a lot of the results will be about having a 3% increased risk of some cancer or an increased risk of dementia. Over time, more and more of the field has performed research on risk, in part due to the expansion of data analytics in genetics after the Human Genome Project. I was interested in why the field had shifted away from finding cures to predicting risk and what the effects of those shifts would be on medicine.
Certainly these are unprecedented times in the United States, Europe, and around the world. What can readers find in your book that will resonate with them during this era?
What is striking about our current situation is the rapid advance of data analytics and artificial intelligence in nearly all areas of life. Their effect is just as important in science and medicine as in any other area like finance or social media. In medicine, though, its introduction can have a profound impact on our sense of our body. Through devices like Fitbit or services like genetic testing, these technologies encourage us to constantly monitor our bodies, looking for risks. This has a profound impact on our sense of health. The book addresses this aspect of genomic research and how it is playing out in the increasing use of artificial intelligence in genetics and medicine. The changes are also affecting humbler tools like electronic medical records. These technologies have entered medicine over the last twenty years and have begun to fundamentally reshape it. To fully appreciate their scope, the book also shows that we need to analyze how these tools and changes are grounded in older ideals of prevention and risk analysis.
How did you perform the research for this book?
I am a scholar of the humanities and theology, so most of my research consists in reading books across many disciplines as well as keeping up with the medical and scientific literature. This project differs from some of my others because a grant allowed me to pursue it in a much more collaborative fashion. I had funds from the John Templeton Foundation to consult with different experts in the fields that I covered, such as Theodore Porter for the history of genetics and eugenics and Nortin Hadler in medicine. Their input on my chapters was invaluable.
In what way is the book you wrote different from the book you set out to write?
When I started out on this project, I thought it could be narrowly focused on the ethics of a few genetic and information technologies. Once I got into the research though, I realized how broad the impact of risk prevention was in our society and how long its history was in medicine. This led to my breaking the project into two books, one of which I published two years ago on risk and practical reason in general and the other being this more applied book for a broader audience that was my initial aim. The book also focuses on broader themes like the definition of health and the role of prevention in medicine than I initially thought would be the case.
Which theologians and ethicists are the biggest influence on you and your work?
In terms of my ethical thought, I am strongly influenced by Alasdair MacIntyre’s writing on virtue and Michel Foucault’s discussions of the practices of the self. Theologically, I am broadly influence by the Latin Church Fathers, like Cyprian, Ambrose, and Augustine, as well as Thomas Aquinas.
What is your writing schedule like?
I like to write in the early morning. I try to be up by 5:30, and most of my writing happens in the first two hours of the day before the kids are up and the day gets running. Otherwise, I will write in cafes later in the days. My first drafts are almost always written in longhand, because I find that writing with pen and paper helps me to better organize my thoughts. I try to write a couple of days a week when I have projects going.
Who would you like to read The Ethics of Precision Medicine and why?
I of course would like it to find an audience with students and researchers in the fields of bioethics and theology, but I also hope it gets into the hands of doctors and patients. The questions I address in the book—how to implement AI in medicine; what are the effects of genetic testing; what kinds of forms of screening are appropriate—are ones that affect everyone.
What project are you working on next?
I am writing a number of smaller and collaborative pieces on AI ethics at the moment, especially its effects on human agency, health care, and misinformation. AI is moving so quickly that there is a lot to address. Those projects may lead to a book down the road. The major book project that I want to do is to look at the integration of Stoicism with Christian ethics.