Medicus Sunday Serial: The power of empathy in ethical design
Like great art, great design is about creating beautiful things. Yet the question of what should be created is a far larger question than just aesthetics, functionality, or even commerce. One of the tech world’s hottest topics is ethical design, an abstract concept with growing importance. But how do we define what is ethical, and how do we respond to genuine ethical dilemmas?
For this Medicus Sunday Serial, Chief Product Officer Makram Saleh chatted with Head of Content and Marketing Serene Touma. Together, they spoke about some of the biggest ethical design questions facing Medicus and the wider world today.
Here’s part one of a two-part series.
Serene:
Over coffee today, we’re going to talk ethical design. This is something that you and I have been talking about consistently since we started working together well over a year ago. Thank you for joining me for this.
Makram:
It was only a matter of time before we did a deep-dive on this topic, and I’m looking forward to seeing where we each stand on certain matters… let’s find out!
Serene:
I think a good place to start is in the nuance. To me, the idea of ethical design a really nebulous concept in the sense that it’s really hard to explain, but you know what it is when you see it, and you know when it’s missing.
One of the examples that I think about often is one that Roman Mars talks about in 99% Invisible in an early podcast. In it, he introduces the urban phenomenon of “unpleasant design,” or “hostile urban architecture” and the example of the controversial Camden bench.
“It’s a strange, angular, sculpted, solid lump of concrete with rounded edges and slopes and unexpected places. It’s virtually impossible to slip on. It’s anti-dealer, anti-litter, anti-theft, anti-skateboard and anti-graffiti and anti-everything.”
You can get into the full description, but for now you get the point. When I first heard about this, I thought two things: initially, “wow, this is super effective,” but at the same time, I felt something else, a visceral and deep-seated discomfort. I thought, “I don’t like the idea of this.”
So why do you think that is? Why do you think that even though some things can be effective in this way, they just don’t sit well with us?
Makram:
Yeah, so thinking like a designer, I had conflicting thoughts. When I first saw the bench design and read about it I thought “this is an elegant design that fits the requirements.” It’s probable that the city asked for these requirements to tackle this known urban problem. Cities do similar things all the time, like adding extra arms to benches to prevent people from sleeping on them in parks.
In one way, this bench does double-duty as something elegant; it looks like an art piece. At the same time, the other half of my brain is concerned about what this bench enables, which is intentional hostility. This is why it’s really hard to separate sometimes. I’m reminded here of this iconic line from Jurassic Park:
Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.
This happens to us often as designers in general, and at Medicus specifically. We’re sometimes so concerned about how to do something and don’t stop to think about why we’re doing it. That’s why it’s really important to take a step back and look at what we did or what we are planning to do, and to think about it in these terms.
Serene:
I think that’s what a lot of these ethical discussions and conversations we have at Medicus are about. Like you said, it’s not about whether we’re able to do something, it’s about what makes it something that we should do.
This question actually came up frequently recently, when we completed our CE certification. We had to take pause and look at the implications of our app, specifically the potential risks that we would have to mitigate with its usage…
Makram:
It definitely forced us to think in a certain way. Instead of just thinking about the features as being nice features to have, or features that the client wants, we had to look at them as whether or not they impose any risk on users. Our compliance auditor often sheds light on things that we didn’t even notice that might be an issue. This was an eye-opening experience for us, and I believe made us better at what we do.
Serene:
This brings me to my next thought, which is how we consider the user experience of any product, whether it’s a coffee machine and elevator (which are examples that I know that you’re fond of, because they seem simple, but they’re actually quite complex.) If you think about them from a design perspective, no matter how simple or complex, what are the priorities that come to mind first?
Makram:
This is a good point because things like this always come up in conversation, and it’s my experience from our conversations that you tend to focus on how something might be hostile or might be annoying by design, or how the everyday user experience is not optimal, but for me, it’s really hard to separate between getting a design done and being aware of all the surrounding layers.
When you set out to design something, you’re focused on getting it done right. Not “done” as in fully developed or produced, but at least as to how it fulfills the concept and requirements.
It can be really challenging to fulfill all the requirements while also thinking about all the layers around it… the social layers, the ethical layers, usability, development complexity and so on.
Under pressure to ship something, designers tend to think “we’ll worry about these points later, let’s just get it out.” They don’t always have the chance to think of the bigger picture and of whether or not a design works in a certain context.
I’m not going to jump too far ahead, but it’s important to point out the critical role of diversity here, even if it seems unrelated. Diversity of thinking is required from the get go.
It’s hard to take a product that was designed for one thing and simply change a few things in it to fit something else. You have to think about it from the beginning with a different mindset.
This is why a designer might not even understand what’s wrong about a product even later after the problem is pointed out.
Serene:
This reminds me of our ongoing discussion as to whether we should have an individual working on a product that has lived the experience of the user, or if it’s perhaps better to have someone who has an objective point of view. I don’t think there’s a “right” answer here, but I do think it requires a designer who leads with empathy.
I think about this when I consider the variety of female health apps out there. One of the things that that period tracking apps and women’s health apps come under scrutiny for is that they always seem to be promoting an idea that women should be wanting to get pregnant or that they shouldn’t be wanting to, usually in the subtle ways that an app is designed; how they contextualize ovulation in the app, for example. It can seem to have an opinion on what a woman should be wanting to do when it comes to fertility.
It’s interesting to see how important diversity of opinion and thinking becomes when we’re building something as personal as a health app.
Makram:
Yes, of course, and I totally agree with you. One thing to note here though is that there’s no way to pre-screen a designer’s intention, motives, background knowledge, social awareness… there’s no standard test for that. Let’s take the example of pregnancy apps: can you tell the gender of the app designer from their work? As far as we know, gender alone is not a sufficient indicator of whether or not someone should design a certain type of apps or products.
Serene:
You’re absolutely right. Often the consequences of unethical design are usually not seen beforehand. There are many examples out there, from the e-scooters that took over cities, littering sidewalks, to the PR crises that Uber had on their hands due to the way they treated drivers. There were a lot of unintended consequences as a result of new technologies that were not mitigated. And you could argue that it’s really hard to think of them when you’re in the design phase.
That’s where empathy comes in, looking past visual design and user journeys at how the app makes the user feel.
I was in conversation with one of our designers today about the importance of not allowing a user to feel incapable when using an app, instead making them feel empowered — that they’re smart and capable enough to use it. This could be very simple and subtle, but I believe it’s an example of design that’s ethical if we are of the belief that confusing design is unethical…
But if we go back for a second to talking about this idea of user-centric design, you have to take into account that at Medicus we have so many stakeholders. So when we use the word “user” we have many different categories across a variety of products: we have the lab, the biologist or technician, we have the doctor that comes in into contact with our reports. We have the patient, we have the nurse maybe, and that’s a lot of different stakeholders to manage. So in the case of Medicus, who are we prioritizing here? How do we strike that balance?
Makram:
Remind me to go back to talk about e-scooters… if time allows I’d also like to talk more about transportation in general, because this is where we disagree on some points. [Coming soon, in part 2!]
When we think about users, patients or any specific audiences, empathy is the headline. One has to be aware not only of the needs, what they like and what they don’t, but also of the context in which they are performing the action or using the product. A nurse at a pregnancy care clinic is operating in a very different environment than a nurse at an ER or a hospital, and different from a nurse sitting at a reception desk at the lab.
It starts from there: stand in the shoes of that person to try and understand what they would want in that particular environment to do a great job. In most cases, this has to be crossed with the requirements of the job, and the requirements of the product you’re designing.
Think of it this way: There is a distinction between design that serves a need, versus art. So when you think about it, you have to approach it like you would a scientific endeavor, where you start out with a hypothesis with the intention to prove or disprove it asking “What’s the structure here? What’s the landscape? What does it look like?” It’s not dissimilar to architecture and designing buildings. You have to consider the structure and then the parts and then the thing as a whole. This is where you see that the topic of ethics is relative.
This might sound controversial, but even ethics is not this ultimate ideal. It’s relative. It’s tied to societies, regions and cultures. This imposes a challenge on us.
That’s why the first question we ask when we are designing anything is who’s using it, and where exactly, not only because of the context and environment that I mentioned before, but also because of the culture that they’re working in. Here is where design “mistakes” happen often and this affects the whole product fit. It might be something as simple as picking the right color that is not offensive to a certain culture. Research obviously helps in this particular case, but the point is that designers should be aware of the near and far implications of their work.
Serene:
This is really important. Speaking from a content perspective, this is something that I interact with or that crosses my path every day. And sometimes it’s really tough for me because a lot of the work that we do is for a paying client, not for a B2C audience where we might have more freedom. Of course, it’s only natural for our clients to have a specific point of view, a specific agenda or cultural norm that they want to perpetuate, and it can be really difficult for us to decide when we should accept what the client is asking for, and when to suggest it may be unethical, for example because we don’t necessarily believe is serving most users.
There was a discussion a few months ago about how do we talk about pregnancies that don’t come to fruition. There are many different outcomes, and one of them is an elective abortion or termination. In some parts of the world, this is positioned as something that should be normalized, but in this case, we were being told not to include it at all as an option. In this case, I had to take an objective position and ask, “what’s best for the user?” Being the creator of the software that someone else is paying for and that someone else is using is where things can get really nuanced.
Makram:
Exactly, and the designer is always the user champion. This is implied when we say that good design starts from empathy. Then we go from this to translating the user needs in a way that the user might not be able to express.
On the other hand, it’s exactly what you were saying, sometimes we know what’s the right thing to do from the way we think, or from an ethical point of view, but a client — operating in a certain market — might see it really differently. We have had requests to remove or to add certain features that we weren’t 100% happy about and we had to have an open discussion about it with them.
Serene:
And I think that’s what makes our approach really healthy, for lack of a better word. It’s not that we always stand up to things or always bow down to things. It’s the fact that we recognize the importance of having this discussion, having it with our clients, having it with each other, to determine really what we think is what we think is best but also being in a consulting position with our clients, being able to advise them and like you said, bring that expertise to the table.
We’re not just building apps and writing code. We are, at the end of the day, also working in an advisory and consulting role regarding what’s the best practice in this very new terrain of health and wellbeing apps, and ethics plays a big part of that.
Makram:
This is at the core of what we at Medicus can bring to the table. We bring this understanding of the user, patient or doctor needs. We don’t say yes to everything. We don’t say no to everything. It’s always a discussion, and an ongoing partnership.
Join our growing team of product designers and content creators. For opportunities and openings, visit medicus.ai/careers.
