Education And Debate Narrative based medicine

Narrative in medical ethics

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7178.253 (Published 23 January 1999) Cite this as: BMJ 1999;318:253
  1. Anne Hudson Jones, professor (ahjones@utmb.edu)
  1. Institute for the Medical Humanities, 2.210 Ashbel Smith Building, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1311, USA

    This is the fourth in a series of five articles on narrative based medicine

    The contributions of narrative to medical ethics come primarily in two ways: firstly, from the use of stories (narratives) for their mimetic content—that is, for what they say; and secondly, from the methods of literary criticism and narrative theory for their analysis of diegetic form—that is, for their understanding of how stories are told and why it matters. Although narrative and narrative theory, like the form and content of a literary work, are inextricably bound up with each other, I will discuss them separately to help chart the evolving appreciation for the importance of narrative in the work of medical ethics.

    Summary points

    • Narrative contributes to medical ethics through the content of stories (what they say) and through the analysis of their form (how they are told and why it matters)

    • The study of fictional and factual stories can be an important aid to understanding in medical ethics

    • The techniques of literary criticism can be applied to the analysis of ethical texts and practices and can inform the understanding of different perspectives in an ethical dilemma

    • To understand and accept a patient's moral choices, a practitioner must acknowledge that the illness narrative has many potential interpretations but that the patient is the ultimate author of his or her own text

    The use of stories

    During the past two decades, stories have been important to medical ethics in at least three major ways: firstly, as case examples for the teaching of principle based professional ethics, which has been the dominant form of medical ethics in the Western world; secondly, as moral guides to living a good life, not just in the practice of medicine but in all aspects of one's life; and thirdly, as narratives of witness that, with their experiential truth and …

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