Stories Matter: The Role of Narrative in Medical Ethics

By Rita Charon; Martha Montello | Go to book overview

CHAPTER 4

CONTEXT: BACKWARD, SIDEWAYS, AND FORWARD

HILDE LINDEMANN NELSON

It is often assumed that, when ethicists work with cases, they are taking a narrative approach to clinical ethics. In this essay I argue that this is typically not true, at least for cases that find their way into print. In the commentary on the case, which is where the ethical analysis takes place, the commentator typically acts as a judge, applying lawlike principles deduced from one or several of the standing moral theories to the situation described in the case; so applied, the principles serve to prescribe the right course of conduct. Judging skillfully and well in accordance with some theory involves a consideration of the economic, cultural, class, gender, and religious contexts in which the participants operate, as these social contexts might have some bearing on which principles to select and how much relative importance to assign to conflicting principles. However, once the commentator has gotten hold of the correct principles and a rationale for ranking them, context is of no further interest. The commentator can now judge impartially what ought to be done in any similar set of circumstances.

After considering a case that has been treated in this way, I offer a narrative approach to the case. In a narrative approach, the social contexts are important, not because they guide the selection of the principles that will be used to resolve the case, but because of what they reveal about the identities of the participants: the religious, ethnic, gender, and other contexts in which a person lives her life contribute to her own and others’ sense of who she is. How others see her crucially influences how they will respond to her, so it matters whether they get these contextual features right. While those who use the “juridical” method described above could in principle take the same view as narrativists of the moral importance of social contexts, only a narrative approach can work with the case’s temporal context. Because juridical methods center on an ethical analysis of what is going on here, in the present moment, they tend to approach the morally troublesome situation as if it were atemporal. But understanding how we got “here” is crucial to the determination of where we might be able to go from here, and this is where narrative is indispensable. The story of how the participants of the case came to their present pass is precisely a story, as is the narrative of the best way to go on in the future. The backward-looking story is explanatory; the forward-looking story is

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