Stories Matter: The Role of Narrative in Medical Ethics

The term narrative ethics is variously understood. It may refer to Aesopian I stories that end with a take-home moral or to the vicarious experience provided by reading, especially novel-reading, that educates and exercises moral perception. The tradition stretches from Horace, ¹ who early in the first millennium wrote that literature should at once teach and delight, to Wayne Booth ² and Martha Nussbaum, ³ contemporary scholars who have restored the consideration of literature’s moral force to critical and theoretical respectability. Adam Zachary Newton has argued that narrative is ethics, ⁴ and an understanding of plot supports him.

Choice is essential to moral life, but both our options and our predispositions have been conditioned, even created, by social forces in the historical moment and by the momentum of our earlier acts. Narrative captures this inextricable tangle of necessity and freedom in human life, and plot enacts it in the selection and ordering of events and in the quasi-causal implications of its telling. Plot links the complicated and uncertain conditions that may—or may not—be essential ingredients in the events being represented, and then plot traces those conditions over time. The suspense of discovering what has happened and how it all turns out may be part of a plot’s effect, but, at the story’s close, contingency continues to seem inevitable—at least for these people in this one predicament at this time and place. That the story might have been otherwise lures us to listen to and tell other stories, even to retell this story another day.

Literary theory is concerned with the complexities of such narrative representation. Theorists, particularly the Russian formalists, distinguish story (fabula) from plot (sjuzet). ⁵ Story is the actual set of events, while plot is the teller’s particular arrangement of those events. Suppose a colleague approaches you and says, “We have a patient who came for a prostatectomy, and as he was getting prepped, the nurses noticed that he wouldn’t talk about his family. Really odd. Then, after the surgery, he tells us that his wife and children—even his secretary—all think he’s away on a business trip, and he doesn’t want us to contact them. Now Mr. Kaufman’s bleeding, and we just took him back to the OR….” The story of this narrative could be said to be the plain sequence of events: (1) a man learns he

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