Stories Matter: The Role of Narrative in Medical Ethics

Primary care medicine is concerned with everyday life. Here, ethical dilemmas arise from the lived life—individual preferences, beliefs, attitudes, choices, and decisions, and how individuals interact with one another as well as care for one another. ¹ Ethical dilemmas in primary care are often subtle, but they are not invisible; most are recognized easily by careful observers. These dilemmas are no less important to the individuals involved than are the dramatic conundrums that touch the lives of hospitalized persons. For instance, an office patient with active gastrointestinal bleeding who refuses hospitalization despite a hematocrit of twenty may die at home due to further bleeding. The ethical dilemmas of primary care are different from those occurring in the hospital setting, but they are no less meaningful.

Narrative informs clinical medicine. Understanding such narrative works as pathographies, novels of illness and healing, and memoirs about medical practice enhances personal awareness, expands the physician’s concept of the patient’s illness experience, enables interpersonal connections and recognition of emotions, and thereby offers a fuller understanding of the moral life as enacted in health care. ²

Patients’ stories as heard and then interpreted by physicians are narratives too. Such clinical cases can, like literature, demonstrate particular points about the moral life. The retelling of these stories by physicians, nurses, or members of the ethics team is also a narrative activity. Such retelling may have consequences for the listeners, just as reading a poem may influence the reader in some deep way. ³ And the decision to retell a specific story is likely to be motivated by personal reasons of the teller, such as the wish to help the patient, to ensure proper care, to clarify or understand some aspect of the physician’s life, or to bear witness in some

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