LITERATURE, LITERARY STUDIES, AND MEDICAL ETHICS: The Interdisciplinary Question
Montgomery, Kathryn, The Hastings Center Report
How do we know what is right, or before that, how do we recognize what is morally salient? Such matters lie deeper than can be plumbed by traditional philosophical modes of inquiry alone. Careful study of them requires also the study of literature, with the meticulous appraisal that it encourages of the intricate, tangled issues involved in apprehending the world, finding our way in it, and representing it to others. In this way, the study of literature contributes to a richer and more complex perspective on moral problems, and a more cautious view of the status and breadth of attempts to solve those problems.
Literature has always been an important part of ethical discourse, and the discourse of medical ethics is no exception. Short stories, novels, poems, plays, autobiographies, and films vividly represent illness, disability, and dying and thus pose many of the questions addressed by ethics and public policy. In the 1960s and 1970s, for example, plays like Peter Nichol's Joe Egg and Brian Clark's Whose Life Is It Anyway? portrayed the human predicaments that were side effects of medicine's technological marvels, the same predicaments that occasioned early debate in medical ethics. A decade later, Larry Kramer's The Normal Heart and William Hoffman's As Is were the first to pound home the evils of the social refusal to at tend to the growing AIDS epidemic. For more than a quarter century, autobiographies of illness like Audre Lorde's The Cancer Journals, Anatole Broyard's Intoxicated by My Illness, and Reynolds Price's A Whole New Life--to say nothing of scores of others by people unknown before their diagnosis--have found a ready audience. Physician-authors, like Richard Seizer, John Stone, Perri Klass, and more recently Sherwin Nuland, Rafael Campo, and Jerome Groopman have revealed the texture of medical practice. Others, like Donald Hall, Lorrie Moore, and Deborah Hoffmann, have made riveting poems or stories or films about the illness of family members.
Fiction, poetry, drama, and autobiographical essays take up such problems not because they are central to medical ethics but because illness, disability, and death are part of the human condition that imaginative writing exists to explore. This is not a recent phenomenon: Philoctetes and King Lear are as relevant to contemporary moral discourse as ER. But these days, with many human ills caught in the prolonged embrace of what Lewis Thomas in Lives of a Cell called "halfway technology," medicine has become central to the way we think about the question of meaning in our lives. Much of contemporary literature concerns not just illness but its medical treatment, the moral choices that treatment engages, and the failures of human compassion that too frequently accompany our trust in technologized care.
Literature's contribution to discourse about ethical values and behavior, nevertheless, can be easily overlooked. Plays and poems and fiction make no explicit argument; stories always seem just to be there. Irony, revelation, and meaning itself depend on what the audience already knows about the character of human beings, the acts they are likely to commit, and the justifications they offer for them, and much of this knowledge has been absorbed in turn from stories. But we do not ordinarily reflect on this: stories are simply our element. We forget that once we were children hungry to hear stories that would make sense of the world. We ignore the awkward fact that moral lessons are often conveyed in gossip, neighborhood rumors, and tales of office politics. We take for granted the movies and television shows and fiction that enable us to look into the abyss--or soothe us past the temptation to peer in.
The power of literature and of patients' stories has been equally overlooked in medical ethics. This essay examines the interplay among literature, medicine, literary theory, and medical ethics; it argues for the importance of the kind of moral knowledge that literature offers and concludes with an account of the narratological critique of medical ethics and the prospects for dialogue between literature and moral philosophy. …