RITA CHARON AND MARTHA MONTELLO
The practice of narrative ethics has developed organically, over the past two decades or so, germinating throughout North America, the United Kingdom, Europe, and parts of Asia, suggesting that this approach to ethics has answered a widespread need within the field. Not a top-down activity, narrative ethics emerged from individuals’ ethics practices as they, often on their own, found themselves listening in new ways to their patients and thinking in new ways about cases. The public life of narrative ethics—this book, for example—is but a distal part of this process: nurses, doctors, ethicists, and patients have already made local discoveries that health care’s primary duties are to bear witness to patients’ suffering and to honor their experiences of illness. From those activities—if pursued with rigor, honesty, humility, and accuracy—flow choices, decisions, and actions. From them also flow healing dividends for patients and for caregivers.
Narrative ethics arose as doctors, nurses, ethicists, and patients found themselves taking seriously their acts of reading, writing, and telling. From patients’ pathographies and caregivers’ stories from practice to ethicists’ written cases, what unified these early efforts was the recognition of the centrality of narrative in the work of health care. Although illness is, indeed, a biological and material phenomenon, the human response to it is neither biologically determined nor arithmetical. In extending help to a sick person, one not only determines what the matter might be; one also by the necessity of illness determines what its meanings might be. Such a search requires the narrative competence to follow the patient’s narrative thread, to make sense of his or her figural language, to grasp the significance of stories told, and to imagine the illness from its conflicting perspectives. Narrative approaches to ethics recognize that the singular case emerges only in the act of narrating it and that duties are incurred in the act of hearing it. How the patient tells of illness, how the doctor or ethicist represents it in words, who listens as the intern presents at rounds, what the audience is being moved to feel or think—all these narrative dimensions of health care are of profound and defining importance in ethics and patient care.
Responding to a widespread narrativist turn of the time, bioethics is one of many fields of knowledge and practice to have been profoundly influenced by