Stories Matter: The Role of Narrative in Medical Ethics

By Rita Charon; Martha Montello | Go to book overview

CHAPTER 18

THE HYPHENATED SPACE: LIMINALITY IN THE DOCTOR-PATIENT RELATIONSHIP

RONALD A.CARSON

The relationship of doctor to patient is primarily a moral, personal one…. Perhaps we should say that diagnosis and cure are processes which go on between doctor and patient.

—Paul Ramsey “Freedom and Responsibility in Medical and Sexual Ethics”

Above all, physicians and patients must learn to converse with one another.

—Jay Katz, The Silent World of Doctor and Patient

The true locus of hermeneutics is this in-between.

—Hans Georg Gadamer, Truth and Method


I

The hyphen is a key to understanding the relationship between patients and doctors. The hyphen simultaneously signifies separation and synergy, disjunction and conjunction. It calls attention to the distance between parties to the clinical encounter. And then, in the blink of an eye, it is a bridge across the divide. 1 The hyphen does double-duty. It signifies the reserve, the holding back, that is no doubt necessary when doctor and patient come together to consider matters personal and sometimes grave. And it reminds us that recasting one’s life story in response to illness or injury is a joint venture requiring doctor and patient to work together to achieve what neither can accomplish individually.

Narrative theorists of medical ethics have put their minds to characterizing the many versions of the story-shaping conversation carried on in the liminal space, the in-between, of the doctor-patient relationship. Before selectively reviewing the work of some of these writers pertinent to my subject, and then articulating my own hermeneutic perspective, a few words about the context of narrative ethics may be apposite.

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