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Telling stories: creative literature and ethics.

Telling Stories: Creative Literature and Ethics

As the discipline of bioethics matures and becomes a recognized part of medical and nursing practice, it is only fitting that a wider, more experientially based ethics will evolve. The vagaries and demands of the clinic have necessarily drawn moral philosophers out of the academy and into a domain of striving, suffering, and the immediacy of choice. It is little wonder, then, that a biomedical ethics based exclusively on a principles approach often has been found wanting in the face of particular clinical circumstances or competing philosophical precepts. Creative literature, and by this term I simply mean intensified language with an artistic end--written words charged with thought and feeling that emanate from imagination and experience--offers a fresh way of looking at the medical encounter. Artfully told renditions not only of the inherent drama of sickness and its deprivations and lessons, but of the larger human drama of choice and meaning and fate add to a wider, more encompassing discussion of bioethical issues.

As Howard Brody reminds us in Stories of Sickness (New Haven: Yale University Press, 1987), "We are, in an important sense, the stories of our lives." Together we are all caught up in the drama of our unfolding stories, the stories we live. The sick, especially those beset with terrible choices, present special stories that draw in the nurse, the physician, the ethicist. Participating in another's story is not only empathetic but, I would suggest, a good way to get one's ethical bearings in a difficult case. The patient's story or a literary equivalent become a vehicle for ethical reflection.

We can begin this kind of bioethical enterprise by reading classic writers like Tolstoy and Chekhov and then move to modern masters like Updike, and Cheever, and Walker Percy. Next we could try on the more modern medically oriented writers like Richard Selzer, Oliver Sacks, or John Stone.

If one wanted to reflect in a more critical and scholarly way about the relationship of literature to ethics, certain key articles and writers have furthered thinking in this direction. For openers I would suggest William Donnelly's "Righting the Medical Record," Journal of the American Medical Association 260:6 (1988), which has a good deal to say about tapping the narrative richness of patients; Richard Baron's "An Introduction to Medical Phenomenology: I Can't Hear You While I'm Listening," Annals of Internal Medicine 103 (1985), talks about the experiencing of illness as it is lived. Cynthia Ozick's illuminating essay, "The Moral Necessity of Metaphor," Harper's, May 1986, speaks to the moral connections among language, imagination, and medcine, while James Terry's and Peter Williams's "Literature and Bioethics: The Tension in Goals and Styles," Literature and Medicine 7 (1988), cautions that the two disciplines may not be compatible. Rita Charon's "Doctor-Patient/Reader-Writer," Soundings 72:1 (Spring 1989), takes on the task of describing how the narrative form works, particularly with reference to using writing as a means of making the role of patient come alive for medical students.

Longer, book-length works about storytelling and the moral imagination include Robert Coles's The Call of Stories (Boston: Houghton Mifflin, 1989) and Howard Brody's Stories of Sickness. Both provide excellent discussions about using literature as an ethical focusing device. The yearly journal, Literature and Medicine, offers thoughtful, scholarly articles that are apt for the student of literature and medicine and its application to bioethics.

In "The Reason for Stories," Harper's (June 1988), Robert Stone declares, "As dreams are to waking life, so fiction is to reality. The brain can't function without clearing its circuits during sleep, nor can we contemplate and analyze our situation without living some of the time in the world of the imagination, sorting and refining the random promiscuity of events." Clearly, bioethics needs to better understand the mystery of living and dying. The moral territory explored by fiction lies at the heart of this mystery.

Charles Radey, a physician in Gaylord, Michigan, recently completed a fellowship in bioethics at the Cleveland Clinic Foundation.
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Title Annotation:The Best of Bioethics
Author:Radey, Charles
Publication:The Hastings Center Report
Article Type:bibliography
Date:Nov 1, 1990
Previous Article:Surrogate decisionmaking and other matters.
Next Article:Desperately seeking science: the creation of knowledge in family practice.

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