Teaching ethics in the context of the medical humanities.

Careful reading of imaginative literature teaches an attentiveness fundamental to the care of the sick. Reflecting on the nature of medical ethics more than twenty years ago, moral theologian Paul Ramsey remarked, '... unless we mean to make medical education more literate, indeed more literary, ethics can find no proper place in it...'. Setting aside what he considered some common misconceptions of ethics-ethics as passionate social concern, ethics as law, and ethics as a procedural method for deciding hard cases-Ramsey asserted: 'Ethics is ... an intellectual inquiry. Therefore, education in medical ethics must necessarily be primarily literate' (1). One need not adopt Ramsey's own normative ethic of care to be stimulated to further thought by his insight that medical ethics as intellectual inquiry requires certain literacies of its practitioners. There are of course many types of literacies, but in the main we use the term in bookish contexts. To be literate is to be lettered, to possess the skills necessary for communicating in a particular language-in our case, a language of morality. The mastery of such literacy, according to Ramsey, is a minimum requirement of medical education. But he goes further: '... unless we mean to make medical education ... more literary, ethics can find no proper place in it...'. 'More literary' refers to something beyond language ability. It implies being versed in a broad range of moral experience, steeped in the stuff of imaginative literature. Why is literacv of this sort a precondition for the proper practice of medical ethics? Because without a sensibility attuned to what people's lives are like outside the auspices of medicine, absent a sense of what matters to people before they get sick and after they get well, the best efforts of physicians to heal the sick are likely to be morally compromised and, especially in cases of chronic illness and disability, therapeutically ineffective as well. Contemporary bioethics has been insufficiently mindful of this fact. Much of its discourse is curiously disembodied. The doctors and patients who populate its case discussions tend not to be full-blooded characters but stand-ins for ethical concepts, one-dimensional moral agents. One does not come away from a consideration of many of the current debates in bioethics with the impression that patients and doctors have moral lives. And yet into what does medical ethics as intellectual inquiry inquire if not into the moral dimensions of the relationship between doctors and …