Stories Tell Us What We Need To Know: Perspective for Ethical Dilemmas.

Narrative in Ethics We hear stories and tell stories every day we practice medicine, without appreciating that the resolutions we seek in ethical dilemmas often unfold from the stories of our patients, their families, and our colleagues. A story holds so much life; knowledge in context leads to better understanding. Yet, misguided, we search for detail in chemical blood levels, shadows in a radiographic image, rising and falling numbers on a graphic. More distracting are assumptions and perceptions from our singleminded perspective. In Stories Matter, Dr Susan Rubin, ethics consultant, has written: “Each individual develops impressions based on the elements of the case with which they are familiar, and unavoidably there are parts of the story they simply do not know. In this way, each individual can claim to hold only a piece of the story.” A growing number of physicians and health care professionals write about their subjective experiences with patients and colleagues to enhance self-awareness. Through this reflective process, they gain perspective in clinical encounters that are routinely reduced to medical record facts. Dr Rita Charon, Columbia University internist, notes in her JAMA article: “The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice.” A narrative approach can be a useful ethics tool in the initial descriptive construction of the case and subsequently in normative reflection. Dr Rubin notes: “Narrative methods can sharpen our attunement to issues of how the narrative of a case or ethical dilemma are constructed, whose voices are given authority, which plot lines are considered relevant, and which possible resolutions are given consideration. The virtue of using a narrative approach is that it forces us to expose our assumptions and biases, to confront them, and to bring competing allegiances into dialogue with one another.”