Issues in "Making a Case"

^Issues in "Making a Case" At first glance, the following essay by Kathryn Montgomery Hunter may seem inappropriate for this volume because it may not appear to be directly related to bioethics, although it does deal with literary issues. Since, as Hunter points out, the patient case study is today fundamental to medical communication and education, how it ought to be written— that is, what one's duty is in this regard—becomes an unavoidable, profoundly significant ethical issue for the medical profession. To be sure, there are conventional questions concerning medical ethics alluded to in Hunter's essay: for example, truth telling, the patient's right to know, the patient's right to control treatment. These, however, are not the focus of Hunter's analysis. In a certain sense, Hunter grapples with one of the most ancient and complex literary and ethical issues. Storytellers, whether or not they are basing their story on facts, are potential tellers of lies or fiction and are thus not to be trusted or believed, as Rabkin's reaction to Barnard's narration of the case indicates. A written case about a patient may be a highly selective medical interpretation, or it may be a replotting of the patient's own story, or some combination of the two. In any event, for the teller and the reader, the case involves considerations of purpose, motive, and method, all of which have ethical implications. David Barnard has proclaimed that his purpose in writing up the case about the Bakers was "to depict illness as a shared experience" between sufferer and healer. One may ask whether it is prudent to attempt to depict a shared experience of illness between patient and physician when the reality is that such a shared experience, in fact, is not ever possible. As related by Barnard, the story of the Bakers is presented somewhat like a medical case history, but this may be misleading because, as written, the case violates many of the conventions of the genre. How should a third-party participantobserver , like Barnard, narrate what is conventionally a doctor's story? Should, for example, the third party take sides? In any attempt to answer these perplexing questions, at least two salient ethical issues arise. The first concerns the purpose of the narrated case. Is it, for instance, to provide understanding or to offer a rationalized justification for wrong doing? The second issue involves truth telling. Literature and Medicine 7 (1988) 64-65 © 1988 by The Johns Hopkins University Press D. Heyward Brock 65 How does a participant-observer, or any kind of narrator, tell the truth about a patienf s case through a narrative? The narrator of a patienf s case must be concerned with why he or she is relating the case, what to say about the case, and how to say it. As Kathryn Hunter is well aware, even if she does not specifically address herself to them, all of these directly involve literary issues and, indirectly, questions of ethical duty or obligation. DHB ...