In the Matter of Stories
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In the Matter of Stories

This essay lays out some of the many resources that a background in literary studies has to offer bioethics. After identifying four useful characteristics of stories, it briefly discusses some kinds of moral work that stories can be put to, including countering ethically undesirable stories and modeling ethically troubling situations. Stories can be invoked in our moral reasoning, compared and parsed, and used to teach moral lessons. They can help us discern which moral concepts are operative in a specific instance. Our personal identities consist of stories, which help us understand who we and other people are. Stories can also be parodied, for political or other effect. Stories can perform these moral functions only to the extent that the persons telling or invoking or parodying them are themselves morally competent. But given that competence, a scholarly grasp of literature and narrative can greatly enhance bioethical reflection.

When I accidentally fell into the job of Associate Editor at the Hastings Center Report, I soon learned that one of my duties was to copyedit the case studies that the Report publishes on a regular basis. The Hastings Center being the kind of institution it is, as I edited the essays, I also imbibed a good deal of bioethics. I began to publish scholarly articles and coauthor a book, all under the mentorship of Dan Callahan and the Center's other associates. Joe Fins, then the [End Page 93] Associate for Medicine, patiently answered all my many questions about ethical issues surrounding the doctor-patient relationship; Susan Wolf, the Associate for Law, taught me some classic court cases, starting with Schloendorff; and Jamie Nelson, Associate for Philosophy, gave me a crash course in moral theory. I learned an immense amount there, and I still think of the Center as my alma mater.

But my first responsibility was to help edit the Report. As I worked with the case studies, I gradually noticed something: they were tales told almost exclusively by physicians or, occasionally, by other health care workers. And they almost always were told in such a way as to drive the reader toward a particular ethical conclusion. My undergraduate major was German literature, and I also had a master's degree in theatre studies. From those disciplines I had learned a thing or two about stories. For one thing, stories are depictive, they are representations of a set of actions. Second, stories are connective, linking this incident to that one in a causal chain, but also linking the story itself to other stories: The Lord of the Rings connects with Harry Potter (think about it), while Pride and Prejudice connects to Cinderella and all other young-women-coming-of-age narratives. Third, stories are selective, choosing from among many possible details the ones the teller thinks are relevant. In that way, fourth, stories are also interpretive, in that the choice and arrangement of incidents and actions gives the story its overall meaning.

Reading the case studies from this background, I came to the cynical conclusion that they were rigged. It seemed unfair, somehow, that they were always told from the health professionals' point of view. And indeed, the commentaries often suggested that more stories were needed—perhaps a tale as the patient might have told it. Or, very occasionally, as the family members might have told it.

Thinking about all this, I wondered what would happen if you took a case study apart, retelling it by including features the original story had papered over or rendered insignificant, and changing the perspective from which the story was told. It seemed to me that you could un-rig it, resisting any unsavory ethical conclusions the first story might elicit by reassembling the ingredients so that they depicted the people and events in a more detailed and accurate light. I called such stories counterstories and later wrote a book about them (Nelson 2001). While writing that book, I came to see that, no matter how well meant they were, counterstories can backfire, unintentionally (or sometimes intentionally) damaging the identity of one social group at the same time as it depicts another group as morally respectworthy. So...