The Salience of Narrative for Bioethics

Clinical narratives are typically much richer and more engaging than ethical analysis and argument, no matter how engagingly the latter are undertaken. Therefore, there is a tendency to celebrate narratives of all sorts as privileged ways of accessing what is important for medical ethics. The importance of narrative for bioethics is less in the way that narratives reveal a true clinical reality than the practical utility of imaginative methods for understanding medicine in ways that augment ethical analysis and argument. Stories, however, serve broader purposes than the straightforward disclosure of truth, but saying this does not imply that truth or clinical experience eludes narrative. Such would be an extravagantly false claim. Chambers, of course, comes nowhere near to making such a claim, but demonstrates in a remarkably clearheaded fashion how narrative can provide a more sophisticated, perhaps even a more reliable, technique for validating ethical theory in bioethics. At the same time, he cleverly shows that narrative can be misunderstood by bioethicists not attentive to the features of narrative that he discusses.

Chambers rightly does not advocate narrative as a panacea for bioethics, but he does commend a more serious bioethical attention to narrative. He does so by illustrating how specific features of narrative operate in bioethics cases. In doing so, he illustrates some of the limitations in the typical bioethics case. Chambers rightly counsels that his discussion is not intended to encourage the use of these narrative features to compose superior ethics cases, but that these features can be employed by bioethicists to assess critically the evidence they use to test ethical theories. This is a sensible suggestion, one that provides a more prominent and useful place for narrative in bioethics.

The role of cases or intuitions in proving or testing ethical theory involves an exceedingly complex set of methodological issues. Whatever Chambers's view of the function of cases in proving or disproving ethical theory, his discussion does show that ethics cases inevitably exhibit narrative commitments of various sorts. Although one cannot escape the hermeneutic circle, one can function hermeneutically with more or less finesse by developing a more nuanced understanding of these features of narrative. This is a modest, but quite important claim. Showing, as Chambers does, is always a more persuasive technique than saying.

Some of the narrative features at work in the stylized bioethics case are undoubtedly reflective of theoretical commitments, but others reflect nontheoretical conceptual or values commitments that have become taken-for-granted components of mainstream bioethics. Using the techniques identified by Chambers could prove to be a useful exercise for philosophers and others interested in clarifying the conceptual commitments operative in bioethics.

Because narratives present complex conceptual or theoretical points with a seemingly compelling and apparently concrete immediacy, there is an understandable tendency to afford them a privileged position. A medical student described the use of cases in one of my classes: "They were the best part, because the cases are what medicine is all about. Cases are real, ethical analysis and theory isn't." Perhaps the comment was simply an exercise in student hyperbole or an attempt to goad a professor. Either way, the comment also exhibited a bit of what Alfred North Whitehead called "the fallacy of misplaced concreteness," that is, the propensity to mistake the abstract for the concrete. Clinical narratives can certainly reveal, but they can also obfuscate the complex experience of illness, sickness, disease, and the practices associated with its diagnosis, treatment, and cure. Chambers has shown how inattention to the structural features of narrative can foment confusion and misunderstanding, a possibility that the field of bioethics is well-advised to take seriously.