Narrative Matters

Tod Chambers makes a convincing argument for the importance of narrative theory in the field of bioethics (Chambers 2001, 1999). Through the careful examination of cases used primarily in texts and journals, Chambers demonstrates how much can be revealed or concealed by the manner in which these cases are selected and told. Moreover, what becomes morally salient can be influenced by the manner in which we tell, read, and hear stories. That is, Chambers reminds us to recognize the biases inherent in our approaches to the rich problems in the field. This perspective is cause for some humility and caution in conceptual approaches to bioethics and would seem to have substantial implications for both descriptive and clinical ethics.

Unlike approaches to narrative ethics that hope to enrich philosophical approaches to ethics, and unlike uses of literature and the arts to enhance awareness of the nuances of ethics cases (Nelson 1997), Chambers' project focuses on the use of the methods of narrative theory in the field. In doing so, it might be argued that narrative theory would join other disciplines and methods that contribute to the field such as philosophy, religion, theology, history, casuistry, the law, ethnography, qualitative research, quantitative surveys, experimental methods, etc. While there is little doubt that the field of bioethics is multidisciplinary, the extent to which it is truly interdisciplinary is unclear (Sugarman and Sulmasy n.d.). Nevertheless, Chambers' critique of philosophical approaches to bioethics tilts toward such an approach but also raises a set of important questions.

How might narrative theory inform the analyses of ethical issues using other normative approaches to bioethics such as religion, theology, and the law? Similarly, how might narrative theory affect descriptive approaches to ethics that often recognize explicitly the problem of bias? In what ways might narrative theory inform clinical ethics? In contrast, how might narrative theory be informed by each of these endeavors? And what are the limits and hazards of enlisting such an approach?

Although each of these questions demands careful analysis, the potential relationship of narrative theory to clinical ethics is especially intriguing. Recalling that Chambers' work is derived primarily from written cases (although he describes masterfully educational film and other media), it is necessary to question whether the analysis translates into clinical settings. Given that the starting point for the use of narrative theory would be a text, or a text-analogue, it seems tenable that cases in clinical practice would qualify. Nevertheless, unlike the nearly telegraphic depictions of most of the cases analyzed by Chambers, real cases in clinical ethics tend to be rich and lengthy; they include elements of action and character, anddifferent perspectives are recognized frequently as being important. Indeed, in working through difficult cases, the task of clinical ethics is akin to constructing a story in the style of William Faulkner, in which the 'true' story is not known to the reader until each of the characters have had an opportunity to tell their story. Obviously, the concept of closure used in narrative theory would seem to be critical in analyzing this phenomenon, but in clinical ethics how can we know prospectively that closure has been achieved? Which of the multiple stories that might be elicited are sufficient to getting the story right? How can we avoid the specter of relativism (Kuczewski 2001)? Finally, even if we can be assured that the description of the case is adequate, will this facilitate the prescriptive tasks inherent to the demands of practice?

Working towards answering questions such as these with respect to clinical ethics as well as others that might be outlined with respect to normative and descriptive scholarship in bioethics will help us reach a better understanding of the rightful place of narrative theory in the field of bioethics. Tod Chambers has extended an intriguing invitation.