Stories and Their Limits: Narrative Approaches to Bioethics (review)

As Hilde Lindemann Nelson’s lively and dynamic collection, Stories and Their Limits: Narrative Approaches to Bioethics, demonstrates, scholars in the still evolving field of narrative ethics have made strides in defining and placing their work within the overall context of ethics and medicine. It has not always been an easy or particularly collegial process. In June 1996, The Journal of Medicine and Philosophy published a thematic issue on “Literature and Medical Ethics.” Co-edited by K. Danner Clouser and Anne Hunsaker Hawkins, the issue considers the question of literature’s contribution to medical ethics and, more specifically, the emerging area known as narrative ethics. The essays present an engaging constellation of ideas and approaches, “examples of how textual analysis, literary theory, and the reading and writing of literature can contribute to an understanding of ethical issues in medicine.” ¹ Unfortunately, Clouser’s essay in response, “Let the Engagement Begin,” treats the earlier writers and their pieces more like adversaries in a legal trial than colleagues in exploration. He brings the gavel down resoundingly against the “literature folks” and their claim that narrative ethics might be more than window dressing for principle-based bioethics. “‘Facts’ for philosophy and history have the same relevant connotations that ‘story’ does for literature. So, unless there is more packed into ‘story’ and ‘narrative’ than has been seen in these articles, these terms may be helpful to some, but they certainly are not necessary” (p. 339). Despite Hawkins’s adroit rejoinder to Clouser’s essay, the volume left me with the sense that the issue’s authors had been patronized (possibly set up) and, as misguided children, put in their rightful place at the margins of philosophical discourse.

Stories and Their Limits is a welcome corrective. In this volume, ethicists and literary scholars come together, neither to be cheerleaders for nor to bash narrative ethics. Instead, the collection represents divergent and thoughtful considerations of the characteristics, shortcomings, and possibilities of this still-evolving field. Although there is some repetition among the essays, the collection is a wide-ranging, rich, and, at times, quirky conversation, thereby modeling the very tenets it explores.

The seventeen essays included in Stories and Their Limits emerged from the 1996 spring meeting of the Society for Health and Human Values hosted by the University of Tennessee’s Center for Applied and Professional Ethics, which Nelson directs. The authors (five of whom appeared in the Clouser and Hawkins issue) are, in the main, ethicists, physicians, philosophers, and/or literary scholars. In her opening essay, Nelson traces the evolution of the “personal turn” in moral theory and the challenges such a turn offered to claims of objectivity and epistemic certainty. Essays are loosely clustered around telling, reading, analyzing, and invoking stories, and all examine the usefulness of narrative approaches to ethics: “Even among those who find them very useful indeed, there are perplexities about which bits of the moral life are most fruitfully examined when approached through narratives, and just how far such an approach can take us” (p. xiv).

Section 1, “Telling the Patient’s Story,” includes work that examines the meaning, uses, methods, and benefits of narrative ethics. Thomas H. Murray, for example, in wondering what we mean by “narrative ethics,” offers tapestry and web as useful metaphors for how meaning is made. He claims that the images of a tapestry “are like excerpts from narratives: they vibrantly capture centrally important scenes from human lives” and are “crucial raw materials for making and justifying moral judgments” (p. 17). Howard Brody, reading Arthur W. Frank’s The Wounded Storyteller, charts directions for bioethics, or to be more accurate, “reforms.” Brody calls for bioethics to consider “how all of us, as a community of humans and hence of fellow sufferers, can live with each other in our suffering and participate fully and responsibly in reciprocal systems of healing” (p. 30). Arthur Frank’s essay looks at the disturbing possibility of patients becoming totalized...