Literature and Bioethics: Different Approaches?

-^Literature and Bioethics: Different Approaches? Howard Brody The incautious, simple-minded teacher of bioethics was probably disappointed with volume 7 of Literature and Medicine, despite its theme, Literature and Bioethics.1 We bioethics folk are happy to consider incorporating some works of uterature into our courses. We are as anxious as the next person to be thought learned; and, besides, snappy short stories and poems, or carefully chosen Uterary passages, might arrest the students ' attention and get them to pay more mind to the topic at hand. (Why, after all, do we use case studies and videotapes?) Obviously, longer works need not apply; the students would lack the patience to get through them in their entirety. So we would have welcomed a series of articles such as "This is how I use scene 7 from act 2 of Titus Andronicus to spice up my lecture on substituted judgment." Naturally, volume 7 is not Uke that at all. Most of the essays are careful analyses of, or reflections upon, a wide variety of Uterary works. Some of the works have no obvious medical connection at all, as with Edward E. Waldron's essay on Of Mice and Men and Ruth Evans Netscher's on The Alchemist. Other works discussed are too long to fit conveniently into any course on medical ethics (Hans-Peter Breuer on Shusaku Endo's The Sea and Poison, RenateG. Justin on Thomas Mann's The Magic Mountain, Chester R. Burns on several late-nineteenth-century novels). Modern medical students might resist dipping into Scribonius Largus, even if enticed by the analysis of his Compositiones Medicamentorum by Edmund D. and AUce A. Pellegrino; they might have better luck with Mikhail Bulgakov's "The Murderer" and Pearl S. Buck's "The Enemy" (Teo Forcht Dagi), with a short story by WilUam Carlos WilUams (Janice Willms and Henry Schneiderman), with essays by Lewis Thomas (AUce Budge and Emil Dickstein), and with depictions of bioethics in film (Edmund L. Erde). The volume begins with a nicely done cautionary essay by James S. Terry and Peter C. Williams, "Literature and Bioethics: The Tension in Goals and Styles." Although the essay makes several important points and illustrates them with helpful discussions of specific Uterary works Literature and Medicine 10 (1991) 98-110 © 1991 by The Johns Hopkins University Press Howard Brody 99 and case studies that might be used in a bioethics course, the general point is that teaching a Uterary work in a bioethics course can result both in mangUng the work itself and in undermining the very points that the students are supposed to appreciate. The conclusion, most appropriately, is not that uterary works should be banned from bioethics courses, but rather that they must be used very carefully and with a full awareness of the likely pitfalls. Several differences between the goals and styles of Uterature and bioethics that Terry and WilUams describe may be somewhat overdrawn for the point they make; but, in at least one example, the tension between bioethical and literary goals seems unavoidable. This is the question of ambiguity. According to Terry and Williams, real-life events and descriptions of these events are fraught with ambiguity, and it is the job of ethical analysis patiently to strip áway the various layers of ambiguity until what remains is amenable to being understood in terms of agreed-upon ethical concepts and principles. By contrast, literature thrives upon ambiguity, and coming to understand a work of literature often means coming to see ambiguity where none was seen before. Ethics, it seems, wants us to see face to face, while Uterature bids us peer through a glass, darkly. (Or, as Mark Twain suggested in "Fenimore Cooper's Literary Offenses," sometimes as through a glass eye, darkly.) If this is so, then we will have to set aside the most fundamental objectives of the bioethics course if we want to do justice to the Uterary works we bring into it. In this commentary I want to explore a bit more the various ways we might look at a literary work in a course on bioethics, and I shall distinguish some different approaches to bioethics that might determine how well or how...