Literature and Bioethics: The Tension in Goals and Styles

^Literature and Bioethics: The Tension in Goals and Styles James S. Terry and Peter C. Williams The power of literary representations of illness and medical care has been as apparent to the bioethics community as it has to all others in the medical humanities. Short stories and poems that are evocative, complex, and imaginatively challenging have been used to supplement or supplant the traditional case study as instruments for raising ethical issues. At best, these literary works more vividly present moral questions and even raise some kinds of issues that case studies leave out. Philosophic understanding of a given moral problem can be enriched by a literary account that places issues in a context of the lives and activities of particular characters. At a minimum, the use of literature in discussions of bioethics offers an escape from too often dry analytic discourse. Tales capture medical audiences in ways that philosophical discussions sometimes cannot.1 Nonetheless, using works of literature in teaching bioethics has distinct disadvantages—substantive as well as pedagogical—which this paper attempts to explore. Though there are genuine reciprocal benefits from the marriage of literature and bioethics, the form and process of the two disciplines have significant differences. These differences risk two important deleterious consequences. On the one hand, literary presentations of problems in medical ethics may end up subordinating, misdirecting , or obscuring ethical analysis and discussion. On the other hand, the isolation of an ethical issue in a piece of literature may ignore important features of literature as art or distort the pedagogical values inherent in literary study. The aim of this investigation is neither to cast aspersions on traditional bioethics nor to discourage the use of literature therein. Rather, it is to make the choice of materials and methods more informed and to foster a felicitous alliance. The teacher and the student should realize that important (and often less than obvious) value decisions are made when a course or lecture on bioethics is designed. Without such a Literature and Medicine 7 (1988) 1-21 © 1988 by The Johns Hopkins University Press THE TENSION IN GOALS AND STYLES realization, the bioethicist using literature or the literary expert teaching bioethics may be encouraging an approach to important problems and issues that is bad for both fields. It is necessary to begin by characterizing the goals that inform the content and methods of bioethics and of literature. After that characterization we shall look at three common topics—the right to refuse medical treatment, euthanasia, and allocation of scarce resources. For each topic, we will compare a well-known and frequently taught work of literature with a typical case study summarized and discussed in Cases in Bioethics published by The Hastings Center.2 By examining the differences between these two kinds of materials, we hope to demonstrate the shortcomings and strengths of each. Goals and Methods Both bioethics and literature are more than subject fields; each field involves a methodology as well. Each stipulates what counts as a significant problem for the discipline and how one looks for a solution. An understanding of the ways in which these fields may augment or conflict with each other must begin with an appreciation of these differences. The subject matter of bioethics is both contemporary and historically grounded. Although modern medical care is a primary focus of attention, bioethicists raise questions that have long been of concern to moral philosophers . What kinds of actions are morally correct? What kinds of character are morally praiseworthy? What states of affairs are most worthwhile ?3 In addition to such obviously important substantive questions, bioethics typically involves a particular methodology, determined to some extent by the goals of those who teach and practice it. In their report The Teaching of Bioethics, several well-known philosophers and theologians listed three major goals for teachers in the field.4 The first is to help students identify moral issues in biomedical contexts . This begins with the requirement that one learn to distinguish normative or value questions from other kinds of questions, such as scientific or technical ones. More difficult, one must also learn to distinguish kinds of evaluative questions, separating those involving moral values from those involving non-moral (e...