The Bioethicist as Author: The Medical Ethics Case as Rhetorical Device

^The Bioethicist as Author: The Medical Ethics Case as Rhetorical Device Tod S. Chambers Every style is a means of insisting on something. —Susan Sontag, "On Style"1 Style is not neutral; it gives moral directions. —Martin Amis2 Unlike most writing in philosophy, essays in bioethics often begin by telling a story. Frequently indented or boldfaced, this story or case presentation is differentiated from the ethicist's philosophical analysis, and the separation intimates that the case is an external writing, a foreign entity imported to introduce the moral quandary, and is unaffected by the bioethicist's abstract arguments. Yet bioethical cases are often written or adapted by the ethicists themselves, and in this essay I examine how the literary style of these case presentations covertly supports the philosophical orientation of their tellers. I contend that just as Gabriel Marcel's dramas mirrored his dialogic orientation and Albert Camus's "white" style reflected his existentialist views,3 bioethicists through their own particular literary techniques (setting, point of view, tone, dialogue, imagery) express and anticipate their philosophical arguments. Far from being morally neutral, the case presentation communicates and persuades readers to see dilemmas within a particular philosophical framework before the ethicist's argument for that perspective . Essentially stylistic decisions permit an ethicist to begin an argument before the reader is aware that he or she is doing so. I shall examine five examples of case presentations from bioethicists who have distinct approaches to ethical issues in medicine and show that in all instances the ethicists' stylistic choices in their case presentations are reflections of their particular approaches to moral decision making. Although in some instances ethicists have been the Literature and Medicine 13, no. 1 (Spring 1994) 60-78 © 1994 by The Johns Hopkins University Press Tod S. Chambers 61 redactors of previous narrations, these acts of editing and rewriting are themselves the result of a series of choices in the presentation of information.4 Case presentation thus must be seen as a part of—not apart from—the rhetoric of the bioethicist; in short, ethicists persuade through narrative style. I. Setting the Scene Ms. R. arrived at the physician's office simultaneously depressed and agitated. She had been under Dr. T.'s care for a little over a year, but today was especially traumatic for her. Her breast cancer was developing rapidly. Since the birth of her daughter a few months ago, she had been rapidly losing strength. She feared that soon she would have to give up her baby in order that someone or some institution could care for her. She had no family, no husband, no one to turn to for help except Dr. T. In the privacy of his office, she reviewed her tragic story. None of the obvious options would work. Adoption would not meet the baby's needs adequately, and given the baby's problem with a malformed hip, probably no one would want to adopt her anyway. As for the institutions that care for the moneyless orphans of the street, Ms. R. said they could not possibly give her baby the care she needed. There were no friends or neighbors she could rely on. The city was large and anonymous. With this case, titled "The Humane Murder of a Helpless Infant," Robert M. Veatch begins A Theory of Medical Ethics.5 He describes how Ms. R. seeks Dr. T.'s assistance in "humanely" (TME, 15) killing her child, for she believes that her child with her special needs will live a miserable existence after Ms. R., herself, has died. She wishes to be responsible for her child and is willing to take "responsibility" (TME, 15) for her action. Veatch ends the narrative: "She turned to Dr. T. for help" (TME, 16). Veatch opens this case presentation with Ms. R.'s arrival at Dr. T.'s office, and he quickly juxtaposes the intimacy of Dr. T.'s office with the hostile city. Outside the safe space of this office lies an urban world with its "institutions," "moneyless orphans of the street," and "the state" (TME, 15, 16); as Veatch pronounces in a matter-of-fact tone at the end of the second paragraph, "The city was...