Positive Wrongdoings: Reading Doctors' Narratives on Ordinary Ethics

The ethics of everyday life, the morality of the ordinary, is the ‘place’ in which medical ethics is enacted [. . .] The case studies filling ethics textbooks do not typically address the moral dynamics of the everyday care of patients. Extraordinary decisions are not routine. An ethics of the ordinary is also required.¹

Doctors’ narratives about their experiences of “the morality of the ordinary” hit on major questions that have troubled ethicists in contemporary philosophy and ethical literary criticism in the last two decades and that deeply concern medical educators and practicing physicians in their endeavor to foster medical professionalism in the day-by-day care of patients. How can one accommodate moral ideals, understood here as the duties of medical professionalism, with the emotional messiness of ordinary living and the harried everyday reality of medical practitioners? Who has moral authority in the clinical setting? Indeed, what do we mean when we talk about caregivers’ moral authority and responsibilities? How can doctors best balance the principles of beneficence and patient autonomy in their relationships with patients? And what images of the “good doctor” does medical education conjure and hope to instill in the minds and hearts of young students and residents?

In their narrated accounts of ethical engagements, the doctors whose autobiographical stories I shall analyze in this essay place their moral choices in concrete, dense contexts that invoke what Martha Nussbaum calls “the indeterminacy, the sheer difficulty of actual human deliberation.”² Because their narratives are more complex and more closely resemble the lived experience of practicing physicians than the usually terse “cases” in bioethics textbooks, those narrative can function as valuable contributors and mediators of shared moral language and practice toward the development of ordinary medical ethics. As Cheryl Mattingly recognized, caregivers’ narratives are more than a mode of structuring raw clinical experience “after-the-fact”: they are bound with experience “in a homologous relationship.”³ Further than that, these narratives not only depict instances of daily moral engagement but also embody a handier and more natural way to reflect upon and understand moral issues than the top-down models of formal deliberation promoted by the prevailing theoretical discourse of bioethical principles. Indeed, if these “ethics narratives” provide a process of clarification of and partial answers to the weighty questions mentioned above, they do so by inviting their audience to think with their stories rather than simply to think about them.⁴

The narratives I offer below, and my approach to reading them, are the product of years of engagement in narrative theory, research, and the pedagogy of narrative medicine.⁵ For the last seven years, I have enjoyed the great privilege of facilitating weekly, semester-long narrative medicine workshops and teaching courses in literature and medicine to different groups of healthcare professionals and learners, including family physicians and residents, nurses, medical students, and medical clowns, in various academic institutions in Israel. Like other literary critics who work with caregivers today in Europe, Canada, and the United States, I have benefited from stimulating interaction with the founders of the narrative medicine movement at Columbia University. Most pertinent to my teaching experience and to this discussion is Rita Charon’s model of attention-representation-affiliation, as discussed in chapter seven of her book, Narrative Medicine: Honoring the Stories of Illness.⁶ The model frames every course and individual conference workshop on narrative medicine that I facilitate and serves as a conceptual and pragmatic point of reference that anchors ongoing class exercises in close reading, narrative writing, and learning to respond to participants’ written accounts. While the readings and topics assigned to the classes do change, and the variety of participants and physicians who co-facilitate the workshops undoubtedly shapes the dynamics of and meanings that emerge in each class, we consistently try to fully attend to the demands of the narrative voices and forms by representing experience in writing and by accommodating our resources of autobiographical memory and other categories of emotional and professional affiliation.

Charon’s model is sturdy and sufficiently inclusive to support narrative therapy ideas such as the externalization of dominant [End Page...