The doctor patient relationship starts with a story. Doctors' notes, a patient's chart, the recommendations of ethics committees and insurance justifications all hinge on written and verbal narrative interaction. The "practice" of narrative profoundly affects decision making, patient health and treatment and the everyday practice of medicine. In this edited collection, the contributors provide conceptual foundations, practical guidelines and theoretical considerations central to the practice of narrative ethics.

I have become curious about reciprocity within clinical practice. A vast topic that mobilizes considerations of money, knowledge, kinship, power, culture, and uses of the body, reciprocity is a strong means by which to achieve the egality required of just health care. Within health care, reciprocity might enable not only so‐called shared decision‐making and patient autonomy. It might open the door to mutual acknowledgement of the value of each participant's beliefs and habits. It might appear as a humble realization that (...) no one understands what health is and a concurrent welcoming curiosity about one another's conception of how the body and speech and mind work. From the intimate to the international levels of care, such forms of reciprocity may culminate in the radical and powerful state of reciprocal recognition.In this short essay, I will focus on one aspect of reciprocity in health care: the narrative and potentially reciprocal nature of attention in health care. A critical element in the development of therapeutic alliance, clinical accuracy, and effective practice, attention requires a donation of the self as a vessel into which can enter that which is perceived or, from the other side, a penetrating of that which is perceived so that one sees it from within its own vessel. (shrink)

This essay is composed of five stories written by practicing physicians about their patients. Each clinical story describes a challenging ethical condition–potential abuse of medical power, gravely ill and probably over-treated newborns, iatrogenic narcotic addiction, deceived dying people. Rather than singling out one ethical conflict to resolve or adjudicate, the authors attempt, through literary methods, to grasp the singular experiences of their patients and to act according to the deep structures of their patients' lives. Examining these five stories with simple (...) literary tools–attention to narrative frames, time, plot, and desire–reveals the mechanisms through which acts of writing and reading contribute to clinical clarity and ethical actions. (shrink)

Abstract:Life-writing combines, collates, or colludes many lives into one text. No work of fiction, biography, poetry, drama, memoir, journaling, blogging, or autobiography—all of them life-writing—does not do this, either blatantly or surreptitiously. I am interested in forms in which authors do not own up to writing about themselves under the cover of writing about another. This essay will focus on the implications of this generic collusion in writing in health care. Health care professionals are given space within their professional journals (...) to write personal essays about their work. Typically, these essays include a patient portrait or vignette as a means to probe some aspect of clinical practice. Some, not all, of these journals provide guidelines for protecting the privacy/confidentiality of patients described in the essay, including instructions for how to “fictionalize” patients or families to render them non-identifiable, even to themselves. A clinician-author may adopt this genre to illuminate a moment in practice that bears reflection and provides insight into the world of care. Often, however, the essay’s tenor is the author, and the patient is pressed into service as but the vehicle for that examination. The genre may be adopted to confess an error, to lament a woe (generalizable to all readers), to critique the actions of colleagues or patients, or to boast of a successful clinical intervention. Perhaps these essays are all, or should all, be co-authored “duets” by patient and clinician. (shrink)