Stories Matter : The Role of Narrative in Medical Ethics

Rita Charon, Martha Montello, Londres, Routledge, 2002, 242 p.

Medical ethics is more than a theoretical abstract to be discussed in committees and academic environments. Every human life is at some time affected by this discipline. The collection of essays presented in Stories Matter: The Role of Narrative in Medical Ethics, skillfully edited by Rita Charon, MD, PhD, and Martha Montello, PhD, broadens and deepens the understanding of how medical ethics is interwoven into our lives, through an illustration of the role of narrative in medical care. Readers from all fields — clinicians, ethicists, and anyone associated with providing healthcare — will benefit from this book. Those with no previous experience in medical ethics may also find the text stimulating, although its concepts may be challenging for those without literary and/or clinical background.

Both Charon and Montello are at the forefront of the narrative medicine movement, which advocates that physicians must learn to become close readers of their patients’ stories (or histories) in order to identify and respond effectively to moral and clinical questions posed. Charon, Editor-in-Chief of the journal Literature in Medicine, and Montello, a Professor of History and Philosophy of Medicine at the University of Kansas, bring together 23 bioethicists and literary theorists, such as Howard Brody, MD (Stories of Sickness), and critic Wayne C. Booth, PhD (The Rhetoric of Fiction), each individually recognized as an expert in their area of focus.

By linking their essays in a logical and iilluminating sequence, the editors have produced a text that educates and inspires. While each author makes a unique contribution, they collectively make the case for the importance of the narrative approach to bioethics.

The editors accomplish their goal of guiding readers « toward a cognitive, practical, emotional, and aesthetic familiarity with the conceptual frameworks, methods, and powers of narrative ethics. » (p. x) While the average clinician may find some of the terminology (such as reliability, intersubjectivity, and textuality) and citations unfamiliar, it is well worth the effort to immerse oneself in new territory throughout this text. Many ideas and perspectives are presented that, when incorporated into everyday clinical practice, can change us and our ability to ethically care for patients.

For example, case studies using the narrative ethics approach are presented, aptly illustrating how the concepts work to accomplish the goal of a more complete and accurate consultation. Richard Martinez states, « Narrative methods help us to listen and see with intensified accuracy and reach — a hermeneutic stethoscope of a sort. » (p. 131) This comparison to a common diagnostic tool provides a powerful visual linkage, likely to be understood by all clinicians.

Some of the material is assimilate, such as a section introducing the importance of context, voice, time, character, plot, and reader response in the narrative approach to bioethics. This simple comparison to the basic components of stories is very effective in providing a manageable framework by which we can expand our view and methodology in the consultation process.