Journal of Bioethical Inquiry

, Volume 11, Issue 2, pp 109–112

Government of the People, by the People, for the People: Bioethics, Literature, and Method


DOI: 10.1007/s11673-014-9535-2

Cite this article as:
Ashby, M.A. & Rich, L.E. Bioethical Inquiry (2014) 11: 109. doi:10.1007/s11673-014-9535-2

Why do we listen to songs and watch soap operas, and some of us even try to read poetry? Why do we love stories, joke about serious issues, and listen in on other people’s conversations? Why are we sad when a good book ends and comforted when the travails of a fictional character speak to us? It may be that the reality of life is colder and harsher than we can bear, and when the going gets tough we need to avert our gaze—from our own lives and the despairs of others—and find ways to soften the blows. Illness and suffering pose particular challenges, whether within the intimate dyad of provider and patient or from the perspective of population health and human rights. And when we are faced with the end of life in the practice of palliative care and the study of death (areas surely difficult for the shrinking and flourishing violet alike), it is hard not to be bemused by the modern usage of the terms “passing” or “passing away.” These idioms have increasingly replaced the more direct Anglo-Saxon word “death,” which by contrast perhaps seems to many to be unfeeling, abrasive, and just too “real,” too direct. As La Rochefoucauld emphasized in the 17th century, “[o]ne cannot look directly at either the sun or death” (cited in Slemrod 2003, 371, emphasis removed). American poet T.S. Eliot concurred three centuries later that “human kind/Cannot bear very much reality” (1971, 14). And according to Freudian psychoanalyst Adam Phillips (2012), we are always doing more than one thing at a time, both consciously and often unconsciously, and that other thing is frequently something we are suppressing, something we do not like, or something we think we should not like. Literature is a powerful vehicle for unlocking these hidden rooms.

For the really serious issues of life, and especially death, we tend to go “around the houses,” as an English expression goes, or, as E.M. Forster observed, we learn at a tangent to reality (Forster 1924).

The tangent of literature, and the arts in general, is essential for leading an examined life. We are meaning-making creatures, ever turning the chaos of being into cohesive narratives, straightened, as Aristotle would say, with a beginning, middle, and end (see, e.g., Mattingly 1998). In this way, there is a fine line between fact and fiction, and often it might not matter whether the emplotted lives we engage in and learn from are more factual or fanciful. Stories—our own or others’—allow us to reflect, compare, assess, regret, improve, repair.

Like our lives-as-lived, however, our most helpful tangents might not be recognizable “plotlines” at all, instead pushing or breaking the boundaries of “sense” for the very purpose of bringing clarity or comfort. An Irish psychotherapist, for example, teaches that what clients cannot tell us they will make us feel (Carroll n.d.), and Sigmund Freud (1899) said that in talk we heal. This opens up bioethics as a form of therapy, not perhaps in the personal but in the analytical sense. When faced with difficult issues, we need to work them through, explore them, embark on circular journeys that return us to the place where we began (hopefully enriched by the process). As T.S. Eliot’s famous lines from “Little Gidding” exhort:

We shall not cease from exploration

And the end of all our exploring

Will be to arrive where we started

And know the place for the first time (Eliot 1971, 47).

Eliot’s lines seem to do a number of things that prose cannot: They have rhythm, they condense, and by elision move quickly across idea spaces, the sense of life captured in a couplet, just as Mahler said his symphonies embraced the whole world (Wright 2014, 314).

Australian poet Peter Porter shows us how to compress and embrace everything in one verse:

When all the lives which ever were or ever will be

are trimmed like stone and share

stone’s magical inertness

winds will still lament the strangeness

which was life and silence look to find

its birthplace in an allegoric music (Porter 2010, 324).

Surely the power of poetry to convey high moral purpose is seen nowhere more powerfully than in the Gettysburg Address. A remarkable website (see now encourages presidents, prominent people, actors, and ordinary citizens to record their version of Lincoln’s immortal words, a living use of poetical rhetoric to inculcate national purpose and moral rectitude, viz.,

that we here highly resolve these dead shall not have died in vain; that the nation, shall have a new birth of freedom, and that government of the people, by the people, for the people, shall not perish from the earth

(Lincoln 1863, 4).

In fact, Abraham Lincoln was apparently well known for telling stories that sometimes baffled his listeners as to their purpose and/or meaning. It seems likely that this style of what might be described as parable exposition (he lived in an age of strongly embedded biblical and classical knowledge), often using stories from his own experiences and ordinary American life of the time, was a way of imparting ideas and dispositions and dealing with difference and politically sensitive issues. It might also be a way of demonstrating morality in everyday life, of highlighting healthy folk wisdom. (After all, as many philosophers have long argued, we are each capable, though unique in our individual and social lives, of moral engagement and development.) This way of making a point is also well developed in religious culture (very much, for example, in the Jewish rabbinical tradition).

Contemporary English language within the Anglo-Saxon lineage, on the other hand, is very direct and spare, privileging “getting to the point” and not taking detours along the way. “Saying what you mean” is prized and ambiguity is to be avoided. Even other European language cultures are historically less candid and will couch points in softening and courteous deference to the audience or listener (for example, compare an English and a Spanish job inquiry letter!). Rather than efficiency and understanding, the “direct” approach quashes the contributions an audience or listener provides—whether he or she ever utters a word—as an active co-constructor of meaning (Griffin 2003; Mattingly 1998). It also undermines the power of ambiguity, which might be problematic when determining safe medicinal dosages or whether a meal contains a potentially life-threatening allergen but in other instances can return us to beginnings and allow us to “know the place for the first time.”

Like the direct approach, the Western bioethics literature inhabits the land of the logical-positive, the empirical and the scientific in the modern understandings of these words. Even if a bioethics scholar is not “empirical” in methodological orientation, the tradition is one of pure logic, rules of argumentation, and linear thinking. In fact, for some, bioethics is no subject at all, due to its failure to be soundly rooted methodologically in science (Baron 2006; Harris 2010). It is not that one cannot talk about bioethical issues; it is that authority is derived from facts garnered by strict academic rules, in which object has to prevail over mere anecdote. And, yet, venturing even to continental Europe and to almost any other part of the world where civilizations do things differently, narrative, speculation, and intuition are often given greater credence. In continental bioethics a more impressionistic style prevails (even if the Vienna school is indeed from very “continental” Vienna!).1 Seen at times as a weakness of many (if not most) non-Anglo-Saxon traditions, even by these very cultures themselves, it is not uncommon to find a speculative end to an argument—in French, for example, marked by a series of continuation or suspense-indicating dots. This dot-dot ending would be unthinkable for Anglo-Saxon writers. Elsewhere one can also speculate and “float” ideas, building whole “projects” without being shot down (before even airborne) due to absence of justification or evidence. The rules of engagement for bioethical discourse in these settings are quite different and may be rejected by Western rules of academic rigor, to the consternation of authors and the embarrassment of editors who espouse a global conversation but reject work that is not written according to “house policies.”

Ethics stripped bare of emotion, doubt, anecdote, and narrative context is a dull prospect indeed, but if we urge people to work with head-hands-heart and mind-body-spirit as an ethical imperative to engage the whole being and all realms of human endeavor, and seek thereby a kinder, more just, and beautiful world, it seems that literary reflection and aesthetic are necessary ingredients.

Even in the province of spiritual and religious belief reduction is in the ascendant. Radical atheist arguments are now popular by authors such as A.C. Grayling (2013) and Richard Dawkins (2006). The logic is usually impeccable, the arguments persuasive, and the impact for all (except the most ardent believer) unsettling at the very least. But the emptiness of the reduced worldview that is left when the religious and spiritual are intellectually demolished can be alienating and … too cold, harsh, and … real! Just as Jean-Paul Sartre and his fellow travelers have left us with stark responsibility for ourselves, and accusations of bad faith if we refuse, so Grayling and Dawkins leave us no solace and no vehicle for self-transcendence. Perhaps that is what we truly have to deal with, but it is still often fictional existentialist texts that convey this stark message—and fictional texts to which we are more apt to listen.

From literature we seek story above all, but also nuance, example, and fellow traveler “same-boat” comfort: We read so as not to feel alone. In literature we see the world mirrored but perhaps also often a bit remodeled into something in which we can find respite and hope. Where else can this be attained? By and large analytical philosophers tell us that, unlike Alain de Botton, there are no consolations for us in philosophy—so much so that an analytic philosopher actually remarked to one of us that he tried thinking of his children as biological machines and “failed”! If we try to analyze beauty in the cinema solely by studying the practice of digital imaging the result will be no less than disappointment. We might become experts in one particular technique but surely we will not have seen (or enjoyed or contemplated) the bigger picture. Why should we limit ourselves in any other investigation, including bioethics discourse? As English philosopher, writer, broadcaster, and former Member of Parliament Bryan Magee (1997) has explained, he abandoned Oxford and logical positivism in favor of Yale, as the language of philosophy had made it impossible to say anything of significance about what interested a young student in the 1940s who wanted to explore politics, music, art, and love.

Across the pond, Canadian academic, politician, and writer Michael Ignatieff (2000) also has spoken of a writer’s covenant with his or her readers: The writer sets down the truth as it seems to him and then asks the reader, “Is it true for you?” Rather than attempt to pre-judge and mold material presented in the academic bioethics space, particularly through peer review, to fit the rules of scientific evidence, it is more productive—and maybe more inspiring and illuminating—to have a deep and wide “open access” approach that allows many genres to address the same issue. The onus is then on readers to decide for themselves “what is true for them,” enabling not only a proliferation of voices and an expansion of dialogue but also an active responsibility in the creation and preservation and improvement of knowledge. This sort of multidisciplinary “360-degree” assessment, much as is the case in the traditions established here at the JBI, is also perhaps in line with the better potential longer-term consequences of the present revolution in publishing: online, openly accessible, and inherently more “democratic.” Like many of our counterparts, we aspire to be a global journal but struggle ourselves to incorporate styles and cultures different from our own due to the rules of the Western academy: intellectual provincialism despite the best of geographical, interdisciplinary, and egalitarian intentions.

We are, however, hopeful, and this issue of the Journal of Bioethical Inquiry offers a small step toward that goal: explorations of the self, duty, hypochondria, hospitals, healing, and human dignity in literature from different eras and locales as well as critical perspectives and even poetry.

In doing so, we “arrive where we started.” In every culture, people, whether family or foreigners, have gathered around tables and fires to feed the body and the imagination through supper and story. Poetry and prose can loosen us up, opening ourselves to new perspectives and ideas. Maybe they can teach us how to be truly global in our bioethics as well? To be sure, there are still horses for courses, methodologies for specific problems: randomized controlled trials for the evaluation of new drugs and certainly “Gettysburgs” for events that go deep to a nation’s soul in grief and high principle.

That said, what some may deem beyond the bounds of “proper” practice and “appropriate” subject matter can in fact reveal not merely the heart of matters but the “magical strangeness” of being, as The Telegraph’s obituary of Gabriel García Márquez explains:

In the course of his life he also frequently repeated his belief that the essential problem for any Latin American novelist was to get across the fact that the magical strangeness emerging from the continent’s fiction was not highly fantastical but a true reflection of the Latin American experience

(The Telegraph 2014, 5).


The Vienna Circle was a group of mathematically inclined intellectuals originating in Vienna during the inter-war years whose influence spread to Oxford University via A.J. Ayer (1936) just before and after World War II. These scholars put forward a manifesto entitled “Wissenschaftliche Weltauffassung” (“A Scientific World-View”). This led to the dominance of logical positivism in which Magee (1997) suggests that philosophy at Oxford at the time paralyzed itself by insisting on linguistic analysis and scientific verification of all statements.


Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Palliative Care Service, Royal Hobart Hospital, Southern Tasmania Area Health Service, and School of Medicine, Faculty of Health SciencesUniversity of TasmaniaHobartAustralia
  2. 2.Department of Health Sciences (Public Health)Armstrong Atlantic State UniversitySavannahUSA