The dramatic essence of the narrative approach

Abstract

Even though it is not a methodology on the level of principlism or casuistry, narrative bioethics nonetheless contributes to and guides decision-making in the field of biomedical ethics. However, unlike other methodologies, the narrative approach lacks a set of specific patterns and formal rules for doing so. This deficiency leaves this approach more vulnerable to the influence of historical factors; in fact, the vital history of a person is made up of thousands of scenes, which one must select and group under different norms. Yet the historicity of narrative does not destroy its normative value; rather, it gives rise to a confluence of stories that contradict one another on the basis of their practical consequences. This problem is less severe in traditional cultures, where some stories take precedence over others according to the normative value conferred through the supposed authority of their sources. But it manifests in an intense manner within current multicultural societies. It is imperative to find the thread that leads outside the labyrinth of subjectivity. This paper shows that the end of this thread lies, paradoxically, not in actions but in the subject-actors that perform them—specifically when such subjects are conceived as dramaturgical characters in narrative.

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References

  1. 1.

    Atienza, Manuel. 2013. Curso de argumentación jurídica. Madrid: Trotta.

    Google Scholar 

  2. 2.

    Seoane, José Antonio. 2010. Las autonomías del paciente. Dilemata 3: 61–75.

    Google Scholar 

  3. 3.

    Frank, Arthur W. 2013. The wounded storyteller: Body, illness, and ethics. 2nd ed. Chicago: University of Chicago Press.

    Google Scholar 

  4. 4.

    Carel, Havi. 2008. Illness: The cry of the flesh. Stocksfield: Acumen.

    Google Scholar 

  5. 5.

    Kidd, Ian James. 2017. Exemplars, ethics, and illness narratives. Theoretical Medicine and Bioethics 38: 323–334.

    Article  Google Scholar 

  6. 6.

    Bosanquet, Simon (prod.), and Mike Nichols (dir.). 2001. Wit. Santa Monica: HBO.

    Google Scholar 

  7. 7.

    Kaufmann, Arthur. 1992. Panorama histórico de los problemas de la filosofía del derecho. In El pensamiento jurídico contemporáneo, ed. Arthur Kaufmann, Winfried Hassemer, and Gregorio Robles, 47–142. Madrid: Debate.

    Google Scholar 

  8. 8.

    Charon, Rita. 1994. Narrative contributions to medical ethics: Recognition, formulation, interpretation, and validation in the practice of the ethicist. In A matter of principles? Ferment in U.S. bioethics, ed. Edwin R. DuBose, Ronald P. Hamel, and Laurence J. O’Connell, 260–283. Valley Forge, PA: Trinity.

    Google Scholar 

  9. 9.

    Hunter, Kathryn Montgomery. 1996. Narrative, literature, and the clinical exercise of practical reason. Journal of Medicine and Philosophy 21: 303–320.

    Article  Google Scholar 

  10. 10.

    Childress, James F. 1997. Narrative(s) versus norm(s): A misplaced debate in bioethics. In Stories and their limits: Narrative approaches to bioethics, ed. Hilde Lindemann Nelson, 252–271. New York: Routledge.

    Google Scholar 

  11. 11.

    Feito, Lydia. 2011. El modelo narrativo como vía de enseñanza de la bioética. In Bioética: El estado de la cuestión, ed. Lydia Feito, Diego Gracia, and Miguel Sánchez, 79–100. Madrid: Triacastela.

    Google Scholar 

  12. 12.

    Burrell, David, and Stanley Hauerwas. 1977. From system to story: An alternative pattern for rationality in ethics. In The foundations of ethics and its relationship to science: Knowledge value and belief, vol. 2, ed. H.Tristam Engelhardt Jr. and Daniel Callahan, 111–152. Philipstown, NY: Hastings Center.

    Google Scholar 

  13. 13.

    Gibson, David. 2015. Toward a postmodern bioethics. Cambridge Quarterly of Healthcare Ethics 24: 175–184.

    Article  Google Scholar 

  14. 14.

    Brody, Howard. 1997. Who gets to tell the story? Narrative in postmodern bioethics. In Stories and their limits: Narrative approaches to bioethics, ed. Hilde Lindemann Nelson, 18–30. New York: Routledge.

    Google Scholar 

  15. 15.

    Brody, Howard. 1999. Narrative ethics and institutional impact. HEC Forum 11: 46–51.

    Article  Google Scholar 

  16. 16.

    Barton, Ansley. 2008. A narrative approach to bioethical decision making: The missing link between bioethics and conflict management? Conflict Resolution Quarterly 25: 497–509.

    Article  Google Scholar 

  17. 17.

    Vergara, Oscar. 2018. Más allá de la retórica: Algunas claves sobre la contribución del enfoque narrativo a la bioética. Dilemata 26: 257–264.

    Google Scholar 

  18. 18.

    Vergara, Oscar. 2016. Principlism and normative systems. In Bioethical decision making and argumentation, ed. Pedro Serna and José-Antonio Seoane, 57–71. Cham: Springer.

    Google Scholar 

  19. 19.

    Pereira-Sáez, Carolina. 2016. Philosophical imperialism? A critical view of North American principlist bioethics. In Bioethical decision making and argumentation, ed. Pedro Serna and José-Antonio Seoane, 43–56. Cham: Springer.

    Google Scholar 

  20. 20.

    Feito Grande, Lydia, and Tomás Domingo Moratalla. 2013. Bioética narrativa. Madrid: Escolar y Mayo.

    Google Scholar 

  21. 21.

    Gracia, Diego. 2011. Teoría y práctica de la deliberación moral. In Bioética: El estado de la cuestión, ed. Lydia Feito, Diego Gracia, and Miguel Sánchez, 101–154. Madrid: Triacastela.

    Google Scholar 

  22. 22.

    Gadamer, Hans-Georg. 2012. Verdad y método. Trans. Ana Agud Aparicio and Rafael de Agapito. Salamanca: Sígueme.

  23. 23.

    Vergara, Oscar. 2017. Hermeneutics and decision making in clinical ethics. Revista Bioética 25: 255–263.

    Article  Google Scholar 

  24. 24.

    Aristotle. 2011. Poética. Trans. Teresa Martínez Manzano and Leonardo Rodríguez Duplá. Madrid: Gredos.

  25. 25.

    Chambers, Tod, and Kathryn Montgomery. 2002. Plot: Framing contingency and choice in bioethics. In Stories matter: The role of narrative in medical ethics, ed. Rita Charon and Martha Montello, 79–87. New York: Routledge.

    Google Scholar 

  26. 26.

    Aristotle. 2000. Retórica. Trans. Quintín Racionero. Madrid: Gredos.

  27. 27.

    Aristotle. 1985. Ética Nicomáquea, Ética Eudemia. Trans. Julio Pallí Bonet. Madrid: Gredos.

  28. 28.

    Behrendt, Kathy. 2017. Narrative aversion: Challenges for the illness narrative advocate. Journal of Medicine and Philosophy 42: 50–69.

    Article  Google Scholar 

  29. 29.

    Carel, Havi. 2012. Phenomenology as a resource for patients. Journal of Medicine and Philosophy 37: 96–113.

    Article  Google Scholar 

  30. 30.

    Spanish Bioethics Committee. 2017. Informe del Comité de Bioética de España sobre los aspectos éticos y jurídicos de la maternidad [Spanish Bioethics Committee report on the ethical and legal aspects of surrogacy]. Madrid: Comité de Bioética de España. http://assets.comitedebioetica.es/files/documentacion/en/spanish_bioethics_committee_report_on_the_ethical_and_legal_aspects_of_surrogacy.pdf. Accessed 20 Sept 2018.

  31. 31.

    Coles, Robert. 1979. Medical ethics and living a life. New England Journal of Medicine 301: 444–446.

    Article  Google Scholar 

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Acknowledgements

I wish to express my gratitude to Katelyn MacDougald for her thorough and excellent job revising the language and bibliography of this article. Her linguistic expertise definitely helped to improve the paper. This work is part of the Research Project “El discurso de los bioderechos. Bases filosóficas y jurídicas para su fundamentación, caracterización y aplicación” (The bio-rights speech. Philosophical and legal basis for its foundation, characterization and application) (DER2014-52811-P), directed by José Antonio Seoane and funded by the Spanish Ministry of Economy and Competitiveness.

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Correspondence to Oscar Vergara.

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Vergara, O. The dramatic essence of the narrative approach. Theor Med Bioeth 39, 361–374 (2018). https://doi.org/10.1007/s11017-018-9466-8

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Keywords

  • Biomedical ethics
  • Narrative approach
  • Methodology
  • Practical reason