Literature and medicine: narrative ethics.

The primary focus of literature’s first decade as part of the formal curriculum of some American medical schools (1972–81) was on teaching literary works to help develop students’ capacity for empathy, to enhance their skills in interpretation, and to complement the teaching of traditional medical ethics. These early concerns of literature and medicine have been discussed in the eight previous essays in this series. In the next decade (1982–91), scholars in literature and medicine, like their counterparts in many other disciplines, were increasingly drawn to the study of narrative. Defined most simply, a narrative is a story. Examples of narratives include not only well-crafted works of literature, such as short stories and novels, but also histories, professional stories such as medical case histories, and unpublished personal or family stories. The second decade of literature-and-medicine scholarship was thus marked by an interest in the centrality of narrative to the work of medicine. Scholars used tools and insights from literary theory to explore the acquisition and transmission of medical knowledge, to study the narrative nature of the physicianpatient encounter, to analyse the conventions of various medical genres, and to consider the relationship between a physician’s narrative skill and a patient’s willingness to accept the diagnosis and comply with recommended treatment. During this second decade, scholars also began to explore more intensely the relation between narrative and medical ethics. These two directions of literature-and-medicine scholarship are now coming together: because of the inherently narrative structure of medical knowledge and practice, doctors’ intellectual skills and habits better prepare them for a kind of narrative ethics than for the analytic, principle-based ethics that has dominated medical ethics for the past 25 years. This principle-based ethics is perhaps best represented by Tom L Beauchamp and James F Childress in their textbook Principles of Biomedical Ethics, now in its fourth edition. In this form of analytic ethics, one begins by establishing certain principles—autonomy, beneficence/