Imagination, literature, medical ethics and medical practice.

Without imagination-without an actively cultivated imagination-not only do health care workers themselves suffer, but so too do their patients, argues Dr Anne Scott in this issue of the journal.' 2 Why? Because only by being able to imagine what it is like to be the other person, the patient, only by being able to enter imaginatively into the world of the patient, is the health care professional able properly to consider the particular situation of the individual patient and the likely implications for that patient in that situation of alternative options. But, argues Dr Scott, a nurse and philosopher who teaches nurses ethics, the moral imagination has to be stimulated, cultivated, educated, nurtured and developed. One valuable way of doing all this is "through the use of the humanities, perhaps particularly the serious reading of literature, especially certain types of novel". In an age of ever-increasing identification of medicine with science, of increasing appeal to "evidence-based medicine" where the paradigm of "evidence" is the statistically valid result of a well-performed randomised controlled clinical trial, the modern scientific doctor might scornfully riposte that the study of literature as a valid part of medical education (and indeed of contemporary nursing education) is a retrogressive move back to the realm of the "anecdote" or the individual case history, and as such a betrayal of the scientific nature of medicine. Similarly, and paradoxically, the contemporary moral philosopher, even one involved in medical ethics, may also react with scoM to the proposal that stimulation of the imagination by reading literature can play much of a part in the pursuit of medical ethics. Ethics as a component of philosophy requires development of rigorous powers of reasoning, of argument and counterargument; individual cases as manifested either in real life or in literature may provide the grist for the mill of philosophical reasoning, but their importance for medical ethics is as stimuli for reasoning and argument, as testbeds for moral hypotheses. Both positions, it will be argued briefly, are based upon false antitheses; neither the scientific component of medicine nor the reasoning and argument of philosophical medical ethics are incompatible with the development of imagination through the reading of literature; rather, both are complemented by it, and it by them. First, medical science. If it is agreed that the primary function of medical science is to make medical practice better, by improving our existing ways of helping people-especially, …