The doctor patient relationship starts with a story. Doctors' notes, a patient's chart, the recommendations of ethics committees and insurance justifications all hinge on written and verbal narrative interaction. The "practice" of narrative profoundly affects decision making, patient health and treatment and the everyday practice of medicine. In this edited collection, the contributors provide conceptual foundations, practical guidelines and theoretical considerations central to the practice of narrative ethics.

I have become curious about reciprocity within clinical practice. A vast topic that mobilizes considerations of money, knowledge, kinship, power, culture, and uses of the body, reciprocity is a strong means by which to achieve the egality required of just health care. Within health care, reciprocity might enable not only so‐called shared decision‐making and patient autonomy. It might open the door to mutual acknowledgement of the value of each participant's beliefs and habits. It might appear as a humble realization that (...) no one understands what health is and a concurrent welcoming curiosity about one another's conception of how the body and speech and mind work. From the intimate to the international levels of care, such forms of reciprocity may culminate in the radical and powerful state of reciprocal recognition.In this short essay, I will focus on one aspect of reciprocity in health care: the narrative and potentially reciprocal nature of attention in health care. A critical element in the development of therapeutic alliance, clinical accuracy, and effective practice, attention requires a donation of the self as a vessel into which can enter that which is perceived or, from the other side, a penetrating of that which is perceived so that one sees it from within its own vessel. (shrink)

Abstract:Life-writing combines, collates, or colludes many lives into one text. No work of fiction, biography, poetry, drama, memoir, journaling, blogging, or autobiography—all of them life-writing—does not do this, either blatantly or surreptitiously. I am interested in forms in which authors do not own up to writing about themselves under the cover of writing about another. This essay will focus on the implications of this generic collusion in writing in health care. Health care professionals are given space within their professional journals (...) to write personal essays about their work. Typically, these essays include a patient portrait or vignette as a means to probe some aspect of clinical practice. Some, not all, of these journals provide guidelines for protecting the privacy/confidentiality of patients described in the essay, including instructions for how to “fictionalize” patients or families to render them non-identifiable, even to themselves. A clinician-author may adopt this genre to illuminate a moment in practice that bears reflection and provides insight into the world of care. Often, however, the essay’s tenor is the author, and the patient is pressed into service as but the vehicle for that examination. The genre may be adopted to confess an error, to lament a woe (generalizable to all readers), to critique the actions of colleagues or patients, or to boast of a successful clinical intervention. Perhaps these essays are all, or should all, be co-authored “duets” by patient and clinician. (shrink)

If our sense of the past is inevitably shaped by the explanatory logic of narrative, then the stories that we create in turn reveal the inescapable presence and ...

In Rita Charon's account of narrative medicine, empathy seems to be an essential element of the clinical relationship. However, empathy has not received much attention, which I believe is problematic. First, I show that not only is there no clear definition of what empathy is, but that this conceptual gap creates ambiguity about its role in the practice of narrative medicine. Second, I argue that certain passages in Charon's work seem to implicitly characterize empathy as a combination (...) of cognitive empathy, affective empathy, and sympathy, and that its inclusion in the practice of narrative medicine can be problematic. Third, following Dan Zahavi, I argue that a phenomenological account of empathy not only seems most compatible with the practices, values, and theoretical framework of narrative medicine, but is also capable of resolving the problems posed by alternative definitions of empathy and the ambiguity about the role of empathy in narrative medicine. (shrink)

Across two studies, a wide age range of participants was interviewed about the nature of death. All participants were living in rural Madagascar in a community where ancestral beliefs and practices are widespread. In Study 1, children (8–17 years) and adults (19–71 years) were asked whether bodily and mental processes continue after death. The death in question was presented in the context of a narrative that focused either on the corpse or on the ancestral practices associated with the afterlife. Participants (...) aged 8 years and older claimed that death brings an end to most bodily and mental processes. Nevertheless, particularly in the context of the religious narrative, they claimed that certain mental processes continue even after death. This assertion of an afterlife was more evident among adults than children, especially with respect to cognitive processes, such as knowing and remembering. In Study 2, 5‐ and 7‐year‐olds were asked similar questions in connection with the death of a bird and a person. Seven‐year‐olds consistently claimed that bodily and mental processes cease at death, whereas 5‐year‐olds were unsystematic in their replies. Together, the two studies replicate and extend findings obtained with Western children showing that, in the course of development, different conceptions of death are elaborated—a biological conception in which death terminates living processes and a religious conception in which death marks the beginning of a new form of spiritual existence. (shrink)

The purpose of this study was to illuminate the ethically difficult situations experienced by care providers working in a nursing home. Individual interviews using a narrative approach were conducted. A phenomenological-hermeneutic method developed for researching life experience was applied in the analysis. The findings showed that care providers experience ethical challenges in their everyday work. The informants in this study found the balance between the ideal, autonomy and dignity to be a daily problem. They defined the culture they work in (...) as not supportive. They also thought they were not being seen and heard in situations where they disagree with the basic values of the organization. The results are discussed in terms of Habermas’s understanding of modern society. Care settings for elderly people obviously present ethical challenges, particularly in the case of those suffering from dementia. The care provider participants in this study expressed frustration and feelings of powerlessness. It is possible to understand their experiences in terms of Habermas’s theory of modern society and the concept of the system’s colonization of the life world. (shrink)

How do René Girard’s theories apply to a context of double colonization? Through a new interpretation of Alexis Wright’s novel Plains of Promise, this paper aims to show the crosscultural relevance of mimetic theory. The study will highlight the way in which the scapegoat mechanism is represented in the Australian colonial context. It also offers a Girardian analysis of the predicament of female characters of Aboriginal descent who are victims of sexual violence.

Anthropology combines two quite different enterprises: the ethnographic study of particular people in particular places and the theorizing about the human species. As such, anthropology is part of cognitive science in that it contributes to the unitary theoretical aim of understanding and explaining the behavior of the animal species Homo sapiens. This article draws on our own research experience to illustrate that cooperation between anthropology and the other sub-disciplines of cognitive science is possible and fruitful, but it must proceed from (...) the recognition of anthropology’s unique epistemology and methodology. (shrink)

This essay is composed of five stories written by practicing physicians about their patients. Each clinical story describes a challenging ethical condition–potential abuse of medical power, gravely ill and probably over-treated newborns, iatrogenic narcotic addiction, deceived dying people. Rather than singling out one ethical conflict to resolve or adjudicate, the authors attempt, through literary methods, to grasp the singular experiences of their patients and to act according to the deep structures of their patients' lives. Examining these five stories with simple (...) literary tools–attention to narrative frames, time, plot, and desire–reveals the mechanisms through which acts of writing and reading contribute to clinical clarity and ethical actions. (shrink)

In written and spoken communications, metaphors are often used as an aid to help convey abstract or less tangible concepts. However, the benefits of using visual metaphors in visualization have so far been inconclusive. In this work, we report an empirical study to evaluate hypotheses that visual metaphors may aid memorization, visual search and concept comprehension. One major departure from previous metaphor-related experiments in the literature is that we make use of a dual-task methodology in our experiment. This design offers (...) an abstraction of typical situations where viewers do not have their full attention focused on visualization (e.g., in meetings and classes). The use of the secondary task introduces “divided attention”, and makes the effects of visual metaphors more observable. In addition, it also serves as additional masking in memory-based trials. The results of this study show that visual metaphors can help participants better remember the information depicted in visualization. On the other hand, visual metaphors can have a negative impact on the speed of visual search. The results also show a complex pattern as to the benefits of visual metaphors in helping participants grasp key concepts from visualization. (shrink)

La notion d'audience n'apparaît que dans les années cinquante pour la presse écrite, soit tardivement. La méthodologie mise en oeuvre butte sur le nombre de titres, la diversité des situations de lecture, l'obligation de faire appel à la mémoire du lecteur. Les enquêtes s'opèrent par questionnaires sur de très vastes échantillons. L'amélioration de la procédure a permis d'élargir le champ des questions couvertes, d'accélérer et lisser les conditions de collecte, mais le nombre de titres étudiés reste forcément restreint, nécessairement limité (...) aux plus grosses diffusions . Il est significatif que les divisions entre quotidiens et magazines se soient manifestées très tôt sur l'étude d'audience, chaque forme de presse réalisant la sienne.The notion of readership did not appear in the Press until the 1950s which is very recently indeed! The methodology used has to deal with the large number of titles, a wide range of reading contexts and the need to appeal to the readers' memories. Surveys are carried out through questionnaires based on a wide range of samples. The improvement of this process has enabled us to extend the field of questions covered and speed up and improve data collection but the number of titles under study inevitably remains limited, and indeed tends to cover only those titles with the largest readership . It is important to note that since many publishers carry out their own readership surveys early in the life of a title, this has meant the division between daily papers and magazines also appeared very early. (shrink)