Narrative, Literature, and the Clinical Exercise of Practical Reason
Hunter, Kathryn Montgomery
Journal of Medicine and Philosophy. 1996 Jun; 21(3): 303-320.
Although science supplies medicine's "gold standard," knowledge exercised in the care of patients is, like moral knowing, a matter of narrative, practical reason. Physicians draw on case narrative to store experience and to apply and qualify the general rules of medical science. Literature aids in this activity by stimulating moral imagination and by requiring its readers to engage in a retrospective construction of a situated, subjective account of events. Narrative truths are provisional, uncertain, derived from narrators whose standpoints are always situated, particular, and uncertain, but open to comparison and reinterpretation. Reading is thus a model for knowing in both morality and clinical medicine. While principals remain essential to bioethics and science must always inform good clinical practice, the tendency to collapse morality into principles and medicine into science impoverishes both practices. Moral knowing is not separable from clinical judgment. While ethics must be open to discussion and interpretation by patients, family, and society, it is nevertheless substantively and epistemologically an inextricable part of a physician's clinical practice.
Aids; Bioethics; Case Studies; Communication; Decision Making; Diagnosis; Education; Ethics; Humanities; Interdisciplinary Communication; Knowledge; Literature; Medical Education; Medical Ethics; Medicine; Methods; Moral Policy; Morality; Patient Care; Patients; Philosophy; Physicians; Science; Technical Expertise; Uncertainty;
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