Abstract

In this dissertation, I draw on my experiences at the bedside of dying patients to explore how narratives and narrative methods are used in medicine and bioethics. Humanities in medicine programs have advocated the use of narratives in medical education, but significant problems arise when attempting to integrate narrative ways of knowing into the traditional epistemological frameworks of medicine and bioethics. Exploring these epistemological discrepancies yields new possibilities for using narrative in medicine and bioethics. ;Before outlining an alternative approach to narrative, I clarify the meanings of the terms story and narrative in relation to their uses in medicine and bioethics. I then explore the infiltration of narrative into medicine through humanities in medicine programs and argue that an amplified conception of narrative, extending beyond a traditional novel-centered understanding, is necessary to recognize narrative's many uses in medicine and bioethics. Fluid definitions of story and narrative make it difficult to understand what sources of knowledge narratives attempt to reveal or express. The disjunction between the stated goals of using narratives in medicine, which rely on narrative ways of knowing, and current pedagogical methods for teaching the use of narratives, which draw on traditional epistemologies, raises serious questions for the emerging area of "narrative medicine." I suggest the metaphor of the koan as a new way of knowing that deepens our understanding of how narratives can function in medical encounters. Instead of examining narratives according to the quality of their expression, I suggest that we understand narratives as a medium of encounter wherein we come to see our responsibilities to the person before us. By risking the encounter with another person in listening to their narrative, we open ourselves to new ways of seeing the other. With this new sight, we can know more about our responsibilities and with this knowledge assess what we can do. This dissertation is an effort to redirect the ways that narrative is used in medicine and bioethics to avoid some of the limits that narrow understandings of narrative impose on what we can see and know about our responsibilities to other people