Jordens Christopher F C, Little Miles
Centre for Values, Ethics and the Law in Medicine, Blackburn Building (D06), University of Sydney, NSW 2006, Australia.
Soc Sci Med. 2004 May;58(9):1635-45. doi: 10.1016/S0277-9536(03)00370-8.
Narrative analysis has been applied by health researchers to investigate (among other things) clinical reasoning, clinical ethics and human identity. The term 'narrative' is often used as a broad category that covers a variety of spoken genres, however, and it thereby lacks delicacy as an analytic tool. We introduce genre theory, which enables us to differentiate more clearly between story genres and other spoken genres. We then apply the theory to ten narrative-style interviews with clinicians involved in the treatment and management of colorectal cancer in Sydney, Australia. We characterise the narrative-style interview as a macro-genre, and draw attention to the occurrence of spoken genres other than stories. We focus our analysis on a policy genre that occurred naturally and frequently in the spoken discourse of the informants, but which has not been described before in either the literature of social linguistics or the health and medical literature. We analyse two examples of this genre in detail in order to characterise its main semantic features, and differentiate it from story genres. We then discuss the genre with reference to Aristotelian interpretations of ethical reasoning in the clinic. We conclude that the policy genre is both the unfolding of practical wisdom in speech, and the appropriate choice of genre where a display of ethical identity is called for. Finally, we discuss the implications of our findings for ongoing research, for ethics education, for bioethical theory, and for communication between some of the different stakeholder groups in clinical medicine.
健康领域的研究人员运用叙事分析来探究（包括但不限于）临床推理、临床伦理和人类身份认同。然而，“叙事”一词常被用作一个宽泛的类别，涵盖了各种口语体裁，因此作为一种分析工具，它缺乏精确性。我们引入体裁理论，这使我们能够更清晰地区分故事体裁和其他口语体裁。然后，我们将该理论应用于对澳大利亚悉尼参与结直肠癌治疗与管理的临床医生进行的十次叙事风格访谈。我们将叙事风格访谈界定为一种宏观体裁，并提请注意故事之外的其他口语体裁的出现。我们将分析重点放在一种在受访者的口语话语中自然且频繁出现，但在社会语言学文献或健康与医学文献中均未被描述过的政策体裁上。我们详细分析了这种体裁的两个例子，以刻画其主要语义特征，并将其与故事体裁区分开来。然后，我们参照亚里士多德对临床伦理推理的阐释来讨论这种体裁。我们得出结论，政策体裁既是实践智慧在言语中的展现，也是在需要展现伦理身份时体裁的恰当选择。最后，我们讨论了研究结果对正在进行的研究、伦理教育、生物伦理理论以及临床医学中一些不同利益相关群体之间沟通的影响。
