Centre of Genomics and Policy, 740 Dr Penfield Ave, Room 5206, Montreal, Quebec, H3A 0G1, Canada.
J Bioeth Inq. 2020 Jun;17(2):297-308. doi: 10.1007/s11673-020-09973-y. Epub 2020 Mar 16.
Narrative ethics taps into an inherent human need to tell our own stories centred on our own moral values and to have those stories heard and acknowledged. However, not everyone's words are afforded equal power. The use of narrative ethics in bioethical decision-making is problematized by a disparity in whose stories are told, whose stories are heard, and whose stories are believed. Here, I conduct an analysis of narrative ethics through a critical theory lens to show how entrenched patterns of narrative neglect in medicine are harming not only our capacity to make use of narrative ethics but also our capacity to deliver effective healthcare. To illustrate this point, I use three examples where the patient's gender affects how their stories unfold: autism, weight, and pain management. From these, I argue that the use of narrative ethics without the application of a critical theory lens risks the exacerbation of what Miranda Fricker refers to as "testimonial injustice," the prima facie harm experienced by individuals whose credibility is undermined by others' prejudices. Finally, I suggest that narrative ethics can be a powerful tool for mitigating oppressive practices in medicine if we couple it with critical analysis that enables us to understand the power dynamics at play in storytelling.
叙事伦理学利用了人类讲述以自身道德价值观为中心的故事的内在需求，并让这些故事被倾听和认可。然而，并不是每个人的话语都具有同等的力量。叙事伦理学在生命伦理学决策中的应用存在问题，因为存在讲述谁的故事、倾听谁的故事以及相信谁的故事的不平等。在这里，我通过批判理论的视角对叙事伦理学进行分析，展示医学中根深蒂固的叙事忽视模式是如何不仅损害我们利用叙事伦理学的能力，也损害我们提供有效医疗保健的能力。为了说明这一点，我使用了三个例子，其中患者的性别会影响他们的故事展开方式：自闭症、体重和疼痛管理。从中，我认为，如果不应用批判理论视角，叙事伦理学的应用可能会加剧米兰达·弗里克（Miranda Fricker）所说的“证言不公正”，即那些因他人偏见而信誉受损的个人所经历的表面伤害。最后，我认为，如果我们将叙事伦理学与批判性分析相结合，使我们能够理解讲故事中发挥作用的权力动态，那么它可以成为减轻医学中压迫性实践的有力工具。
