Lanphier Elizabeth
Perspect Biol Med. 2021;64(2):211-234. doi: 10.1353/pbm.2021.0013.
Narrative is now a commonly used term in medical education, ethics, and practice. Yet the concept of narrative defies singular definition, and definitional and functional pluralism about narrative in health care remains underappreciated. Diverse conceptualizations of narrative are generically grouped under umbrella terms like "medical humanities" or "narrative medicine." Such broad grouping risks undermining attention to relevant differences in use, meaning, or theory of narrative, overestimating the scope of certain criticisms of narrative practice or use, while overlooking more insidious concerns. This essay moves toward a conceptual clarification of narrative in medicine through a process of naming and sorting. Narrative conceptualizations are grouped into narrative premises which include descriptive and normative claims about narrative, and narrative practices, which put narrative into action as process, method, or tool. A philosophical pragmatist approach to narrative in medicine reworks narrative anxieties about fact and fiction, truth or falsehood, in terms of the justifiability of belief, the inclusion or exclusion of experience, and the rationality of practices that are never perfect and always up for revision.
叙事如今是医学教育、伦理学及实践中常用的术语。然而，叙事的概念难以给出单一的定义，而且医疗保健领域中叙事的定义和功能的多元性仍未得到充分认识。叙事的各种概念化表述通常被笼统地归类在“医学人文学科”或“叙事医学”等总括性术语之下。这种宽泛的归类可能会削弱对叙事在使用、意义或理论方面相关差异的关注，高估对叙事实践或用途某些批评的范围，同时忽视更隐蔽的问题。本文通过命名和分类的过程，朝着对医学叙事进行概念澄清的方向迈进。叙事的概念化表述被分为叙事前提，其中包括关于叙事的描述性和规范性主张，以及叙事实践，即将叙事作为过程、方法或工具付诸行动。一种关于医学叙事的哲学实用主义方法，从信念的合理性、经验的纳入或排除以及永远不完美且总是有待修正的实践的合理性等方面，重新审视了关于事实与虚构、真理与谬误的叙事焦虑。
