Dr. Roberto Llanos Zuloaga, Clinic Ricardo Palma, Ave. Javier Prado Este 1038, Lima 27, PERU
The narrative ethics turns the case in stories told by different protagonists (point of view of patient, doctor, family), to know the most intimate particularities of the persons in the stories and their interactions, in order to know what happens and what should be done. This line is the opposite of the traditional line based on universal applications.
DEVELOPMENT OF THE CONCEPTS OF NARRATIVE ETHICS
JURGEN HABERMAS has dedicated special attention to the communicational
ethics. The “pragmatic linguistic” is
The use of the language as an instrument of interaction that looks for the moral consensus (2). Some conclusions would be:
1) Every affirmation can be questioned.
2) Each participant can express his desires; needs and points of view, there are no prejudices.
3) Each reader(?) has free rights for every imposition or restriction, there are no discriminations. (2)
RAWLS has also given some postulates(?) in the communication
1) If the communications is understandable, true, sincerely and right, the communicative interaction will occur with respect and will be ethically irreproachable.
2) The ideal communicative discourse(?) should be democratic, and free of dogmas, censures, prejudices and discriminations.
HOLLENWEGER, gives an example of narration related with the new and
Old Testament in his book about “Ephesus”, one of his stories tells about
the dialog between PRISKA and MIRJAI, where PRISKA says:
“Just my son Akila answers: “which are the bases of your argumentation about your beliefs”? to which Mirja says: “Which arguments to you have to demonstrate that you are the son of your mother?, “Which arguments do you have?, none, for the over understandable(?) you don’t need arguments, we only need arguments for the words that could be right or wrong”. (3)
HOLLENWEGER says that the best comprehension of the narrative will be
produced if the group dramatizes it, it is not necessary a really theater
scenario, better were the reading of the narration, the advantages for
the motivation are. The acoustic and visual experience. It will be better
if in the discussion after the narration, the actor begins his identification
with his role played, in this moment begins the dialogue and the dramatization
will be serious, without to be a dramatic play.(3)
The Ethic in general works with the good, the correct and the bad, also the incorrect in the human action- the applied ethics, in the same way, works with the relevance’s questions for the people and the mankind. The Bioethics focal the ethic reflexion about the lives phenomena.(4).
The history of the ethics thought in the last third of the XX century is characterized because the grown interest in the solution of the individual and collective problems, who from day to day makes the people and the mankind troubles. Phenomena as the destruction of the forest make the people and the countries trouble, it is the same interest of the quality of life by the anencephaly children, the moral behavior against a terminal patient. All this cases have to do with correct or incorrect behavior, with the good and the bad . That is the way of the applied ethics.(4).
The applied ethics works with relevant questions for the people and the mankind. An idea is ethically relevant when is accepted by the majority of the human been . SINGER says: a very important part of the normative ethics belongs the applied ethics, which works with practically ideas, for example abortion, euthanasia etc.(5),
The applied ethics is a result of the occidental philosophy of the last decades and the expression of the ethics thought of the XX century.
Hegemonies are generally grounded on the predominance of a partial trait and on the absolutization of a particular standpoint. Nowadays, to traditional differences in race and geography, those ones due to knowledge and learning based communities must be added. Having knowledge, is a particular way of participating, thought which group members are recognized in the signals and symbols they exchange, getting identified and obeying them. Dialectic and non-dialectic codification of knowledge, its objects of exchange (ideas, inventions, devices, concepts, beliefs) is a mingling together of sensory, emotional, and volitional experiences. When knowledge grounds on data and pieces of information it gives place to a social practice that formalizes the former and the latter conferring them a social interest or finality (6).
In modern and contemporary age, groups based on the sharing of knowledge can be added to previous ones due to race, religious belief or geographical location. It may be stated that a modern professional, as the exponent of an expertise-based grouping, has got a greater community of interests with a professional alike, thousands of kilometers away, than with his very neighbor (6).
COMPARACION ENTRE ETICA APLICADA Y ETICA NARRATIVA
Perhaps the appearance of the bioethical discourse may be seen under the guise of a reaction against of the unilateral expansion of technological mentality. Science crisis was faced with new forms of science or a novel gazing upon the praxis of thinking, for instance phenomenology, existentialism, the extreme certitudes of metaphysical positivism in the behavioral sciences and the unfolding of uncertainty and probability as the basis of scientific thinking. Medicine itself, as social practice was brought to trial for its imperfect breakthroughs and progressive technology, replied by adding new dimensions to its task. Thus, psychoanalytic and psychosomatic thinking, the social sciences, and the social perspective were added to academic medicine as an inner – born response stemming from the very discipline, as an attempt of rebuilding itself. In the short run, those efforts had been neutralized by the principal current of technocratic outgrowth. Social scientists were absorbed by the institution and their critical potentialities were neutralized, psychoanalysis adopted the cosmetic rhetoric of technique and empiric research as a way of gaining validity in the context of the legitimate knowledge, the psychoanalytic movement became another specialty and the biopsychosocial was adopted as a rhetorical device bound to insinuate a lot, but achieving quite little in the praxis of the curing trade.
What nowadays we refer to as bioethics was initially no more than a movement, a trend toward the correction of developments that imprecisely troubled conscience. Scientific and medical experimentation under major European totalitarianisms, the invention of lifesaving devices and procedures not accessible to the great majorities, the stretching of social demands to new or different groups and ages posed dilemmas already unmanageable within the same sciences and techniques, or even from traditional philosophic reflection.
An authentic discomfort in the culture is codified in bioethics. Not the one of a sentimental type as alluded to by some religious traditions and by no means merely grounded on appeals to the trace dent. Rather the result of a plurality of visions and conceptions of the world, not only cultural, economical or values related,
In the literature, the ethics resides in the moral quality of a character, a story, perhaps the relation between author and reader. In Bioethics, the ethical consequences of telling stories and fictionalizing character, and the reciprocal claims binding teller, listener, witness, and reader in the process(7).
Narrative Ethics is a powerful experience. This alternative way of thinking-and living- has its roots in the work of the Jewish philosopher Emmanuel Levinas and finds support in the writing of Milchail Bakhtin and Stanley Cavell.
There are key questions about what do we gain-and what dangers do we run when we fully enter the life of an other through that others story ¿. ADAM NEWTON asks what it is to turn one’s life into a story for another, and what it is to respond to, or avoid the claim of, another person narration(7),
The medical axes history is a prevent tool for approaching the question what is wrong with this person¿. Its virtues, however can become vices, in part as a consequence of the dehumanizing flight from sensitive subjectivity to sanitized objectivity, from human interest to science . The case history, because it is so useful and effective, is not likely to be profoundly altered in the future, but medical educators can make themselves and their students more aware of the serious flaw in this form of discourse, i.e., The erasure of the unique individual from his or her disease. The exercise of asking medical plays or operas, might heighten students recognition of the poverty of the medical case history. To illustrate this idea, the story of Eva, a dying woman is presented by SOBEL (8) initially as a typical medical case history; it is thorn contrasted with excerpts from a novelist’s narrative of Eva’s life.
Literature and medicine is a flourishing sub discipline of literary studies that examines the many relations between literary acts and texts and medical acts and texts. CHARON examines the historical connections between these two fields and suggests that the growth and decline in medicine’s attentiveness to the power of words can be used as a marker for medicine-s degree of attentiveness to the individual patient’s predicament. The recent explosive growth in medicine’s interest in literature and narrative is taken as evidence that medicine’s swing toward the reductionism and away from the narrative has ended (0).
SIMILARITIES AND DIFFERENCES BETWEEN APPLIED AND NARRATIVE ETHICS
Life threatening illness, such as HIV-AIDS, also threaten people´sence of identity and taken-for-granted assumptions about the temporal framing of their lives. In response, people often experience transformations in values, spirituality and life priorities. Drawing on a combined quantitative study of people living with HIV-AIDS in Australia, three different narratives that people use to make sense of their illness experience are identified : linear restitution narratives, linear chaotic narratives and polyohonic narratives. Linear illness narratives colonise the future, assuming that the future can be controlled through human action. They emphasise a faith in medical science, tend to be secular and self – centred and assume the end of life to be in the distant future. Hope is focused on concrete outcomes such as improved health or material possessions. Linear narratives can be either restitutive or chaotic. Restitutive linear narratives anticipate a life that will fail to meet the linear ideal resulting in despair and depression. In contrast, polyphonic illness narratives are oriented toward the present, emphasizing the unpredictability of the the future, Tese narratives tend to include spiritual experiences, a communally oriented value system, and to recount increased self-understanding and the gaining of new insights as a consequence of their illness(10).
In an integrative team approach, psychotherapy can facilitate vocational rehabilitation by helping consumers reconstruct aspects of personal narratives related to disability and work and by processing painful affects evoked by work. We report how within a reflective and nonhierarchical relationship.
USES AND ADVANTAGES-DISAVANTAGES OF NARRATIVE ETHICS IN BIOETHICS
KüHNER (11) gives narrations in relation with the ethic of the values and virtues: In a town lived a Christ knowed as the mistic , people in town wanted to make a joke a to give him a probe of patience, they stolled his house´s roof , at the next morning, he didn´t found his roof. People said him: go to the police and take them to the jail, but the Christ change the decition and seid to the people¨you have work a lot, the whole night, and now you need a good breakfast, j have prepared it, please coming, after the breakfast the people reconstructed the roof , there were not hate and reveange , there were virtues.(11),
Another example from KUHNER has a relation with the narration of the evangelist DAPOZZO, in a concentrations place the nazi officer eat the meals of a prisoner, sender by his relatives, …. I only had 45 kilos weight, my whole body was sick. My right arm had a fracture and I had not a treatment , the officer said ironic: Dapozzo, I know you believe in the salm 23 because you give this wonderfull table , you know I am your enemy… I only say to God to give me the virtue of forgiveness . After ten years I visited him, at first he didn’t recognize me … I said: I am number 17531, do you remember the Christmanns 1943, at this moment he bekam anguish and said: you are coming to make a revenge , yes I said and opened a packet with a beautiful cake, at the same time asked his wife to make coffe, we began to eat in silence, but after some time he cried and said my forgiveness, I said that only were a Christ . AFTER ONE YEAR the officer and his wife did Christs (11).
LAPIDE (12) says the best EXAMPLES OF VIRTUES by narrations are the
commandments, their use has a relation with love and hate, he believes
that the enemy can be loss if he becomes friendship till his hate is converted
in love. The Russian narrations and the from ESOPO´S fables are clear
examples this virtues. The Jewish prohibit the offense our neighbors and
the badness against badness. The princes … love your neighbor is the moral
practice of a normal human being. In the commandments..Love your neighbor
is not in accusative, it is in ethics dative. Another narration says¨
a person is going on a way, and saw the enemy’s donkey fall on the floor
because his heavy load, the person came near give him the hand bad help
him middle in the warm dessert., after that, they went to a restaurant,
were the donkey’s owner said: he loves me, and I ignorant believed he hate
me, after this moment, they were friends,----
Ethics in a general manner, is concerned with what is good and correct
and with what is bad and incorrect in human behaviour. Applied ethics,
along the same lines, deals with matters relevant to people and to mankind.
Bioethics tries to focus the ethical considerations on the phenomenon life.
Narrative ethics has a relations with values and virtues.- The recent growth
of medicine, takes the narrations as an instrument of the Bioethics to
understand the human being.
1 MONTORI,V.: “Medicina, Ethica et Thanatos”, 1996, 69-70, Univ. Cayetano
2 KOTTOW,M.: “Introducción a la bioética“, 1995, pgs. 46-48, ed. Universitaria, Santiago-Chile.
3 HOLLENWEGER,W.: “Erfahrungen in Ephesus”, 1979, pgs. 30-59, Ed. Kaiser Munich.
4 CLOTET,J.: “Bioética como Etica aplicada e Genética”, en: Bioética, 1997,5,173-183, Brasilia.
5 SINGER,P.: “ETHICS”, 1994, Oxford University Press, Oxford.
6 LOLAS,F.: “Bioethics and the culture of life: a contribution to peace”, 2000,VI, 19, 8-11, Santiago-Chile.
7 NEWTON,A.: “Narrative Ethics”1995, Harvard University Press
8 SOBEL,R.J.:”Eva´s stories; recognizing the poverty of the medical case history”, in: Academic Medicine, Jan. 2000, 75,(1),85-9, Ben Gurion University Press, Ben Sheva, Israel.
9 CHARON,R.: “Literature and medicine, origins and dstinities”,in: Academic Medicine, Jun 2000,75,(1),23-7,85-9,Columbia University Press, New York.
10 EZZY,D.:”Illness narratives: time, hope, and HIV”, in: Social Science and Medizine, Mar. 2000,50(5),605-17,Tasmania University Press, Australia.
11 KUHNER,A.: “Uberlebens Geschichten für jeden tag,1998, Ed. Aussat, Neukirchen, Alemania, pgs. 44-45, 120-21, 174-75.
12 LAPIDE,P.: “wie liebt man seine Feinde”,1984,pgs.28-29,Ed. Grünewald , Mainz-Alemania.