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Narratological examination of cases to be used in medical ethics case studies

  • HATTORI Kenji

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  • 医療倫理学ケースの物語論

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We, in terms of narratology, examine how the structure and mode of cases as such affect the manner of conducting discussions and the quality of arguments in medical ethics case studies. To do so in the concrete, we consider similar three cases from well-written textbooks and compare their narrative characteristics. This shows that some of these cases are prepared according to the style followed in the writing of clinical case reports. The descriptive style of case reports in general medicine is likely to be diegetic (Platon), monologic (Bakhtin) and too brief, and reflects little information about the patient's personality, way of life and life history. For medical ethics case study should deal with values and all aspects of each patient's life as such, every case description should convey more detailed relevant information about the patient's personal matters and that of her/his family members. Psychiatrists, as we all know, used to pay great attention to the aforementioned aspects in the process of diagnosis and treatments before the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association prevailed among psychiatric practices in the early 1980s. In this respect, the previous style of drawing case reports in psychiatry apparently seems to have implications for medical ethics case study. Nevertheless we should admit that psychiatry differs from medical ethics in that while the former has a standardized system of both nosologic and diagnostic judgments, the latter does not have such a system to date, as is accepted by most medical or clinical ethicists. The nature of medical ethics case study cannot be merely deductive. Then it is plausible that we should explore specific rhetoric or poetics for describing cases so that case study is really practical and goes far beyond exemplification of how to apply moral principles to individual cases. A case to be used in medical ethics case studies should be messy and be constructed, like a literary work, with much nuanced taste (Barthes) or ambiguity, polyphonic voices (Bakhtin), and drama.


  • Bioethics

    Bioethics 19 (1), 112-119, 2009

    Japan Association for Bioethics

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