PART III: CASE STUDIES IN NARRATIVES ETHICS: CHAPTER 14: IN THE ABSENCE OF NARRATIVE.

This article points that in the absence of the patient's narrative, medical care fails and is unethical. Primary care medicine is concerned with everyday life. Here, ethical dilemmas arise from the lived life--individual preferences, beliefs, attitudes, choices, and decisions, and how individuals interact with one another as well as care for one another. Ethical dilemmas in primary care are often subtle, but they are not invisible; most are recognized easily by careful observers. The ethical dilemmas of primary care are different from those occurring in the hospital setting, but they are no less meaningful. Narrative informs clinical medicine. Understanding such narrative works as pathographies, novels of illness and healing, and memoirs about medical practice enhances personal awareness, expands the physician's concept of the patient's illness experience, enables interpersonal connections and recognition of emotions, and thereby offers a fuller understanding of the moral life as enacted in health care. Patients' stories as heard and then interpreted by physicians are narratives too. Such clinical cases can, like literature, demonstrate particular points about the moral life. The retelling of these stories by physicians, nurses, or members of the ethics team is also a narrative activity. Such retelling may have consequences for the listeners, just as reading a poem may influence the reader in some deep way.