The Medical Humanities and Bioethics Program at Northwestern University's Feinberg School of Medicine is responsible for humanities education in all four years of medical school: five units of the required four-year Patient, Physician, and Society course, 37 to 40 medical humanities seminars in years one and two, more than 125 ethics case conferences in third-year clerkships, and electives for fourth-year students. The program faculty also participate in ethics and humanities education in residencies, and the program offers an annual one-year fellowship. The program introduced the small-group teaching that now characterizes much of the school's curriculum, and its course units and seminars have been a resource for faculty development and curricular innovation. Drawing on literature, religion, ethics, philosophy of medicine, film, history, social and cultural anthropology, and jurisprudence, humanities education is designed to foster habits of discourse on social and moral issues in medicine. Small-group teaching and interactive learning are its central pedagogical methods. Essential to their successful use in a school that enrolls approximately 170 students each year is a large cadre of volunteer clinicians who serve as tutors and the college system, a four-part division of each class instituted by the 1993 curriculum reform. Students are evaluated on preparation, class participation, and regular writing assignments. All course units and seminars are pass/fail (as are all first- and second-year courses); tutors supply narrative comments. The courses themselves are thoroughly evaluated by students and reviewed both by the relevant faculty-student committee and at an annual curriculum retreat.
Recently, bioethics has become interested in engaging with narrative, but in this engagement, narrative is usually viewed as a mere helpmate to philosophy. In this precis to his book The Fiction of Bioethics, Tod Chambers argues that narrative theory should not be simply a helpful addition to medical ethics but instead should be thought of as being as vital and important to the discipline as moral theory itself. The reason we need to rethink the relationship of medical ethics to narrative is that ethicists test their ideas by applying them to cases, and cases are a narrative genre. Recognizing the importance that cases have for the way medical ethicists do ethics is essential in order to appreciate the field as a form of applied philosophy. Like other forms of representation, narrative has distinct and defining features, which ethicists, in order to understand the data of their field, must learn to recognize and differentiate. Ethicists need to attend to the way decisions about the discourse of a narrative influences the kind of moral theories judged relevant to it. The author briefly examines six features of narrative discourse that rhetorically condition the way we understand medical ethics cases: filter, reportability, closure, characters, chronotope, and gender.
Contra those bioethicists who think that their cases are based on "real" events and thus not motivated by any particular ethical theory, Chambers explores how case narratives are constructed and thus the extent to which they are driven by particular theories.
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