The Moral of the Story…Is There One?

“Christianity isn’t a list of rules, it’s a relationship” is how the cliché goes and I’ve never been very fond of it. While I agree that Christianity is about the transformative power of the gospel in the real lives of God’s children and not about keeping ice-cold rules without any practical meaning or relevance, in a very real sense a false dichotomy has been created between our “story” and what it means to live in a way that pleases God (ethics).

If you’re unfamiliar with her work, Rita Charon is Professor of Clinical Medicine and founding Director of the Program in Narrative Medicine at Columbia University. A general internist, she earned a Ph.D. in English when she realized the centrality of stories in medical practice. She directs the Narrative Medicine curriculum for Columbia’s medical school and teaches literature, narrative ethics, and life-telling (more info).

Charon is also the author of Narrative Medicine: Honoring the Stories of Illness. In it, she describes the narrative approach to health care and its relationship to bioethics.

“Those who assist individual patients to navigate the moral channels of illness have discovered that training in health law and knowledge of moral principles do not suffice to fulfill ethical duties toward the sick…they also must equip themselves with sophisticated skills in absorbing and interpreting complex narratives of illness—the better to hear their patients, to accompany them on their journeys, and to assist them in making health care choices consonant with their values [emphasis mine]. Echoing its transformative force in other disciplines and professions, narrative practice has renewed and redefined the very enterprise of what used to be called bioethics.”[1]

The goal of narrative ethics is a noble one—to create an environment conducive to showing value to the patient and patient’s family by listening to and honoring their story of illness. In agreement, Charon appeals to the thought of a bioethicist whose work[2] I am intimately familiar with, H. Tristram Engelhardt,

“When health care professionals and patients meet as strangers … disclosures and safeguards must frequently be explicit and often detailed. … [O]ne needs a disinterested application of the rules to protect against misunderstandings and to guard against abuses of power.”[3]

Like Charon, Engelhardt holds that rules simply complicate things when the task is to be more focused on “accompany[ing] them on their journeys.” The communication of moral principles apparently shortens this excursion.

We can have a qualified agreement with Charon that “moral principles do not suffice to fulfill ethical duties toward the sick” because this work should encompass a ministerial component obvious to so many of us engaged in theological ethics. We should listen, we should discuss, but eventually we do need to advise and this involves the communication of moral principles as understood through scripture. As Christians with particular theological commitments, no good reason exists to avoid sharing ethical principles derivative of our theology in answering difficult life and death questions.

What is it then that narrative ethics is really proposing? This we need to ask because as a system, narrative ethics doesn’t fully resist principles. Rather, it insists that the principles that matter are ultimately those that line up with the values of the patient, and it is through discourse that those values are discovered. In other words, the task of the doctor, nurse, pastor, bioethicist, or family friend practicing narrative ethics does not involve bringing a normative moral framework into the discourse as a way that advises the individual, couple or family toward a decision. For Charon and Engelhardt, the pluralistic context rejects such a proposal, but within the context of Christianity, the communication of moral norms should not be problematic. We have been given the tools to minister to the whole person.

At CT’s Her.meneutics blog, the floodgates on this topic have opened wide, pouring forth the narrative ethic position of Ellen Painter Dollar. To give you a bit of background on Dollar, she is a “Christian woman with a genetic disorder called osteogenesis imperfecta (OI).”[4] This is a condition that causes extremely fragile bones. Because Dollar’s OI is caused by a defect in a gene, she and her husband opted for IVF and PGD (preimplantation genetic diagnosis) in an effort to conceive children without OI. PGD is the process of sorting “good” embryos from the “bad” embryos, leading ultimately to the destruction of the “bad” ones. But for them, this was a morally legitimate option because they were aware of the chances of genetic transmission—their first child is also afflicted with OI.

“After one failed PGD cycle, we decided to conceive our second child, and eventually a third, the old-fashioned way. Neither our second daughter nor our son inherited OI.”[5]

Dollar is an advocate of “narrative ethics” because of what she sees as the limitations of an approach she believes if focused exclusively on principles, a straw man she has created. She has been writing on reproductive technology for awhile, emphasizing this narrative ethic approach and even citing Rita Charon as someone who shares her belief that stories matter significantly in ethical discourse.[6]  At Her.meneutics, Dollar wrote,

“Traditional ethics uses a juridical process, in which experts consider the moral questions raised by a situation, explore those questions using established ethical principles, and render a judgment based on which principles are most applicable. Narrative ethics is less cut-and-dried. It allows room for amateurs to weigh and discuss the complexities of a particular person’s story, acknowledging that such factors as the person’s intentions and past experience are relevant.”

Not only has she created a false distinction between “traditional” ethics and the narrative approach, but she says that “traditional” ethics is too complicated for the “amateurs.” What she means by “traditional” ethics is what she perceives to be a cold-hearted principlism that never reaches into the life of the person entertaining the moral dilemma, whatever it may be. Moral imperialism, perhaps. What she is ignoring is that Christian ethics can be informed by scripture in both the content and method of delivery (because doing good theology isn’t just about moral correctness, but ministry to the whole person which involves listening). This, however, doesn’t preclude the responsibility to, when the situation demands, simply state that some of our moral choices are completely misguided and morally unadvisable.

In the comments on her piece at Her.meneutics, she indicates that taking a position on the moral status of the embryo is a “deliberate omission.” She says “But the moral status of embryos is, for me, not the central issue with reproductive technology, and I’ve observed that a focus on this one issue often blinds people to other concerns that are equally or more troubling.” Apart from the fact that this is an excellent point—that there are other troubling issues related to reproductive technology, it is impossible to agree that anything could be more troubling than what the industry (and those participating in it) is doing to the smallest of our kind. Only the exploitation of young women, risking their life, health, and fertility in order to harvest their eggs, can compare to the risk to and destruction of embryos. Can there possibly be concerns in reproductive technology greater than the protections of innocent human life? Indeed, she easily is placing the other values learned through “ethical discourse” as greater in importance than those concerned with the human life and dignity.

(If the Her.meneutics piece I’m linking to in this article is your only knowledge of Dollar’s views and you wonder if I’m taking her out of context, I challenge you to read more of her writings here.)

In the same piece (in the comments), she continues to defend her position on the primacy of narrative ethics over the straw man she created.

“But my experience has been that, when we raise ethical concerns with repro tech in a way that honors people’s experiences, recognizes diversity of theological interpretation, and doesn’t rest solely on one principle (such as embryos or choice), people are actually quite open to discussing these very hard and complex issues.”

When I first read this, I thought perhaps she was building a case for an open door to conversation that might eventually lead the person, with some gentle prompting, to make decisions in accordance with a high view of the embryo. And if she hadn’t written elsewhere that she is a proponent of abortion rights, I might still be generous in my understanding of this statement.

Also note that in order for ethical discourse to ensue, she calls us to adopt more of the Charon/Engelhardt model that calls us to give respect to or “recognizes diversity of theological interpretation.” Recognize is an interesting term here, because she’s talking more about seeing it. Narrow theological commitments are going to produce principles. Theologies with a lower view of scripture, a skewed sense of authority and a distorted view of humanity will produce a more “open-minded” approach to ethics that will allow the patient to not necessarily discover moral truth, but actually invent it. Charon and Engelhardt are disinterested in the imposition of values in a pluralistic context, and it appears Dollar has the same problem in a theologically diverse context.

But Dollar rejects this assessment.  She states,

“But there’s a problem with focusing exclusively on our and others’ stories: Humans are prone to self-absorption, self-pity, and a tunnel vision that puts our own pain, problems, and desire for happiness front and center. We are all too capable of justifying poor decisions and bending or obscuring the truth to suit our needs. In short, we are all sinful and overly caught up in the self.

So practicing narrative ethics does not mean that anything goes, that people have unlimited freedom to pursue whatever they want in isolation from moral, cultural, and emotional consequences. Rather, practicing narrative ethics means that we give weight to the myriad and significant circumstances that lead people to make ethically fraught decisions, and allow people’s stories to influence our dialogue and our language.”

The question remains, how much weight is to be given to individual circumstances? With the theological flexibility she insists upon as well as her own views on abortion rights and her own unqualified use of pre-implantation genetic diagnosis, it seems that the moral principles she’s willing to embrace are similar to those of Charon and Engelhardt, those that belong to the individual.

While God sent his son to pay the debt for our own sin, each of us entered into his story of redemption. But even within the story, God has provided moral guard rails, principles, that help us to become more like him and even protect us from the every day consequences of sin. The narrative ethics of Ellen Painter Dollar appear to be more interested in the experience of the story rather than the moral of the story.