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Narrative Ethics: A Modest Proposal

(Tim Reckmann)

“I wryly refer to the universal adoption of narrative ethics as a ‘modest proposal’ because while telling stories is a fundamental part of human nature, telling stories in perfectly ethical ways is, unfortunately, too often alien to our nature.”

Stories are the rivets that hold together the machine of human cognition. Stories are omnipresent in our society, thoughts, and creations. Our conversations, religious texts, legal claims, scientific articles, creative works, and historical works tend to be structured as narratives. We are hardwired to think in narrative formats. It is, thus, no wonder that the very human belief in stories’ fundamental importance has been called “the foundational assumption of our species.”

What happens, then, when a story is falsely or unethically told? The answer can range anywhere from personal offense at best to tragedy at worst. On an individual level, there are few insults graver or offenses deeper than to have a false or incomplete story told about one. Worse than a personal offense, in the medical arena, an incomplete case history or one that lacks nuance can lead to ineffective care or devastating medical consequences. For example, there is a long and devastating tradition of medical providers downplaying or dismissing pain experienced by women and people of color, leading to delayed or absent treatment, individual tragedies, and public health crises like high rates of maternal and infant mortality. On a societal level, the effects can be catastrophic. A politician can lie about breaking into an opponent’s election headquarters, lie that a country has weapons of mass destruction to justify a war, or help to incite an insurrection within his own country. At the very extreme of this noxious phenomenon, leaders can advance false or misleading stories about entire groups of people, often to provide amoral “justifications” for those targeted groups to be persecuted, enslaved, or even systematically killed.

The field of narrative ethics can serve to combat unethical stories of all types and magnitudes. Narrative ethics advances that all stories—from novels to medical case histories and beyond—are constructed rather than composed purely of objective fact, as well as that ethical questions are inevitably part of the composition of all stories. Stories are inherently subjective, but that does not mean that there are not vital ethical considerations inherent in the process of constructing and telling them. While every person and organization inevitably has beliefs, values, and agendas, we more or less universally condemn both lying and intentionally perpetuating falsehoods that harm others. Therein lies the scientific validity, political neutrality, and moral urgency and prescience of narrative ethics. Narrative ethics can (and should) be applied to any story, but the field had its origins in medicine and it has particular relevance there.

Public health, public health policy, and the Coronavirus (COVID-19) pandemic, in particular, are ripe targets that can benefit from the application of narrative ethics. Public figures from all fields and of all political affiliations have at times told false or unethical stories throughout the pandemic, more than I can possibly enumerate here. Some notable examples include those who discouraged vaccination and championed scientifically discredited treatments like ivermectin and hydroxychloroquine.

Misinformation, which can often begin and spread in a narrative ethics vacuum, has been and continues to be a serious problem throughout the pandemic. (Nor is it only public figures who are to blame; misinformation spread on social media or through social networks can be equally harmful, if not more so.) Many studies show that misinformation at any and all levels remains a severe threat to public health. Unvaccinated people are more likely to believe COVID-19 misinformation; this leads them to be less likely to get vaccinated, which greatly increases their risk of dying from the virus. Over half of people who refuse vaccinations believe at least one conspiracy theory about COVID-19 vaccines. Over a third of the American public believes that the government is exaggerating the number of COVID-19 deaths (which is likely an undercount, if anything), and 14% of Americans, according to a 2021 report, believe that one can acquire COVID-19 from a vaccine.

I cannot emphasize enough that this state of affairs costs lives. As of early 2022, unvaccinated people died of COVID-19 at seven times the rate of vaccinated people and 20 times the rate of vaccinated people who received boosters. The United States has recently passed the horrific threshold of one million COVID-19 deaths, and of those one million, 319,000 were unvaccinated adults who died after COVID-19 vaccines were widely available. It is a foregone conclusion that misinformation played a role in bringing about thousands upon thousands of those deaths, many of which would have been entirely preventable with vaccination. Narrative ethics, if applied properly (i.e., if everyone told stories truthfully and ethically) would serve as an antidote to misinformation and its devastating public health consequences.

In William Shakespeare’s Hamlet, Hamlet asks his friend Rosencrantz, “What’s the news?” When Rosencrantz reports: “None, my lord, but that the world’s grown honest,” Hamlet cynically asks in reply, “Then is doomsday near” and straightforwardly accuses him, “your news is not true.” In other words, Hamlet reasons that no peril less than the imminent threat of eternal, tormentous hellfire could make humanity as a species “honest.” Sadly, Shakespeare was not entirely incorrect. I wryly refer to the universal adoption of narrative ethics as a “modest proposal” because while telling stories is a fundamental part of human nature, telling stories in perfectly ethical ways is, unfortunately, too often alien to our nature. A vision of a world that operates according to narrative ethics is nothing short of utopian, but it should serve as an ideal and model toward which we strive. This should particularly be the case in the fields of medicine and public health—fields in which countless lives hang in the physical and moral balance.

Isabelle Breier is a recent graduate of the University of Pennsylvania, where she double majored in medical anthropology and global health and health and societies. 

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