Medicine and bioethics today are though as fields of pure logic, reasoning, and science, with physicians and ethicists trained to approach patients with an attitude of detatched rationality. In reality, neither medical care nor ethics can be practiced well without an acknowledgement for their deeply emotional, relational, and narrative qualities. Medical care and bioethics must both be practiced through a narrative lense in order to truly meet the humanity of both patients and practitioners. There are practical methods to integrate narrative skills into clinical practice, as well as tangible benefits to doing so. Practially, this is performed through narrative medicine: an approach to medical care that recognizes the stories as a critical component to healthcare; as well as narrative ethics: an awareness of the essential role of narrative in moral understanding. Using narrative as a tool to understanding illness and moral grounds the more abstract and universal aspects of both in practical, individual reality. There are many practical aspects of narratives when applied to bioethics, such as aquiring narrative skills, what happens when stories are shared, recognizing how narratives are built, how they convey knowledge, organize life, and provide meaning. Illness creates an isolation – for both patient and practitioner – and stories allow each to express their experience and be supported though the stories of others. Stories help brigdge the gap in experiences of illness between practioner and patient while helping pracitioners to maintin their empathy in the face of continual suffering. Narrative skills are also useful for practioners to bring awareness to the power dynamics that influence patient stories, such as the power of practitioner as co-creator, whose voice is given credibility, external and internal influences on a story, who determines the meaning of a story, and how the patient is characterized within the story. Narrative permeates every aspect of human life, including medical and ethical situations, and approaching both through a narrative lens is imperative for the development of true understanding, empathy, and compassion. Cultivating a narrative framework towards illness allows both practioners and patients to be cared for while also caring for the other, thus creating deep, meaningful connections. / Urban Bioethics

Medicine and bioethics today are though as fields of pure logic, reasoning, and science, with physicians and ethicists trained to approach patients with an attitude of detatched rationality. In reality, neither medical care nor ethics can be practiced well without an acknowledgement for their deeply emotional, relational, and narrative qualities. Medical care and bioethics must both be practiced through a narrative lense in order to truly meet the humanity of both patients and practitioners. There are practical methods to integrate narrative skills into clinical practice, as well as tangible benefits to doing so. Practially, this is performed through narrative medicine: an approach to medical care that recognizes the stories as a critical component to healthcare; as well as narrative ethics: an awareness of the essential role of narrative in moral understanding. Using narrative as a tool to understanding illness and moral grounds the more abstract and universal aspects of both in practical, individual reality. There are many practical aspects of narratives when applied to bioethics, such as aquiring narrative skills, what happens when stories are shared, recognizing how narratives are built, how they convey knowledge, organize life, and provide meaning. Illness creates an isolation – for both patient and practitioner – and stories allow each to express their experience and be supported though the stories of others. Stories help brigdge the gap in experiences of illness between practioner and patient while helping pracitioners to maintin their empathy in the face of continual suffering. Narrative skills are also useful for practioners to bring awareness to the power dynamics that influence patient stories, such as the power of practitioner as co-creator, whose voice is given credibility, external and internal influences on a story, who determines the meaning of a story, and how the patient is characterized within the story. Narrative permeates every aspect of human life, including medical and ethical situations, and approaching both through a narrative lens is imperative for the development of true understanding, empathy, and compassion. Cultivating a narrative framework towards illness allows both practioners and patients to be cared for while also caring for the other, thus creating deep, meaningful connections. / Urban Bioethics

The Inverted Compass traces the influence of geography on early American writing. Maps, quadrants, and compasses are at the heart of America’s most celebrated stories, and these geographic tools shaped how Americans understood themselves and their relationship to the landscape in the late eighteenth and early nineteenth centuries. But the emerging discipline also provided writers a way to address the young Republic’s most pressing political and ethical problems. The word geography itself - from the Greek geo (earth) and graphia (writing) - articulates the central paradox. Mapping, even as it claims to represent the world, continuously produces it. Literary works follow a similar logic. The Inverted Compass argues that certain early American writers recognized the parallels between mapping and writing and confronted their political implications through narrative fiction. These writers imagined counter-spaces. They created alternate geographies. They inverted the compass. Their allegories, hoaxes, and satires sharpened readers’ awareness of the role of writing and rhetoric in law and government, directing attention to the often-obscured ethical responsibilities related to Westward expansion and the treatment of minority bodies in nineteenth-century America. The Inverted Compass examines the work of Jefferson, Poe, Melville, and Twain alongside exploration narratives, maps, journals, ship logs, field manuals, land surveys, city plans, political cartoons, spelling primers, court cases, land laws, and Congressional documents to uncover the patterns of reading that guide the spatial imagination and its material products.

abstract: The advent of advanced reproductive technologies has sparked a number of ethical concerns regarding the practices of reproductive tourism and commercial gestational surrogacy. In the past few decades, reproductive tourism has become a global industry in which individuals or couples travel, usually across borders, to gain access to reproductive services. This marketable field has expanded commercial gestational surrogacy--defined by a contractual relationship between an intending couple and gestational surrogate in which the surrogate has no genetic tie to fetus--to take on transnational complexities. India has experienced extreme growth due to a preferable combination of western educated doctors and extremely low medical costs. However, a slew of ethical issues have been brought to the forefront: the big ones manifesting as concern for reduction of a woman's worth to her reproductive capabilities along with concern for exploitation of third world women. This project will be based exclusively on literature review and serves primarily as a call for cultural competency and understanding the circumstances that gestational surrogates are faced with before implementing policy regulating commercial gestational surrogacy. The paper argues that issues of exploitation and commodification hinge on constructions of motherhood. It is critical to define and understand definitions of motherhood and how these definitions affect a woman's approach to reproduction within the cultural context of a gestational surrogate. This paper follows the case study of the Akanksha Infertility Clinic in northern India, a surrogacy clinic housing around 50 Indian surrogates. The findings of the project invokes the critical significance of narrative ethics, which help Indian surrogates construct the practice of surrogacy so that it fits into cultural comprehensions of Indian motherhood--in which motherhood is selfless, significant, and shared. / Dissertation/Thesis / M.S. Biology 2011

Genetic medicine is an emerging area of healthcare which constantly raises novel ethical challenges in the clinical realm due to its capacity to reveal information that has deeply personal meaning. Genetic tests can reveal more than is strictly essential for immediate medical care because they can diagnose conditions that cannot be cured, treated or effectively managed. The diagnosis of a genetic condition in one individual can have repercussions throughout an extended family, and genetic knowledge has created innovative, technologically driven, reproductive options. For clients of genetic counselling, moral choice does not readily result from uncluttered logic or easy personal preference, nor does it involve the application of sterile principles and laws, but is a much richer process involving personal history and culture, as well as reflection upon personal values, current resources and projected life goals. For these reasons, I question the validity of the exclusive use of a narrow version of Principlism, as it is commonly operationalised, for the medical sub-specialty of clinical genetics. Its heavy emphasis on individual autonomy, which has become synonymous with clinical medicine, does not take into account the fact that most genetic tests have little or no immediate clinical utility, or that genetic medicine is primarily about the way in which genetic conditions pass through families, and management of recurrence risks by choice of reproductive options. Therefore, the aim of this dissertation is to develop and explore a broader contextual moral framework, which is better suited to deliberation about complex ethical dilemmas in clinical genetics, than the current dominant approach which tends to follow a restrictive and non-inclusive application of Principlism. To achieve this aim, I have started with a review of relevant history and socio-political forces that have shaped the current status of the genetic medicine, and examined the evolution of current attitudes that underpin recognition, analysis and management of the ethical challenges in genetic medicine. I have analysed the manner in which Principlism and other normative theories are employed by bioethicists and clinicians in response to ethical dilemmas, and presented an alternative approach which employs a broader contextual ethical framework. I have devised an approach which attends to the importance of both current social opinion, and the tradition of evidence-based medicine, with reference to selected traditions in philosophical analysis. vi In conclusion, I advocate attention to concrete circumstances, which includes recognition of historical development, which has shaped current medical and wider social values, beliefs, norms and attitudes political context, including critical analysis of relevant political motivations social context, particularly situational power structures, trust relationships and relational obligations personal values, resources and experiences of the stakeholder(s) the range of realistically available options for the stakeholder(s) the impact of economic limits, which might be institutional and / or personal And, to achieve this objective of building a ‘thick’ ethical discourse, I propose a series of questions, which can be readily utilised by genetic and non-genetic health professionals as well as other members of society to work towards resolutions that represent a balance of fairness, economic responsibility with scarce resources, and socially acceptability. This approach appropriately attends to the relational and communicative aspects of moral dilemmas in clinical genetics, and is likely to yield more meaningful (and less likely paternalistic) conclusions, which would be of greater value to our morally pluralist society.

<p>This dissertation examines fictional representations of Argentine and Spanish authoritarianism from the position of exiled, traumatized and/or marginalized subjects. Though the primary texts and films engage questions of terror, trauma and repression from the 1930s to 80s in Spain and Argentina they stand out from works made within these contexts (that is, works lacking spatial and/or temporal distance) by focusing on how and to what extent individual and collective rebirth can arise from the ashes of terror, exile and oblivion. On the one hand, these works explore the ways in which authoritarian terror and repression maintain and are maintained psychologically, historically and ideologically in these cultures by a series of artificial separations between self and other, fantasy and reality, history and fiction, female and male, desire and responsibility, the spiritual and material, plurality and unity, the past and the future. On the other hand, these works suggest that it is by confronting the repressed authoritarian past through pluralistic, fictional, "exilic" retellings that these binaries may be transcended and that identity, history and reality itself may be radically re-membered. </p><p>In effect, the capacity to "re-member", which is revealed to be essentially synonymous with the act of "rebirth", demands a confrontation with the past that is every bit as dependent on "fantastic retellings" of both reality and fiction as it is on history or reality--to the same degree, in fact, that the realization of the self is contingent on an encounter with radical alterity. The various forms of monstrosity, exile and ambiguity that coalesce within these films and texts not only enable this to happen, but they imply that the creation of the primary work depends as much on its audience as it does on its author. Accordingly, the ethical processes these works establish, through narrative layering, ambiguity and other techniques, occur not only within the films and texts but in the outer relationships and responses they elicit from their readers or viewers.</p><p>Thus, the processes of exile and rebirth that these works establish can only be fully appreciated in dialogue with their audiences (via a "narrative ethics"), with history and with theories ranging from feminism to mysticism to psychoanalysis (drawing on Jacques Lacan, Julia Kristeva, Carl Jung and Sigmund Freud) to ethical philosophers, in particular, Emmanuel Levinas. In my endeavor to stimulate this dialogue, in which I both build on and depart from these theories, I reveal how and why "exile" fiction has become such a crucial medium for refiguring "identity"--a term which itself becomes inseparable from spirituality. Accordingly, spirituality is not detached from reality or fantasy, but rather buried in the repressed identities and memories that, when exposed through the "monstrous ambiguities" of fiction, reveal an indestructible bond between self and other, desire and responsibility, fantasy and reality, among other dichotomies. </p><p>At the same time that these works offer positive models of spirituality, rebirth, and re-membering, they incisively critique the repressive ways in which religion and specifically, Christianity, have been manipulated, in conjunction with authoritarian paradigms, to terrifying, repressive, "sacrificial" ends. More generally, all of these works, notwithstanding their "timeless" and exilic dimensions, represent pivotal moments in Spanish and Argentine history while at the same time revealing innate links or analogies between authoritarianism and religious doctrine. On the other hand, the timeless, placeless, exilic nature of these works helps shed light on the growing and global importance of exile film and literature as well as the correspondingly great and ever-growing need to re-examine the lost, buried and terrifying past that they re-member.</p> / Dissertation

Personal knowledge was disclosed amongst a group of experienced registered nurses in relation to feeding severely ill patients with cancer and dementia (I,II,III), communicating with severely demented patients (IV,V), and receiving group supervision (VI). Principled ethics did not seem an adequate model for describing the ethical reasoning of experienced RNs. For the twenty RNs working in oncological care the question of whether or not to accept active euthanasia was the most urgent. The twenty RNs working in dementia care emphasized the difficulty they had in understanding the meaning of communicative cues in severely demented patients. Both groups of nurses saw themselves as advocates for their patients and seemed to reason mainly in accordance with the Golden Rule. Through a phenomenological hermeneutic analysis of video recordings of two RNs' interaction with each of four severely demented patients, it was possible to interpret the patients' vague and unclear communicative cues. But observations based on an assessment of facial muscle movements showed that it was very difficult (the FACS). Group supervision based on a narrative framework was carried out in order to support nurses working in dementia care. Interviews with the fifteen RNs showed that they experienced recognition and reassurance of worth, an increased repertoire of actions, gained new perspectives, an increased awareness of their professional role, and interdependence. It is proposed that the care of severely ill patients can be improved by the use of a narrative approach both as regards understanding patients and encouraging RNs to develop their clinical knowledge through reflecting on their own and their coworkers' narrations about care. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 6 uppsatser.</p> / digitalisering@umu

Genetic medicine is an emerging area of healthcare which constantly raises novel ethical challenges in the clinical realm due to its capacity to reveal information that has deeply personal meaning. Genetic tests can reveal more than is strictly essential for immediate medical care because they can diagnose conditions that cannot be cured, treated or effectively managed. The diagnosis of a genetic condition in one individual can have repercussions throughout an extended family, and genetic knowledge has created innovative, technologically driven, reproductive options. For clients of genetic counselling, moral choice does not readily result from uncluttered logic or easy personal preference, nor does it involve the application of sterile principles and laws, but is a much richer process involving personal history and culture, as well as reflection upon personal values, current resources and projected life goals. For these reasons, I question the validity of the exclusive use of a narrow version of Principlism, as it is commonly operationalised, for the medical sub-specialty of clinical genetics. Its heavy emphasis on individual autonomy, which has become synonymous with clinical medicine, does not take into account the fact that most genetic tests have little or no immediate clinical utility, or that genetic medicine is primarily about the way in which genetic conditions pass through families, and management of recurrence risks by choice of reproductive options. Therefore, the aim of this dissertation is to develop and explore a broader contextual moral framework, which is better suited to deliberation about complex ethical dilemmas in clinical genetics, than the current dominant approach which tends to follow a restrictive and non-inclusive application of Principlism. To achieve this aim, I have started with a review of relevant history and socio-political forces that have shaped the current status of the genetic medicine, and examined the evolution of current attitudes that underpin recognition, analysis and management of the ethical challenges in genetic medicine. I have analysed the manner in which Principlism and other normative theories are employed by bioethicists and clinicians in response to ethical dilemmas, and presented an alternative approach which employs a broader contextual ethical framework. I have devised an approach which attends to the importance of both current social opinion, and the tradition of evidence-based medicine, with reference to selected traditions in philosophical analysis. vi In conclusion, I advocate attention to concrete circumstances, which includes recognition of historical development, which has shaped current medical and wider social values, beliefs, norms and attitudes political context, including critical analysis of relevant political motivations social context, particularly situational power structures, trust relationships and relational obligations personal values, resources and experiences of the stakeholder(s) the range of realistically available options for the stakeholder(s) the impact of economic limits, which might be institutional and / or personal And, to achieve this objective of building a ‘thick’ ethical discourse, I propose a series of questions, which can be readily utilised by genetic and non-genetic health professionals as well as other members of society to work towards resolutions that represent a balance of fairness, economic responsibility with scarce resources, and socially acceptability. This approach appropriately attends to the relational and communicative aspects of moral dilemmas in clinical genetics, and is likely to yield more meaningful (and less likely paternalistic) conclusions, which would be of greater value to our morally pluralist society.

My work is a critical view of a modern principle of personal autonomy and an idea of autonomous man, which stems from philosophy of liberalism. The practice of personal autonomy in bioetics, which takes over the features of this political concept and does not comprise a metaphysical question about a man seems to empty a concept of humanity. My work tries to turn attentation to this problem and show the difficulties of personal autonomy when presented from the secular point of view. I want to offer then the concept of narrative ethics as a vision of supplementing the concept of modern principal bioetics.

This Diploma Thesis "Moral Aspects of Fairy Tales" asks questions - Is it possible to find God's message in the fairy tales? Can God speak to us through these stories? Can the fairy tales be touched by history of redemption? In the beginning, this Diploma Thesis speaks about myth, about it's origin, functions and message, because the fairy tales have their roots in myth. For better apprehension of the fairy tales, there is used the theory of narrative as well as theory and history of fairy tales. The Diploma Thesis analyzes Jung's Archetypes. Archetypes help us to find messages for good life of human beeing in fairy tales. Another issue is "History of mankind as a chain of storries." This issue asks, why there is just few functions in the stories. It analyzes Jesus Christ as the first example of a main hero of fairy tales ant myths. The mankind should follow him in it's own storry. Universality of the storries is demonstrated in comparing of stories from Old Testament (Jonas, Jakob and Eliah) with motives in the fairy tales. Keywords narrative, change, history of redemption, fairy tale, archetypes,etics