A reader responds: Literature Should Be a Medical School Admissions Requirement
Short stories aren’t perfect, either. Like doctors, fiction writers have their own biases and limitations, and the traditional Western canon represents a rather narrow (and mostly white and male) perspective. But unlike the pseudo-objective tone of case studies, stories like “Fetishes” at least attempt to promote overlooked points of view. And instructors certainly could seek out stories by authors of diverse backgrounds.
Overall, Nash says he’d prefer to “jettison” medical-ethics case studies entirely. He writes in an email, “The real world is messy, of course, and ethics cases often teach us (implicitly) to clean up that mess by oversimplifying it.” Furthermore, case studies “are themselves a byproduct and reflection of clinical practice’s overemphasis on efficiency. Not just in primary care, but in many areas of medicine, doctors spend far too little time really listening to patients and trying to appreciate the depths of their patients’ problems.”
Other scholars agree that medical-ethics case studies have limitations. Leslie McNolty and Matthew Pjecha, program associates at the Center for Practical Bioethics in Kansas City, praised Nash’s paper overall, especially the idea of rewriting short stories to help teach inexperienced medical and nursing students.
But they caution against too sweeping a condemnation of case studies. “In nearly every discussion of real ethical issues, you’ll hear someone say [things like], ‘I wish I knew more about her husband,’ or ‘why’s she so afraid of dementia,’” McNolty says. When presented with case summaries, in other words, people often do ask questions and seek out more information.
Along those same lines, Pjecha notes that “people actually using [case studies] in ethics committees in hospitals”—as opposed to students in classes—“are aware of how austere and truncated they are.” Often, someone who treated the patient on which the case is based will be present to answer more questions. Overall, Pjecha says, ethics committees see case studies “as an important first step, but then you unpack it further, and it spins into a story.”
Still, Nash stands behind the idea of eliminating case studies. “Good short stories are far more effective means of teaching students and health-care professionals to wrestle with the mess, to pay attention to narrative perspective and detail, and to become more comfortable with ambiguity,” he says.
They’re also, Nash points out, much better reads. “Why continue to use ethics cases if short stories are better at inviting realistic reflection and more enjoyable to read and discuss?” It’s a sentiment that Chekov, Maugham, and others who wrestled with such issues in both their life and work would appreciate.