Narrative Bioethik in der klinischen Ethikberatung - am Beispiel des Marburger Modells und unter besonderer Berücksichtigung des Storykonzepts von Dietrich Ritschl
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Abstract
In the 1980s Dietrich Ritschl developed his theory known as ‘Storykonzept’. His theory pointed out and acknowledged the importance of narratives for the formation of both individual and Jewish-Christian communal identity as well as the alignment of the way individuals act. After having introduced the theory and the English term of >story< into German-language theology, Ritschl then applied his ‘Storykonzept’ to clinical ethics and clinical ethics consultation both emerging branches of research in Germany at that time. Thus Ritschl provided an early contribution to German-language narrative bioethics.
In a theological context, Ritschl stressed the close relationship between the dynamic and discursive character of identity and stories. In the theoretical field of clinical ethics consultation he engaged in sensitizing people to patients narratives of their remembered past and anticipated and hoped for future. This narrative sensitization was aimed at the accomplishment of a diaconal attitude of consolation and cure. Furthermore it is supposed to achieve a better consideration of patients’ social and biographical contexts as well as their individual needs for medical treatment.
In spite of a narrative turn having occurred in the humanities, the German contribution to concepts of narrative bioethics aside from Ritschl’s ‘Storykonzept’ is still very modest. German-language bioethical literature is usually narrowed down to selective references to narrativity without reflecting on the theoretical framework of narrative bioethics. Besides, the heterogeneity of narrative approaches to ethics hinders a specific application of narrative bioethics in the practical carrying out of clinical ethics consultations.
As such this thesis suggests a typology of narrative bioethics that is based on relevance for clinical practice and action. It sets apart clinical ethics of literature and performative narrative ethics. On the one hand, clinical ethics of literature deals with fiction and narratives of patients’ experiences. Therefore it is often not considered in clinical everyday routines. The ethical efficacy of clinical ethics of literature unfolds through a theoretical and affective demonstration of alternative ways of thinking and experiencing. Clinical ethics of literature tend to educate and transform the reader of a written text. On the other hand, performative narrative ethics considers both the discursive mediation of a patient’s story and its emancipative acceptance as ethically effective. It assumes a performative impact of the collective creation and acceptance of patients’ stories on clinical action in favour of the patient.
The model of clinical ethics consultation from the University of Marburg consists of both an ethics liaison service which expands the routine of clinical rounds and of team and family-conferences if a need for further disclosure of patients’ life-context arises. The Marburg model of clinical ethics consultation is practicing ethics consultation in cases of conflict procedurally and context-sensitively taking into account the patient’s social, biographical and psychological background. As a model of clinical pragmatism the model strives to work out a medical treatment-strategy and an objective of treatment that is consensually supported by the patient, the patient’s relatives and the medical team. The procedural character of ethics consultation helps to actualize relational autonomy of the patient and care for the patient. The actualization of autonomy can benefit from the heuristic potential of narrative ethics by expanding consultation directories and by accepting and asking for patient stories. By unfolding the heuristic potential a broader insight can be gained into the patient’s life situation, his perspective of the illness and the meaning for his life. Moreover a narrative expansion leads to a bigger emphasis on performance and on a dedicated attitude of the ethics counselor. The ethics counselor’s dedication is determined by his or her willingness to listen to the patient’s story, to acknowledge it and to enter this chapter of the patient’s story by establishing a bond with the patient. Further treatment procedures can then be anticipated as the mutual continuation of the story.
This heuristic and performative narrative expansion of clinical ethics consultation requires a narrative sensitization of ethics counselors. This sensitization can be initiated by narrative bioethical training and the study of literature but can only be concluded by gaining first hand experience in the practice of counselling and narrative exploration.
This narrative expansion of bioethics is limited by individual professional capacity and institutional constraints. Interpersonal and institutional barriers of communication further limit the potential of narrative expansion to be achieved.
Advance care planning programs promise to improve the institutional conditions for narrative performance. Patients with a high risk for health decline or fatal health crises are given the chance to present their treatment preferences narratively in their biographical context as part of a documented interview-process. The interview process should be continued regularly and medical records should be updated.
The preventive orientation of the offer to receive advance care planning creates a communicative setting in which the heuristic potential of patients stories and the narrative emancipation of patients can be realized.
Narrative sensitization both in clinical ethics consultation and in advance care planning promises a stronger patient-centered approach to clinical actions, strengthening relational autonomy and thereby improving the well-being of the patient.
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Created: 2018Issued: 2018-08-08Updated: 2018-08-08
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
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DoctoralThesis
Keywords
narrative BioethikMarburger Modell StorykonzeptAdvance Care Planning StorykonzeptDietrich RitschlKlinische Ethikberatung
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610
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Weifenbach, Elisabeth: Narrative Bioethik in der klinischen Ethikberatung - am Beispiel des Marburger Modells und unter besonderer Berücksichtigung des Storykonzepts von Dietrich Ritschl. : Philipps-Universität Marburg 2018-08-08. DOI: https://doi.org/10.17192/z2018.0319.
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This item has been published with the following license: In Copyright