Narrative based medicine

Developmental Medicine & Child Neurology 2003, 45: 147–147 147 know they have become an object of medical interest. This only happens with certainty when the patient is asked for permission to describe them. If harm is likely to be done, it is no less harmful if they refuse. Asking the question, ‘do you mind if I write this about you?’ confirms absolutely that they are the subject in question. Were the details not recognisable by any other than the participants, then the only way the subject would ever be likely to know would be through our asking them. Then, medical Predicaments that are of importance would have wide application and patients might easily see themselves in vignettes that do not actually represent them. Many notable English film stars in Los Angeles sometimes draw towards kerbs, whether to buy early editions of newspapers or for some other amusement. The worst effect of the proscription is that it precludes communication about items of intense medical concern where the patient would not give consent, such as relate to various degrees of abuse of the public medical services, or abuses of trust, or forensic matters. To my view, the profession, the professional bodies and medical editors have failed to defend the profession’s need to traffic in true human Predicaments. A nice ethical question arises as to whether it is proper for a parent who is not acting in the best interests of the child, or who is abusing the public’s health service, to retain the right to preclude medical description of the child’s consequent condition. Another is whether a minor can properly either give, or withhold consent. The emergence of interest in the human Predicament under the rubric of Narrative Medicine, although that is a more negotiated process, is therefore of intense ethical as well as medical interest. Given prurient media and intrusive internets how do we resolve the dilemmas to which it gives rise?