Confronting the Medical Leviathan: Reading a Report from the Front Lines.

This essay discusses how two physicians in Britain's National Health Service describe and analyze the conditions of their work: how algorithms and protocols structure the care they can provide and create the dilemmas they and their patients face. In these issues, the NHS is a canary in the mineshaft of contemporary Western health care. NHS practices are understood as how states and state-like entities, Leviathans, seek to render their subjects legible; in this instance, to make both physicians and patients transparently visible to surveillance and administration by standardizing medical work and patient need.

Three Types of Stories About Encountering Bioethics.

This commentary discusses 12 stories about receiving ethics consultation in hospitals. Five stories are by physicians, three by nurses, and four by family members; three of the writers have training in bioethics. Some writers requested the consultation, others experienced the consultation as an imposition forced upon them, and in two cases, the story is about the absence of any consultation service.

While Icarus Falls: Conditions for Pandemic Ethics.

This symposium contribution presents three vignettes of resistance to COVID-19 public health measures in Alberta, Canada, where I live. These show resolutely individualistic attitudes toward health and a desire to understand the pandemic as a one-off aberration. I then suggest four ways that the work of bioethics needs to change.

The Twin Crises of Principles and Stories.

This symposium contribution argues that politicized responses to the COVID-19 pandemic mark the fracturing of the consensus that bioethics has been built upon. This consensus involved the mutual dependence of principles and stories: principles need stories to become applicable in clinical action, and stories need to reflect principles if they are to make generalized claims. Two mid-20th-century theorists, Erving Goffman and Walter Benjamin, each predicted the thinness of appeals to principles and to stories, respectively; their skepticism describes our moment.

Moral Distress in Deciding How Others Die.

This essay discusses how Susan Shapiro's Speaking for the Dying (2019) contributes to understanding surrogate decision-making in intensive care. Shapiro's ethnography is based on over two years of observing day-to-day decision-making by surrogates and family members who found themselves having to speak for loved ones who were no longer capable of expressing their own wishes for treatment or its termination. After summarizing Shapiro's specific findings-in particular what made no observable difference in decision-making, including advance directives-greater attention is given to how she acts as a witness to the emotional burden and distress that these decisions cause for both family members and professional staff.

Becoming a cancer survivor: An experiment in dialogical health research.

The article makes cancer survivorship the topic of an experiment in a form of writing we call . First, in the style of autoethnography, each author presents an account of her or his long-term survivorship of cancer and the issues that involves. Less conventionally, we then respond each to the other's story.

Tragic Realism: Reading Simon Critchley for Bioethics.

The essay explores how Simon Critchley's critique of philosophy and understanding of tragedy might affect bioethics and health-care practice. What I playfully call the Critchley Doctrine begins with a rejection of philosophy's aspiration to a non-contradictory life and its premise that humans act on rational deliberation. This rejection opens us to a recognition of the uncontainable that is expressed in tragedy, and that speaks to what is inexplicable about the suffering of illness.

"Who's There?": A Vulnerable Reading of .

Vulnerable reading asks how literary works can be useful as companions to people who suffer; its focus is literature as solace. Questions of why we should turn to Shakespeare to express suffering, and why to poetic literature, are considered. An exemplary reading of Hamlet discusses three levels of vulnerable reading: the play as mirror in which readers can see reflections of their own troubles and gain new expressive possibilities for themselves; the play as training in acquiring a new voice to resist these troubles; and the play as a pedagogy of engagement in dialogue with others in relations of care.

Not Whether but How: Considerations on the Ethics of Telling Patients' Stories.

The ethics of telling stories about other people become questionable as soon as humans learn to talk. But the stakes get higher when health care professionals tell stories about those whom they serve. But for all the problems that come with such stories, I do not believe it is either practical or desirable for bioethicists to attempt to legislate an end to this storytelling.

Suffering, Medicine, and What Is Pointless.

Beginning with Eric Cassell's much-cited definition of suffering, this essay engages with Scott Samuelson's Seven Ways of Looking at Pointless Suffering (2018). How each of Samuelson's seven ways is relevant to health care and bioethics is suggested through various examples. The discussion underscores the crucial choice for health-care professionals between being an expert technician who provides treatment or being a healer, in an expansive sense first described by Cassell and elaborated by extending Samuelson's useful typology.

The Voices that Accompany Me.

This essay begins with a metaphor describing who enters the field of humanities in medicine and healthcare and the types of work they do. The role of witness is discussed, underscoring tensions between witnessing and analyzing. The essay then turns to my own background as an example of how each professional in this field brings something distinct.

When Professional Rightness is Personal.

This commentary discusses twelve stories in which physicians tell what happened when they were involved in the care of a family member. The stories display considerable differences in attitude toward the ethics and usefulness of physicians treating members of their own families. But the more significant tension is between the analytical or objective attitude that all the writers presuppose as necessary for doing good medical work, opposed to the emotions aroused by seeing a loved one suffer.

Bioethics and "Rightness".

If bioethics seeks to affect what people do and don't do as they respond to the practical issues that confront them, then it is useful to take seriously people's sense of rightness. Rightness emerges from the fabric of a life-including the economy of its geography, the events of its times, its popular culture-to be what the sociologist Pierre Bourdieu calls a predisposition. It is the product of a way of life and presupposes continuing to live that way.

Truth Telling, Companionship, and Witness: An Agenda for Narrative Ethics.

Narrative ethics holds that if you ask someone what goodness is, as a basis of action, most people will first appeal to various abstractions, each of which can be defined only by other abstractions that in turn require further definition. If you persist in asking what each of these abstractions actually means, eventually that person will have to tell you a story and expect you to recognize goodness in the story. Goodness and badness need stories to make them thinkable and to translate them into individual and collective actions.

Virtue Ethics in Monetized Medicine.

This review essay situates Abraham Nussbaum's The Finest Traditions of Our Calling (2016) within the contemporary genre of physician memoirs that shade into critiques of institutional medicine. Nussbaum's primary concern is the demoralization of medicine as it becomes increasingly monetized; patients are reduced to body parts and reimbursement schedules. He argues that physicians continue to have considerable choice in how they practice, despite institutional constraints.

From sick role to narrative subject: An analytic memoir.

Questions of illness experience and identity are discussed, based on the analysis of a story told by the breast-cancer activist Audre Lorde. Displacing Parsons' conceptualization of illness as a sick role, I understand the ill person as a narrative subject, defined by discursive possibilities. Three discourses of illness are proposed: the medical institutional discourse, the discourse of illness experience, and the pink-ribbon discourse.

Narrative ethics as dialogical story-telling.

The narrative ethicist imagines life as multiple points of view, each reflecting a distinct imagination and each more or less capable of comprehending other points of view and how they imagine. Each point of view is constantly being acted out and then modified in response to how others respond. People generally have good intentions, but they get stuck realizing those intentions.

Dense junctures of ethical concern.

A collection of stories by bioethicists writing about their own illnesses displays the importance of microethics. From this perspective, ethics happens not in the application of principles to specific decisions, but rather in the moment-to-moment flow of clinical interaction, as healthcare workers and patients make decisions, especially in their use of language. Microethical issues that are common to multiple stories are described as dense junctures of ethical concern.

From sick role to practices of health and illness.

Context: Health care research generally, and medical education research specifically, make increasingly sophisticated use of social science methods, but these methods are often detached from the theories that are the substantive core of the social sciences. Enhanced understanding of theory is especially valuable for gaining a broader perspective on how issues in medical education reflect the social processes that contextualise them.

Methods: This article reviews five social science theories, emphasising their relevance to medical education, beginning with the emergence of the sociology of health and illness in the 1950s, with Talcott Parsons' concept of the 'sick role'.