Review Article

Narrative medicine in ethics education: from theory to practice

Abstract

Historically, medicine has been grounded in storytelling; however, contemporary practice has shifted toward expertise and empirical data, often neglecting the patient's narrative. This shift has created a gap in understanding the complexity of human suffering. Narrative medicine bridges this gap by prioritizing empathy, ethical sensitivity, and patient-centred care. It integrates patients’ life experiences and cultural backgrounds into clinical practice and aims to harmonize empirical methodologies with phenomenological insights. This review examines the theoretical foundations and practical applications of narrative medicine, particularly within medical ethics education. It highlights how narrative approaches improve moral reasoning, empathy, and cultural competence in healthcare professionals.Pedagogical methods such as reflective writing, attentive reading, and group discussions enhance ethical awareness and improve practitioners' capacity to manage complex clinical situations. Narrative medicine promotes a comprehensive understanding of illness and care by bridging the gap between evidence-based medicine and narrative approaches; it can also be integrated into education to address challenges such as cultural diversity, health inequalities, and ethical dilemmas arising from technological developments. However, ethical issues like power dynamics, privacy, and representation in patient narratives require careful management. Despite the existing challenges, narrative medicine offers a transformative framework for rethinking medical education and practice, ensuring that healthcare remains empathetic, equitable, and ethical.

Charon R. Narrative medicine : honoring the stories of illness. Oxford University Press; 2006. 304 p.

Greenhalgh T, Hurwitz B. Narrative based medicine: why study narrative? BMJ [Internet]. 1999 Jan 2 [cited 2025 Jan 4];318(7175):48–50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9872892

Meadows K. Patient-reported Outcome Measures – A Call for More Narrative Evidence. J Patient Exp. 2021;8:1–4.

Murphy JW, Franz BA. Ethics in Narrative Health Interventions. Perm J. 2019;24:1–6.

Lewis B. Narrative and psychiatry. Curr Opin Psychiatry. 2011;24(6):489–94.

Ahlzén R. Narrativity and medicine: Some critical reflections. Philos Ethics, Humanit Med. 2019;14(1):1–10.

Daryazadeh S. Application of narrative in medical ethics. J Med Ethics Hist Med. 2019;12(13):1–4.

Erbay H. On Medical Ethics, Story and Narrating. Turkish J Bioeth. 2017;4(1):29–35.

Garden R. Who speaks for whom? Health humanities and the ethics of representation. Med Humanit. 2015;41(2):77–80.

Jones AH. Why Teach Literature and Medicine? Answers from Three Decades. J Med Humanit. 2013;34(4):415–28.

Shapiro J, Coulehan J, Wear D, Montello M. Medical humanities and their discontents: Definitions, critiques, and implications. Acad Med. 2009;84(2):192–8.

Charon R, DasGupta S, Hermann N, Irvine C, Marcus ER, Rivera Colsn E, et al. The Principles and Practice of Narrative Medicine [Internet]. Vol. 1. Oxford University Press; 2016 [cited 2025 Jan 4]. Available from: https://academic.oup.com/book/38747

Ricoeur P, Thompson JB. Hermeneutics and the Human Sciences [Internet]. Thompson JB, editor. Cambridge University Press; 2016 [cited 2025 Jan 4]. Available from: https://www.cambridge.org/core/product/identifier/9781316534984/type/book

Hunter KM. Doctors’ Stories : The Narrative Structure of Medical Knowledge. Princeton University Press; 2021.

Frank AW. Narrative Ethics as Dialogical Story‐Telling. Hastings Cent Rep [Internet]. 2014 Jan 9;44(s1):16–20. Available from: https://onlinelibrary.wiley.com/doi/10.1002/hast.263

Mattingly C, Garro LC. Narrative and the cultural construction of illness and healing. University of California Press; 2000. 279 p.

Bolton GEJ, Delderfield R. Reflective Practice : Writing and Professional Development [Internet]. SAGE Publications Ltd; 2018 [cited 2025 Jan 4]. 296 p. Available from: https://books.google.com.tr/books/about/Reflective_Practice.html?id=veBHDwAAQBAJ&redir_esc=y

Kleinman A. The Illness Narratives: Suffering, Healing, And The Human Condition. 1989.

Zaharias G. What is narrative-based medicine? Can Fam Physician. 2018;64:176–80.

Brody H. Narrative Ethics and Institutional Impact. HEC Forum. 1999;(111):46–51.

Charon R. Knowing, seeing, and telling in medicine. Lancet. 2021;398(10316):2068–70.

Tan L, Le MK, Yu CC, Liaw SY, Tierney T, Ho YY, et al. Defining clinical empathy: A grounded theory approach from the perspective of healthcare workers and patients in a multicultural setting. BMJ Open. 2021;11(9):1–9.

Stringer A, Liu L, Marino J, Mupparapu A, Fergus A, Rosenberg N, et al. The Power of Story Slams: A Mixed-Method Analysis of Narrative Medicine Connecting, Encouraging and Comforting Healthcare Trainees and Professionals. Int J Med Students [Internet]. 2024 Oct 16;12(3):239–45. Available from: http://ijms.info/IJMS/article/view/2182

Remein CDF, Childs E, Pasco JC, Trinquart L, Flynn DB, Wingerter SL, et al. Content and outcomes of narrative medicine programmes: A systematic review of the literature through 2019. BMJ Open. 2020;10(1):1–15.

Machost H, Stains M. Reflective Practices in EducationA Primer for Practitioners. CBE Life Sci Educ. 2023;22(2):1–11.

Charon R, Hermann N. Commentary: A sense of story, or why teach reflective writing? Acad Med. 2012;87(1):5–7.

Walker MU. Moral understandings: Alternative “epistemology” for a feminist ethics [1989]. Justice Care Essent Readings Fem Ethics. 2018;4(2):139–52.

Jarrah HY, Bilal DA, Halim M, Helali MM, AlAli RM, Alfandi AAA, et al. The impact of storytelling and narrative variables on skill acquisition in gamified learning. Int J Data Netw Sci [Internet]. 2024;8(2):1161–8. Available from: http://www.growingscience.com/ijds/Vol8/ijdns_2023_218.pdf

Beauchamp T, Childress J. Principles of Biomedical Ethics : Marking Its Fortieth Anniversary. Am J Bioeth [Internet]. 2019 Nov 2;19(11):9–12. Available from: https://www.tandfonline.com/doi/full/10.1080/15265161.2019.1665402

Barnes-Holmes Y, Barnes-Holmes D, McEnteggart C. Narrative: Its Importance in Modern Behavior Analysis and Therapy. Perspect Behav Sci [Internet]. 2018 Nov 4;41(2):509–16. Available from: http://link.springer.com/10.1007/s40614-018-0152-y

Ellis BD, Stam HJ. Addressing the Other in Dialogue. Theory Psychol [Internet]. 2010 Jun 21;20(3):420–35. Available from: https://journals.sagepub.com/doi/10.1177/0959354310364280

Kavas MV. Narrativity and its Place in Medical Ethics Education (in Turkish). Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2011;64(2):59–73.

MacIntyre A. After Virtue: A Study in Moral Theory. University of Notre Dame Press; 1981.

Lang M, Laing C, Moules N, Estefan A. Words, Camera, Music, Action: A Methodology of Digital Storytelling in a Health Care Setting. Int J Qual Methods [Internet]. 2019 Jan 1;18. Available from: https://journals.sagepub.com/doi/10.1177/1609406919863241

Spielthenner G. The casuistic method of practical ethics. Theor Med Bioeth [Internet]. 2016 Oct 17;37(5):417–31. Available from: http://link.springer.com/10.1007/s11017-016-9382-8

Zielina M, Škoda J, Ivanová K, Dostál D, Juríčková L, Anthony Procházka D, et al. Exploring moral competence regression: a narrative approach in medical ethics education for medical students. BMC Med Ethics [Internet]. 2024 Jun 21;25(1):73. Available from: https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-024-01073-5

Bilač S, Öztop F, Kutuk Y, Karadag M. Cultural Narratives and Their Impact on Family Mental Health. J Psychosociological Res Fam Cult [Internet]. 2024;2(2):18–24. Available from: https://journals.kmanpub.com/index.php/jprfc/article/view/2362

DasGupta S, Meyer D, Calero-Breckheimer A, Costley AW, Guillen S. Teaching Cultural Competency Through Narrative Medicine: Intersections of Classroom and Community. Teach Learn Med [Internet]. 2006 Jan;18(1):14–7. Available from: http://www.tandfonline.com/doi/abs/10.1207/s15328015tlm1801_4

Gunaratnam Y. Cultural Vulnerability and Professional Narratives. J Soc Work End Life Palliat Care [Internet]. 2011 Oct;7(4):338–49. Available from: http://www.tandfonline.com/doi/abs/10.1080/15524256.2011.623464

Evanoff RJ. Universalist, relativist, and constructivist approaches to intercultural ethics. Int J Intercult Relations [Internet]. 2004 Sep;28(5):439–58. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0147176704000458

Li S, Miles K, George RE, Ertubey C, Pype P, Liu J. A critical review of cultural competence frameworks and models in medical and health professional education: A meta-ethnographic synthesis: BEME Guide No. 79. Med Teach [Internet]. 2023 Oct 3;45(10):1085–107. Available from: https://www.tandfonline.com/doi/full/10.1080/0142159X.2023.2174419

Katz AM, Alegría M. The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context. Soc Sci Med [Internet]. 2009 Apr;68(7):1238–46. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0277953609000094

Obeidat A, Komesaroff PA. The struggle for clinical ethics in Jordanian Hospitals. J Bioeth Inq. 2019;16(3):309–21.

Rukadikar C, Mali S, Bajpai R, Rukadikar A, Singh AK. A review on cultural competency in medical education. J Fam Med Prim Care [Internet]. 2022 Aug;11(8):4319–29. Available from: http://www.jfmpc.com/article.asp?issn=2249-4863;year=2017;volume=6;issue=1;spage=169;epage=170;aulast=Faizi

Woods A. The limits of narrative: provocations for the medical humanities. Med Humanit [Internet]. 2011 Dec;37(2):73–8. Available from: https://mh.bmj.com/lookup/doi/10.1136/medhum-2011-010045

Häyry M. A Defense of Ethical Relativism. Cambridge Q Healthc Ethics [Internet]. 2005 Jan 18;14(01). Available from: http://www.journals.cambridge.org/abstract_S0963180105050024

Tosam MJ. Global bioethics and respect for cultural diversity: how do we avoid moral relativism and moral imperialism? Med Heal Care Philos [Internet]. 2020;23(4):611–20. Available from: https://doi.org/10.1007/s11019-020-09972-1

Garcia LF, Fernandes MS, Moreno JD, Goldim JR. Mapping Bioethics in Latin America: History, Theoretical Models, and Scientific Output. J Bioeth Inq. 2019;16(3):323–31.

Palla I, Turchetti G, Polvani S. Narrative Medicine: theory, clinical practice and education - a scoping review. BMC Health Serv Res. 2024;24(1).

Xiao S, Yuan J, Lan H, Li Q, Cheng Y, Cao K, et al. Investigation of clinical medicine undergraduates’ recognition of narrative medicine. BMC Med Educ. 2024;24(1):1–6.

Franco JVA, Dwan K, Garegnani LI, Kunneman M, Madrid E, Metzendorf M-I, et al. Advocating for evidence-informed decisions to make healthcare fit for each person. BMJ Evidence-Based Med [Internet]. 2022 Apr;27(2):65–6. Available from: https://ebm.bmj.com/lookup/doi/10.1136/bmjebm-2022-111953

Giubilini A, Milnes S, Savulescu J. The Medical Ethics Curriculum in Medical Schools: Present and Future. J Clin Ethics. 2016;27(2):129–45.

Nasri N, Xu W, Jamaludin KA, Mohamad Nasri N. Socio-culturally responsive medical professionalism and ethics education: A curriculum co-creation approach. Med Educ Online [Internet]. 2024;29(1). Available from: https://doi.org/10.1080/10872981.2024.2303209

Wear D, Zarconi J. Can compassion be taught? Let’s ask our students. J Gen Intern Med. 2008;23(7):948–53.

Shamim MS. A contextually relevant ethics education model. Int J Ethics Educ. 2020;5(1):97–100.

Shamim MS, Torda A, Baig LA, Zubairi N, Balasooriya C. Systematic development and refinement of a contextually relevant strategy for undergraduate medical ethics education: a qualitative study. BMC Med Educ. 2021;21(1):1–12.

Coulehan J, Williams PC. Vanquishing virtue: The Impact of medical education. Acad Med. 2001;76(6):598-605. Available from: https://journals.lww.com/academicmedicine/fulltext/2001/06000/vanquishing_virtue__the_impact_of_medical.8.aspx

Woods A. The limits of narrative: provocations for the medical humanities. Med Humanit. 2011 Dec;37(2):73–8.

Frank AW. Letting Stories Breathe : A Socio-Narratology. University of Chicago Press : University Presses Marketing [distributor]; 2012.

Topol EJ. High-performance medicine: the convergence of human and artificial intelligence. Nat Med [Internet]. 2019;25(1):44–56. Available from: http://dx.doi.org/10.1038/s41591-018-0300-7

Coeckelbergh M. Artificial Intelligence, Responsibility Attribution, and a Relational Justification of Explainability. Sci Eng Ethics [Internet]. 2020;26(4):2051–68. Available from: https://doi.org/10.1007/s11948-019-00146-8

Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA [Internet]. 2001 Oct 17;286(15):1897–902. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.286.15.1897

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Keywords
Medical ethics; Narrative medicine; Medical humanities; Ethics education.

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Erbay H. Narrative medicine in ethics education: from theory to practice. J Med Ethics Hist Med. 2025;18.