Narrative Medicine in Hospice Care: Identity, Practice, and Ethics through the Lens of Paul Ricoeur (Studies in the Thought of Paul Ricoeur)

Narrative medicine, an interdisciplinary field that brings together the studies of literature and medicine, offers both a way of understanding patient identity and a method for developing a clinician’s responsiveness to patients. While recognizing the value of narrative medicine in clinical encounters, including the ethical aspects of patient discourse, Tara Flanagan examines the limits of narrative practices for patients with cognitive and verbal deficits. In Narrative Medicine in Hospice Care: Identity, Practice, and Ethics through the Lens of Paul Ricoeur, Flanagan contends that the models of selfhood and care found in the work of Ricoeur can offer a framework for clinicians and caregivers regardless of the verbal and cognitive capabilities of a patient at the end of life. In particular, Ricoeur’s concept of patient identity connects with the narrative method of life review in hospice and offers an opportunity to address the religious and spiritual dimensions of the patient experience. Cover 1 Narrative Medicine in Hospice Care 2 Series page 3 Narrative Medicine in Hospice Care: Identity, Practice, and Ethics through the Lens of Paul Ricoeur 4 Copyright page 5 Contents 6 Acknowledgments 8 Introduction 10 Chapter 1 16 Narrative Medicine 16 Clinical Detachment as a Practical Skill for Health Care Providers 18 The Turn toward Narrative in the Medical Humanities 19 Clinicians and the Practice of Narrative Medicine 22 Clinical Pedagogy in Narrative Medicine 23 The Narrative Self for Ricoeur 26 Medical Ethics and Clinical Practice 29 Conclusion 35 Notes 36 Chapter 2 46 Narrative Identity and Practice in the Hospice Model of Care 46 Patient Identity in the Hospice Model of Care 48 Cicely Saunders and the Concept of Total Pain 50 Pain and Patient Identity 51 Loneliness as a Manifestation of Pain 53 Life Review and Narrative Practices in the Hospice Model of Care 54 Attending to the Religious Dimension of Human Experience 61 Religion in Clinical Medical Education 63 Spiritual Assessments as an Example of Narrative Practice 63 Distinction between Spiritual Assessments and Life Review 66 Conclusion 68 Notes 68 Chapter 3 74 Narrative Ethics and Practices from the Patient’s Perspective 74 Life Review for End-of-Life Patients 76 Modalities of Life Review 79 Life Review in Hospice as a Mode of Moral Reflection 82 Themes That Point to Ethical Analysis 84 Life Review and the Limits of Ricoeur’s Concept of “Life Plan” 88 CONCLUSION 91 Notes 91 Chapter 4 98 The Limits of Narrative Medicine for End-of-Life Patients 98 Limitations to Patient’s Abilities: Cognitive Decline and the Impaired Ability to Narrate Coherently 99 Moral Identity and Life Review for Verbally and Cognitively Compromised Patients 102 Agent Narrativity 103 Partial Narrativity 105 Social Narrativity 109 Context of Care and the Effects on Narrative Practices 110 Long-Term Residential Care and Other Contexts of Care 113 Narrative Identity in the Clinical Encounter Taking Context into Account 114 Conclusion 115 Notes 117 Chapter 5 122 Expanding beyond Narrative 122 Paul Ricoeur’s Meditation on the End of Life 123 How Religion Can Address the Limits of Narrative Methods in Medicine with Nonverbal Patients 126 Hospitality as a Practice for Hospice Patients and Caregivers 127 Dorothee Soelle on Suffering, Language, and Bearing Witness 130 A Theology of Hospitality for Hospice Caregivers 132 Hospitality as Bearing Witness to Those Who Are Dying 133 Accompaniment as a Model of Presence Possible Regardless of Narrative Ability 134 Conclusion 138 Notes 140 Bibliography 142 Index 154 About the Author 160 Narrative Medicine in Hospice Care argues that the models of selfhood and care found in the work of Paul Ricoeur can serve as a framework for clinicians, caregivers, and end-of-life patients regardless of the patients' verbal and cognitive capabilities.