The Ethics Behind Narrative Medicine
In the efforts to promote a patient-centred approach to healthcare, the discourse surrounding maintaining good ethics is critical to bring to the forefront. Confidentiality isn’t a loose term; it is strictly endorsed and should not be treated lightly. It is a key asset in facilitating the building of a rapport with a patient, and establishing trust and assurance. When this is breached and disrespected, it can reflect poorly on the credibility of the professional and threaten the integrity of the patient. Not to mention, the reputation of the institution in which care is being provided becomes unstable and in worst cases, blacklisted.
“Confidentiality is not just an important legal and ethical principle; it’s a fundamental building block of trust.”
Encouraging patients to tell their stories while assuring their words will not be manipulated or altered in any way makes for a better healthcare system
Patients expect their privacy to be protected while they are under the care of a physician, and a lack of regard for this creates an unsettling, hostile environment for the patient. Certain protocols call for specific information to be collected, such as name and home address, emergency contacts, etc. This sensitive information can prompt patients to become fearful of its possible distribution, and they may even consequently feel unheard by their providers. This is where narrative medicine steps in. Encouraging patients to tell their stories while assuring their words will not be manipulated or altered in any way makes for a better healthcare system. We must acknowledge its benefits, and its ethical downfalls in terms of prioritizing patient-provider confidentiality within the implications of narrative medicine.
When we consider the idea of patient-provider confidentiality, we have to be considerate of patient autonomy. When patients have a direct say in their care, this is what patient autonomy encompasses. It is the fundamental right and authority patients have to make decisions about their healthcare. For example, they can accept or refuse treatment if they deem themselves comfortable or uncomfortable with its measures and implications, weighing the costs and benefits (The Medic Portal, n.d.). No health professional should be guided by whatever personal biases they may have or intentionally persuade the patient to make one decision over another. This is why when patients offer narratives, it offers a deeper understanding of the patient, what they desire, and how a provider must demonstrate respect.
The healthcare system thrives on patient narratives to serve as a learning tool in the field. These enriched stories can be inspirational and groundbreaking when brought to the forefront. It educates professionals on how to display compassion, reminding them of the importance of culture and traditions, as well as learning from other people’s mistakes. However, the ability to distribute said stories for the purposes of learning can only be ethically legitimate if explicitly established in a confidentiality pledge. At the beginning of care, a pledge is stated between the patient and provider, “advocat[ing] that patients and physicians openly discuss the ways patients want their information treated” (Petronio, Dicorcia, & Duggan, 2012). These pledges are performed face-to-face to minimize miscommunication and to ensure the patient is confident in their decision. This exemplifies “the physician [...] illustrating a level of care and concern for the patient’s wishes regarding information considered private” (Petronio et al., 2012) These conversations, although some may argue are tedious, are not to be undermined. Not only do these pledges carry a level of professional trust, but they educate the patient about their rights and remind the provider about their role in healthcare.
For a successful implementation of narrative medicine, ethics must follow. There may be a hot debate in other sectors, but they are there for a reason. Patient care is a two-way-street and it requires the effort of everyone involved.
By: Saray Membreno (She/Her) | VP Marketing
