Literature and Ethics Research Paper

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Abstract

Literature has been proposed as a means to enrich an understanding of ethical issues within medicine and health care and as a resource in medical education. Its proponents argue for the value of understanding human suffering and the experience of health care, through literature, rather than solely through the more abstract and analytic philosophical methods of bioethics. Literature is claimed to serve as a corrective to the rational and individualist approaches of bioethics, by drawing attention to “our vulnerable and interdependent human existence.” In this research paper, the history of a relationship between ethics and literature is discussed, along with more recent scholarship on the ethical relevance of literature, and research focusing on the constitution of ethics as literary form. It is apparent that literature, and especially futurist writing and science ﬁction, has an inﬂuence on the construction and understanding of ethical issues for both specialist practitioners and the lay public. It is concluded that literature enhances understanding of ethical issues in health care and research, and the manner in which it does so needs to be better understood through the skills of literary analysis as a necessary complement to bioethical analysis.

Introduction

Although discussion of the ethical signiﬁcance of literature stretches back over thousands of years, literature’s relevance to bioethical inquiry is a relatively new topic of discussion. When in 2014, the Journal of Bioethical Inquiry held its ﬁrst symposium on literature and bioethics, its editors, Grant Gillett and Lynne Bowyer, suggested that this ﬁrst foray into the territory “may well become one of its signiﬁcant strands of scholarship.” In their view, literature promised new lines of inquiry around certain lesions in bioethical thought, speciﬁcally those that are insensitive to “our vulnerable and interdependent human existence” (Gillett and Bowyer 2014). They might well have added, as Howard Brody had commented almost 20 years earlier, that ambiguity and other signiﬁcant features of literature may stand in productive tension with the methods of bioethical inquiry, challenging and extending them in innovative ways (Brody 1991).

This research paper traces the history of a relationship between literature and ethics and considers why literature has only recently come into view as a potentially fruitful method for bioethical inquiry. Literature’s contribution to medicine and bioethics has (to date) been from two quite separate sources. The ﬁrst is the medical humanities which is championed by clinicians and medical educators who argue for the value of literature in providing a nuanced understanding of human vulnerability and suffering. That approach stands in contrast with biomedical approaches to disease, in which the technicalities of pathology are seen and treated, but in a way that is detached from the qualitative experiences and meanings of illness for sufferers. The second source of literature’s contribution to medicine and bioethics is from utopian, dystopian, and science ﬁction writing. Many of the works within this genre have explored futuristic possibilities for new biotechnologies, and they, in turn, have had a role in framing pertinent ethical issues for both practitioners and the public. It is also noted that advocates for some new biomedical technologies adopt both the style and (on occasion) the substance of science ﬁction writing without making this explicit.

Differences between bioethics and literature in their methods for exploring ethical issues are considered, and the case is made for the value of literature in contributing to ethical understanding. It is proposed that the most cogent philosophical framework for considering literature’s contribution is provided by philosopher Martha Nussbaum, and her views are outlined. From a global perspective, there is a paucity of discussion of ethically relevant literature from non-Western cultures. However, some exploratory work highlighting the ethical themes of aging, human rights, and human nature has been done by Emmanuel Omobowale (e.g., 2013) in the Nigerian context. Discussion of literature from other cultures could challenge Western approaches to ethics and bioethics. In this regard, the ongoing development of non-Western ethical frameworks will provide a useful tool for harnessing bioethical insights from literary works in these cultures.

History And Development: Literature, Philosophy, And Ethics

There has been extensive debate about what the relation between literature and moral philosophy actually is, and what it should be, for at least 2,500 years. In these debates, literature has been seen alternately as a necessary vehicle for moral learning and development or as antithetical to moral development. Many, if not most, cultural traditions have versions of these arguments. A brief history of the debates, from Western scholastic traditions, is outlined. Bioethics is a relatively recent emergence from these traditions.

Ancient Greek philosophers spoke of “an old quarrel between philosophy and poetry.” Plato – making a case for philosophy at a time when poetry was the ascendant form – took the position that literature, or at least poetry, undermined reason and ethics because the arts (and particularly poetry) exert their inﬂuence through emotive power rather than rational argument. His disquiet was that the claims of the poets may be false and harmful and ought to be critically examined through philosophy. Of relevance, however, is the fact that he wrote these claims in a literary form – that of characters in dialogue – underscoring the power of literature in presenting philosophical argument. Equally interestingly, Aristotle defended the claims of tragedy (as a literary form) to tell a certain kind of truth – but made those claims as an academic thesis, rather than in a literary or poetic form.

Nonetheless, until the very late nineteenth century, writers largely understood literature as inseparable from morality and from particular moral projects. An obvious form of such literature was the ‘morality tale,’ which explicitly aimed to develop and inculcate moral lessons in readers. These tales were a particularly dominant form in the late eighteenth and most of the nineteenth century. More generally, however, for the period up to the early twentieth century, the pleasure and value of literature was considered to be derived, in large part, from its capacity to illuminate poignant moral issues and to educate readers and listeners about moral choices (Nussbaum 1990a). Authors stood in judgment of their characters’ virtues and moral shortcomings. This role of author as moral commentator was supported by the philosopher David Hume who, in his essay “Of the Standard of Taste” (1757), argued for standards of “morality and decency” in judging works of art. He wrote “where vicious manners are described, without being marked with the proper characters of blame and disapprobation; this must be allowed to disﬁgure the poem, and to be a real deformity.”

However, there was some disquiet that particular works of literature – especially novels – were actually doing something rather different, perhaps encouraging readers to question established moral principles, or even seducing them into immoral behavior through the undisciplined pursuit of entertainment and pleasure or unrealistic and romantic expectations of life. From the mid-nineteenth century, there were shifts, in both literary writing and nascent literary and art criticism, to create more separation between aesthetic expression and explicit moral content. Some argued that ethics and the arts are autonomous spheres that should be kept quite separate. The concern was that any moral constraint on the arts threatened aesthetic freedom, which was regarded as foundational for creativity. Art, for these proponents, was “a refuge or arena for the free play of the imagination” and “the last bastion of authentic freedom.” The advocates (including John Ruskin, Roger Fry, and Clement Greenberg) considered that importing moral standards into the assessment of art and literature was to morally censor artworks and to inhibit the freedom that is necessary for artists to produce their best work (Macneill 2014).

Others, however, argued that the goal of literary study was to identify and understand quality or ‘greatness’ in works of literature and that greatness could be identiﬁed most coherently as the capacity of the work to adequately explore moral questions. Inﬂuential scholars like FR Leavis and Harold Bloom defended the signiﬁcance of the Western literary ‘canon’ – a generally accepted list of literary works regarded as having attained the highest possible artistic merit and maximum cultural inﬂuence – in part as a result of the quality of the way in which moral questions were handled. This approach has received recent support from philosophers of art including Berys Gaut and Noël Carroll (Macneill 2014).

However, the canon itself was severely criticized by scholars afﬁliated with the social justice movements in the 1960s. They pointed out that nearly all the writers celebrated in the canon were ‘dead white males,’ and their works propagated worldviews reﬂective of the perspectives and social power of those writers. These scholars were concerned with analyzing how power is deeply embedded in the structures of language and the composition of texts. Their methods were ‘deconstructive’: they worked by analyzing the components of texts to reveal the hidden tricks of language that gave credence to conventional assumptions of power and moral certitudes (Eagleton 1990; Nussbaum 1990a). In this way, they sought to destabilize knowledge, by deconstructing accepted verities, moral positions, and partialities. As commentators have since noted, this was and is a profoundly ethical project of its own. However, that project was never framed in the language or concepts of contemporary philosophical ethics, which were themselves seen to reproduce the same dominant paradigms that postmodernists had set out to critique. Hence, “it was assumed that any work that attempts to ask of a literary text questions about how we might live . . . must be hopelessly naïve, reactionary and insensitive to the complexities of literary form and intertextual referentiality” (Nussbaum 1990a).

In this way, literary studies and academic philosophical ethics found themselves positioned as mutually antithetical at the end of the twentieth century. In an interesting reversal of Plato’s position, ascendant academic philosophy was now being assessed as overly cold and analytic, needing to bring emotion and experience back into the picture. This was the direction taken by Martha Nussbaum and others within philosophy and, at the same time – although more naïvely – within the nascent medical humanities, in making new arguments for the ethical relevance of literature, as is discussed below.

Bioethics

Any failure of bioethics, and medical education more generally, to embrace literature can be understood in terms of the history of bioethics as a discipline. Bioethics is a relatively recent ﬁeld. Its methods have relied on formal and principle based analyses (often utilitarian or Kantian), and its content has been limited to the body, disease, health and medical (including nursing) practice, and issues arising from new developments in medical research and biotechnology. A more recent development has been an ‘empirical turn,’ arguably brought about by the insufﬁciency of philosophically derived principles on their own, to deal with the ‘messiness’ of real cases. Although bioethics has not embraced literature, much of its content is the stuff of media productions such as TV soap operas and movies, and there is a particularly close connection between science ﬁction and associated utopian or dystopian writing and the subject matter of bioethics. As such, a point of departure will be an examination of medical humanities.

The Medical Humanities

Literature has had a strong presence in one area over the past 40 years: the medical humanities. The medical humanities is a broad, heterogeneous ﬁeld of practice and research focused on the qualitative experience and meaning of health and illness. The founders comprised a group of passionate clinician-educators who feared that medicine’s increasingly sophisticated technical orientation was developing at the expense of humanistic responses to social, emotional, and existential patient needs. Advocates within the medical humanities argue for studying narratives, literature, and the creative arts as well as the philosophy and the history of medicine as a corrective to some of the shortcomings of medicine (Hudson Jones 2013; Macneill 2011).

Collectively, the medical humanities are claimed to “humanize medicine” by “providing a different viewpoint” and a “critical and questioning attitude”; “bringing patients being back into focus as unique persons living with an illness” and “providing an understanding of character within its context.” Advocates claim that the “arts can assist in developing the student as a communicative doctor” by developing “sensitivity to nuances, ambiguities, and hidden meanings.” It is also claimed that studying the humanities promotes empathy although many commentators are skeptical about this claim (Macneill 2011; Garden 2007).

The other major claim is that “the humanities are justiﬁed, even if they do not make people better doctors, because they enrich and bring greater pleasure to their lives” and because they touch “the student more deeply at a personal level.” Related to this are ideas about “what it means to be ‘educated’ as distinct from simply ‘trained.’” Jane Macnaughton argues that a course in medicine is an insular vocational training and that the humanities are needed for authentic and broad medical education. John Warner notes that this has been a “persistent refrain” since the early 1900s, and he argues (more skeptically) that the underlying motivation is to maintain the “ideal of the ‘gentleman-physician’ well versed in the classic liberal arts” (Macneill 2011).

The medical humanities generally, and the use of literature within it speciﬁcally, has been critiqued as naive on both practical and theoretical grounds. The assumptions and texts around which the ﬁeld has been constructed have uncritically reﬂected the Western canon of literary works, omitting much of the critical humanities scholarship that deconstructed it. It is also argued that the humanities are “too often engaged as if they are non-critical resources which can be deployed in the service of the ends determined by the medical and medical ethical powers that be” (Rees 2010; Macneill 2011). Although it has received surprisingly little attention within the medical humanities itself, there has been considerable scholarship expounding on the ethical relevance of literature and the literary constitution of ethics, over the past two decades, led especially by Martha Nussbaum.

Discussion

Literature: A Different Method For Moral Philosophy?

To illustrate the different approaches of literature and bioethics, two very inﬂuential works are discussed: a popular satirical novel and a standard textbook of bioethics. Published within a year of each other, Beauchamp and Childress’s textbook The Principles of Biomedical Ethics and Samuel Shem’s novel The House of God rapidly came to be regarded as foundational, deﬁnitive texts for bioethics and the medical humanities, respectively. This raises some questions: can the ethical issues within the capacities of the latter – a novel – be adequately explained by the former, a text on bioethical reasoning? Is there anything that can be learnt from the novel that cannot be learnt from the work of formal ethics? Are they functionally equivalent, as far as ethical learning goes? The answer to these questions is typically “No.” There are features of ethical engagement with literature that cannot be analytically reduced to the sorts of philosophical categories and explanations that Beauchamp and Childress employ. The actions of the characters in The House of God can be neither described nor explained, nor critiqued, by reference to Beauchamp and Childress’s principles of autonomy, beneﬁcence, non-maleﬁcence, and justice alone.

In explaining ‘why not,’ Nussbaum points to the central methodological importance of literature within the Aristotelian ethical framework that she argues is critical for pursuing ethical life and action. The neo-Aristotelian process for living ethically, as advocated by Nussbaum, requires engaging in an inclusive, open-ended, dynamic, and constant inquiry about what it means to live well. This dialectic allows for alternative perspectives and positions to be put and explored and for the evolution of one’s ethical sensibilities as a result of the process. The inquiry should be both empirical and practical, enabling us to try out and explore what ﬁts most deeply with what is important to us. While no one form and no one genre can be adequate to this task alone, works of literature can utilize all the subtle complexities of form and style to do this in a particular way: one that gives primacy to the speciﬁc, the contextual, and the individual; and one that elicits, confronts, engages, seduces, and alters emotion. Indeed, it offers an approach that is morally responsive to the uniqueness of human being and human experience; one that is ﬁnely discerning, richly aware, subtle, complex, irreducibly messy, and loving. This methodological approach is profoundly different from the reductive methods of bioethics.

Particularity is a key feature of this methodology. The very concreteness of works of literature is what enables their ethical relevance. Only literature can indicate, as generalized works of philosophy cannot, how ethical judgments may shift with the emergence of new or unanticipated features in the web of relations between a set of characters. Similarly, literature can show how ethical features are greatly inﬂuenced by context, such that an ethically repugnant character can be understood in very different, sympathetic, and ﬁnely inﬂected ways. Literature can take account – as most bioethical analyses cannot – of a person’s moral development over a lifetime. Very subtle shifts in the qualities of another person’s conception of responsibility and integrity, for example, may well impact on how moral choices are viewed, something exempliﬁed by the delicacy and subtlety with which Michael Cunningham handles suicide in The Hours, for example.

Further, literature insists on giving attention to the ethical relevance of particular persons or relationships, a point made very powerfully in Kazuo Ishiguro’s Never Let Me Go; a novel that explores organ harvesting and transplant. It is the unbearably multivalent qualities of relationships where most of the ethical meaning of these works are played out. It is often the ambivalent, unforeclosed, and unresolved aspects of characters and their situations that are signiﬁcant in the ways in which literature illuminates ethical issues. This stands in methodological tension with analytic and empirical bioethics. Literature is also vested in plurality, in what Nussbaum calls “the incommensurability of valuable things.” This plurality of valuable things is difﬁcult to capture in traditional bioethical analysis.

It is however not merely complexity qua complexity, or subtlety, or even particularity, that gives literature a unique methodological capacity for ethical exploration. It is the use and capacities of language that are critically important. Literary scholars such as James Phelan, who are interested in literature as ethical methodology, have turned their attention to “rhetorical literary ethics.” They tie ethics systematically to matters of technique and form, showing how ethics is an intrinsic part of rhetorical form and how that form comes to constitute ethics itself. By conceiving of the literary text as a site of a multilayered communication between author and audience, scholars can identify both the ethical dimensions of what is represented and the ethical consequences of how those things are represented (Phelan 2004). In this way, the powerful relationship between aesthetic strength and an ethical dynamic can be better understood.

This richness of language and literary technique enables compelling and fundamental aspects of the human condition to become tangibly felt and hence traces the ways in which emotion is both critically important and may inﬂuence cognition within ethical decision-making. Literature offers insights into what it is about striving, grief, pain, and mortality that deﬁnes humanness, in all its brief and distinctive variations (e.g., Arwen’s choice, to accept marriage to a mortal with all the grief it entails, in Lord of the Rings).

For Nussbaum, another important aspect of one’s humanness – which is deeply entwined with ethics – is love. Nussbaum’s ethical philosophy explores what it means to be richly responsible by ﬁnding one’s way to loving ways of acting toward others. In her view, love demands the most full and complete ethical engagement possible for a human being. In grappling with the ineffable and mysterious qualities of these dimensions of existence – through the uniquely qualitative and subjective modes offered by literature and the creative arts – responses to moral questions are potentially modiﬁed and ameliorated. This includes responses to moral questions arising in situations concerning common bioethical topics of abortion, euthanasia, organ donation, and assisted reproduction. It is through the ﬁneness and sensitivity of responses to such issues, as they arise in individual and ‘true-to-life’ circumstances, that literature restores ethical value to the emotions, as resonances that help guide ethical responses without determining them.

Literature And Bioethics: Instrumental Implications

The ﬁne awareness and loving responsibility that Nussbaum advocates offer a persuasive explanation for the sense of moral expansion that many people feel in reading literature. Some skepticism about the moral effects of literature on human behavior needs to be acknowledged, however. It is obvious to anyone who considers the last 200 hundred years of history, whether it be the imperial British or the German National Socialists, that reading great literature or loving art has little or no inﬂuence on ethical action. Indeed, moral philosophers themselves are not necessarily people of outstanding ethical conduct. It has to be concluded that written exhortations, literary exemplars and illustrations, philosophical analysis, and great works of literature all similarly have no clear causal inﬂuence on ethical action. Even so, it can still be maintained (optimistically perhaps) that the ethical inﬂuence of literature may be profound, albeit in ways that are context dependent and unpredictable, expressed in periods of deeply attentive listening and questioning, or in moments of insight and enlightenment. There is very little quantitative evidence for the utility of literature in medical education. This may be because, even when the value of an experience is profound, it is difﬁcult to measure. However, it may also be that the relevance and impact of an experience of literature only become apparent many years after exposure.

A second ethical function proposed for literature and the arts generally is that they are highly relevant to bioethics as different means for imagining or rehearsing bioethical or clinical ethics dilemmas or choices. Medical TV dramas, a genre that is one of the most successful staples consumed by global television audiences, are perhaps the preeminent exemplar of this. Medical dramas have introduced a wide range of ethical dilemmas to student and nonspecialist audiences alike – ranging from the impact on patients from unprofessional workplace behavior and competitive specialists to ‘classic’ clinical ethics scenarios such as organ donation, scarce resource distribution, the impacts of contested diagnoses, conﬂicts between patient preferences and medical advice (such as refusal of blood transfusion or other life-saving treatment by adherents of particular religious groups), patient conﬁdentiality, euthanasia, and abortion. A question remains about the ethical value of simple exposure to these issues, given that the ways in which they are portrayed and resolved in TV dramas are often heavily constrained by the perceived demands of the genre. For example, no one’s best interest or integrity is well served by a deeply ingrained media-driven and wholly inaccurate expectation of a positive outcome from heroic resuscitation. This is where a novel may be better placed to present an issue from multiple perspectives and as unresolved, as, for example, in Ian McEwan’s The Children’s Act in its treatment of the refusal of blood transfusion by a young Jehovah’s Witness.

Novels, short stories, pathographies, and memoirs may also expand one’s ethical repertoire. The qualities of experience, and the sociocultural or socioeconomic contexts that shape experience, can be more extensively explored in literature. Examples include the struggles of George Eliot’s Dr Tertius Lydgate to remain committed to his intellectual passion amid the hampering social prejudices and petty politics of the middle England society in which he works, and the bitterly hilarious, illusion-shattering anecdotes produced by young doctor-writers like Michael Foxton, Vincent Lam, or Samuel Shem. Indeed, the entire genre of pathography might be said to serve the critically important ethical function of introducing readers – practitioner and lay alike – to what it means to experience illness. Novels can overcome the disempowering alterity created by disease and disability (albeit momentarily and imperfectly). Novels can also illuminate the experiences of those who are deaf, mentally ill, in pain, or profoundly physically limited or confronted (from Oliver Sack’s A Leg to Stand On to Jean-Dominique Bauby’s The Diving Bell and the Butterﬂy). While some worry that such works may be used in ways that are disempowering to some patients – for example, because a single account should not be assumed to stand for all patient experiences of that condition or illness – others appreciate the capacity of literature to provide some insight into experiences of suffering and deprivation.

Literature and the arts also provide moral models and articulate normative values within medicine. There is considerable literary and popular writing (including for ﬁlm and television) that depicts the experience of clinical work and illustrates and constructs particular values as ideals for biomedicine and clinical ethics. A convention of medical dramas is to portray a ﬂawed, struggling, socially awkward or problematic physician protagonist, who is known for an apparent rudeness or lack of empathy toward patients and ungenerous interactions with colleagues. Each of these characters enacts his role (usually ‘his’) in plots that highlight an overriding ethical commitment, which may be to truth seeking, questioning power and authority, or supporting the desires and priorities of particular patients. Examples include House, Hawkeye, Perry Cox, Martin Ellingham, and The Fat Man. The values these protagonists champion are constructed as redemptive and overriding. They are typically values that are also prized within clinical ethics.

The ‘ﬂawed doctor’ genre sits in contrast with works that explore the ethical challenges of caring, as demonstrated by characters such as Anne Sullivan, Martin Arrowsmith, Yuri Zhivago, or “Doc” Ed Ricketts. In some cases, what is modeled is acceptance of the complexity of a situation, the inability to heal physical conditions or redress social or mental afﬂiction, and the consequent ethical requirement for the doctor or healthcare worker or carer to embrace a sufferer amid their struggles (e.g., Leo Tolstoy’s Ivan Ilych).

The Social Influence Of Literature

Literature is claimed to have ethical impacts at social and individual levels. However, there is also a history of complaint that literature delights in, advocates for, or stimulates immorality of one kind or another – a fear that has troubled many since the novel ﬁrst emerged. The novels Lolita, American Psycho, Catcher in the Rye, and Lady Chatterley are just some of many novels that elicited calls for banning or censorships on moral grounds. Yet, from another perspective, these works could be claimed to have ethical power in their critique and challenge to explicit social injustices and prevailing social norms. This may explain, in part, the fear and power of the reaction they have engendered. English language and European literature include a strong literary tradition of giving voice to the socially marginalized, impoverished, diseased, or enslaved and of holding the social practices and processes that produce such circumstances up for scrutiny. Examples include John Steinbeck’s Grapes of Wrath, Maya Angelou’s I Know Why the Caged Bird Sings, Charles Dickens’ Bleak House, Harriet Beecher Stowe’s Uncle Tom’s Cabin, Alan Brennert’s Moloka’i, Victor Hugo’s Les Miserables, Thomas Mann’s The Magic Mountain, Giacomo Pucccini’s La bohème, Eugene O’Neill’s Long Day’s Journey Into Night, and many more. Literature and the arts also offer opportunities for powerful witnessing and testimony (such as Eva Mozes Kor’s survivor account of Nazi medical experimentation) and of redemptive or confessional healing in exploring impacts of brutal social and political situations.

This use of the pen to challenge social norms and practices has such a strong tradition in literary history that it can often appear as the overriding ethical imperative of good literature. However, as poststructuralist critics of the literary canon point out, the very same works that challenged some forms of social injustice – for example, works that critiqued and satirized repressive gender norms, including those problematizing cultural constructions of gender and mental illness (such as the novels of Charlotte Bronte, Virginia Woolf, or Charlotte Perkins Gilman) – may simultaneously have themselves reproduced other repressive cultural constructs (say, about class and race).

Nonetheless, literature’s capacity for social critique has become increasingly important as a key strategy for cross-cultural understanding in a globalizing world (e.g., Chinua Achebe’s Things Fall Apart and Jung Chang’s Wild Swans). Two examples have been offered here, although there is an abundance of literature that illustrates this point. Understanding people whose lives and thoughts are very different from one’s own is a function unique to literature and the arts. Literature’s capacity to provide insights into ‘the Other’ and alterity has sometimes prompted novelists to deliberately break with literary conventions so as to resist the immediacy and transparency of language in ways that engage the reader ethically. T S Eliot and Virginia Woolf (along with many in the experimental, modernist era) provide prime examples. Just as pathographies enable a reader to have some understanding of the radical otherness of being ill or of inhabiting a non-normal body, the function of understanding alterity in social terms – what it is like to be someone of a different sex or an oppressed race or culture, or a different age or religion – is an enduring theme in many literary works.

Literature’s capacity to elucidate ‘otherness’ has not as yet been seen as a valid extension of either philosophical ethics or bioethics. Nor has bioethics, or the medical humanities, explored non-Western literature and the arts (Hooker and Noonan 2011). There is a potential for deep engagement with literature about ‘otherness’ as well as with literature and the arts of non-Western cultures. Non-Western literature and art forms could challenge Western approaches to ethics and bioethics and add richness to the current discussion within bioethics about whether there are meaningful and distinctive cultural constructions of ethical experience and approach: such as ‘African’ or ‘Chinese’ ethics (for examples of current discussions within bioethics: see Asian Bioethics Review 2011:Vol.3, No.1.).

Science Fiction’s Influence On Bioethics

There is another reason for exploring the relationship between literature and bioethics, and that is the inﬂuence that literature, and particularly science ﬁction, has on framing bioethical issues and questions. Science ﬁction and genres of ‘futurology,’ including utopian, dystopian, and fantasy ﬁction writing, often explore issues relevant to bioethics. Inherently speculative, much science ﬁction writing explicitly and deliberately sets out to fulﬁll two of the ethical functions identiﬁed above: the imaginative rehearsal of possible ethical dilemmas and scenarios, speciﬁcally, those arising out the development and application of new technologies (particularly biotechnologies) and the forms of social injustice they might alternatively confront or cement. Some works have been written explicitly to explore already-existing contemporary bioethical dilemmas, such as Jody Picoult’s savior-sibling thriller My Sister’s Keeper, or John le Carre’s exploration of global pharmaceutical politics in The Constant Gardener. Interestingly, these works are typically classed as popular rather than literary ﬁction, utilizing detective and thriller genres. Such ﬁction is usually not morally prescriptive.

Clayton is one of very few writers to bring the bioethical debate in contact with (what he calls) “the massive, culturally signiﬁcant body of writing on the topic, popular science ﬁction” (Clayton 2013). Much science ﬁction and futurist writing have included thought experiments about the possible bioethical or social impacts of new biotechnologies. This genre dates back to early expressions of discomfort about the possible impacts of arising biomedical technologies including Mary Shelley’s Frankenstein, HG Wells’ The Island of Dr Moreau, and Aldous Huxley’s Brave New World. Speculative ﬁction, along with mainstream movies, has provided a way of exploring possible consequences of contemporary biotechnologies. These have impacted on public attitudes toward issues such as genetic technology (including cloning), stem cell research, and cosmetic pharmacology (Guyer and Moreno 2004). Indeed, constraints on research, health and medical policy, and legislation have been signiﬁcantly, and many argue inappropriately, inﬂuenced by speculative futuristic writing (Clayton 2013).

In some cases, the distinctions between science and science ﬁction can truly collapse. Nanotechnology, for example, is considered at once a science and a science ﬁction. It employs the same tropes, conventions, metaphors, and narrative strategies in funding proposals as appears in published ﬁction, and the speculative worlds it imagines, as a result of as-yet uninvented technologies, drive its research questions. It does this by blurring two different genres: research-based projections and scientiﬁc ﬁction (Clayton 2013).

There are many topics within bioethics where ﬁction writing offers one of the most powerful forms of imaginative grip on ethical signiﬁcance. To take the example of ‘transhumanism,’ the edges and possibilities of being human are challenged by technologies that impact on biological functions (including those of genes, musculature, organs, brains, and reproductive systems).

Transhumanism questions separation between individuals, from animals and robots, and from the natural world, questions that have been recurrent in science ﬁction writing from Frankenstein through to Peter Goldsworthy’s Wish or Honk If You Are Jesus. Other such topics on the edge of science and science ﬁction include ‘living forever’ (or ‘preventative geriatrics’) and sexuality. Speculative ﬁction has enabled feminist writers to conduct thought experiments about what features have impacted most on patriarchy, for example, by exploring the potential consequences of having a society in which (biological) reproductive capacity and experience are not asymmetrically distributed across two sexes – or where there are more than two sexes (Kendal 2015).

Clayton writes that “the failure of bioethicists to examine the images, metaphors, and storylines of the science ﬁction that they so frequently invoke distorts their ﬁndings and recommendations.” For this reason, bioethicists would be well advised to adopt the tools of deconstructive literary theorists in order to analyze and critique the rhetorical strategies that shape and drive “science ﬁctionality” in research and policy. Clayton puts it simply in proposing that the “ﬁeld of bioethics could beneﬁt from literary approaches to science” and science ﬁction (Clayton 2013).

Conclusion

In this research paper, the relations and disjunctions between literature and ethics have been explored. It has been shown that literature has had some inﬂuence on medical education through the medical humanities, aimed at enhancing empathy for patients and compassionate insight into patient experience as crucial components of medical practice. While this has signiﬁcant implications for biomedical (speciﬁcally narrative) ethics, it was not considered a bioethical project per se. At the same time, bioethics evolved in separation from the major concerns of literary scholarship and has as yet hardly begun to embrace literature. Nevertheless, there are good reasons for expanding bioethics to include literature. Martha Nussbaum has argued for the importance and relevance of literature as a method of ethical inquiry. Similarly, the scholarship of James Phelan into the rhetorical construction of ethics suggests not only that literary analysis is relevant to understanding ethics but that indeed it is impossible to entirely separate the two, as ethics is always instantiated in rhetorical form. It is also noted that literature has a major inﬂuence on bioethics, research, and ethical policy, by shaping the manner in which ethically relevant issues are framed and discussed. This is particularly in relation to biomedical discoveries and biotechnological innovations. The inclusion of these issues within science ﬁction, including both utopian and dystopian scenarios, has had a major impact on how these issues are understood in popular culture and within scientiﬁc research.

Literature thus offers a means to broaden and deepen the ethical understanding of practitioners, students, and the general public. This is because literature takes multifaceted and dynamic approaches in analyzing what it means to live well. It does this in ways that are contextually related and ﬁnely attuned to a particular character’s development over time. For these reasons, it can act as a complement to, or even in tension with, the more abstract methods of bioethical inquiry. It is also important to be cognizant of literary means for constructing and presenting ethical issues because these are already active in understanding these issues (as discussed above). Studying literary construction would require developing and maintaining techniques for analyzing literary strategies and devices so as to better understand literature’s inﬂuence on bioethics and those strategies that are already employed within bioethics advocacy. This would offer some protection against naïveté about the manner in which literature has its inﬂuence and some protection against poorly constructed bioethical argument. Although literature and ethics have a strong relationship with one another, this has not been adequately and systematically explored in the various relevant ﬁelds of study including bioethics, the medical humanities, literary studies, philosophical ethics, and the philosophy of literature. Bringing these ﬁelds together would provide a rich harvest of skills, ideas, and understanding.

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