Pediatric Bioethics: Narrative Ethics: More Than Just Stories
Narrative ethics helps us to connect with others through stories while understanding each other’s lived experiences and collective values, creating true partnership in developing health and well-being. These personal connections can also assist with making health and ethical decisions with patients and families, especially during difficult times. An essential part of this practice is acknowledging culture, rituals and stories passed down generationally that lead to shared empathy, the creation of safe and collaborative spaces, understanding and trust.
We can use skills such as inviting storytelling, listening attentively to one another, identifying ethical lessons and moral virtues that can be derived from the stories, and working together to co-construct the next steps of the story’s plot.1,2 This process includes understanding our own morals and values, as well as those of others, and beliefs about what is ethical or unethical through storytelling.
Listening to each other’s stories is essential. However, there is no guarantee that listening to such stories will provide clear answers. What listening can help with is gaining empathy; validating each other’s beliefs, values and experiences; developing greater understanding; resolving ethical issues together; and creating goals of care and decisions collaboratively.
Narratives can present ethical lessons or create awareness and empathy through expression of ethical issues and experiences. They can also provide relevant insight into “ethical decision-making” by helping us understand the moral reasoning that is created through contemplation and exploration of individual narratives.3 Narrative dimensions of health care illustrate the importance in ethics, ethics education and patient care, particularly when a patient tells their story of illness and when health professionals represent it in words, including when interns, residents or students present cases on rounds.
Rita Charon writes, “The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” 4 Narrative competence includes reading, writing, listening, retelling, and bearing witness to suffering, as well as honoring patients’ experiences of illness. This competence leads to increased knowledge and understanding of the meaning of stories as interpretation of experiences, and definition of what constitutes right and good care.4 In Stories Matter: The Role of Narrative in Medical Ethics, Charon and Martha Montello write, “The practice of narrative ethics demands vision and courage, all the while replenishing one’s store of vision and courage.” 5
As patients and families build moral agency and make decisions related to their health journey through shared experience with health care professionals who listen to their stories, goals and wishes, ethicists can engage when needed to help guide decisions and ensure that these goals are honored through understanding and ongoing acknowledgment of both narratives. This is what Charon and Montello describe as the practice of narrative ethics and the unforeseen dividend of new clarity given between clinical practice and bioethical practice—in recognition that we are all trying, clinically and ethically, to heal, as we witness, not necessarily by solving puzzles but by beholding mysteries.
At times, it is the health professional who needs to tell the story and have another person listen to understand the intensity of the work they do and the impact of caring on their well-being. In these moments, turning to narrative—writing, reflecting and putting the words on paper—can help clinicians address the moral distress or burnout that can potentially lead to leaving the profession they love. This process allows for “self-empathy” and honors the humanness required to seek others—and oneself—to listen and move forward again.
Treating others—and ourselves—as experts of our own lives by engaging in storytelling, listening with an open mind and an open heart, striving to gain a better understanding of cultural attributes, values and ethics is an essential part of cultural humility.6 Acknowledging culture, rituals and generational stories creates empathy, safe and collaborative spaces, understanding, and trust.7 In today’s world this practice is even more important than ever. Finding ways to talk simply and honestly with patients, families, health care colleagues and our communities is truly what is needed to make responsible decisions and choices around pain, suffering, justice and compassionate care.
Sources for narrative medicine and ethics:
JAMA, A Piece of My Mind: https://jamanetwork.com/collections/44046/a-piece-of-my-mind (To submit narratives - https://jamanetwork.com/journals/jama/pages/instructions-for-authors)
Narrative Inquiry in Bioethics: https://nibjournal.org/
Intima – Journal of Narrative Medicine: https://www.theintima.org/
References:
- Barsky A. Ethics alive! Narrative ethics and the value of storytelling. Socialworker.com. July 2022. Accessed May 14, 2026. https://www.socialworker.com/feature-articles/ethics-articles/narrative-ethics-value-of-storytelling
- Barsky AE. Essential Ethics for Social Work Practice. Oxford University Press; 2022.
- Daryazadeh, S. Application of narrative in medical ethics. J Med Ethics and Hist Med. 2019;12(13):1-3.
- Charon R. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286:1897-1902.
- Charon R, Montello M. Memory and anticipation: the practice of narrative ethics (Introduction). In: Charon R, Montello M, eds. Stories Matter: The Role of Narrative in Medical Ethics. Routledge; 2002.
- National Association of Social Workers. Code of Ethics of the National Association of Social Workers. NASW; 2021. Accessed May 14, 2026. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
- Young J. Narrative, embodiment, and health. AMA J Ethics. 2025;27(6):E409-413. https://edhub.ama-assn.org/ama-journal-of-ethics/module/2834325