Open Access Open Access  Restricted Access Subscription Access

The ethical and epistemic roles of narrative in person-centred healthcare

Mary Jean Walker, Wendy A Rogers, Vikki A Entwistle


Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH.


Biomedical model, causality, communication, diagnosis, empathy, epistemology, ethics, illness experience, interpretation, listening skills, narrative, objectivity, person-centered care, subjectivity, understanding

Full Text:



Morris, D.B. (2008). Narrative medicines: challenge and resistance. Permanente Journal 12 (1) 88-96.

Moore, L., Britten, N., Lydahl, D., Naldemirci, O., Elam, M. & Wolf, A. (2017). Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scandinavian Journal of Caring Sciences 31, 662-673.

Savard, J. (2013). Personalised medicine: A critique on the future of health care. Journal of Bioethical Inquiry 10, 197-203.

Vogt, H., Hofmann, B. & Getz, L. (2016). Personalized medicine: Evidence of normativity in its quantitative definition of health. Theoretical Medicine and Bioethics 37 (5) 401-416.

Hogarth, S. & Marks, L. (1998). The golden narrative in British medicine. In: Narrative based Medicine: Dialogue and Discourse in Clinical Practice (T. Greenhalgh & B. Hurwitz Eds.), pp. 140-148. London: BMJ Books.

Entwistle, V.A. & Watt, I.S. (2013). Treating patients as persons: A capabilities approach to support delivery of person-centred care. American Journal of Bioethics 13 (8) 29-39.

Buetow, S. (2016). Person-centred health care: Balancing the welfare of patients and clinicians. London: Routledge.

Frank, A. (1995). The Wounded Storyteller: Body, Illness, and Ethics. Chicago: University of Chicago Press.

Woods, A. (2010). The limits of narrative: provocations for the medical humanities. Medical Humanities 37, 73-78.

Woods, A. (2012). Beyond the Wounded Storyteller: rethinking narrativity, illness and embodied self-experience. In: Health, Illness and Disease: Philosophical Essays (H. Carel & R. Cooper Eds.), pp. 113-128. Newcastle: Acumen.

McKechnie, C.C. (2014). Anxieties of communication: the limits of narrative in the medical humanities. BMJ Medical Humanities 40, 119-124.

Conway, K. (2013). Beyond words: Illness and the limits of expression. Albuquerque: University of New Mexico Press.

Kalitzkuz, V. & Matthiessen, P.F. (2009). Narrative-based medicine: Potential, pitfalls, and practice. Permanente Journal 13 (1) 80-86.

Charon, R. 2006. Narrative medicine: Honoring the stories of illness. Oxford: Oxford University Press.

Montgomery Hunter, K. (1991). Doctor’s stories: The narrative structure of medical knowledge. New Jersey: Princeton University Press.

Montgomery Hunter, K. (1996). Narrative, literature, and the clinical exercise of practical reason. Journal of Medicine and Philosophy 21, 303-320.

Greenhalgh, T. & Hurwitz, B. (1998). Why study narrative? In: Narrative based medicine: Dialogue and Discourse in Clinical Practice (T. Greenhalgh & B. Hurwitz Eds.), pp. 3-16. London: BMJ Books.

Charon, R. (2001). Narrative medicine: A model for empathy, reflection, profession, and trust. Journal of the American Medical Association 286 (15) 1897-1902.

Kleinman, A. (1988). The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books.

Nelson, H.L. (2001). Damaged Identities, Narrative Repair. New York: Cornell University Press.

McNaughton, J. (1998). Anecdote in clinical practice. In: Narrative based medicine: Dialogue and Discourse in Clinical Practice (T. Greenhalgh & B. Hurwitz Eds.), pp. 202-211. London: BMJ Books.

Montgomery Hunter, K. (1997). Aphorisms, maxims, and old saws: narrative rationality and the negotiation of clinical choice. In: Stories and Their Limits (H.L. Nelson Ed.), pp. 215-231. New York: Routledge.

Garden, R. (2010). Telling stories about illness and disability: The limits and lessons of narrative. Perspectives in Biology and Medicine 52 (1) 121-135.

Woody, J.M. (2004). When narrative fails. Philosophy, Psychology and Psychiatry 10 (4) 329-345.

Buckley, C., McCormack, B. & Ryan, A. (2017). Working in a storied way - Narrative-based approaches to person-centred care and practice development in older adult residential care settings. Journal of Clinical Nursing 27, e858-872.

Entwistle, V.A., Cribb, A., Watt, I.S., Skea, Z.C., Owens, J., Morgan, H.M. & Christmas, S. (2018). “The more you know, the more you realise it is really challenging to do”: Tensions and uncertainties in person-centred support for people with long-term conditions. Patient Education and Counseling 101, (8) 1460-1467.

Velleman, J.D. (2003). Narrative Explanation. Philosophical Review 112 (1) 1-25.

Hempel, C.G. (1942). The function of general laws in history. The Journal of Philosophy 39 (2) 35-48.

Currie, G. (2006). Narrative representation of causes. Journal of Aesthetics and Art Criticism 64 (3) 309-316.

White, H.V. (1987). The Content of the Form: Narrative Discourse and Historical Representation. Baltimore: Johns Hopkins University Press.

White, H.V. (1975). Historicism, history, and the figurative imagination. History and Theory 14 (4) 48-67.

Dray, W. (1957). Laws and Explanation in History. Oxford: Clarendon.

Carr, D. (2008). Narrative explanation and its malcontents. History and Theory 47, 19-30.

Bevir, M. (2000). Narrative as a form of explanation. Disputatio 9, 10-18.

Ricoeur, P. (1992). Narrative Identity. In: On Paul Ricoeur: Narrative and interpretation (D. Wood Ed.), pp. 188-199. London: Routledge.

Ricoeur, P. (1992). Oneself as Another. Trans. K. Blamey. Chicago: University of Chicago Press.

Mackenzie, C. & Poltera, J. (2009). Narrative integration, fragmented selves, and autonomy. Hypatia 25 (1) 31-54.

Steuber, K.R. (2012). Understanding versus explanation? How to think about the distinction between the human and the natural sciences. Inquiry 55 (1) 17-32.

Lamarque, P. (2009). The Philosophy of Literature. Oxford: Blackwell.

Klauk, T. (2016). Is there such a thing as narrative explanation? Journal of Literary Theory 10 (1) 110-138.

Mink, L.O. (1970). History and fiction as modes of comprehension. New Literary History 1 (3) 541-558.

Danto, A. (1985). Narration and Knowledge. New York: Columbia University Press.

Koppe, T. (2016). Narrative events. StoryWorlds 6 (1) 101-116.

Langewitz, W., Denz, M., Keller, A., Kiss, A., Ruttimann, S. & Wossmer, B. (2002). Spontaneous talking time at start of consultation in outpatient clinic: Cohort study. British Medical Journal 325, 682-683.

Blau, J.N. (1989). Time to let the patient speak. British Medical Journal 298 (6665) 39.

Labaf, A., Masoomi, R. & Raeisi, M. (2015). How long it takes patients initial statement of concerns? Brief report. Tehran University Medical Journal 73 (8) 608-613.

Lussier, M.T. & Richard, C. (2006). Time to talk. Canadian Family Physician 52, 1401-1402.

Movaffaghi, Z., Makarem, A., Beyraghi, N., Hosseini, F. & Farsi, M. (2013). Time allowed to patients to explain their problem in outpatient clinics of Mashhad University of Medical Science hospitals. Iranian Journal of Medical Education 13 (7) 561-570.

Rehmann-Sutter, C., Porz, R., & Scully, J.L. (2012). How to relate the empirical to the normative: Toward a phenomenologically informed hermeneutic approach to bioethics. Cambridge Quarterly of Healthcare Ethics 21 (4) 436-447.



  • There are currently no refbacks.