Narrative Ethics

Much is written about the concept of person-centred practice in long-term care. At the same time, however, the dominant form of ethical reasoning in health care is that of principlism: autonomy, beneficence, non-maleficence and justice. Principlism has been criticised for its reliance on deontological and utilitarian philosophies, for its Western assumptions regarding the individual and autonomy, for its failure to accommodate diversity, and its failure to incorporate any notion of the Self or personhood into its framework. As such there seems to be a contradiction between a person-centred practice focusing on individual uniqueness and the imposition of abstract principles. In Long-term care (LTC) narrative approaches to care have an established history: life history/review, reminiscence, narrative therapy and, more recently, narrative care. Such approaches focus on the individual and the centrality of her/his story and story-making activity. Further narrative and narrativity are increasingly seen as shaping individual identify and sense of Self. The links between narrative, care and personhood, then, point towards the need to introduce narrative into ethical reasoning. In medicine narrative ethics has gained ground but outside of medical schools there is little training available. As such, those intimately involved with the care of older adults do not have access to education, training and resources in this area.

The purpose of the project is to develop and test a training program, aimed at those working in long-term care facilities, in narrative ethics, using an action research methodology. The aims of the project are:

a) To enhance ethical awareness and reasoning among the LTC workforce;
b) To contribute to the development of person-centred care through ethical awareness and training;
c) To develop and test open access training materials for LTC providers;
d) To design and test a model for ethics support in LTC facilities;
e) To contribute to culture change in LTC, focusing on narrative and individual identity