Deciphering the silence of patients from Bartleby

A trial of medical ethics case study through analysis of a literary work

Abstract

    We might face a problem with a patient who does not provide adequate reasons for disagreeing with life-or-death treatment. Although medical staff and family might consider the patient's self-determination important, they would not know how to cope with it without understanding his/her reasons accurately. Thus, deciphering the silence of patients becomes essential. In this study, I attempt to consider the ethically problematic case of an incurable neurological disease, Multiple System Atrophy (MSA), by analyzing Herman Melville's famous controversial short story, “Bartleby, the Scrivener.” The primary character Bartleby refused to do the work that the lawyer, his boss, requested of him and did nothing at the office. The lawyer made an effort to communicate and support Bartleby but agonized over his inactivity and became frustrated. The motif of this novel shares several common aspects with my case so I utilize various theoretical explanations proposed by literary critics, recent medical ethicists, social scientists, and postmodern philosophers to understand the unsolved puzzle of Bartleby. As a result, I diversify the viewpoints into potential patients' protests against the healthcare system, intractable disease patients in Japan, and unintentional paternalism. Thereby I reveal that the autonomy of patients is easily distorted under these circumstances. Through this study, I clarify the significance of comparative studies between literary works and medical ethics cases that has not been attempted sufficiently thus far.