More than cautionary tales: the role of fiction in bioethics

“Why should I struggle through hundreds of pages of fabrication to reach half a dozen very little truths? …Words are for truth. For facts. Not fiction.”—Conchis in The Magus, John Fowles [1].

Is there a role for fiction in explorations of ethics? Are words, as Conchis says, only for truth, for facts? Or is it perhaps the case that words can be used to help us reach a deeper truth—through fiction? This month the Journal of Medical Ethics features a form of publication rarely found in the pages of scholarly journals: the first instalment of a fictional “bioethics soap opera” designed to offer a somewhat different exploration of the issues that are the subject of the journal’s usual offerings.

The subject matter of bioethical discussions often borders on the territory of speculative or science fiction. Human cloning, animal–human hybrids and genetic engineering have all found a place in fictional as well as bioethical literature. Similarly, creatures and concepts from science fiction populate bioethical debate, albeit sometimes as a form of metaphorical shorthand for an underlying argument. One such example is that of Frankenstein’s monster, often invoked to illustrate the dangers of “playing God”, the moral sin of humankind daring to reach beyond our natural limitations (as indicated, indeed, by the subtitle of the novel Frankenstein: a modern Prometheus)—a form of argument that still rears its head in bioethical commentaries almost 200 years later. Another is Aldous Huxley’s Brave new world, a “cautionary tale” about human cloning, seemingly cited in perpetuity whenever the cloning debate arises [2]. But is there more to this relationship than metaphor?

The usefulness of fiction and imagination in bioethical discourse is evident when one considers that hypothetical scenarios, thought experiments and case studies are also a form of fiction. These tools are commonly used in ethics education as well as in the development of ethical argument, often constructed to highlight a particular ethical dilemma or point of contention. As such, they give us a starting point to engage with the issues as well as to develop and refine our analyses of the problem; they present the ethical arguments in an immediately accessible form and inspire debate.

The importance of stories in ethics has been recognised by many philosophers [3-5] as a way of providing a “thick” description of moral cases. The creation of a fictional backdrop helps readers to address ethical issues by allowing us more easily to envision ourselves in the place of another. As Hilde Hein notes in a slightly different context, “(i)mages and characters and… fictitious plots can become so deeply embedded in our lives that they share mental space with personal memories and experiences and, like them, shape our ethical and political convictions” (Hein [6] at p 78). Indeed, the irony underlying the opening quote, that “Words are for truth… Not fiction”, is that the very work of fiction in which these words appear, and in which Conchis himself is a fabricated character, itself explores a variety of moral and philosophical questions. While fiction does not always preach a single truth—nor, perhaps, should it—nevertheless, it may be argued that fictional exposition can be a means of attaining understanding. Fiction gives us a way to understand bioethics by creating resonances with personal experiences both real and imagined, engaging emotional and empathic responses to develop moral intuitions, which, once identified, can be analysed in a more structured manner.

Fictional explorations of ethical questions may also serve a broader purpose, raising public awareness of a particular issue. For example, the New York Times bestselling novel My sister’s keeper [7] brought the issue of saviour siblings, already the subject of some attention in academic circles, more sharply into the public focus. Nor is this function limited to the written word; the cinematic medium has been the vehicle for many stories relating to bioethical themes, which have exerted subsequent and in some cases significant influence over public opinion. In a survey of the Dutch population, 91% were opposed to cloning; 64% cited as a reason for their opposition the 1978 movie The boys from Brazil (based on the novel of the same title) [8], which features a post-World War II Nazi plot to clone Adolf Hitler.

The influence of fiction on public attitudes to bioethical questions—and on public understanding of science—may be far more widespread, in fact, than the impact (at least the immediate impact) of scholarly debate over the same issues or academic efforts at public engagement. Given this, it is arguable that creators of fiction ought to have some concern for the impact of their fictional representations and bear at least partial responsibility for the likely consequences. Science fiction in particular, consisting as it does (or ought to do) of speculative imaginings based on scientific facts, incurs responsibilities for its creators in respect of the accuracy of these facts: “Science fiction must not offend against what is known” (Russ [9] at p 114). More than this, though, because of the potential of popular works of fiction to affect public attitudes towards the ethical issues associated with science, authors should take some care that their work does not encourage misconceptions or false impressions about these issues. Stories that include deliberate or wilfully careless distortions of science offend against what is known; but stories that grossly misrepresent either the issues or the archetypal characters in whose lives these issues play out, thus distorting their presentation of the ethical issues, are an offence against ethics as well.

Science fiction may sometimes be used to articulate fears over science without really exploring or drawing attention to the deeper ethical questions. Expressing concerns can certainly be a valid literary purpose in itself without requiring further exploration of those concerns—although the addition of the latter often enhances the work; but nevertheless creators of fiction should be wary of resorting to scaremongering and sensationalism in their pursuit of a good story. Portrayals of science in the media have drawn criticism for exactly that: sensationalising the science to get a good story, either playing on people’s fears or overstating the possible benefits to create “hype”. While we may recognise and even expect that the science portrayed in science fiction often contains an element of speculation, the influence on our emotions and beliefs and hence on our ethical thinking may be more insidious, more subtle and harder to weigh up objectively. Fiction, then, can be unethical in the sense of being against ethics when it reinforces irrational fears or false beliefs. Such misdirection may have serious negative consequences if it turns the public against science that would otherwise produce benefits in terms of human wellbeing. Equally, however, science fiction that indulges in blind technophilia is not always ideal; the tension that drives the narrative often arises from qualms and unanswered questions about the possibilities of technology and its implications. Posing and addressing these questions is part of the purpose of such fictional oeuvres.

Of course, the role of fiction in examining philosophical questions is not limited to issues of medical ethics or bioethics—fiction can also be used effectively to explore problems of moral philosophy and metaphysics. Commenting on the writing of Jorge Luis Borges and its power to draw out philosophical themes, Matthew Asma notes that “Conventional philosophic prose does not have the tools to express the richness of content of (fiction)… the writer of fiction can animate metaphysical possibilities in ways that writers of conventional philosophy cannot.” [10] The piece Tlön, Uqbar, Orbis Tertius, [11] for example, as well as a fascinating story, is an exposition of themes including existentialism, the nature of reality and the philosophy of science. Stories such as these can be used to transform abstract philosophical concepts and questions into more “real” (or at least, real in the imaginations of the reader) issues. To give just a few more examples: the classic short stories The nine billion names of God [12] and The last question [13], by science fiction greats Arthur C Clarke and Isaac Asimov, respectively, pose existential questions about the meaning of life and the purpose of the universe; whereas a more recent piece, Learning to be me [14], by contemporary Australian author, Greg Egan, explores questions about consciousness and personal identity—issues that look back to fundamental philosophical problems as well as forward to the increasing contemporary interest in neuroethics and the ethics of artificial intelligence. There are many more such flights of both philosophical and fantastical imagination.

As well as serving some educational purpose, enlightening us in matters of morals and metaphysics, all these stories share another purpose in common: to capture the imagination, to enthral, to delight the reader. This, we might argue, is at least as important as their didactic role—not just for the benefit of the pleasure gained by reading them, but also because in order to fulfil their educational potential they need to be read; and what better way to encourage that than to make it enjoyable as well as enlightening to do so?

To conclude, then, and attempt to answer not just the question of whether there is a role for fiction in ethics—for, as I have tried to argue, fiction does play a part in our understandings and explorations of ethics—but what that role might be. Works of fiction allow us to consider ethical problems that fall outside our experience: either outside our immediate personal experience, allowing us to “personalise” and thus better understand the issues involved; or outside the limits of our common experience, acting as thought experiments that stretch the boundaries of our ethical imagination. They seek to expand the reader’s understanding, not merely to inculcate or preach but to set us on a journey of ethical development in parallel with the narrative development experienced as we “journey” through the text. Perhaps the best works of “ethical fiction” are those that, rather than bludgeoning us with a particular viewpoint, allow readers to come to a deeper comprehension of philosophical or ethical “truth”; and not only that, but also provide us with a worthy diversion, a source of entertainment—in short, a “darn good read”! The chronicle of events at Erehwon General Hospital we may hope will fulfil all of these roles.