1. What Have Patients Taught Me? Some Reflections Joan Berkley Bioethics Symposium April 20, 2013 Richard Payne, M.D. John B. Francis Chair, Bioethics Center for Practical Bioethics Esther Colliflower Professor of Medicine and Divinity Duke University rpayne@practicalbioethics.org

2. “What kind of a story have we fallen into…?”

3. Why Stories?

4. Why Illness Narrative? “Stories do not simply describe the self; they are the self’s medium of being” “Stories have to repair the damage that illness has done…” “When a doctor tells you, ‘You are sick’, he’s not just diagnosing; he is initiating a new chapter in the story of our life”

5. Why Illness Narrative? “I have schooled myself to pay explicit attention to the sequence of what, the imagery, the temporal dislocations, the intrusions of life events into illness events and vice versa.” --Rita Charon, M.D. Narrative Competence… p 35 Narrative Medicine…”medicine practiced with a … competence to recognize, absorb, interpret and be moved by the stories of illness” p 35

6. What the Circus Clown Taught Me About Dignity Intrinsic vs. Attributed Dignity

7. Sometimes it’s all about body, mind and spirit Why is God taking away my children’s mother from them? The power of lament

8. “Dr. Payne--Just dial up the morphine” Intractable pain-death by self-inflicted gunshot to the head By whose authority do you relieve pain and suffering?” Stanley Hauerwaus Professor of Theological Ethics Duke Divinity School Authority & Authenticity of Relationship and Community

9. “Try to see the world as others around you see the world. When you do that, you realize anything is possible” -Michael Corleone The Godfather Lesson