chapter  14
10 Pages

IN THE ABSENCE OF NARRATIVE

ByJulia E. Connelly

Primary care medicine is concerned with everyday life. Here, ethical dilemmas arise from the lived life-individual preferences, beliefs, attitudes, choices, and decisions, and how individuals interact with one another as well as care for one another.1 Ethical dilemmas in primary care are often subtle, but they are not invisible; most are recognized easily by careful observers. These dilemmas are no less important to the individuals involved than are the dramatic conundrums that touch the lives of hospitalized persons. For instance, an office patient with active gastrointestinal bleeding who refuses hospitalization despite a hematocrit of twenty may die at home due to further bleeding. The ethical dilemmas of primary care are different from those occurring in the hospital setting, but they are no less meaningful.