Letter argues clinician patient narratives require casuistry and aesthetic judgment

Shane Neilson and Alan Bleakley argue in a 2026 letter to the editor that a conceptual review of consent and ethical considerations in clinician-authored patient narratives mistakenly treats aesthetics as separable from ethics. In their view, calls for broad consensus guidelines privilege universal rules over the distinctive moral qualities of individual cases, thereby narrowing discussion of how clinical encounters are represented in nonfiction writing.

The letter responds to “For Clinicians Who Write Essays About Patients: Conceptual Review of Consent and Ethical Considerations” by Willett, Levy, and Charon. Neilson and Bleakley contend that the review’s emphasis on codes, consent, privacy and trust comes at the expense of aesthetic concerns central to narrative accounts. They describe morality and value as tied to qualities, form, beauty and sublimity, and argue that reducing ethical worth to instrumental function suppresses productive ambiguity rather than resolving it. The review is described as a conceptual article drawing on a literature search concerning publication guidelines and patient reference; the response itself is an argument-based Letter to the Editor rather than a systematic review, simulation, experiment or clinical study.

At the center of the response is a distinction between casuistry and principlism. Casuistry, as the authors define it in the letter, begins with the particulars of a single case and may subsequently support an abstract rule. Principlist ethics instead begins with universal rules, including autonomy, beneficence, non-maleficence and justice, and applies them across cases. Neilson and Bleakley argue that public dissemination of descriptions of individual clinical encounters is better approached through casuistry than through an effort to establish a single consensus framework. They also characterize the search for universal guidance as analogous to the biomedical preference for single answers, contrasting that preference with the divergent and complex character of clinical work.

The authors further contend that even codes intended to protect patients can become instruments of “stiffer universal rule.” They acknowledge that clinician-writers have repeatedly emphasized the ethical treatment of patient subjects, but maintain that no clear consensus-based solution has emerged. Their concern is not the stated protective aims of privacy, dignity and trust, which they say the reviewed article professes to uphold, but what they view as its category error: treating ethical questions about particular clinical narratives primarily as a problem of rulemaking. The limited basis for this conclusion is the authors’ philosophical interpretation of the earlier article; the supplied letter reports no empirical methods, participant population, outcome measurements or evidence that casuistry produces better consent outcomes or patient trust.

Subject of Research: Ethical and aesthetic considerations in clinician-authored patient narratives

Article Title: Response to Willett, Levy, and Charon

Article References: Neilson, S., & Bleakley, A. (2026). Response to Willett, Levy, and Charon. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10831-7

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10831-7

Keywords: clinician-writers, patient narratives, clinical ethics, casuistry, principlism, medical consent, patient privacy, aesthetics, narrative medicine, conceptual review, Response, Willett