The rapid evolution of modern medicine tends to contribute to the challenges posed to narrative medicine due to the requirement of profound attitudinal and technical modifications. These changes are of great significance and are difficult to apply. During its initial stages, the practices of narrative medicine can be converted into a destabilization phase, which, in turn, position a capable healthcare practitioner in doubt about his or her practices [ 46 ]. Another major challenge that can be encountered during the integration of narrative medicine include is acknowledging when to discontinue.
Healthcare practitioners who closely associated themselves with the notion of narratives often forget to realize that their position is not safe [ 46 ]. The ethics required for medical narratives are considered as the act of evaluating language that is aligned with perceptions, thoughts, and sensations experienced by the teller so that others can relate to what he or she is trying to describe [ 14 ]. The individual who receives narrative of another person also receives virtue of the teller, which, in turn, plays the role of an inter-subjective bridge to the ethics of narrative medicine.
On the other hand, the major ethical problem associated with patient narratives is the use of data with intention other than treatment which may result in maleficence [ 14 ]. Simultaneously, the critical aspects underpinned by the identity of a healthcare professional are operating within the formal prospects in more subtle way. Moreover, any attempt that is put forth for the development of comprehensive syllabus of ethics must allow the manifestation of wider setting of different cultures within which the syllabus must be implemented. For the purpose of fostering ethics among students, formal as well as informal syllabus must be addressed through the aid of syllabus planners.
However, Goldie states that without an adequate consideration, physicians may be in danger of objectifying and manipulating patients in accordance with an egocentric self-interest [ 49 ].
The current form of narrative medicine provides a small space for aligning the properties of critical reflection or examination of larger inequities and violence. The violence is of structural nature that takes place within a healthcare setting in the light of which feelings of people are neglected. Marini illustrates that narrative medicine lacks consideration of the narrative limits, particularly ignoring the contexts related to suffering, trauma, and oppression. In other words, people are often bounded by certain experiences due to which their assimilation with the storyline does not match.
Experiences gained by a human cannot be narrated in a single story as a result of which gesture and metaphor can be integrated as an effective means for the development of better communication between patient and healthcare professional [ 26 ]. Of course, confidentiality protections play a fundamental role in the practices of patient narratives for patients and people who are involved in the process of writing.
In this context, a number of questions have been raised such as, does patient narrative lead to the promotion of new learning and self-understanding or is it the procedural intention toward self-justification? However, regarding the ethical concerns, the practices of patient narratives entail alteration or removal of personal data through which an individual can be identified.