The Nature of Suffering and the Goals of Medicine

The Nature of Suffering and the Goals of Medicine

The Nature of Suffering and the Goals of Medicine

The Nature of Suffering and the Goals of Medicine

Synopsis

This is a revised and expanded edition of a classic in palliative medicine, originally pulished in 1991. With three new chapters and a new preface summarizing the progress in the area of pain management, this is a must-have for those in palliative medicine and hospice care. The obligation of physicians to relieve human suffering stretches back into antiquity. But what exactly is suffering? One patient with metastatic cancer of the stomach, from which he knew he would shortly die, said he was not suffering. Another, someone who had been operated on for a minor problem - in little pain and not seemingly distressed, said that even coming into the hospital had been a source of pain and suffering. With such varied responses to the problem of suffering, inevitable questions arise. Is it the doctor's responsbility to treat the disease or the patient? What is the relationship between suffering and the goals of medicine? According to Dr Eric Cassell these are cruical questions, but unfortunately have remained only queries void of adequate solutions. It is time for the sick person, Cassell believes, to be not merely an important concern for physicians but the central focus of medicine. With this in mind, Cassell argues for an understanding of what changes should be made in order to successfully treat the sick while alleviating suffering, and how to actually go about making these changes with the methods and training techniques firmly rooted in the doctor's relationship with the patient. Dr Cassell offers an incisive critique of the approach of modern medicine. Drawing on a number of evocative patient narratives, he writes that the goal of medicine must be to treat an individual's suffering, and not just the disease. In addition, Cassell's thoughtful and incisive argument will appeal to psychologists and psychiatrists interested in the nature of pain and suffering.

Excerpt

The test of a system of medicine should be its adequacy in the face of suffering; this book starts from the premise that modern medicine fails that test. In fact, the central assumptions on which twentieth-century medicine is founded provide no basis for an understanding of suffering. For pain, difficulty in breathing, or other afflictions of the body, superbly yes; for suffering, no. Suffering must inevitably involve the person—bodies do not suffer, persons suffer. You may read this as merely another way of saying that modern medicine is too devoted to its science and technology and has lost touch with the personal side of sickness. The argument of this book is that such criticism, as correct as it may seem, does not get at the root of the difficulty and is consequently inadequate.

The difficulty is not with medical science or technology per se. No solutions to important problems can be based on a return to innocence, even if that were possible. Neither do the troubles arise because the wrong students are chosen— for decades medicine has had the best and the brightest the country has to offer. Nor is it money, power, or status. The problems were present when there was plenty of all three and they are there now when all are diminished. Finally, I believe the high cost of medical care and the malpractice crisis are more likely derivative than causative.

For more than two generations remedies for medicine's dehumanization and impersonality have been a failure. Great teachers have tried, wonderful books have been written, innovative medical school courses and curricula have been established, and even new medical schools have been founded on ideas believed to offer solutions. For the most part, all these attempts, large and small, have been disap-

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