Magazine article Humane Health Care International

Ethical Implications of Human Suffering, with Afterword

Magazine article Humane Health Care International

Ethical Implications of Human Suffering, with Afterword

Article excerpt

Sister Kenny recalls us to an ancient duty--that of the alleviation of suffering. As a clinician and ethicist, she warns us that our care will remain incomplete until we can embrace the suffering of our patients.

1 Humane Medicine Volume 13, Number 2, 1997, pp. 27-30.

One of the fundamental tenets of the Hippocratic tradition is physician commitment to the alleviating of suffering. Despite changes in the world view about the meaning of suffering and advances in modern medical science, the relief of suffering is still an essential goal of medicine. However, 15 years after Eric Cassell's paper "The Nature of Suffering and The Goals of Medicine," there is still little research, writing, or reflection on suffering in medical practice or education. This lack of attention is incomprehensible to those patients and families who assume that this is still a key concept in clinical practice and in the education of physicians. Without an understanding of suffering, physicians cannot fulfill their primary obligations to patients; they may even cause harm by ignoring or denying suffering that is not amenable to pharmacologic or technologic intervention. Today we discuss most dilemmas of duty to patients as ethical issues; however, if ethics is truly about choices that relate to "goods" and "harms" in the interaction between patients and physicians, insights gained from a reflection on suffering can strengthen medical ethics and ethical practice.

If suffering can enrich our understanding of ethical dilemmas, why has modern medicine paid such little attention to it? In the past century, Western industrial nations have made a phenomenal commitment to medical science in a drive to prevent, cure, and alleviate disease. Despite these advances, patients express a growing concern regarding the "humanity" of medicine. Over the past 40 years, repeated attempts have been made to reform medical curricula in order to provide "humane" physicians and formal ethics education has been added to undergraduate and post-graduate curricula. There is not strong evidence that new graduates are more "humane."

To address these concerns, we need to answer certain fundamental questions about medicine and science. In itself modern medicine's dependence on science is a barrier to an empathic recognition of suffering and a compassionate response to it. This kind of knowing, which is the essence of good medical practice, is not valued as central to our art. Malterud looks toward a theory of knowledge (epistemology) that will embrace both clinical science and the art of medicine.

Medical education in particular must ask whether compassion is essential to good care or is an heroic "extra" found in some physicians and not in others. How medicine and, in particular, medical education responds to this question over the next decade will determine the nature of medicine and the quality of medical care in the 21st century. Despite our incredible advances in diagnosis and treatment, people will expect doctors to respond to their suffering. McWhinney got it right when he said:

Physicians' personalities and their perceptions of themselves enter deeply into clinical method. Changing the tool, therefore, requires changing the person. If we are on the brink of a transformation of clinical method, we are also on the brink of a change in the way physicians think and feel.

This change can be for the good if it brings re-thinking of the meaning of medicine as an art and science. …

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