Ethical Perspectives on Pain and Suffering

Betty Ferrell, PhD, FAAN

Disclosures

Pain Manag Nurs. 2005;6(3):83-90. 

In This Article

Respect

The third concept derived from the work of feminist ethicists is that of respect. With confidence, I can assert that every nurse in this room and every nurse committed to pain is familiar with the definition of pain introduced in 1968 by the "godmother" of nursing care of patients in pain, Margo McCaffery. Her definition, "Pain is what the person says it is and exists whenever he or she says it does" (McCaffery, 1968), has revolutionized the field of pain management. Prior definitions of pain provided only physiologic perspectives and defined pain from the tissue level, not the human level. McCaffery's contribution is often recognized as providing a clinically relevant, simple definition. Far more important, McCaffery's definition challenged the field of pain management in a way similar to the feminist scholar Gilligan's questioning of moral development (Gilligan, 1982). McCaffery's admonition that "pain is what the person says it is …" was also a different voice. This nursing voice spoke of pain as personal, as individual, and of the patient as expert. McCaffery was laying a foundation for respect of people in pain.

Feminist scholar and theologian Katie Cannon wrote the text Womanism and the Soul of the Black Community (Cannon, 1995). Cannon has explored a deeper level of feminist scholarship in her writings of black feminism, described by author Alice Walker as "Womanist is to feminist as purple to lavender." Walker is known for her portrayal of African American women in her book The Color Purple. Walker helps portray the issues of not only women, but women who are further disadvantaged due to the ethnicity or economics.

Cannon's discourse on the plight of black women includes vivid descriptions of pain and suffering endured in the era of slavery. Cannon writes of physical abuse of women as slaves in questioning, "What are the emotional resources for dealing with forgotten memories that lie dormant in our bodies and therefore our souls" (Cannon, 1995, p. 75). She concludes that having no language to carry the memory of suffering is the final devastation.

In recent years, nurses have advocated for the need for improved pain relief for the most vulnerable in society—the poor, the elderly, women, children, and diverse communities. Pain is a problem society wants to avoid. Nurses have the ability to speak of pain and its consequences. As Cannon wrote, "The womanist voice is one of deliverance from the deafening discursive silence that the society at large has used to deny the basis of shared humanity" (Cannon, 1995, p. 127).

Recognition of pain as a deeply human experience, more than a neurologic phenomenon, is a critical step toward a social recognition of its urgency. Feminist scholars have challenged traditional perspectives and recognized the value of women's experiences, women's ways of knowing, and women's ways of being and doing (Tong, 1993; Welch, 2000). These feminist ways of knowing provided a much better lens than traditional thought in understanding the experience of pain.

Jaggar, a feminist ethicist and philosopher, has written extensively of the role of emotion in understanding (Jaggar, 1989). Recognition of the intense emotions of pain (fear, anxiety, powerlessness, anger, and depression) is essential if we are to recognize the full impact of the pain experience. Jaggar contends that emotions bring us closer to the truth because emotions are not only a way of feeling but also of knowing. Jaggar writes of "outlaw emotions," those which are unacceptable by society. This is applicable to the plight of women in pain, particularly women experiencing pain from chronic noncancer causes, who are often further alienated from their caregivers when they express emotions.

Of special significance in application of the work of feminist ethics to the problem of unrelieved pain has been work by Margaret Farley, a professor of Christian ethics and a Catholic lay woman (Farley, 2002). Farley contends that medical ethics has emphasized the autonomy of patients while neglecting social contexts and responsibilities. Farley challenges us to combine compassion with our duty to be merciful, to be just, and to act. Her work also challenges us to avoid a paternalistic notion ("I will relieve your pain") and instead through our compassionate respect we mobilize the patient and family. She writes:

The point is that suffering in some form, great or small, overwhelming or overcome, has the power to grasp us when we see it in others. It has the power to hold us so that we cannot avoid the reality of the sufferers or the reality of ourselves. Insofar as we genuinely behold it, it awakens in us a moral response—to alleviate it, ameliorate it, prevent it in others, or if none of this is possible, to companion and literally "bear with" the sufferer, in love and respect (p. 41).

Farley wrote of the disparity of a healthcare system that has neglected persons with acquired immune deficiency syndrome and other life-threatening diseases. She proposed the notion of "Compassionate Respect," aligning these two concepts while also contrasting their unique meanings. She states that "compassion requires at its core not only love but truth—not only the passion of compassion but the truth that compels respect" (p. 20). She explains that these concepts are "mutually illuminating" and that compassionate respect means compassionate justice and provides a framework for medical ethics by "requiring care to be respectful of embodied autonomy as well as every level of need in the person to whom care is owed" (p. 43).

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