Ethical Perspectives on Pain and Suffering

Betty Ferrell, PhD, FAAN

Disclosures

Pain Manag Nurs. 2005;6(3):83-90. 

In This Article

The Effect of Unrelieved Pain and Suffering

Increased attention to the problem of pain over the past two decades has helped to move thinking beyond pain as the outcome of injury and to explore the effects of pain on the individual. My work since 1984 has focused on the impact of pain on quality of life (Ferrell et al., 1991; Ferrell, Rhiner, Cohen, & Grant, 1991; Ferrell, Taylor, Sattler, Fowler, & Cheyney, 1993). Our conceptual model of pain and quality of life identifies four dimensions impacted by pain including physical well-being, psychologic well-being, social concerns, and spiritual well-being. In the domain of physical well-being, patients have described pain not as a single physical sensation, but rather through the complex effects such as a lack of sleep, fatigue, and other associated symptoms such as nausea or severe gastrointestinal distress from pain or pain medications.

In the psychologic realm, abundant literature has documented that people living with chronic pain experience psychologic effects such as anxiety, depression, and fear of future pain. In the social realm, literature has also demonstrated that people living with chronic pain do not experience the effects of pain in isolation. Rather, pain affects family caregivers and others surrounding the patient by increasing caregiver burden, interfering with sexuality, and greatly impacting roles and relationships. For many, pain becomes a family experience. In the spiritual well-being domain, pain is viewed as a spiritual crisis as patients experience hopelessness or a sense of abandonment, and undertreated pain causes the person to question the meaning of life and in some situations to consider assisted suicide.

The dimension of spiritual well-being encompasses the religious, such as a sense of abandonment from God or a higher power. Often the expression of pain includes cultural dimensions or traditional perspectives such as the belief by many that pain is necessary or that pain brings one closer to God. Because pain is often associated with serious chronic illness or terminal illness, there is often a spoken or unspoken association of pain with death. For example, if a child is experiencing worsening pain, parents often interpret this as a sign that the child is worse and thus that the child may die sooner. Interestingly, this often Results in parents denying that the child is in pain to avoid the reality that their child may be dying soon. Thus, pain has also been described as a metaphor for death (Ferrell, Rhiner, et al., 1991).

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