Ethical Perspectives on Pain and Suffering

Betty Ferrell, PhD, FAAN

Disclosures

Pain Manag Nurs. 2005;6(3):83-90. 

In This Article

Pain and Suffering

A major voice in recognition of the ethical perspectives on pain and suffering has been Dr. Eric Cassell. His classic article "The Nature of Suffering and the Goals of Medicine" was published in The New England Journal of Medicine initially, and later as a text (Cassell, 1982). Cassell contributed to the attention to the problem of pain and suffering. Cassell argued that there are four essential ideas related to patients who are in pain and who are suffering. The first is that "suffering is experienced by persons." He described the historical separation of mind and body and the limiting of personhood if we ignore the subjective context. Cassell suggested that understanding the place of the person in pain requires that we reject the historical dualism of mind and body. His second contention is that "suffering occurs when an impending destruction of the person is perceived; it continues until the threat of disintegration is past or until the integrity of the person can be restored in some other manner" (Cassell, 1982). This philosophy relates closely to the patient in pain who feels the underlying causes of the pain and the destruction of the body and spirit with enduring, unrelieved pain. Cassell has written about suffering beyond the physical. He defines suffering as "a state of severe distress associated with events that threaten the intactness of the person." Finally, Cassell states that suffering can occur in relationship to any aspect of the person.

Although Cassell's writing and perspectives have been directed toward the advancement of medicine, his work can be applied very closely to the profession of nursing. Nurses are intimately involved in the patient's care, often serving as the advocate for the patient in relation to their health care community and caring professionals.

Numerous scholars in feminist ethics have explored concepts that are relevant to the experience of pain. I have selected three central concepts derived from these theorists that I believe are most relevant to the understanding of nursing care of patients in pain. The concepts are respect, relationship, and compassion. Moving away from the bedside to explore these broad concepts allows us to "get higher on the mountain," and it is hoped in doing so nearer to the true experience of nurses caring for patients in pain.

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