Spiritual Suffering, Physical Wounds: What Medieval Theology Can Teach Us about the Ethics of Pain Management
The Rev. Dr. Stewart Clem, Director, Ashley-O'Rourke Center, Aquinas Institute of Theology
Most Christians believe that it is morally acceptable, within certain parameters, to minimize one’s pain through medication. We find this affirmation especially in contemporary analyses of cases in which patients are in the process of dying. According to the counsel of the Ethical and Religious Directives for Catholic Health Services, “[dying] patients should be kept as free of pain as possible so that they may die comfortably and with dignity,” and, moreover, “Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person’s life so long as the intent is not to hasten death.” Most moral theologians and Christian health care ethicists would agree that pain is an evil to be avoided and that medical practitioners who help patients alleviate pain are doing good.
Yet, as we all know, pain medications are not always effective. Sometimes we may wish to alleviate a patient’s pain, yet we are unable. According to the ERDs, “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.” On this account, it seems that 1) pain is an evil to be avoided, yet 2) there are specific goods that may be found in the suffering brought about through pain, and, by implication, 3) the goods brought about through pain are not necessarily greater than the goods brought about through the alleviation of pain.
To complicate matters further, Ashley, deBlois, and O’Rourke suggest, “The opportunity to use suffering as a means of spiritual growth is not destroyed if pain-killing drugs are used. Rather, the individual and those who care for him or her have the right to use such drugs in a way that permit the best used of the patient’s remaining energies and time of consciousness, so that the patient can complete life with maximal composure.” This claim suggests that the goods normally brought about through the experience of pain can be pursued while actively striving to alleviate one’s pain. There is a paradox here that demands a resolution.
The aim of this paper is to propose a resolution, and it hinges on a particular account of pain as a passion of the soul known to the medieval scholastic theologians as dolor (Latin, ‘pain’). On this account, pain is a postlapsarian response to the corruption of the body resulting from the loss of original justice. I draw upon St. Thomas Aquinas’s distinction between bodily pain (dolor) and sadness (tristitia) to illuminate pain’s moral significance. I argue that this account allows for a qualified defense of pain management through medication, insofar as this practice aims to remove obstacles to the contemplation that is requisite for living a good life— and for dying a good death. I also argue that this account makes room for the notion of redemptive suffering, but it does so without fetishizing bodily pain, insofar as it delineates clear limits on one’s participation in the suffering of Christ.
Yet, as we all know, pain medications are not always effective. Sometimes we may wish to alleviate a patient’s pain, yet we are unable. According to the ERDs, “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.” On this account, it seems that 1) pain is an evil to be avoided, yet 2) there are specific goods that may be found in the suffering brought about through pain, and, by implication, 3) the goods brought about through pain are not necessarily greater than the goods brought about through the alleviation of pain.
To complicate matters further, Ashley, deBlois, and O’Rourke suggest, “The opportunity to use suffering as a means of spiritual growth is not destroyed if pain-killing drugs are used. Rather, the individual and those who care for him or her have the right to use such drugs in a way that permit the best used of the patient’s remaining energies and time of consciousness, so that the patient can complete life with maximal composure.” This claim suggests that the goods normally brought about through the experience of pain can be pursued while actively striving to alleviate one’s pain. There is a paradox here that demands a resolution.
The aim of this paper is to propose a resolution, and it hinges on a particular account of pain as a passion of the soul known to the medieval scholastic theologians as dolor (Latin, ‘pain’). On this account, pain is a postlapsarian response to the corruption of the body resulting from the loss of original justice. I draw upon St. Thomas Aquinas’s distinction between bodily pain (dolor) and sadness (tristitia) to illuminate pain’s moral significance. I argue that this account allows for a qualified defense of pain management through medication, insofar as this practice aims to remove obstacles to the contemplation that is requisite for living a good life— and for dying a good death. I also argue that this account makes room for the notion of redemptive suffering, but it does so without fetishizing bodily pain, insofar as it delineates clear limits on one’s participation in the suffering of Christ.