A Critique of Comfort: Questioning the Medicalizing Tendencies of End-of-Life Care
Benjamin Frush, Kennedy Institute Ethics, Georgetown University
The hospice and palliative medicine (HPM) movement has been lauded as a welcomed alternative to a highly “medicalized” form of death. In this narrative, HPM is framed as an alternative to the burdensome, intervention-based, control-oriented form of care exemplified in its clearest form in the intensive care unit (ICU).1
With a transition to HPM-focused care comes an emphasis on symptom management and comfort—a welcomed reprieve from the painful and often morbid form of diagnosis and therapy that precede this transition. By prioritizing the patient’s comfort and symptom management, modern HPM posits itself as an alternative to burdensome “medicalization” in the dying process.2
Yet I will argue that if we understand medicalization as Ivan Illich did- as that which “expropriates power from patients” in the name of medical control—then physician-directed palliative care in the inpatient hospice and comfort-focused setting often instantiates rather than resists this tendency.3 By emphasizing patient comfort and symptom control above all else, palliative care in these settings elides (1) necessary diagnostic reasoning surrounding the etiology of patient symptoms and (2) a practical consideration of the risks and benefits of aggressive symptom control weighed against other potential goods. This often results in reflexive and disproportionate symptomatic management which is clinician rather than patient-driven and may impair patients’ abilities to interact with loved ones and continue to make decisions related to the care they receive.
More specifically, I will argue that that this medicalizing tendency of HPM is driven by a modern understanding of the term “comfort” which belies its initial meaning. The classical and pre-modern etymological understanding of “comfort” –a synthesis of the terms “con” and “fort” or “with strength”— was to work toward the restoration of one’s agency, or to be in this state of having strength. Yet this term took on new meaning in the nineteenth century, coming to signify “a state of physical and material well-being, with freedom from pain and trouble, and satisfaction of bodily needs.”4
I will argue that contemporary HPM has come to assume this latter goal, of working toward an unrealistic expectation of “freedom from pain and trouble” to the effect of enervating patients, rather than working to support their strength and agency. I will draw on the work of the theologian Gerald McKenny’s idea of the “Baconian Project” in his book To Relieve the Human Condition to offer a brief recapitulation of how this excessive emphasis on relief of suffering has contributed to this misguided, modern sense of “comfort,” with particular focus on its medicalizing effects upon HPM.5
I will conclude by drawing on an alternative understanding of “comfort” as a theological injunction in Isaiah 40—a call to “comfort, comfort my people.”6 The intention of “comfort” in this contxt prophetically calls to those caring for the hurting to help raise their voices, rather than stifle them—to strengthen, rather than enervate. I will explore how clinicians in the HPM setting can work to resist the medicalizing tendencies of end-of-life care by taking seriously this call to strengthen rather than reflexively prescribe which may involve, among other considerations (1) better diagnostic acumen to consider underlying etiologies and not merely downstream symptoms; (2) broader use of simple, safe therapies with few uncomfortable side effects (antibiotics for UTI; furosemide for pulmonary edema) for which only symptom-managing medications are typically prescribed; and (3) more judicious discussion of benefits and burdens of end-of-life sedating medications which allow patients to preserve consciousness even when sometimes experiencing discomfort if that is their preference.
References
With a transition to HPM-focused care comes an emphasis on symptom management and comfort—a welcomed reprieve from the painful and often morbid form of diagnosis and therapy that precede this transition. By prioritizing the patient’s comfort and symptom management, modern HPM posits itself as an alternative to burdensome “medicalization” in the dying process.2
Yet I will argue that if we understand medicalization as Ivan Illich did- as that which “expropriates power from patients” in the name of medical control—then physician-directed palliative care in the inpatient hospice and comfort-focused setting often instantiates rather than resists this tendency.3 By emphasizing patient comfort and symptom control above all else, palliative care in these settings elides (1) necessary diagnostic reasoning surrounding the etiology of patient symptoms and (2) a practical consideration of the risks and benefits of aggressive symptom control weighed against other potential goods. This often results in reflexive and disproportionate symptomatic management which is clinician rather than patient-driven and may impair patients’ abilities to interact with loved ones and continue to make decisions related to the care they receive.
More specifically, I will argue that that this medicalizing tendency of HPM is driven by a modern understanding of the term “comfort” which belies its initial meaning. The classical and pre-modern etymological understanding of “comfort” –a synthesis of the terms “con” and “fort” or “with strength”— was to work toward the restoration of one’s agency, or to be in this state of having strength. Yet this term took on new meaning in the nineteenth century, coming to signify “a state of physical and material well-being, with freedom from pain and trouble, and satisfaction of bodily needs.”4
I will argue that contemporary HPM has come to assume this latter goal, of working toward an unrealistic expectation of “freedom from pain and trouble” to the effect of enervating patients, rather than working to support their strength and agency. I will draw on the work of the theologian Gerald McKenny’s idea of the “Baconian Project” in his book To Relieve the Human Condition to offer a brief recapitulation of how this excessive emphasis on relief of suffering has contributed to this misguided, modern sense of “comfort,” with particular focus on its medicalizing effects upon HPM.5
I will conclude by drawing on an alternative understanding of “comfort” as a theological injunction in Isaiah 40—a call to “comfort, comfort my people.”6 The intention of “comfort” in this contxt prophetically calls to those caring for the hurting to help raise their voices, rather than stifle them—to strengthen, rather than enervate. I will explore how clinicians in the HPM setting can work to resist the medicalizing tendencies of end-of-life care by taking seriously this call to strengthen rather than reflexively prescribe which may involve, among other considerations (1) better diagnostic acumen to consider underlying etiologies and not merely downstream symptoms; (2) broader use of simple, safe therapies with few uncomfortable side effects (antibiotics for UTI; furosemide for pulmonary edema) for which only symptom-managing medications are typically prescribed; and (3) more judicious discussion of benefits and burdens of end-of-life sedating medications which allow patients to preserve consciousness even when sometimes experiencing discomfort if that is their preference.
References
- Clark D. Between hope and acceptance: the medicalisation of dying. BMJ. 2002 Apr 13;324(7342):905-7. doi: 10.1136/bmj.324.7342.905. Erratum in: BMJ 2992 Jun 8;324(7350):1391. PMID: 11950744; PMCID: PMC1122840.
- Blinderman CD. Comfort Care for Patients Dying in the Hospital. N Engl J Med. 2016 Apr 28;374(17):1693. doi: 10.1056/NEJMc1600661. PMID: 27119250.
- Illich, Ivan. Medical Nemesis: The Expropriation of Health. New York: Pantheon Books (for Random House), 1976.
- Etymology of “comfort.” Oxford English Dictionary. https://www.oed.com/dictionary/comfort_n?tl=true. Accessed 10/31/2025
- McKenny, Gerald P. To Relieve the Human Condition: Bioethics, Technology, and the Body. Albany, NY: State University of New York Press, 1997.
- Bible Gateway. Isaiah 40:1. https://www.biblegateway.com/passage/?search=Isaiah%2040&version=NIV. Accessed 10/31/2025