A Theory of Suffering for Medicine and Bioethics
Tyler Tate, MD, Stanford University
Suffering is strange, vexing, tragic, obliterating, unfathomable. It defies language yet is everywhere we look, structuring policies, guiding ethical decision-making, catalyzing art, crushing the poor and the oppressed, motivating (and justifying state-sanctioned) suicide, building resilience, producing patience, organizing religious beliefs and practices—even defining the ever-cryptic, ever-rapturous, La Condition Humaine. For medicine, uniquely, suffering sits at the spine, the heart. At the center of medicine is the patient: etymologically speaking, the one who suffers. Bioethics is similarly organized; since its beginnings as a response to the war crimes of Nazi doctors, the prevention of unnecessary or nonconsensual suffering has been intrinsic to the field. Yet for all its gravity and salience, both for human society and politics as well as medicine and bioethics, the concept of suffering is underdetermined.
In this talk I will analyze the concept of suffering and attempt to rectify this underdetermination. To do so I will first examine the “value-based” view of suffering (Kious 2022, 622–24), which has become the dominant mode of understanding of suffering in medicine and bioethics. This view has been popularized in these fields due to the accessible and widely read work of physicians Eric Cassell and John D. Loeser (Cassell 1982; Loeser 2000).
According to the value-based view, suffering is a wholly subjective experience related to one’s personal interpretation of meaningful negative events, events that erode personhood and personal identity. I will briefly track the history of this idea and hypothesize why it has become so popular in a highly individualistic and identity-oriented culture like the United States. Then I will advance a novel, alternative view that, unlike other prominent accounts of suffering, starts with the semantics (meanings) and pragmatics (uses) of suffering: suffering is the undergoing of something very bad and is related to the capacity for human beings to experience a gap in their lives and the world, i.e. a gap between how things are and how things ought to be. Drawing from this “gap hypothesis” of suffering I will further qualify suffering taxonomically and argue that there are three primary categories of suffering. These categories include [1] transitive suffering [2] life suffering and [3] experiential suffering; category 3 will be composed of multiple types, with each type corresponding to the erosion of a creature-specific capacity.
I will conclude with two brief considerations. First, I will mention the ways that this tripartite account of suffering is in fact closely aligned with more ancient views of suffering, which I will demonstrate by comparing it to the ways that Buddhism (Bodhi 2024) and Scholastic Christianity (Miner 2009) understood the term. Second, I will mention two implications of this account for medical ethics and disability justice, including what it could mean for questions regarding the common conflation of disability and suffering.
References
Bodhi, Bhikkhu. 2024. Noble Truths, Noble Path: The Heart Essence of the Buddha’s Original Teachings. First edition. Wisdom Publications.
Cassell, Eric J. 1982. “The Nature of Suffering and the Goals of Medicine.” The New England Journal of Medicine 306 (11): 639–45.
Kious, Brent M. 2022. “Three Kinds of Suffering and Their Relative Moral Significance.” Bioethics 36 (6): 621–27. https://doi.org/10.1111/bioe.13021.
Loeser, J. D. 2000. “Pain and Suffering.” The Clinical Journal of Pain 16 (2 Suppl): S2-6. https://doi.org/10.1097/00002508-200006001-00002.
Miner, Robert C. 2009. Thomas Aquinas on the Passions: A Study of Summa Theologiae, 1a2ae 22-48. Cambridge Univ. Press.
In this talk I will analyze the concept of suffering and attempt to rectify this underdetermination. To do so I will first examine the “value-based” view of suffering (Kious 2022, 622–24), which has become the dominant mode of understanding of suffering in medicine and bioethics. This view has been popularized in these fields due to the accessible and widely read work of physicians Eric Cassell and John D. Loeser (Cassell 1982; Loeser 2000).
According to the value-based view, suffering is a wholly subjective experience related to one’s personal interpretation of meaningful negative events, events that erode personhood and personal identity. I will briefly track the history of this idea and hypothesize why it has become so popular in a highly individualistic and identity-oriented culture like the United States. Then I will advance a novel, alternative view that, unlike other prominent accounts of suffering, starts with the semantics (meanings) and pragmatics (uses) of suffering: suffering is the undergoing of something very bad and is related to the capacity for human beings to experience a gap in their lives and the world, i.e. a gap between how things are and how things ought to be. Drawing from this “gap hypothesis” of suffering I will further qualify suffering taxonomically and argue that there are three primary categories of suffering. These categories include [1] transitive suffering [2] life suffering and [3] experiential suffering; category 3 will be composed of multiple types, with each type corresponding to the erosion of a creature-specific capacity.
I will conclude with two brief considerations. First, I will mention the ways that this tripartite account of suffering is in fact closely aligned with more ancient views of suffering, which I will demonstrate by comparing it to the ways that Buddhism (Bodhi 2024) and Scholastic Christianity (Miner 2009) understood the term. Second, I will mention two implications of this account for medical ethics and disability justice, including what it could mean for questions regarding the common conflation of disability and suffering.
References
Bodhi, Bhikkhu. 2024. Noble Truths, Noble Path: The Heart Essence of the Buddha’s Original Teachings. First edition. Wisdom Publications.
Cassell, Eric J. 1982. “The Nature of Suffering and the Goals of Medicine.” The New England Journal of Medicine 306 (11): 639–45.
Kious, Brent M. 2022. “Three Kinds of Suffering and Their Relative Moral Significance.” Bioethics 36 (6): 621–27. https://doi.org/10.1111/bioe.13021.
Loeser, J. D. 2000. “Pain and Suffering.” The Clinical Journal of Pain 16 (2 Suppl): S2-6. https://doi.org/10.1097/00002508-200006001-00002.
Miner, Robert C. 2009. Thomas Aquinas on the Passions: A Study of Summa Theologiae, 1a2ae 22-48. Cambridge Univ. Press.