The Scientific & the Sacrosanct Differentiating Pain & Suffering in Neonates
James Thobaben, Ph.D., MPH, M.Div., Dean, School of Theology & Formation, Asbury Theological Seminary
For clinical and bioethical purposes, pain and suffering can be differentiated. The former (as nociception) is a sensation (burning, stabbing, etc.) that is unpleasant, but which generally functions as a component of an internal communication mechanism whereby injury (internally or externally generated) is recognized and a corrective response elicited. The range of responses is broad: from mechanical withdrawal from the source of negative stimuli to physiological change. Pain is measurable, at least to some degree, by direct and indirect assessments (direct such as vital signs, etc.; indirect such as patient-self-reports, evaluation by clinicians of facial expressions, body postures, etc.). The latter, suffering, is an emotional and existential state arising in response to an experience of threat to the self (however ‘self’ might be defined). Frequently, but not necessarily, the experience is associated with deterioration of physical well-being, but does not necessarily require such causally. Suffering is often expressed with fear and almost always includes some sense of degradation.
Research seems to indicate that prayer, meditation, and other means of distancing the self from the immediate threat or somehow putting that experience into a larger perspective are at least marginally effective in controlling pain by helping the individual functionally differentiate pain from suffering. This body of research, though very useful, tends to:
(1) assume the individual functions in contradistinction from the communities in which s/he lives, and,
(2) put blame, albeit unintentionally, on the suffering individual who is experiencing significant turmoil for not properly differentiating the two types of experiences.
The distinction between pain and suffering is even more complicated in newborns. Self - reporting is impossible. Direct measurements of pain may be obfuscated by other sources of physiological distress. The infant, apparently, cannot distinguish at all between good reasons for pain (e.g. receiving a vaccination) and those that indicate a genuine threat or potential decline. Caregivers, especially parents, may themselves confuse the pain experience of the child with a threat to the child’s well-being. They may assume any experience of pain is suffering.
The difference between pain and suffering in infants may be all the more clinically important since the capacity to suffer is (functionally, if not formally) a primary indicator of what is commonly referred to as ‘personhood’ in bioethics literature. Also, pain when confused with suffering is used to determine the value of procedures or even the value of on-going life in some utilitarian calculi.
The presentation includes discussion of terms, consideration of various approaches to measuring pain and suffering in neonates, suggestions for responding to confused family members, and examination of why suffering has been and should remain an indicator of human personhood for purposes of bioethics.
For clinical and bioethical purposes, pain and suffering can be differentiated. The former (as nociception) is a sensation (burning, stabbing, etc.) that is unpleasant, but which generally functions as a component of an internal communication mechanism whereby injury (internally or externally generated) is recognized and a corrective response elicited. The range of responses is broad: from mechanical withdrawal from the source of negative stimuli to physiological change. Pain is measurable, at least to some degree, by direct and indirect assessments (direct such as vital signs, etc.; indirect such as patient-self-reports, evaluation by clinicians of facial expressions, body postures, etc.). The latter, suffering, is an emotional and existential state arising in response to an experience of threat to the self (however ‘self’ might be defined). Frequently, but not necessarily, the experience is associated with deterioration of physical well-being, but does not necessarily require such causally. Suffering is often expressed with fear and almost always includes some sense of degradation.
Research seems to indicate that prayer, meditation, and other means of distancing the self from the immediate threat or somehow putting that experience into a larger perspective are at least marginally effective in controlling pain by helping the individual functionally differentiate pain from suffering. This body of research, though very useful, tends to:
(1) assume the individual functions in contradistinction from the communities in which s/he lives, and,
(2) put blame, albeit unintentionally, on the suffering individual who is experiencing significant turmoil for not properly differentiating the two types of experiences.
The distinction between pain and suffering is even more complicated in newborns. Self - reporting is impossible. Direct measurements of pain may be obfuscated by other sources of physiological distress. The infant, apparently, cannot distinguish at all between good reasons for pain (e.g. receiving a vaccination) and those that indicate a genuine threat or potential decline. Caregivers, especially parents, may themselves confuse the pain experience of the child with a threat to the child’s well-being. They may assume any experience of pain is suffering.
The difference between pain and suffering in infants may be all the more clinically important since the capacity to suffer is (functionally, if not formally) a primary indicator of what is commonly referred to as ‘personhood’ in bioethics literature. Also, pain when confused with suffering is used to determine the value of procedures or even the value of on-going life in some utilitarian calculi.
The presentation includes discussion of terms, consideration of various approaches to measuring pain and suffering in neonates, suggestions for responding to confused family members, and examination of why suffering has been and should remain an indicator of human personhood for purposes of bioethics.