Unless medicine properly addresses suffering, it betrays its aim. This hit home with me upon viewing the documentary "Escape Fire: The Fight to Rescue American Healthcare" recently at Saratoga's Film Forum. I was honored to share the panel with retired physician George Jolly, Saratoga Springs Mayor Joanne Yepsen and integrative medicine expert Michael Wayne.
The film exposes our twisted health care labyrinth of error, misery, and profit commingled with success, expertise and good intentions. Most physicians are committed to their patients. Yet they operate within a flawed ethos that loses sight of health care's moral center — caring for patients as persons and relieving their suffering. Regarding ethical issues, where do we even start?
A clue lies in Francisco de Goya's 1820 masterpiece, "Self-Portrait with Dr. Arrieta," a stunning testament to medicine's moral center (see http://tinyurl.com/l7hzela). When the aged Goya (1746-1828) endured chronic pain and total deafness from combined cerebrovascular and central nervous system maladies, he suffered depression and feelings of isolation. This was well before modern medicines. Helpless in halting his patient's pain, Arrieta eased his suffering by faithfully being-there-with-and-for him, embodying what I call the "virtue of presence."
Goya painted this gift to Arrieta as tribute to his "skill and care." Against a dark, foreboding background, the doctor offers a glass of medicine with one hand; with his other he comforts him, holding him up. The doctor's face exudes understanding and compassion.
As American medicine experienced breakthroughs in pharmacological balms for pain, it underwent a strange reversal. While we now consume sophisticated and costly pain-treatment, we attend less to the patient's suffering.
Pain and suffering are distinct, though not completely different. As we know, physical pain, whether from major diseases or chronic ailments like arthritis, back pain, asthma and migraines, involves a body. Whereas suffering, often indelicately intertwined with physical pain, involves a person.
Noted physician Eric Cassell, in his "Nature of Suffering and the Goals of Medicine," defines suffering as a "state of severe distress associated with events that threaten the intactness of a person." Bodies do not suffer. Persons do. We persons are infinitely complex and unique unfolding narratives.
Pain and suffering's distinction is phenomenological. It is not simply pain that may incur personal suffering, but meanings we assign to pain — cognitive, physical, emotional, spiritual. However we label my pain, it is still my pain. And how I perceive and understand my pain becomes my suffering. Illness is a biological and existential affair.
In her landmark "Meaning of Illness," my good friend and philosopher Baylor University's Kay Toombs describes how we live in meaning domains. While medical science imprints "objectivity" in bestowing medical meaning to my condition, I subjectively live my condition. Intimately personal, familial, social, religious and cultural webs color my illness and my suffering. Certain imaging devices may scientifically validate my report of physical pain, making my pain more "real" than my suffering. Yet through such quantification, we fall prey to our most lethal delusion: measurability equals reality.
Hence, our first step to escape the fire. In order to relieve suffering, medicine must first acknowledge its crippling reality. This is our human mandate as well. Given our complexity as persons, alleviating suffering never ends. This is no reason to abandon the challenge. What makes us humane is that we face it head-on.
Michael Brannigan is the Pfaff Endowed Chair in Ethics and Moral Values at The College of Saint Rose. His email is michael.brannigan@strose.edu; website is >www.michaelcbrannigan.com>.