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A Taste of Pain and Suffering and the Role of the Physician
Should every human taste some individual pain and suffering so as to gain a better perspective of their own life? Can we agree that we will better understand our good life if we suffer a little?
The medical profession has always had its goal aimed toward the relief of pain and suffering. But is that really a professional action that is ethically untouchable? Could there be times when it would be to the patient’s benefit and good for the physician to allow some pain and allow some suffering? Should it be the physician's decision as to when to permit that pain and suffering? I await your response. ..Maurice.
p.s.- I posted the same issue on
Medpedia. You might want to go there to read the responses there as they are made.
15 Comments:
ALLOW pain and suffering? Dr. M. you and I mustt have very different experiences of medicine. It is my experience that plenty of pain and suffering is allowed (inadequate pain relief after laparotomy with no on-call staff to adjust medication, for example), and that in fact plenty is caused by the medical profession. From the simple blood test (which while it isn't more than a tiny bit and momentarily bad, still involves the firing of c-fibres in the brain) right up to the inssertion of a naso-jeneunal tube and the filling of my obstructed bowels with radio-visible fluid without pain relief, I've certainly been on the receiving end of plenty of suffering CAUSED by the medical profession, some of it profoundly unnecessary (i.e. with medication or even kindness some of it could have been avoided). Now, I'm quite prepared to put up with minor discomfort for the sake of assessing my health, and I make this choice often, as someone who suffers from a chronic illness, but the question of whether doctors should allow pain and suffering isa strange one when they so regularly cause it.
To the original question though--I think the answer must be rooted in patient autonomy: the role of the doctor is to treat what ails the patient to the best of their ability. Withholding possible easement of suffering without consulting the patient and letting them decide for some greater moral or spiritaul reason to me seems to put the doctor back in that paternalistic god-like role that we have happily largely foregone. The patient's spiritual development, and that of their family is well outside of the doctor's purview, and if the doctor is not the one dealing with the pain and suffering, it is not them who should decide, IMO.
--PG
Having seen medicine from both sides, I would suggest that there is never really a situation where it would be GOOD for the physician to allow pain and/or suffering, unless acting upon it would cause even greater harm to the patient. There are, unfortunately circumstances in medicine where some degree of pain and suffering is a necessary part of the diagnosis or treatment of a particular condition, but it is one of the physician's primary duties to alleviate it as much as possible, with some degree of latitude for the expressed wishes of the involved patient.
Individuals vary greatly in their degree of pain tolerance, and it should not be up to the physician to determine per se how much a person can withstand; however, the caveat to this is the balance between the degree of pain and suffering and the potential for side effects/toxicity/injury from attempting to treat it. Also to be considered are situations like the first commenter mentioned, where medical treatment itself is the source of pain; in those instances, a physician should use any and all of their expertise to minimize the pain to the patient and maximize the benefits. (Hence the utility of things like anesthesia and sedation.) The balance between the desires of the patient and the potential for harm must be carefully considered, always leaning towards the greater benefit to the patient. To do otherwise would be unethical.
I would like to present here what I wrote on Medpedia (above link) with regard to this question. It was in response to a comment by a visitor to Medpedia who wrote in part:
“I'm 16 and have been undiagnosed for 3 years now, the doctors haven't been able to figure out what's wrong with me. I'd say I've gone through more pain and suffering than a teenager should, in these years that are supposed to be full of fun and partying and making stupid mistakes; not staying home while your (slowly disappearing) friends are out, constant doctor/hospital clinic visits, tests tests and more tests... plus the pain of being sick. You get the picture.
As for your question, I want more than anything for my doctors to just figure it out and make me feel better already. I've had enough of this "pain and suffering". I think it's in a physician's job description to do their best to use their knowledge to end a person's pain and suffering, and make them feel better. I see why you ask the question, though. It definitely got me thinking. “
I then responded:
“ Let me ask you: if hopefully your pain and suffering was correctly diagnosed and there was a ready and effective treatment with the complete and permanent curing of your condition, relief of the pain and you moved on to your latter teen-age years and beyond without pain, without uncertainty, don't you think you would have a different perspective, a more realistic and appreciative understanding of what life is all about than your teen aged friends who are "full of fun and partying and making stupid mistakes; not staying home " ? I think you would.
I worry about patients I have attended who want prescription analgesics for minor and transient pains. I worry about doctors who readily prescribe tranquilizer medications for transient, reversible emotional upsets on patients' request. Does this mean that the patients look at a "good life" as requiring pain meds and tranquilizers for relief? Intractable pain does require the consideration of prescription analgesics for use, but short of that, there are life changes and new behaviors which can mitigate or ease many of the pains patients experience. And ventilation, talking out stressful situations with a listening physician or others and again changing life patterns may diminish the need for tranquilizers for many anxieties. Perhaps, in this situation, the physician can decide and tell the patient "it will be better for you in the long run not to begin with narcotics or tranquilizers but let's try for some changes in your life or other techniques to ease the pain and distress."
With this experience, the patient in later years will look at the "downs" in their life as yet part of a "good life" which they themselves will be able to manage without drugs. ..Maurice.”
what I´m afraid about, and has happened to me, is that after allowing doctors to make a laparotomy on me(I don´t know what was I thinking) I felt a lot of pain, because of insufficient anesthesia) and wanted relief. None of the sort; they were going to show who's boss. They knew i was really at their mercy, and they took advantage of the ocassion to force procedures on me I would have never give consent for otherwise. In shot, they held me hostage. They said, "if you don´t have x done, you don´t get Y"
All to reliee the pain they themselves caused!!!
That's why I don't trust them or seek their attention anymore.
Part 1
What would lead you to believe that any human being can experience this life without ever suffering pain? The First Noble Truth of the Buddhist religion is that "All Life is Suffering," which reflects the reality that everyone experiences pain, suffering and loss at some point in their lives. I see absolutely no merit whatsoever in inflicting more suffering in the dubious belief that a little extra pain inflicted by a doctor will somehow develop a person's character. Quite the contrary, acts of cruelty and the wilfull infliction of pain may often damage a person's character, making them bitter, angry, cruel or vengeful, particularly if the suffering is prolonged, arbitrary or the result of an injustice...your proposal meeting at least two of those criteria. As W.B. Yeats once said, "Too long a sacrifice makes a stone of the heart." I would expect the result of this sort of thing to be anger and distrust by the patient towards the doctor, and rightfully so.
Patients with pain, particularly chronic pain, already face overwhelming hurdles getting their pain taken seriously and treated appropriately by the medical profession. Not least of these hurdles is the arrogant, hostile and judgmental attitudes the majority of doctors have towards people in pain. We already have to run a veritable gauntlet of accusations and insinuations that we are drug seekers, drug sellers, malingerers, whimps, hysterical, or have personality or conversion disorders. We are told that we are that we are weak, lazy and irresponsible, and that we need to "be a man," and "take the pain." We are told the pain is "all in our heads," is psychosomatic, or can't be as bad as we claim it is.
You now propose to add a new layer of judgmentalism and denial of treatment to our already overfull quota: your pain is real, but I, your doctor, being one of the "Best and Brightest," have decided that you need a little remedial suffering to improve your obviously defective character. This attitude is shamelessly elitist, and requires for its acceptance the presumption that doctors are such excellent judges of character and human nature that they should be encouraged to do a little social engineering through the medium of untreated pain whenever they in their omniscience decide your character is in any way lacking, which of course is all the time if you're a pain patient.
Part 2
Sadly, these attitudes are not uncommon, as I have seen them expressed elsewhere. According to Daniel Brookoff, in his article "Chronic Pain: A New Disease" medical textbooks fifty years ago advised that patients at the end of life should be allowed to suffer so that they could experience the agony suffered by Jesus Christ. In my opinion, any doctor who thinks suffering the agony of Jesus Christ would be beneficial should arrange for his own crucifixion. He shouldn't sentence a patient to the barbarous ordeal of untreated pain.
Doctors would do well to dispense with their elitist judgmentalism and look to their own characters for a change. Every doctor needs to start asking themselves some serious questions about their role and moral responsibility in the epidemic of avoidable medical errors and adverse reactions to drugs that claim the lives of over 250,000 Americans a year and injure over a million more. They need to start asking themselves why they are silent in the face of these appalling statistics, or why they lock arms to protect incompetent, corrupt or dangerous colleagues even to the point of attacking a patient's reputation and sabotaging that patient's medical care. The AMA approved wholeheartedly of a recent website that blacklisted patients who had filed malpractice claims, though the site later closed due to the controversy from outraged patients.
This is the reason I strongly support the moral and natural right of people with pain to treat their own pain without permission from a doctor. No one should be able to infringe upon that right for any reason, let alone to build character.
Payne Hertz, as I responded to your identical commentary on Medpedia:
"I have related the question as to whether people should experience a "taste" of pain and suffering to the role of physicians since it is the physicians who have the societal permission to prescribe potent medications which can relieve pain and suffering to various extents. However, I really and sincerely doubt that physicians generally will be accepting an approach to treatment which as its only action or "value" to permit continued pain and suffering for the patient. A physician has nothing to gain by such a decision and much to lose including the trust of his or her patient. However, and this is the tricky part, if the physician's evaluation of the patient and the patient's symptoms is one of suspecting the patient's abuse of the physician's prescribing potential, then the physician may consider other approaches to manage the patient's request. There has to be trust and integrity on both sides of the doctor-patient relationship.
..Maurice.
I'm not sure I'm getting your point here, Dr Bernstein. Are you suggesting that physicians never withhold pain medication for purely arbitrary reasons, including the belief that letting the patient suffer a bit if for his own good? That this only occurs where there is a legitimate "suspicion" of drug abuse? I can tell you from personal experience and that of the many chronic pain patients I have talked to that that is definitely not the case. It's not even close to being the reality we have to deal with.Jere are a few examples of that reality:
http://tinyurl.com/36z7zev
or
http://web.archive.org/web/20031203132253/www.paincare.org/pain_management/correspondence/patient_letters/toc.php
If I told you that I sincerely doubt a husband would ever abuse his wife, because he nothing to gain and everything to lose, including the trust of his wife, would you find that argument convincing?
In any case where there is a massive power differential and also where the weaker party has little choice but to deal with the stronger party, the potential for abuse is not only there it is almost guaranteed to happen. Show me any human relationship where abuse of power doesn't happen. The only solution is to eliminate the imbalance of power. Talking about ethics and doing the right thing is all well and good, but at the end of the day, only the freedom of the weaker party to choose otherwise will make any meaningful difference.
Payne Hertz, while your talking to the patient does provide you with one side of the story between the patient and the doctor, you must also talk with the doctor to make a fair and balanced interpretation of the actions which had occurred within that relationship.
You wrote "If I told you that I sincerely doubt a husband would ever abuse his wife, because he nothing to gain and everything to lose, including the trust of his wife, would you find that argument convincing?" Do you really think that the relationship between a physician and a patient is the same as that of a husband and a wife? Is the professional oath, the professional standards to maintain a physician license and the laws regulating physician behavior and actions and the potential of a malpractice action by the patient are the same as a husband and wife simply taking marriage vows? Notwithstanding the question I posed initially to this thread, I still doubt that most physicians would allow their patients to suffer simply to demonstrate some power of the physician or to teach their patient a lesson. ..Maurice.
Dr. Bernstein, my response is too long to post here so I posted it on the Medpedia site only.
Read Payne Hertz response on Medpedia..Maurice.
nitke wrote the following comment today. ..Maurice.
as medrecgal said, I experienced this when I went to see a doctor for my back injury. the doctor didn't bother how painful it is and was asking me to bend .. one thing started rolling in my mind 'why isn't the doctor understanding how painful it is for me in bending' but later I realized on my mom's sayings that if a doctor tries feeling the pain then the doctor cannot give a right treatment.
"Should every human taste some individual pain and suffering..."
Unfortunately, this question assumes a fallacy . . . the idea that (absent our intervention) some people will not have the character-building experience of pain and suffering. That's a fallacy. Whatever advantages people enjoy, every life includes a generous helping of pain and suffering.
Should physicians allow pain for its character-building qualities (as opposed to all the other reasons we can and do tolerate pain; in order to diagnose and treat and so on)?
It seems like the answer is in the question. To build insight and promote growth, the pain must be chosen; a patient must chose to walk through the pain themselves. We should validate the choice to endure pain, if that is the patient's wish.
Should we allow people to suffer as a form of discipline, or, to put the question another way, do we do harm by protecting people from the suffering brought on by their own bad choices? It's an interesting philosophical question, but really, it's a moot point. In order to implement a scheme of allowing pedagogic suffering, we would need to know precisely how much a given person deserves to suffer -- which is an impossible thing to determine. (A drunk driver who broken their leg? Maybe. A chest pain patient who smokes? A DKAer who does eat right?)
It's not our place to judge our fellow human beings in that kind of way.
It's the God complex, pure and simple. It is not a medical professional's job to decide how much a patient needs to suffer. That goes for mental torture as well.
Whether or not a doctor can alleviate a patients physical suffering there is a great possibility that in the process he can cause a great deal more suffering, mental suffering, with his methods. I imagine most doctors would be against inflicting more pain than necessary, or refusing to help alleviate pain if possible. But very few care about the mental and psychological pain they inflict by not treating their patients with respect by ignoring the patient's morals, traditions and modesty concerns. Quite often patients leave the doctor's office or hospital with much more pain than they arrived with due to the lack of respect and professionalism of the healthcare staff. Cruel and perverted nurses are my biggest pet peeve.
I would rather suffer through many types of health problems, particularly those that involve my private parts or lower abdoman, than be treated like a slab of meat without morals or feelings. If moral beliefs or cultural traditions are ignored I find the so-called healthcare "professionals" are completely worthless and do more harm than good.
Through my experiences and the experiences of others I've noticed that nurses allow pain and suffering much more often than doctors. They have a larger God complex than anyone else in the medical world. The sense of entitlement they believe they have for the bodies of any and all patients and the notion that they know more than the doctors causes many more problems than anyone else IMO, physical and mental. Doctors need to try harder to keep the nurses under control.
Does this discussion assumes that pain and suffering isn't just a part of every human's life. I think of the Greeks, especially the Greek tragedians. A common theme (see Sophocles) is that no one will get out of this life without pain and suffering. That's just part of the human condition.
Doug Capra
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