Suffering

Suffering—background Clinicians commonly see the alleviation of their patients' suffering as one of the principal aims of their clinical work. Public health specialists adopt a similar view. For example, the World Health Organisation website includes >10,000 references to 'suffering'. Crucially, the alleviation of suffering is not the same as alleviation of symptoms. Some interventions may alleviate symptoms while at the same time exacerbating suffering. An added complication is that, as a term, 'suffering' has come to be used imprecisely, and hence also potentially devalued. Thus, we talk of 'suffering from intense pain' or 'suffering from a terminal illness', but also 'suffering a cold' or even 'suffering a hangover'. This is perhaps one reason why clinicians tend not to ask their patients directly about their suffering. However, there are at least three other important reasons why suffering is not mentioned as often as it deserves to be in clinical encounters. First, it is traditionally been considered very difficult to quantify suffering and, in the absence of reliable metric, clinicians perhaps consider that they cannot elicit reliable information from their patients about the patients' suffering. Secondly , clinicians may consider that by relying on an empathic approach to their patients, they can gauge the extent of a patient's suffering. Finally, as will be argued below, suffering is an intensely personal and private experience, and hence enquiring about it might elicit a complex and detailed response for which there is insufficient time available in the clinical encounter, since any individual's suffering needs to be understood in the context of his or her Personhood. Cassell [1] described suffering as a state of severe distress associated with events that threaten the intactness of the person and stated that suffering occurs when an impending destruction of the person is perceived; it continues until the threat of disintegration has passed or until the integrity of the person can be restored in some other manner. A key feature of suffering is that it is a property of the whole person—suffering is not a phenomenon that can be reduced to part of the person. This is a key distinction between suffering and pain. Pain is a common cause of suffering (although there are many others). However, while we may complain that we experience pain in the head or the arm, it is only the whole person who suffers. Suffering is a feature of Personhood [2] 1 , and hence …