Human suffering is a complex phenomenon that can manifest physically or psychologically. As the negative valence of affective phenomena, with the positive being pleasure or happiness, human suffering could easily be interpreted as something to avoid. Sartre explored existential aspects of human suffering in Being and Nothingness. Examining each occurrence of the word suffering in that work provides a basis for understanding the roles Sartre assigned to it within the human experience and consequently provides a more nuanced appreciation of this (...) complex phenomenon. An electronic copy of Being and Nothingness was searched for all occurrences of the word suffering (N = 50), tabularized using the Key Word In Context (KWIC) approach at the sentence level, resulting in 40 sentences for thematic analysis. That analysis resulted in 5 themes, showing the complexity of suffering in Sartre’s major philosophical work and suggesting that suffering is quintessentially human, unavoidable, and potentially liberating. (shrink)

According to the care crisis in modern medicine, the existential needs of patients are not sufficiently satisfied. One idea is that to address the crisis physicians should be educated to be virtuous. This suggestion is helpful but incomplete. It does not take into account the part of (non-)human factors, including (medical) technologies. In particular, the paper focuses on online caring forums and argues that they are technological factors that can play the role of focal things, in which the members gather (...) together to do a care-related focal practice. Furthermore, we empirically study the online forums of Ninisite, a popular Persian website on pregnancy, childbirth, and parenting, and suggest that these forums shape focal practices that are helpful in alleviating the care crisis. (shrink)

One way in which bioethicists can benefit the medical community is by clarifying the concept of disorder. Since insurance companies refer to the DSM for whether a patient should receive assistance, one must consider the consequences of one’s concept of disorder for who should be provided with care. I offer a refinement of Jerome Wakefield’s hybrid concept of disorder, the harmful dysfunction analysis. I criticize both the factual component and the value component of Wakefield’s account and suggest how they might (...) be improved. I propose that the factual component should be statistical variation analyzed in multilevel and chronological compilations of physiological data. I propose that the value component should prioritize the individual’s authority regarding the experience of suffering from a physiological condition. My account preserves the insight of using a factual and a value component while avoiding the problems that Wakefield’s original account faces. (shrink)

How can we draw the line between health and disease? This crucial question of demarcation has immense practical implications and has troubled scholars for ages. The question will be addressed in three steps. First, I will present an important contribution by Rogers and Walker who argue forcefully that no line can be drawn between health and disease. However, a closer analysis of their argument reveals that a line-drawing problem for disease-related features does not necessarily imply a line-drawing problem for disease (...) as such. The second step analyzes some alternative approaches to drawing the line between health and disease. While these approaches do not provide full answers to the question, they indicate that the line-drawing question should not be dismissed too hastily. The third step investigates whether the line-drawing problem can find its solution in the concept of suffering. In particular, I investigate whether returning to the origin of medicine, with the primary and ultimate goal of reducing suffering, may provide sources of demarcation between health and disease. In fact, the reason why we pay attention to particular phenomena as characteristics of disease, consider certain processes to be relevant, and specific functions are classified as dys-functions, is that they are related to suffering. Accordingly, using suffering as a criterion of demarcation between health and disease may hinder a wide range of challenges with modern medicine, such as unwarranted expansion of disease, overdiagnosis, overtreatment, and medicalization. (shrink)

When talking about decisionmaking for children with a life-threatening condition, the death of children with brain tumors deserves special attention. The last days of the lives of these children can be particularly harsh for bystanders, and raise questions about the suffering of these children themselves. In the Netherlands, these children are part of the group for whom a wide range of end-of-life decisions are discussed, and questions raised. What does the end-of-life for these children look like, and what motivates physicians (...) and parents to make decisions that may affect the life and death of these children? This article highlights the story of the parents of the sisters Roos and Noor. When both their daughters were diagnosed with a hereditary brain tumor, they had to make similar decisions twice. Their story sheds light on the suffering of children in the terminal phase, and how this suffering may motivate parents and physicians to make decisions that influence the end of life of these children’s lives.We argue that complete knowledge about suffering in the terminal phase of children with brain tumors is impossible. However, by collecting experiences like those of Roos and Noor, we can move toward an experienced-based understanding and better guide parents and physicians through these hardest of decisions. (shrink)

On the face of it, suffering from the loss of a loved one and suffering from intense pain are very different things. What makes them both experiences of suffering? I argue it’s neither their unpleasantness nor the fact that we desire not to have such experiences. Rather, what we suffer from negatively transforms the way our situation as a whole appears to us. To cash this out, I introduce the notion of negative affective construal, which involves practically perceiving our situation (...) as calling for change, registering this perception with a felt desire for change, and believing that the change is not within our power. We (attitudinally) suffer when negative affective construal is pervasive, either because it colours a large swath of possibilities, as in the case of anxiety, or because it narrows our attention to what hurts, as in the case of grief. On this view, sensory or bodily suffering is a special case of attitudinal suffering: the unpleasantness of pain causes pervasive negative affective construal. Pain that doesn’t negatively transform our world doesn’t make for suffering. (shrink)

BackgroundThis article aims to contribute to a better conceptualization of pain and suffering by providing non-essential and non-naturalistic definitions of both phenomena. Contributions of classical evidence-based medicine, the humanistic turn in medicine, as well as the phenomenology and narrative theories of suffering and pain, together with certain conceptions of the person beyond them are critically discussed with such purpose.MethodsA philosophical methodology is used, based on the review of existent literature on the topic and the argumentation in favor of what are (...) found as better definitions of suffering and pain.ResultsPain can be described in neurological terms but cognitive awareness, interpretation, behavioral dispositions, as well as cultural and educational factors have a decisive influence on pain perception. Suffering is proposed to be defined as an unpleasant or even anguishing experience, severely affecting a person at a psychophysical and existential level. Pain and suffering are considered unpleasant. However, the provided definitions neither include the idea that pain and suffering can attack and even destroy the self nor the idea that they can constructively expand the self; both perspectives can b e equally useful for managing pain and suffering, but they are not defining features of the same. Including the existential dimension in the definition of suffering highlights the relevance of suffering in life and its effect on one’s own attachment to the world. An understanding of pain and suffering life experiences is proposed, meaning that they are considered aspects of a person’s life, and the self is the ever-changing sum of these experiences.ConclusionsThe provided definitions will be useful to the identification of pain and suffering, to the discussion of how to relieve them, and to a better understanding of how they are expressed and experienced. They lay the groundwork for further research in all these areas, with the twofold aim of a) avoiding epistemological mistakes and moral injustices, and b) highlighting the limitations of medicine in the treatment of suffering and pain. (shrink)

In this article I investigate the ways in which phenomenology could guide our views on the rights and/or wrongs of abortion. To my knowledge very few phenomenologists have directed their attention toward this issue, although quite a few have strived to better understand and articulate the strongly related themes of pregnancy and birth, most often in the context of feminist philosophy. After introducing the ethical and political contemporary debate concerning abortion, I introduce phenomenology in the context of medicine and the (...) way phenomenologists have understood the human body to be lived and experienced by its owner. I then turn to the issue of pregnancy and discuss how the embryo or foetus could appear for us, particularly from the perspective of the pregnant woman, and what such showing up may mean from an ethical perspective. The way medical technology has changed the experience of pregnancy—for the pregnant woman as well as for the father and/or other close ones—is discussed, particularly the implementation of early obstetric ultra-sound screening and blood tests for Down’s syndrome and other medical defects. I conclude the article by suggesting that phenomenology can help us to negotiate an upper time limit for legal abortion and, also, provide ways to determine what embryo–foetus defects to look for and in which cases these should be looked upon as good reasons for performing an abortion. (shrink)

Merleau-Ponty se vale de casos patológicos para elaborar una teoría de la percepción que ubica a la corporalidad como expresión central. El artículo indaga y problematiza la experiencia de enfermedad a partir de la propuesta fenomenológica en torno al cuerpo vivido o fe-nomenal. Repensar esta vivencia, desde las antípodas a un abordaje biomédico que la circunscribe a un cuerpo objetivo, permite considerarla a la luz de una perspectiva filosófica como instancia crítica. La experiencia de enfermedad, inaugura una disrupción en el (...) modo de ser-en-el-mundo e introduce la inhabitualidad, como dimensión que participa de una reconfiguración necesaria del esquema corporal. Este aspecto permite repensar los procesos de salud/enfermedad y discutir con concepciones de índole restitutivas, tan características a la hora de abordar los mismos.Merleau-Ponty uses pathological cases to elaborate a theory of perception that places corporality as the central expression. The article investigates and problematizes the experience of illness from the phenomenological proposal around the lived or phenomenal body. Rethinking this experience, from the antipodes to a biomedical approach that circumscribes it to an objective body, allows us to consider it in the light of a philosophical perspective as a critical instance. The experience of illness inaugurates a dis-ruption in the way of being-in-the-world and introduces the unusual, as a dimension that participates in a necessary reconfiguration of the body scheme. This aspect allows to rethink the health / disease processes and to discuss with concepts of a restorative nature, so characteristic when it comes to addressing them. (shrink)

Neonatal suffering has been the focus of recent debate in pediatric bioethics and suffering theory. How to access and conceptualize the suffering that can be attributed to newborns? How to discern the suffering of newborns who, due to being non-neurotypical, may have a short life and severe neurocognitive disabilities, in addition to being entirely dependent on people or life-sustaining technologies? Phenomenology has provided valuable tools for analysing human experiences of suffering, but its application to the neonatal suffering experience is not (...) without fundamental challenges. In this article, I will consider recent contributions to elucidating the phenomenon of neonatal suffering, especially those in the field of non-experiential theories of suffering. Based on this review, a recent phenomenological approach to suffering will be examined. Explicitly directed toward narrative persons, this approach appears to be inherently limited in elucidating the phenomenon of neonatal pediatric suffering. Nevertheless, a suggestion will be offered to partially elaborate the theoretical foundations of a phenomenological theory of neonatal suffering. This suggestion points to the program of a phenomenology of the existential feelings of newborns. (shrink)

This paper has two aims. The first is to defend a recent critique of the leading medical theory of suffering, which alleges too narrow a focus on violent experiences of suffering. Although sympathetic to this critique, I claim that it lacks a counterexample of the kinds of experiences the leading theory is said to neglect. Drawing on recent clinical cases and the longer intellectual history of suffering, my paper provides this missing counterexample. I then answer some possible objections to my (...) defence, before turning to my second aim: an expansion of my counterexample into a spectrum of suffering that varies according to the selves and purposes that suffering affects. Next, I connect this spectrum to the tolerability of suffering, which I distinguish from its affective intensity. I conclude by outlining some applications of this distinction for the psychometric reliability of assessment instruments that measure suffering in clinical contexts. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

This article develops a phenomenological exploration of chronic pain from a first-person perspective that can serve to enrich the medical third-person perspective. The experience of chronic pain is found to be a feeling in which we become alienated from the workings of our own bodies. The bodily-based mood of alienation is extended, however, in penetrating the whole world of the chronic pain sufferer, making her entire life unhomelike. Furthermore, the pain mood not only opens up the world as having an (...) alien quality, it also makes the world more lonesome and poor by forcing the sufferer to attend to the workings of her own body. To suffer pain is to find oneself in a situation of passivity in relation to the hurtful experiences one is undergoing. In making the body and the world more unhomelike places to be in, pain also tends to rob a person of her language. Severe pain is hard to describe because it pushes the person towards the borderlines of imaginable experience and because it makes it hard to see any meaning and purpose in the situation one has been forced into. The analysis of chronic pain in the article is guided by the attempts made by Maurice Merleau-Ponty, Jean-Paul Sartre, and Martin Heidegger to understand the nature of human embodiment and existence, and also by descriptions of chronic pain found in the Swedish author Lars Gustafsson’s novel The Death of a Beekeeper. (shrink)

The aim of this discussion paper is to explore factors and contexts that influence how nurses might conceptualise and assign personhood for people with altered consciousness, cognition and behaviours. While a biomedical framing is founded upon a dichotomy between the body and self, such that the body can be subjected to a medical and objectifying gaze, relational theories of self, multiculturalism and technological advances for life‐sustaining interventions present new dilemmas which necessitate discussion about what constitutes personhood. The concept of personhood (...) is dynamic and evolving: where historical constructs of rationality, agency, autonomy and a conscious mind once formed the basis for personhood, these ideas have been challenged to encompass embodied, relational, social and cultural paradigms of selfhood. Themes in this discussion include: the right to personhood, mind–body dualism versus the embodied self; personhood as consciousness, rationality and narratives of self; social relational contexts of personhood and cultural contexts of personhood. Patricia Benner's and Christine Tanner's clinical judgement model is then applied to consider the implications for nursing care that seeks to reflexively incorporate personhood. Nurse clinicians are able to move between conceptions of personhood and act to support the body, as well as presumed autonomy and relational, social and cultural personhood. In doing so, they use analytical, intuitive and narrative reasoning which prioritises autonomous constructions of self. They also incorporate relational and social contexts of the person receiving care within the possibilities of technological advances and constraints of contextual resources. (shrink)

In his carefully documented article, “From reciprocity to autonomy in physician-assisted death: an ethical analysis of the Dutch Supreme Court ruling in the Albert Heringa case,” Berand Florijn (20...

As previous pandemics, the coronavirus disease 2019 (COVID-19) has direct and indirect effects on mental health and well-being. The purpose of the current study was to examine whether meaning in life mediated the association between coronavirus suffering and satisfaction with life and whether stress-related growth moderated the mediating effect of meaning in life on the association between these variables. Stress-Related Growth Measure (SGM) was also conducted for the purpose of this study. The participants were 402 (66% women) young adults who (...) completed the Suffering Measure During COVID-19, Meaningful Living Measure, Satisfaction With Life Scale, and SGM. The results indicated that the SGM has adequate psychometric properties with unidimensional structure of stress-related growth in the face of adversity. Moderated mediation analysis revealed that coronavirus suffering directly influenced satisfaction with life as well as indirectly by its effect on meaning in life. Additionally, stress-related growth was found as a moderator in the relationship between coronavirus suffering–meaning in life and coronavirus suffering–satisfaction with life. These results suggest that meaning in life mitigates the effect of coronavirus suffering on satisfaction with life, and this mediating effect is moderated by stress-related growth in young adults. While meaning in life helps explain the relationship between coronavirus suffering and satisfaction with life, the stress-related growth functions as a protective factor against the adverse effect of coronavirus experiences. (shrink)

Research Problem: The onset of the COVID-19 pandemic has triggered a multi-faceted crisis worldwide. Researchers and health authorities in various parts of the world echoed the dire condition of the public's mental health. This study sought to examine the mediating effect of personal meaning on the association between coronavirus -related suffering, mental health problems, and life satisfaction. Participants included 231 adults and completed measures of suffering related to COVID-19, meaning, life satisfaction, and mental health problems online.Results: Findings from mediation analysis (...) showed that suffering had significant associations with personal meaning, mental health, and well-being. Furthermore, personal meaning was significantly associated with adults' mental health and well-being and mediated the negative effect of suffering on mental health and well-being.Discussion: Overall, results from this study indicate that personal meaning is an important promotive factor that may help to understand the negative effect of coronavirus-related suffering on mental health and well-being amid the public health crisis. (shrink)

Suffering, defined as a state of undergoing pain, distress or hardship, is a multidimensional concept; it can entail physical, psychological and spiritual distress that prompts the sufferer to seek medical attention. As a construct originating from and unique to each patient, no patient’s suffering is equal to another’s or completely reducible to any generalizable frame of understanding. As it happens in a common medical encounter, the suffering patient requires an anamnesis provided by attentive and comprehensive listening to both the said (...) and unsaid parts of his or her discourse interpreted through the hermeneutical skills of the physician. Suffering can then be decoded into a complex construct, which can guide the formulation of a strategy to help patient coping by attempting to find meaning in it. To help this search for meaning, one may employ philosophic therapy, bibliotherapy and counseling, among other approaches. Suffering-based medicine (SBM) thus circumvents the limitations of the reductionistic Allopathic medical frame of understanding of disease. Such an attitude should be a common goal for all scientific medicine practitioners, as it complements and does not conflict with any of its therapeutic modalities. Furthermore, medical education should include humanistic disciplines to empower physicians to better understand their patients’ experience of suffering. (shrink)

In response to cancer, patients may be thrown into precarious processes of remaking their purpose, identity, and connections to the world around them. Thoughtful and thorough responses to these issues can be supported by person-centered phenomenological approaches to caring for patients. The importance of perspectives on illness offered by theoretical phenomenology will become apparent through the example of the experience of nausea, or perhaps more accurately put—chemo sickness. The focus here is on how chemo sickness alters one's way of relating (...) to the world. I will examine the phenomenon of nausea through the lens of the phenomenological concept of mood—an existential feeling that engenders a diffused tone permeating through one's world and shapes the envisioned possibilities on one's horizon. (shrink)

Although by no means mainstream, phenomenological approaches to bioethics and philosophy of medicine are no longer novel. Such approaches take the lived body —as opposed to the body understood as a material, biological object —as their point of departure to offer a more robust understanding of a plurality of experiences that go far beyond those surrounding disease...

In recent years the phenomenological approach to bioethics has been rejuvenated and reformulated by, among others, the Swedish philosopher Fredrik Svenaeus. Building on the now-relatively mainstream phenomenological approach to health and illness, Svenaeus has sought to bring phenomenological insights to bear on the bioethical enterprise, with a view to critiquing and refining the “philosophical anthropology” presupposed by the latter. This article offers a critical but sympathetic analysis of Svenaeus’ efforts, focusing on both his conception of the ends of phenomenological bioethics (...) and the predominantly Heideggerian means he employs. Doing so reveals certain problems with both. I argue that the main aim of phenomenological bioethics as set out by Svenaeus needs to be reformulated, and that there are important oversights in his approach to reaching this end. I conclude by arguing that to overcome the latter problem we should draw instead on the works of Max Scheler and Hans Jonas. (shrink)

In this paper I aim to show why pediatric suffering must be understood as a judgment or evaluation, rather than a mental state. To accomplish this task, first I analyze the various ways that the label of suffering is used in pediatric practice. Out of this analysis emerge what I call the twin poles of pediatric suffering. At one pole sits the belief that infants and children with severe cognitive impairment cannot suffer because they are nonverbal or lack subjective life (...) experience. At the other pole exists the idea that once child suffering reaches some threshold it is ethical to eliminate the sufferer. Concerningly, at both poles, any particular child vanishes from view. Second, in an attempt to identify a theory of suffering inclusive of children, I examine two prominent so-called experiential accounts of suffering. I find them both wanting on account of their absurd entailments and their flawed assumptions regarding the subjective experiences of people who cannot communicate expressively. Finally, I extend arguments found in Alastair MacIntyre’s Dependent Rational Animals to argue that child suffering can be understood only as a set of absences—absences of conditions such as love, warmth, and freedom from pain. An evaluation of these absences reveals the exquisite dependency of children. It also discloses why pediatric suffering is necessarily a social and political event. Unlike adults, children will never be either the authors or the mitigators of their own suffering. Rather, children must rely wholly on others in order to resist suffering, grow, and flourish. (shrink)

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending (...) their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge. (shrink)

During the last few decades, many thinkers have advocated for the importance of the phenomenological approach in developing the understanding of the lived experience of illness. In their attempts, they have referred to ideas found in the history of phenomenology, most notably, in the works of Edmund Husserl, Martin Heidegger, Maurice Merleau-Ponty and Jean-Paul Sartre. The aim of this paper is to sketch out an interpretation of illness based on a yet unexplored conceptual framework of the phenomenology of French thinker (...) Jean-Luc Marion. Focusing on concepts of the saturated phenomenon and flesh, the paper develops an interpretation of illness as the saturated phenomenon, which highlights a variety of dimensions of illness already elaborated within the phenomenology of medicine, such as the affective dimension of illness, the disruptive dimension of illness, the transformed perception of the self in illness, mineness of flesh in illness and the inexpressible and hermeneutical dimension of illness. In addition to that, the paper explores some of the consequences the proposed interpretation of illness offers regarding the nature of illness and health. It is argued that illness in its essence is very similar to the experience of other saturated phenomena, suggesting that the difference between them does not lie within the character of the affective givenness, but rather within the dynamic relationship between the affective givenness and its conceptualization. It is also shown that the experience of health is compatible with the experience of saturation and thus is not limited to the tacit and harmonious background state. (shrink)

This article explores how meanings around risk, health/safety, and workers’ bodies are constructed in an academic context. I do so through the study of a single academic in Australia who sustained a back injury at work. Through an analysis of in-depth interviews and documents, I attempt to show the embodied experience of an injured worker’s struggle for care, recovery, and survival in the neoliberal academy. Writing from the nexus of workplace health and safety and critical management literatures, the raw testimony (...) of this injured academic lays bare the violences that are enabled within a wider culture of self-discipline, individualism, and performativity in the university. The story presented in this article exposes how physiological and psychological injuries can be exacerbated through the very health and safety procedures that are designed to prevent and alleviate harm. Please note that this article contains references to suicide and suicidal ideation. (shrink)

The paper presents an account of suffering as a multi-level phenomenon based on concepts such as mood, being-in-the-world and core life value. This phenomenological account will better allow us to evaluate the hardships associated with dying and thereby assist health care professionals in helping persons to die in the best possible manner. Suffering consists not only in physical pain but in being unable to do basic things that are considered to bestow meaning on one’s life. The suffering can also be (...) related to no longer being able to be the person one wants to be in the eyes of others, to losing one’s dignity and identity. These three types of suffering become articulated by a narrative that holds together and bestows meaning on the whole life and identity of the dying person. In the encounter with the patient, the health-care professional attempts to understand the suffering-experience of the patient in an empathic and dialogic manner, in addition to exploring what has gone wrong in the patient’s body. Matters of physician assisted suicide and/or euthanasia—if it should be legalized and if so under which conditions—need to be addressed by understanding the different levels of human suffering and its positive counterpart, human flourishing, rather than stressing the respect for patient autonomy and no-harm principles, only. In this phenomenological analysis the notions of vulnerability and togetherness, ultimately connecting to the political-philosophical issues of how we live together and take care of each other in a community, need to be scrutinized. (shrink)