Suffering, in one form or another, is present in all of our lives. But why do we suffer? On one reading, this is a question about the causes of physical and emotional suffering. But on another, it is a question about whether suffering has a point or purpose or value. In this ground-breaking book, Michael Brady argues that suffering is vital for the development of virtue, and hence for us to live happy or flourishing lives. After (...) presenting a distinctive account of suffering, and a novel account of its core element, unpleasantness, Brady proceeds to focus on three claims that are central to his picture. The first is that forms of suffering, like pain and remorse, can themselves constitute virtuous responses. The second is that suffering is essential for four important classes of virtue - virtues of strength, such as fortitude and courage; virtues of vulnerability, such as adaptability and humility; moral virtues, such as compassion; and the practical and epistemic excellences that make up wisdom. His final claim third is that suffering is vital for the social virtues of justice, love, and trust, and hence for the flourishing of social groups. (shrink)

Distant Suffering examines the moral and political implications for a spectator of the distant suffering of others as presented through the media. What are the morally acceptable responses to the sight of suffering on television, for example, when the viewer cannot act directly to affect the circumstances in which the suffering takes place? Luc Boltanski argues that spectators can actively involve themselves and others by speaking about what they have seen and how they were affected by (...) it. Developing ideas in Adam Smith's moral theory, he examines three rhetorical 'topics' available for the expression of the spectator's response to suffering: the topics of denunciation and of sentiment and the aesthetic topic. The book concludes with a discussion of a 'crisis of pity' in relation to modern forms of humanitarianism. A possible way out of this crisis is suggested which involves an emphasis and focus on present suffering. (shrink)

"This book focuses on arguments from suffering against the existence of God and on a variety of issues concerning agency and value that they bring out. The central aim is to show the extent and power of arguments from evil. The book provides a close investigation of an under-defended claim at the heart of the major free-will-based responses to such arguments, namely that free will is sufficiently valuable to serve as the good, or prominently among the goods, that provides (...) a God-justifying reason for permitting evil in our world. Offering a fresh examination of traditional theodicies, it also develops an alternative line the author calls a divine intimacy theodicy. It makes an extended case for rejection of the position of skeptical theism. The book expands upon an argument from evil concerning a traditional doctrine of hell, which reveals a number of interesting issues concerning fault, agency, and blameworthiness. In response to recent work contending that the problem of evil is defanged since God's baseline attitude toward human beings is indifference, the book defends the essential perfect moral goodness of God. Finally it takes up the question of whether or not it makes sense to live a religious life as an agnostic or as an atheist"--. (shrink)

Medical phenomenology describes the illness experience while providing an alternative to the reductionist biomedical discourse. Phenomenologically oriented critical theories focus on the experiences of structural paradoxes manifesting as social suffering. While both approaches elaborate different patterns of suffering, so far, their parallelisms and interactions have not been adequately analyzed. This task is all the more important because illness experience is never only about the disabled body or the distressed mind, it is also inseparable from a distorted intersubjectivity; and (...) vice versa, untreated social suffering also has the potential of turning into illness. After overviewing various experiences characterizing illness and those disrupted intersubjectivities, which can produce a homologous phenomenological pattern, four idealtypical patterns are analyzed. The parallel occurrence of illness and social suffering represents extreme existential disembedding; illness without social suffering represents a chance for countering the bodily disembedding by intersubjective re-embedding; social suffering without illness is a constellation, wherein the chance of medicalizing structural distortions is high; the lack of illness and social suffering represents a carefree, yet unreflective potential. Differentiating between these patterns opens new horizons for medical phenomenology and critical theories as well, both on the theoretical and the practical level. (shrink)

Interdisciplinary in approach, this book combines philosophy, sociology, history and psychology in the analysis of contemporary forms of suffering. With attention to depression, anxiety, chronic pain and addiction, it examines both particular forms of suffering and takes a broad view of their common features, so as to offer a comprehensive and parallel view both of the various forms of suffering and the treatments commonly applied to them. Highlighting the challenges and distortions of the available treatments and identifying (...) these as contributory factors to the overall problem of contemporary suffering, Empty Suffering promises to widen the horizon of therapeutic interventions and social policies. As such, it will appeal to scholars across the social sciences and humanities with interests in mental health and disorder, social theory and social pathologies. (shrink)

In this work, Jamie Mayerfeld undertakes a careful inquiry into the meaning and moral significance of suffering. Understanding suffering in hedonistic terms as an affliction of feeling, he claims that it is an objective psychological condition, amenable to measurement and interpersonal comparison, although its accurate assessment is never easy. Mayerfeld goes on to examine the content of the duty to prevent suffering and the weight it has relative to other moral considerations. He argues that the prevention of (...) suffering is morally more important than the promotion of happiness, and that the duty to relieve suffering is much stronger than most of us acknowledge. (shrink)

Suffering is the unique distress of persons whose intactness or integrity is disrupted or destroyed. The first lesson of suffering is that bodies do not suffer, persons suffer. It follows that a loss of dignity may incite suffering, as do other injuries to the person. Three cases are cited in this chapter of persons who suffer at least in part because of disruption of their dignity. These cases allow us to go further into the nature of persons, (...) human dignity, and the relation of suffering to dignity. Since the mid-twentieth century, the ideas and ideals of science became universal in medicine and then spread out to the entire culture, where they are present in great strength and wider influence. These ideas include the belief that only objective data have validity. But objectivity in the absence of subjectivity renders persons as one-dimensional and robs medicine of the compassion and human relationships that have defined it in history and in the care of an individual sick person. (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)

This article offers a new theory of suffering as significantly disrupted agency. In presenting it, I here make three significant contributions. First, I subject the leading account of suffering as undesired unpleasant experience (Brady, 2018) to its first dose of sustained scrutiny. Second and drawing on this discussion, I identify and liberate eight desiderata for any account of suffering. Third, I present the novel account of suffering as significantly disrupted agency and argue that it satisfies these (...) desiderata. Moreover, I argue that elaborating this proposal with a minimal model of agency allows us to capture both the suffering of a wide range of organisms and the complex dynamics of suffering as it is endured. I conclude by briefly highlighting some of the potential implications of the theory for further theoretical and practical inquiries. (shrink)

Abstract“Suffering” is a central concept within bioethics and often a crucial consideration in medical decision making. As used in practice, however, the concept risks being uninformative, ambiguous, or even misleading. In this paper, we consider a series of cases in which “suffering” is invoked and analyze them in light of prominent theories of suffering. We then outline ethical hazards that arise as a result of imprecise usage of the concept and offer practical recommendations for avoiding them. Appeals (...) to suffering are often getting at something ethically important. But this is where the work of ethics begins, not where it ends. (shrink)

Animals are an important part of our social, economic and corporate world. Their wellbeing is significantly affected by the ways in which humans treat them. However, animals have long remained (and, indeed, continue to remain) effectively invisible in the business ethics and corporate responsibility discourse. This article argues in favor of the moral necessity of according animal welfare a higher priority in business. In line with most streams in both recent and traditional animal ethics, this article derives the avoidance of (...) unnecessary animal suffering as the moral minimum standard for responsible management in the livestock industry. Based on a broad range of different interpretations of what animal suffering may be necessary, the article discusses three distinct ways in which humans working in the animal industry could meet their moral responsibility to avoid unnecessary suffering, and, with this, increase animal welfare: by ameliorating circumstances for animals, by aiming at a two-pronged transformation, or by transforming into a “zero-suffering” business. Considering animal welfare as a legitimate ethical value in and of itself is a first step towards overcoming the anthropocentric bias in today's sustainability and corporate responsibility debate. (shrink)

In this chapter we suggest that many experiences of suffering can be further illuminated as forms of transformative experience, using the term coined by L.A. Paul. Such suffering experiences arise from the vulnerability, dependence, and affliction intrinsic to the human condition. Such features can create a variety of positively, negatively, and ambivalently valanced forms of epistemically and personally transformative experiences, as we detail here. We argue that the productive element of suffering experiences can be articulated as transformative, (...) although suffering experiences are not the type mostly discussed in the transformative experience literature. We correct for this here by developing a taxonomy of negatively valenced transformative experiences. We suggest three features that make such experiences ones of suffering, following Michael Brady’s definition: intensity, novelty, and attentional focus. Finally, we suggest that one possible explanation for the edifying capacity of suffering comes from it requiring more transformation than positive experiences. (shrink)

Kant’s theory of friendship is crucial in defending his ethics against the longstanding charge of emotional detachment. But his theory of friendship is vulnerable to this charge too: the Kantian sage can appear to reject sympathetic suffering when she cannot help a suffering friend. I argue that Kant is committed to the view that both sages and ordinary people must suffer in sympathy with friends even when they cannot help, because sympathy is necessary to fulfill the imperfect duty (...) to adopt others’ merely permissible ends, and we ought to take friends’ MPEs as our own. MPEs are individuated in terms of concepts which include marks of the first person, and no marks of law other than permissibility. To adopt ends of others individuated in terms of such concepts rather than merely promote them as means to different ends, those concepts must engage with one’s feelings in a way that requires sympathy. (shrink)

As ever more advanced digital systems are created, it becomes increasingly likely that some of these systems will be digital minds, i.e. digital subjects of experience. With digital minds comes the risk of digital suffering. The problem of digital suffering is that of mitigating this risk. We argue that the problem of digital suffering is a high stakes moral problem and that formidable epistemic obstacles stand in the way of solving it. We then propose a strategy for (...) solving it: Access Monitor Prevent (AMP). AMP uses a ‘dancing qualia’ argument to link the functional states of certain digital systems to their experiences—this yields epistemic access to digital minds. With that access, we can prevent digital suffering by only creating advanced digital systems that we have such access to, monitoring their functional profiles, and preventing them from entering states with functional markers of suffering. After introducing and motivating AMP, we confront limitations it faces and identify some options for overcoming them. We argue that AMP fits especially well with—and so provides a moral reason to prioritize—one approach to creating such systems: whole brain emulation. We also contend that taking other paths to digital minds would be morally risky. (shrink)

When people suffer they always suffer as a whole human being. The emotional, cognitive and spiritual suffering of human beings cannot be completely separated from all other kinds of suffering, such as from harmful natural, ecological, political, economic and social conditions. In reality they interact with each other and influence each other. Human beings do not only suffer from somatic illnesses, physical pain, and the lack of decent opportunities to satisfy their basic vital, social and emotional needs. They (...) also suffer when they are not able to experience and grasp any meaning of life even if such suffering is not quite as obvious as most forms of physical, social and emotional suffering. Suffering from the lack for the sense of the meaning of life is a special form of emotional, cognitive, and spiritual suffering. Although all human beings share the same basic human need for some meaning of life, the fulfilment of this need is highly individual and personal. Although all forms of human suffering can be a challenge to the meaning of life, the personal conditions of suffering usually are a stronger challenge for the meaning of life. Among the personal conditions of human suffering, the Grenzsituationen cannot be cancelled or raised at all, but only accepted and coped with as existential aspects of the conditio humana. According to Karl Jaspers these are: death, suffering, struggling, guilt, and failing. The challenge for human beings to cope with these Grenzsituationen is a way to move from the mere Being-there to true human Existence. (shrink)

Ng :255–285, 1995. https://doi.org/10.1007/bf00852469) models the evolutionary dynamics underlying the existence of suffering and enjoyment and concludes that there is likely to be more suffering than enjoyment in nature. In this paper, we find an error in Ng’s model that, when fixed, negates the original conclusion. Instead, the model offers only ambiguity as to whether suffering or enjoyment predominates in nature. We illustrate the dynamics around suffering and enjoyment with the most plausible parameters. In our illustration, (...) we find surprising results: the rate of failure to reproduce can improve or worsen average welfare depending on other characteristics of a species. Our illustration suggests that for organisms with more intense conscious experiences, the balance of enjoyment and suffering may lean more toward suffering. We offer some suggestions for empirical study of wild animal welfare. We conclude by noting that recent writings on wild animal welfare should be revised based on this correction to have a somewhat less pessimistic view of nature. (shrink)

Animals are an important part of our social, economic and corporate world. Their wellbeing is significantly affected by the ways in which humans treat them. However, animals have long remained (and, indeed, continue to remain) effectively invisible in the business ethics and corporate responsibility discourse. This article argues in favor of the moral necessity of according animal welfare a higher priority in business. In line with most streams in both recent and traditional animal ethics, this article derives the avoidance of (...) unnecessary animal suffering as the moral minimum standard for responsible management in the livestock industry. Based on a broad range of different interpretations of what animal suffering may be necessary, the article discusses three distinct ways in which humans working in the animal industry could meet their moral responsibility to avoid unnecessary suffering, and, with this, increase animal welfare: by ameliorating circumstances for animals, by aiming at a two‐pronged transformation, or by transforming into a “zero‐suffering” business. Considering animal welfare as a legitimate ethical value in and of itself is a first step towards overcoming the anthropocentric bias in today's sustainability and corporate responsibility debate. (shrink)

In this study, I present the Chan Buddhist alternative to phronesis or ‘practical wisdom’. Instead of involving the skill or ‘know-how’ in applying moral principles to particular situations, the Chan Buddhist virtuously responds to situations because they understand how each situation is a ‘part’ of a larger whole or a ‘function’ (用) of the ‘body’ (體). Ultimately, this sensitivity to how each situation is meaningfully situated within a context of relationships is what motivates the Chan Buddhist’s spontaneous compassion towards the (...) suffering of existence in its entirety. (shrink)

This essay argues that what distinguishes a negatively valenced phenomenal experience from suffering is an ability to make meaning of the experience. In this sense, intellectual ability influences the extent and nature of suffering. But this connection is not a straightforward one, since intellectual ability cuts both ways. On the one hand, those with higher levels of intellectual functioning are better able to make meaning of negative experiences, thereby reducing their suffering. On the other, intellectual ability can (...) influence the depth and breadth of one’s negative experiences, thereby increasing suffering. This means that we cannot make any assumptions about a person’s susceptibility to suffering based on their level of intellectual functioning alone. (shrink)

This paper argues that it is possible for suffering to occur in the absence of phenomenal consciousness – in the absence of a certain sort of experiential subjectivity, that is. (Phenomenal consciousness is the property that some mental states possess, when it is like something to undergo them, or when they have subjective feels, or possess qualia.) So even if theories of phenomenal consciousness that would withhold such consciousness from most species of non-human animal are correct, this neednt mean (...) that those animals dont suffer, and arent appropriate objects of sympathy and concern. (shrink)

While the evidential problem of evil has been enormously influential within the contemporary philosophical literature—William Rowe’s 1979 formulation in “The Problem of Evil and Some Varieties of Atheism” being the most seminal—no academic research has explored what cognitive mechanisms might underwrite the appearance of pointlessness in target examples of suffering. In this exploratory paper, we show that the perception of pointlessness in the target examples of suffering that underwrite Rowe’s seminal formulation of the problem of evil is contingent (...) on the absence of broader context. In other words, we show that when such suffering is presented alongside broader contextual information, the appearance of pointlessness, on average, significantly diminishes. In §1 we briefly elucidate Rowe’s formulation of the problem of evil and the thought experiment that motivates a key premise. In §2 and §3 respectively, we briefly explain our hypothesis regarding Rowe’s case and our methods for testing these hypotheses. In §4, we elucidate our results, and in §5 we explore some of the philosophical implications of our findings and gesture towards some areas for future research. Finally, in §6, we briefly connect our research to some of the established philosophical literature on suffering and narrative before concluding. (shrink)

It is the persistence of social suffering in a world in which it could be eliminated that for Adorno is the source of the need for critical reflection, for philosophy. Philosophy continues and gains its cultural place because an as yet unbridgeable abyss separates the social potential for the relief of unnecessary human suffering and its emphatic continuance. Philosophy now is the culturally bound repository for the systematic acknowledgement and articulation of the meaning of the expanse of human (...) suffering within technologically advanced societies that are already committed to liberal ideals of freedom and equality. (shrink)

Traditionally, it is believed that God is all-powerful and omnipresent. Given the notion of divine omnipresence, why does it seem like God is absent amidst suffering? This paper presents a philosophical and theological analysis of God’s omnipresence. I hope to show how we may construe a robust and viable doctrine of divine omnipresence amidst suffering. I argue that although God’s presence results in divine action, given that divine action is mostly experienced in a relational, covenantal context, his presence (...) does not always lead to the absence of suffering. Although God is ontologically and maximally omnipresent, he is specially and covenantally present only with those who are open to a relationship with him. His presence with worshippers can be both interventional and noninterventional. In the former, he might remove suffering; in the latter, only inner peace and comfort might be experienced. (shrink)

In this communication recent evidence from cognitive neuroscience is presented showing that believing is a fundamental brain function. It integrates the perception of information from the environment with personal perspective taking (“what does it mean to me?”) as the basis for predictive coding of action. Observing that another person becomes injured can make one believe that the pain in the injured person is similar to pain that oneself has experienced previously. This first-person perspective has been called empathy and includes primal (...) beliefs about potentially pain eliciting objects and painful events in the sense of “what does it mean to you?”. Furthermore, observing other people to suffer involves the conceptual belief that their condition is aversive and burdensome. Believing in love and peace involves the perspective of “what does it mean to us?”. Contradictory events may cause the sensation of pain and suffering in the afflicted individuals resulting in mutual distrust and eventually disruption of social bonds. In conclusion, beliefs play an important, though long underestimated role in cognitive neuroscience of pain and suffering and more generally for the cultural notions of deities and evil. (shrink)

The paper aims at clarifying the distinctions and relations between pain and suffering. Three negative theses are defended: 1. Pain and suffering are not identical. 2. Pain is not a species of suffering, nor is suffering a species of pain, nor are pain and suffering of a common (proximate) genus. 3. Suffering cannot be defined as the perception of a pain’s badness, nor can pain be defined as a suffered bodily sensation. Three positive theses (...) are endorsed: 4. Pain and suffering are categorically distinct: pain is a localised bodily episode, suffering is a non-localised affective attitude. 5. Suffering can be expressed, pains cannot. As a consequence, we can have compassion for the suffering of others, not for their pains. 6. The relation between pain and suffering is akin to the relation between danger and fear, injustice and indignation, wrongdoing and guilt: suffering is the correct reaction to pain. One upshot is that both the influential view that the experience of pain is incorrigible and the influential view that the ordinary conception of pain is paradoxical are false. (shrink)

Does an affirmation of theistic evolution make the task of theodicy impossible? In this article, I will review a number of ancient and contemporary responses to the problem of evil as it concerns animal suffering and suggest a possible way forward which employs the ancient Jewish insight that evil—as resistance to God's will that results in suffering and alienation from God's purposes—precedes the arrival of human beings and already has a firm foothold in the nonhuman animal world long (...) before humans are ever tempted to go astray. This theological intuition is conferred renewed relevance in light of the empirical reality of evolutionary gradualism and continuity and in view of the recent findings of cognitive ethology. Consequently, I suggest that taking biological evolution seriously entails understanding “moral evil” as a prehuman phenomenon that emerges gradually through the actions and intentions of “free creatures” which—as evolutionary history unfolded—increasingly possessed greater levels of freedom and degrees of moral culpability. (shrink)

Suffering Art Gladly is concerned with the ostensibly paradoxical phenomenon of negative emotions involved in the experience of art: how can we explain the pleasure felt or satisfaction taken in such experience when it is the vehicle of negative emotions, that is, ones that seem to be unpleasant or undesirable, and that one normally tries to avoid experiencing? The question is as old as philosophical reflection on the arts, beginning with Plato and Aristotle, and subsequently addressed by Hume, Burke, (...) Diderot, Kant, and Schopenhauer, among others. Moreover, it is still an important and unresolved question in contemporary philosophy of art, where the discussion has been notably enlivened by recent research on the nature of imagination, cognition, and the emotions. Suffering Art Gladly comprises essays of two kinds, though the division between them is not airtight. The first kind are essays with a primarily historical focus, examining the problem of negative emotion from art as treated by important figures in the history of aesthetic thought, including Aristotle, Hume, Diderot, Kant, and Schopenhauer. The second kind are essays with a primarily contemporary focus, in which the methods and tools of contemporary analytic philosophy are much in evidence. In addition to the thirteen essays forming the heart of the book there is a general introduction by the editor, motivating the basic problem with which the essays are variously concerned and identifying the presuppositions or assumptions that are involved in different solutions to the problem. The individual essays are wide-ranging, dealing with a variety of artforms, negative emotions, and specific works of art, and the contributors, all recognized scholars in the field of aesthetics, are a mixture of junior and senior figures representing seven nationalities. (shrink)

This article explores the defense Indian Buddhist texts make in support of their conceptions of lives that are good for an individual. This defense occurs, largely, through their analysis of ordinary experience as being saturated by subtle forms of suffering . I begin by explicating the most influential of the Buddhist taxonomies of suffering: the threefold division into explicit suffering , the suffering of change , and conditioned suffering . Next, I sketch the three theories (...) of welfare that have been most influential in contemporary ethical theory. I then argue that Buddhist texts underdetermine which of these theories would have been accepted by ancient Indian Buddhists. Nevertheless, Buddhist ideas about suffering narrow the shape any acceptable theory of welfare may take. In my conclusion, I argue that this narrowing process itself is enough to reconstruct a philosophical defense of the forms of life endorsed in Buddhist texts. (shrink)

Is suffering ever redemptive? I argue here that, from a Protestant perspective, only certain suffering is redemptive, and that applying the concept of redemptive suffering to the situation of a dying or very ill patient eviscerates the true meaning of redemptive suffering. Contrary to some traditions, the suffering that accompanies disease is not redemptive, and should therefore be reduced or eliminated if possible. The only redemptive suffering is that voluntarily undertaken in the cause of (...) justice and the effort to combat disease. While the moral obligation to relieve suffering is not distinctively Christian, it is certainly central to Christian belief. Christians who, out of compassion, risk their lives by exposing themselves to contagion in an effort to heal others can be said to be modeling Christ’s compassion. (shrink)

There is an ongoing debate in bioethics regarding the nature of suffering. This conversation revolves around the following question: What kind of thing, exactly, is suffering? Specifically, is suffering a subjective phenomenon—intrinsically linked to personhood, personal values, feelings, and lived experience—or an objective affair, amenable to impersonal criteria and existing as an independent feature of the natural world? Notably, the implications of this determination are politically and ethically significant. This essay attempts to bring clarity to the subjective (...) versus objective debate in suffering scholarship by examining the history of the concept of “objectivity,” and putting that history in conversation with physician Eric Cassell’s famous theory of suffering. It concludes with a novel, albeit tentative, definition of suffering: suffering is the experience of a gap between how things are and how things ought to be. (shrink)

Kant claims that animal suffering only matters if it affects us indirectly by making us more callous toward other persons. This seems inconsistent with Kant’s formal moral theory, and it seems to entail that we are morally better off if we remain willfully ignorant of animal suffering. In defense of Kant’s indirect view, I explain how psychological facts should play a role in the application of the categorical imperative. I then give three responses to the objection that Kant (...) encourages willful ignorance. First, supporting practices of animal exploitation facilitates a system that harms workers. Second, moral ignorance as a habit of mind makes us more likely to ignore morally relevant harm to other persons. Third, remaining intentionally ignorant is not in keeping with our capacity for intellectual self-determination. (shrink)

It is often accepted that we may legitimately speak about voluntary euthanasia only in cases of persons who are suffering because they are incurably injured or have an incurable disease. This article argues that when we consider the moral acceptability of voluntary euthanasia, we have no good reason to concentrate only on persons who are ill or injured and suffering.

Subtitle: "Experiential understanding and the impossibility of intrinsically valuing suffering." Suffering, I argue, is bad. This paper supports that claim by defending a somewhat bolder-sounding one: namely that if anyone—even a sadistic ‘amoralist’—fully understands the fact that someone else is suffering, then the only evaluative attitude they can possibly form towards the person’s suffering as such is that of being _intrinsically against_ it. I first argue that, necessarily, everyone is disposed to be intrinsically against their _own_ (...) suffering experiences, holding fixed their specific overall degree of emotional aversiveness, because any evaluative attitude other than ‘being against’—including mere indifference—would in certain key circumstances make our suffering less emotionally aversive and thus different from the suffering experience (stipulatively) at issue. Second, fully understanding that someone else is having a given experience—Mary’s experiencing a vividly blue sky, say, or Job’s experiencing heart-rending grief—requires that we represent _experientially_ their very instance of that experience-type (it requires, in other words, token phenomenal concepts). The result is that what goes for our own suffering goes for others’, too: maintaining an accurate experiential representation of the fact that someone else is having a suffering experience with a specific degree of overall emotional aversiveness is only compatible with coming to be intrinsically against their suffering. So suffering is—‘objectively’—bad: it’s only possible to respond with indifference towards anyone’s suffering if we don’t fully understand that they are suffering in the first place. (shrink)

The goals of this chapter are to provide a coherent depiction of the human experience of suffering and to explain why the discussion of suffering is not prominent in bioethics. The first section uses examples and illustrations to elucidate the nature of suffering. Suffering results from profound loss that forecloses the satisfaction of values that define and drive a life. The second section considers responses to suffering. Intractable suffering can be made livable, but when (...) suffering is drastic and extreme, a life has to be transformed, as the conversion of Donald Cowart to Dax and Job’s acceptance of humility demonstrate, or ended by assisted suicide or euthanasia. The concluding sections reveal the values implicit in reviews of requests for euthanasia in the Netherlands when suffering is deemed unbearable, and how the constitutive values of orthodox bioethics render suffering morally peripheral. (shrink)

Uterus transplantation is a relatively new intervention. A woman with absolute uterine factor infertility receives, by a surgical procedure, a transplanted uterus, most often by living donation. The uterus recipient may thus become pregnant and conceive her own child. As with any other medical treatment, UTx requires legitimation. The anticipated benefits must outweigh the risks of the medical intervention. The risks and benefits of UTx are by no means unequivocal and cannot be easily determined. The benefits depend on the final (...) evaluation of the suffering to be alleviated by the intervention. In the following, we will analyze the suffering addressed by UTx and discuss its normative value. First, we point out that (a) suffering is generally considered an important normative criterion in medicine as well as in the context of UTx; (b) we then describe the risks and anticipated benefits of UTx for the three persons directly concerned: the child, the donor, and the recipient; (c) we further analyze the suffering addressed by UTx. The intervention addresses a form of existential suffering. We discuss the common notion that existential suffering should be evaluated from the subjective perspective of the sufferer; (d) afterwards, we argue that in a social practice like medicine, a one‐sided evaluation stemming from the sufferer alone is not sufficient; and (e) finally, arguments from a societal perspective lead us to the conclusion that the existential suffering addressed by UTx does not possess a sufficiently strong normative value to legitimize a high‐risk, expensive procedure. (shrink)

Background The interaction of health personnel with relatives is linked to the quality of care results in nursing homes. However, there is limited knowledge of how relatives perceive being an integral part of the nursing home context. This secondary analysis has its starting point in an ethical concern about relatives’ experiences in a previous study. Aim To critically discuss relatives’ experiences of suffering when their next of kin live in a nursing home in a rural arctic context. Research Design, (...) Participants and Context The critical hermeneutic stance is informed by Habermas. The secondary analysis is conducted on original data from five semi-structured focus groups with 18 relatives of residents of two nursing homes in a rural part of Norway. The theoretical framework concerning dignity, well-being, and suffering, as developed by Galvin and Todres, contrasts the analysis. Ethical Considerations The study followed the principles of the Helsinki Declaration. It was approved by the Norwegian Center for Research Data (NSD) (reg. no. 993360). Findings The main theme of this study is: suffering while resigning to an unacceptable violation of dignity. This theme is deepened by two subthemes: (a) suffering while adapting to a relationship of dependence and (b) suffering while accepting the unacceptable. Conclusions Relatives experience suffering as a cross-pressure in their struggle to interact responsibly with health personnel in nursing homes. This may have a negative outcome, where relatives end up adapting to being silent witnesses to missed care and a violation of dignity. (shrink)

SUFFERING HUMAN AND DIVINE INTRODUCTION I KNEW when I asked Dr. H. Wheeler Robinson to write this volume on Suffering that I was giving him the most difficult ...

Taking as its starting point a recent statement of the Goals of Medicine published by the Hastings Centre, this paper argues against the dualistic distinction between pain and suffering. It uses an Aristotelian conception of the person to suggest that malady, pain, and disablement are objective forms of suffering not dependent upon any state of consciousness of the victim. As a result, medicine effectively relieves suffering when it cures malady and relieves pain. There is no medical mission (...) to confront the spiritual condition of the patient. (shrink)

Isn’t there something like an amount and density of horrific suffering whose discovery would make it irrational to think God exists? Use your imagination to think of worlds that are much, much, much worse than you think Earth is when it comes to horrific suffering. Isn’t there some conceivable scenario which, if you were in it, would make you say “Ok, ok. God doesn’t exist, at least in the way we thought God was. We were wrong about that”? (...) Pursuing this question leads to what I call the Problem of Absurd Evil. (shrink)

This chapter argues that the legitimate effort to address medical causes of infertility is compromised when the suffering brought about by an unrealized desire for children is medicalized and the suffering of infertility is trivialized. Not all suffering is equal, nor are physicians required to treat every form of suffering. Unfortunately, when assisted reproductive technology is understood as a product and the infertile are considered consumers, the values and virtues that should govern reproductive medicine are threatened. (...) As is true with some forms of cosmetic surgery, many assistive reproductive treatments are offered to “patients” who have nothing medically wrong with them. The chapter concludes by arguing that the best way to combat the commodification of medicine that results from treating patients as consumers and medical treatments as products is to recover a social-trustee model of medical professionalism. (shrink)

The missing piece for many inquirers about God is a recognized experience of God as supporting evidence for belief in God. This article characterizes such experience in terms of a self-confirming and self-manifesting God who suffers with humans. It does so in the context of the issue whether God, if real, would do better now with the world. Inquirers often give an affirmative answer to support atheism implying that God does not exist. A silencing theodicy, in response to atheism, questions (...) supposedly firm objections to the reality and goodness of God based on the world’s evils. Such a theodicy does not show that atheism is false, but it undermines the evidential support for atheism sought in claiming that God, if real, would do better now with the world. The article examines whether God asks too much of humans with ‘higher’ divine ways, but it proceeds without relying on a contested notion of the best of all possible worlds. It explains how God self-confirms divine reality and goodness in the midst of unexplained suffering for humans. (shrink)

I present and explore a new version of the Person-Affecting View, according to which reasons to do an act depend wholly on what would be said for or against this act from the points of view of particular individuals. According to my view, (i) there is a morally requiring reason not to bring about lives insofar as they contain suffering (negative welfare), (ii) there is no morally requiring reason to bring about lives insofar as they contain happiness (positive welfare), (...) but (iii) there is a permitting reason to bring about lives insofar as they contain happiness. I show how my view solves the non-identity problem, while retaining the procreation asymmetry and avoiding implausible forms of antinatalism. We can be morally required to ensure that the quality of life of future people is higher rather than lower when this involves bringing about (worth living) lives that would contain less suffering rather than bringing about different (worth living) lives that would contain more suffering. (shrink)

Whence comes suffering? If the divine reality is a reality of bliss, and all is derived from this divine reality, how can suffering arise? Does the reality of God contain suffering? Might suffering be understood as a mode of bliss? These are the questions I take up in this essay. I suggest that the various states of suffering may best be understood as fragments of bliss, progressively resolved as fragmentation is overcome. Spiritual life is the (...) progressive movement from the suffering of ontological fragmentation toward the bliss of reunion. (shrink)

Background Some have hypothesized that talk about suffering can be used by clinicians to motivate difficult decisions, especially to argue for reducing treatment at the end of life. We examined how talk about suffering is related to decision-making for critically ill patients, by evaluating transcripts of conversations between clinicians and patients’ families.Methods We conducted a secondary qualitative content analysis of audio-recorded family meetings from a multicenter trial conducted in the adult intensive care units of five hospitals from 2012–2017 (...) to look at how the term “suffering” and its variants were used. A coding guide was developed by consensus-oriented discussion by four members of the research team. Two coders independently evaluated each transcript. We followed an inductive approach to data analysis in reviewing transcripts; findings were iteratively discussed among study authors until consensus on key themes was reached.Results Of 146 available transcripts, 34 (23%) contained the word “suffer” or “suffering” at least once, with 58 distinct uses. Clinicians contributed 62% of first uses. Among uses describing the suffering of persons, 57% (n = 24) were related to a decision, but only 42% (n = 10) of decision-relevant uses accompanied a proposal to limit treatment, and only half of treatment-limiting uses (n = 5) were initiated by clinicians. The target terms had a variety of implicit meanings, including poor prognosis, reduced functioning, pain, discomfort, low quality of life, and emotional distress. Suffering was frequently attributed to persons who were unconscious.Conclusions Our results did not support the claim that the term “suffering” and its variants are used primarily by clinicians to justify limiting treatment, and the terms were not commonly used in our sample when decisions were requested. Still, when these terms were used, they were often used in a decision-relevant fashion. (shrink)

The Nature of Suffering underscores the change that is taking place in medicine from a basic concern with disease to a greater focus on the sick person. Cassell centers his discussion on the problem of suffering because, he says, its recognition and relief are a test of the adequacy of any system of medicine. He describes what suffering is and its relationship to the sick person: bodies do not suffer, people do. An exclusive concern with scientific knowledge (...) of the body and disease, therefore, impedes an understanding of suffering and diminishes the care of the suffering patient. The growing criticism that medicine is not sufficiently humanistic does not go deep enough to provide a basis for a new understanding of medicine. New concepts in medicine must have their basis in its history and in the development of ideas about disease and treatment. Cassell uses many stories about patients to demonstrate that, despite the current dominance of science and technology, there can be no diagnosis, search for the cause of the patient's disease, prognostication, or treatment without consideration of the individual sick person. Recent trends in medicine and society, Cassell believes, show that it is time for the sick person to be not merely an important concern for physicians but the central focus of medicine. He addresses the exciting problems involved in such a shift. In this new medicine, doctors would have to know the person as well as they know the disease. What are persons, however, and how are doctors to comprehend them? The kinds of knowledge involved are varied, including values and aesthetics as well as science. In the process of knowing the experience of patient and doctor move to center stage. He believes that the exploration of the person will engage medicine in the 21st century just as understanding the body has occupied the last hundred years. (shrink)

It is a common claim in debates about abortion and the killing of animals that individuals, such as foetuses and non-human animals, that have psychological capacities significantly lower than those of adult human persons also have a moral status lower than that of persons. And those who defend this claim typically assume that it implies that the moral constraint against killing a foetus or animal is, if other things are equal, weaker than the constraint against killing a person. Many of (...) these same people also claim, however, that the difference in moral status makes no difference to the strength of the constraint against causing suffering. They argue that the reason not to cause suffering to an individual who neither deserves nor is liable to be caused to suffer is equally strong whatever the nature or moral status of the potential victim is. There is, however, a type of individual whose psychological capacities and moral status are such that it is plausible to believe that the reason not to cause them to suffer is weaker than the reason not to cause equivalent suffering to a person. Most non-human animals are psychologically intermediate between these low-status individuals and persons. This raises the question, which is explored in this chapter, whether most animals have an intermediate moral status that makes their suffering matter more than that of the low-status individuals but less than that of persons. (shrink)

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood (...) as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context. (shrink)

Background How often does refractory suffering, which is suffering due to symptoms that cannot be adequately controlled, occur at the end of life in modern palliative care? What are the causes of such refractory suffering? Should euthanasia be offered for refractory suffering at the end of life? We sought to shed light on these questions through interviews with palliative care specialists. Methods Semi-structured interviews with six nurses and six doctors working in palliative care in five Norwegian (...) hospitals. Transcripts were analysed with systematic text condensation, a qualitative analysis framework. Results Informants find that refractory suffering is rare, and that with palliative sedation satisfactory symptom control can nearly always be achieved at the end of life. However, the process of reaching adequate symptom control can be protracted, and there can be significant suffering in the meantime. Both somatic, psychological, social and existential factors can contribute to refractory suffering and potentiate each other. However, informants also place significant weight on factors pertaining to the organization of palliative care services as contributing to insufficient symptom control. Conclusions If refractory suffering is indeed rare, then this arguably weakens a common prima facie argument for the legalization of assisted dying. However, the process of reaching adequate symptom control can be protracted and involve significant suffering. The experiences of palliative care clinicians constitute important empirical premises for the assisted dying debate. The study points to several areas in which palliative care can be improved. (shrink)

Both Marilyn Adams and Eleonore Stump have endorsed requirements on theodicy which, if true, imply that we can never suffer all-things-considered harms. William Hasker has offered a series of arguments intended to show that this implication is unacceptable. This chapter evaluates Hasker’s arguments and finds them lacking. However, it also argues that Hasker’s arguments can be modified or expanded in ways that make them very powerful. The chapter closes by considering why God might not meet the requirements endorsed by Stump (...) and Adams and shows how they can modify their requirements to avoid the untenable implications about harm while still respecting the concerns that motivated their requirements in the first place. (shrink)