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SUFFERING RECLAIMED: MEDICINE ACCORDING TOJOB THEODORE E. FFEISCHER* Along with other thoughtful people through the ages, Jewish and Christian communities have long wrestled with the mystery of suffering. Although many solutions have been offered, no definitive answers have been recognized by either community. While these ancient traditions persist in their search to understand the moral and spiritual meaning of suffering, 20th-century medicine conceptualizes the enigma of suffering as primarily a technical, rather than a moral or a spiritual, problem. We ask why doctors fail to give adequate pain relief, but not how patients can shape a response to their suffering. The culmination of this approach is, in one sense, the heated debate over physician-assisted suicide. Through physician-assisted suicide, medical technology makes good on its promise to eradicate suffering , even if this means eradicating the sufferer. Much recent analysis of palliative care and physician-assisted suicide has focused on narrowly framed moral and legal issues. We pay less attention to questions about the meaning of intractable suffering. Instead we act as if suffering has no meaning, or as if it is an unambiguous and unalloyed evil, more to be feared than death itself. When medicine, health law, and bioethics take this approach, they ignore thousands of years of effort by philosophers, theologians, and writers to uncover the meaning of human suffering. We learn something about the moral dimensions of human suffering in Tithe Olsen's haunting story, "Tell Me a Riddle" [I]. In the story, Eva— a bitter old woman—is dying of cancer. She has become estranged from David, her husband of 47 years. It seems impossible that anything good can emerge from her horrible suffering. Yet in her last days, Eva gathers her memories of childhood in Russia and celebrates long-forgotten ideological The author wishes to thank Carl Elliott and John Lantos for invaluable suggestions that significantly crystallized and refined the ideas and themes. *MacLean Center for Clinical Medical Ethics, University of Chicago, 5841 Maryland, Chicago , IL 60637.© 1999 by The University of Chicago. All rights reserved. 0031-5982/99/4203-1099$01.00 Perspectives in Biology and Medicine, 42, 4 ¦ Summer 1999 475 beliefs that re-emerge from the dim past. She fiercely resists hospitalization and never requests help in committing suicide, solutions that David considers . Either would end Eva's battle to regain her identity and reclaim her memories, a struggle that ultimately helps her to prevail over her suffering. Reluctantly David honors Eva's request to stay at home despite her perpetual agony, and eventually he is drawn into Eva's search. Years ofantagonism melt as he realizes how much he still cares for Eva. As death approaches, David lies down on the bed next to Eva and reaches out to her: "their hands, his and hers, clasped, feeding each other." Eva's fight to make sense of her life and her losses has led to reconciliation. I do not mean to belittle the achievements of palliative care or to argue that this care should be abandoned. However, as Olsen's story suggests, we pay a price for treating suffering as a morally neutral problem amenable to a tidy technical solution. Daniel Callahan argues that the transformation of suffering into simply one more medical challenge marginalizes our search for philosophical or religious meaning in suffering [2]. Even worse, "the search itself is denied as meaningful—when it is transformed into an effort to rid life of suffering altogether." When we let medicine interpret our suffering in terms of a mechanical model, which views all suffering as subject to therapeutic intervention, we relinquish the power to shape our lives. Thus, in a strange way, by diminishing the task of finding meaning in suffering, we also dimmish one important form of autonomy [3]. Those who seek to make sense out of their suffering must contend with a modern secular world view that offers drugs and ultimate release from pain, but few answers to questions about the meaning of suffering. More troubling, this world view denies the legitimacy of the question. Suffering is seen as a physiologic problem searching for a physiologic solution, rather than an existential or theological problem calling for a philosophical or...


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