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  • Pain Management, Theological Ethics, and the Problem of Redemptive Suffering:A Thomistic Analysis
  • Stewart Clem

"Physical pain always mimes death and the infliction of physical pain is always a mock execution."

– Elaine Scarry1

"Sorrow in the heart exceeds every external wound." – St. Thomas Aquinas2 "I am strapped up with a broken rib, of all things. I broke it coughing. I never knew such was possible but I warn you: if you get a cough, buy yourself some cough syrup, don't just sit around coughing."

– Flannery O'Connor3

MOST CHRISTIANS believe that it is morally acceptable, within certain parameters, to minimize one's pain through medication. We find this affirmation especially in contemporary analyses of cases in which patients are in the process of dying. According to the Ethical and Religious Directives for Catholic Health Services, "[dying] patients should be kept as free of pain as possible so that they may die comfortably and with dignity," and, moreover, "Medicines [End Page 91] capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person's life so long as the intent is not to hasten death."4 Most moral theologians and Christian health-care ethicists would agree that pain is an evil to be avoided and that medical practitioners who help patients alleviate pain are doing good.

Yet, as we all know, pain medications are not always effective. Sometimes we may wish to alleviate a patient's pain, yet we are unable to do so. According to the ERD, "Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering."5 In a similar vein, Benedict Ashley, Jean deBlois, and Kevin O'Rourke write, "Although suffering is to be alleviated whenever possible, it is not in itself a moral evil nor without supernatural benefits if rightly used. The Christian tradition holds that great spiritual good can come out of suffering when it is joined to the sufferings of Jesus."6 On this account, it seems that (1) pain is an evil to be avoided, yet (2) there are specific goods that may be found in the suffering brought about through pain, and, (3) the goods brought about through pain are not necessarily greater than the goods brought about through the alleviation of pain.

To complicate matters further, Ashley, deBlois, and O'Rourke suggest that

the opportunity to use suffering as a means of spiritual growth is not destroyed if pain-killing drugs are used. Rather, the individual and those who care for him or her have the right to use such drugs in a way that will permit the best use of the patient's remaining energies and time of consciousness, so that the patient can complete life with maximal composure.7 [End Page 92]

This claim goes beyond the recommendation to seek redemption in the suffering brought about through pain when pain medication will not work. It suggests, rather, that the goods normally brought about through the experience of pain can be pursued while actively striving to alleviate one's pain. There is at least an apparent paradox here that warrants an explanation.

The aim of this article is to propose just such an explanation, and this explanation hinges on a particular account of pain as a passion of the soul known to the medieval Scholastic theologians as dolor (Latin, "pain"). On this account, pain is a postlapsarian response to the corruption of the body resulting from the loss of original justice.8 I draw upon St. Thomas Aquinas's distinction between bodily pain (dolor) and sadness (tristitia) to illuminate pain's moral significance. I argue that this account allows for a qualified defense of pain management through medication, insofar as this practice aims to remove obstacles to the contemplation that is requisite for living a good life—and for dying a good death. I also argue that this account makes room for the notion of redemptive suffering, but it does so without fetishizing bodily pain, insofar as it delineates clear limits on one's "participation" in the suffering of Christ.

I. What is Pain? A N...