Mark Miller, C.Ss.R. Ph.D.
One of the ideas most often heard in the debate about euthanasia or assisted suicide is the phrase ‘ending the person’s pain and suffering.’ My suspicion is that most of us are at least as afraid of dying as we are of death because we fear the agonizing struggle which accompanies dying.
A question then poses itself for health care professionals who are generally called upon to assist the dying. What is the obligation to treat a person’s pain and suffering? Obviously, we would all be horrified by a caregiver who could alleviate pain and suffering but would not. Still, how far ought the doctor or nurse go to overcome pain and suffering in patients?
Let us begin with a distinction which our usage in our English language does not always abide by. Pain is what our body feels because of the physiological mechanisms which respond to intrusions, illnesses, breakdowns and so on. Such pain can almost always be controlled today by the arsenal of drugs which serve modern medicine. Indeed, palliative care— which is the art of caring for the dying—today claims that 95% of its patients are able to be pain-free in such a way that they can continue to live their lives to the best of their ability. And the other 5%, who are often plagued by extreme or unusual forms of pain, can still be sedated such that they do not feel any pain.
Controlling the pain of dying patients is perhaps the key to good medical care for these persons. When people are in excruciating pain all they want, all they can think of, is escape, often by any means available. When, however, pain is taken care of, most people are delighted to be able to continue to live their lives. Modern medicine and, in particular, good palliative care offer this treatment as part of true health care.
Now, however, I ask you to reflect for a moment on the meaning of suffering. Suffering is often caused by physical pain, but it is much more than that. Suffering encompasses all those dimensions of life which weary the human spirit. One may suffer from the pain of a disease or from the facts surrounding the having of the disease. A cancer patient often faces fear and uncertainty, an inability to do day-to-day tasks, strained family relations, and anger or depression as well as the pain of the disease. An AIDS patient will face the anguish of a body whose immune system can no longer counter the breakdown of many bodily functions, but also has to deal with suspicion and hostility in our judgemental society. The dying person faces the reality of one’s own mortality, the fear of extinguished life, the loss of one’s loves among family and friends. Nor are these experiences foreign to the Christian who lives in a special relation of acceptance by a loving God. Death, fear, loss, and pain do not bypass the believer; indeed, they often challenge the believer’s faith more profoundly than he or she ever thought possible.
So what is suffering? Suffering is the anguish of the human spirit, a spirit which seeks love and peace and unity but often confronts the opposite. Suffering is the encounter of the human person with a life and a world that is often ambiguous and even hostile.
What does medicine have to offer in the face of suffering? Here we must be careful not to expect more of medicine than it can possibly produce. Medicine today is driven by powerful scientific forces which are constantly looking for new wonder drugs and better surgeries to control and overcome problems in our bodies. Fortunately, though, health care is a whole lot more than medicine. Thus, we must be aware that when we think of the ability of medicine to ‘control’ pain, we must not confuse this ability with some mystical power to ‘control’ suffering. In fact, many medical treatments today actually increase the suffering of the patient! Drugs and surgery, it seems to me, can only ‘control’ suffering by putting people to sleep or by ending their lives.
Suffering demands attention to the human spirit. I, as a suffering patient, must pay attention to the suffering and not ‘turn it over to the doctor’ like I might my pain. Doctors do not cure fear, although they can do much to ameliorate it— because they are human, not because they are doctors! And while drugs may help with such emotions as anger and depression, these are experiences which I, in my weakness and suffering, have to face in order to find a pathway through them. Accordingly, we need to understand health care for the suffering patient as an encounter with the spirit or the fullness of the patient. Pastoral care workers, social workers, chaplains, family members and, of course, doctors and nurses all have much to contribute on this level. A gentle caress may do more than a drug; taking time to chat or, especially, to listen (both to what is said and what is not being said) is a great gift; just being present may counter devastating loneliness.
It frightens me to hear people speak of ‘ending someone’s suffering’ because such talk suggests to me that death is more important than the journey ALL of us makes in a world where none of us is immune to suffering. It is often hard to walk with the one who is suffering (com-passion). Nor does our society countenance or give much value to suffering. But I invite each reader to go back into your life and examine what role suffering has played for you, what you have learned through the really tough times, how they have shaped you (not always for the better, I will concede), and how much of life takes its very meaning from encounters with suffering.
Suffering is not a good in itself. It is simply a reality, a part of life. Rather than killing the sufferer, faith in the human spirit which has always faced so much suffering—and, for the Christian, faith in the God who is with us in our suffering—must provide the impetus for health care, particularly for the dying.