Not All Suffering Can Be Erased
Few causes or crusades have such universal support as medicine’s war against suffering. None of us wants to be sick or to be in pain. Most people do not want to die. Yet we rarely ask when enough is enough in waging that war.
At the extreme, almost everyone deplores the end-of-life killings allegedly confessed to, though later denied, by a respiratory therapist at Glendale Adventist Medical Center. Let us assume, kindly, that such killings occur when the killer cannot bear watching people die, some of them perhaps miserably. The legal requirement of informed consent to terminate life-sustaining care for the terminally ill may seem at times a lesser moral demand than the need to stop the suffering. Such reasoning would still be condemned because it violates the rights of the patient to decide when life support should end.
But we can’t be terribly surprised. There is a connection between modern medicine’s impossible quest for perfect health for all and the way suffering is demonized as the worst of human evils. We should hardly be surprised that moral boundaries will be breached on occasion and, with increasing frequency, overcome.
Perhaps the most subtle damage done by medicine’s crusade for perfection, egged on by an eager public, is that it has made it almost impossible for people to find any meaning in suffering. Medicine treats death and suffering as accidents, one day to be overcome by research and the momentum of progress. The palliative care and hospice movements offer an effective antidote to that attitude--and indeed help many people find some meaning in their suffering--but they are hardly sufficient.
Modern medicine has set no limits to the battle against suffering (which is a different issue than pain relief alone) constantly escalating the war against it in the name of medical progress. This is evident in the recent history of biomedical research and health care spending.
Biomedical research--nicely symbolized by the research agenda of the National Institutes of Health--has set its face against every medical evil: disease, disability, death. While many compassionate doctors are working hard to help people to accept death as an inevitable part of life, the research juggernaut resists. It has targeted death and illness as horrors to be implacably fought. The proposal in an otherwise tightfisted Congress to double the NIH budget over the next five years--from $13 billion to $26 billion--is ample testimony to the political popularity of the war against medical suffering.
Health care spending in the United States--14% of our GNP and $1 trillion a year--far more per capita than any other country, displays a comparable syndrome. No matter how much health status improves in this country--it is now at an all-time high--it is never good enough. There is no such thing in medicine as “good enough.” Progress begets progress, ever raising the standards for what counts as good health. When the 19th century union leader Samuel Gompers was asked what labor wanted, he had a simple answer: “More.” That seems to be the medical motto also.
Am I saying that we should just accept the suffering of cancer or arthritis or Alzheimer’s or infertility? Not at all. They mar the human condition and they bring human misery. I recently had a cancer scare and it wasn’t nice, nor am I much enthused by my mild, but inexorably progressing, emphysema. But I am saying that the crusade against any and all suffering can itself turn sour.
While few will want to go as far as furtive injections of lethal drugs or pinching the air hoses of the helpless, it can and has led us to spend too much money, too inefficiently and too ineffectively, on the always escalating cost of technological innovation. The crusade has made it harder for Americans to come to grips with death and the suffering that can sometimes accompany it. For if suffering cannot be relieved by medicine and if suffering is taken to be utterly evil, then why not turn to physician-assisted suicide? Through religious and philosophical traditions, many of which are being drawn upon in hospice settings, meaning can be found in suffering, even if the suffering cannot be fully relieved.
We would be much more fully served by a practice of medicine that knew its own limits in triumphing over suffering--limits to the benefits of research, limits to the struggle against death, limits to relieving our pain and misery. Medicine has offered us many benefits but also many false hopes. If we could learn to say that enough is enough, we might open the way to a fresh exploration of human suffering. We might bring medicine back to a better balance between the desperate search for cures and the enduring human need for care and comfort.
