Catholic Medical Quarterly Volume 67(2) May 2017
Scottish Catholic Medical Association Meeting Report
‘The Meaning & Place of Suffering in Bioethics’,
Speaker Dr Mary-Frances Dysko, 29 November 2016.
We were delighted to welcome Dr Mary-Frances Dysko to the Catholic Chaplaincy in the University of Glasgow on Tuesday 29th of November 2016 for the SCMA early Advent Meeting. Dr Mary-Frances has recently been completing Master Studies in Bioethics at St Mary’s University, Twickenham and was well able to speak on the topic of discourse that evening; ‘The Meaning and Place of Suffering in Bioethics’. She gave a comprehensive and thought provoking talk which was well received by members of the SCMA, visitors and a number of healthcare students also who we were delighted to see in attendance at the talk also.
The problem of suffering
Mary-Frances began her talk with a discussion on the demands placed on modern medicine to eradicate suffering. Suffering is a difficult issue and the humanitarian response to it is placed at the feet of healthcare professionals in most societies. To unpack the issue further, it’s important to first consider suffering as a concept in its own right. Not only does suffering vary between individuals but it’s clear that different individuals struggle differently with suffering over time. For the purpose of our talk, Mary-Frances used Eric Cassell’s definition of suffering; ‘the unique distress of persons whose intactness or integrity is disrupted or destroyed’. Mary Frances discussed how suffering does not equate exactly to physical or emotional pain but these concepts are clearly central to the common ways in which humans beings suffer. At times, suffering can be intractable and when this occurs it can be both destructive and transformative. Mary Frances posed the question, “Does our capacity to suffer contribute to our dignity as human beings and children of God?”
Assessing and understanding suffering
Our discussion therefore began with consideration about what it is to suffer and this led on to the inevitable question, ‘who can judge?’ – who can (or should) be an effective judge on the suffering of others? Healthcare professionals are called on most frequently to arbitrate on the suffering of others but there is a disconnect here. Suffering is often bigger than the biomedical model which healthcare professionals are trained to apply. What happens when suffering is bigger than the solutions available or when suffering doesn’t fit neatly into one biomedical category or another?
From these considerations we moved on to thinking about the problem of suffering over time. In the past when relatively few medical ‘cures’ were available biological suffering was widespread and pronounced across all levels of society. Suffering from biological disease was a societal leveller afflicting rich and poor alike. However as scientific medicine has progressed, access to an increasing number of cures became a means which the rich could afford but the poor could not. This brought to mind the importance of healthcare organisations for delivering care as well as the importance of universal access to health-care as a human right (something we are privileged to enjoy in the UK).
Dilemmas for the future
Moving on from historical consideration of suffering Mary-Frances went on to discuss the advances that medical technology might bring in future years. With its successes of the past there is continued expectation from the public that healthcare will continue to to go further and progress develop further still. Nonetheless the aims of pharmaceutical and biotechnology companies do not always match-up to the sufferings which large numbers of people in society are struggling with. One could contrast for instance the great benefit of vaccination programmes in the early twentieth century with technologies like IVF for instance which are far more costly, often overlook important societal interventions (like adoption and fostering) and are frequently ethically questionable particularly in relation to the status of the human embryo. This brought up the question, ‘Do numbers matter when it comes to suffering?’ Is the suffering of the few less important than the suffering of the many?
It was noted that the biotechnology industry is increasingly coming to focus on human enhancement technology over recent decades. These are technologies which seek to reduce or eradicate suffering through augmentation or enhancement of human function. Innovations are aimed at addressing suffering which individuals are experiencing in the here as well as fear of future suffering or ‘expectant suffering’. Insulin pumps which seek to mimic pancreatic function are an example of an example of an enhancement technology which continues to be developed today in order to address the suffering which many diabetic patients face in the here and now. One could consider the contraceptive pill an example of a technology which seeks to alter a future human suffering – that is the anticipated suffering from pregnancy and maternity. Human enhancement technology therefore calls into question to some extent what is ‘normal’.
The fear of suffering
Mary drew our attention to the words of Wesley Smith in his book ‘Our Neurotic Fear of Suffering’ where the author points out that:
‘Never in human history has suffering been more readily relieved than today. And yet, paradoxically, we have never been more afraid of suffering.’
Anxiety and fear of future suffering are a growth area for the biotechnology industry and this drew us to consider the psychological and emotional dimensions which suffering brings. For Catholics, it also calls to mind many of our great Saints who readily embraced suffering in their lives and frequently prayed for it as well. Is this an area where our Catholic faith can help our society to address some of the issues surrounding suffering currently? Fear and anxiety over future suffering in Belgium and Holland appears to have reached epidemic proportions in some instances that physician assisted suicide & euthanasia are being used as ‘the ultimate solution’ to suffering which is considered intractable. How can we as Catholic healthcare professionals address patients’ anxieties and fear of suffering to a greater extent whilst remaining respectful towards immense importance of human life.?
The threat to the disabled
Mary-Frances also drew our attention to the issue of disability in relation to the ethical questions which arise from the topic of suffering. The advancement of assisted reproductive technologies, particularly in the UK continues to throw-up ethical questions for parents, families and societies. Should parents or societies be allowed to exclude certain forms of disability as a means of avoiding suffering? If they should, what sufferings can be included or precluded? Prominent bioethicists around the world including Kuhse, Singer, Harris and Savulescu continue to promote the idea of ‘Procreative Beneficence’ that modern societies should be able to preclude the suffering of individuals being ‘genetically suboptimal’. In that regard it was useful to be reminded of the words of Harriet McBryde-Johnson in her debate with Peter Singer in 2003. Harriet McBryde-Johnson was a US lawyer who suffered from muscular dystrophy. She said in this debate:
“He [Peter Singer] insists he doesn't want to kill me. He simply thinks it would have been better, all things considered, to have given my parents the option of killing the baby I once was, and to let other parents kill similar babies as they come along and thereby avoid the suffering that comes with lives like mine and satisfy the reasonable preferences of parents for a different kind of child. It has nothing to do with me. I should not feel threatened.”
Suffering indeed has much to teach us in our lives. It is a universal human concern and something which varies between individuals and over time. Its multifaceted nature involves physical, psychological, emotional and spiritual elements and perhaps similar to the ‘Total pain’ concept in palliative medicine we need to develop ‘Total suffering’ formations for our patients in future? For Christians, suffering can be meaningful – it can be transformative as well as humanising and even redemptive towards our personal salvation. Suffering can also provide an impetus for change in people’s lives. These ideas are clearly at odds with the scientific / rational and technological worldview which sees suffering as meaningless and something to be avoided at all costs;
‘The worldview of modern science sees health not only as a foundation but also a principal goal; not only as a beginning but also an end. Relief and preservation—from disease and pain, from misery and necessity—become the defining ends of human action, and therefore of human societies’.4
- Eric Cassell, ‘Suffering & Human Dignity’ in Suffering & Bioethics, RM Green & NJ Plapant. Oxford Scholarship online 2014.
- Smith, W. Our Neurotic Fear of Suffering. First Things, Aug 2012.
- Harriet McBryde-Johnson in Unspeakable Conversations, New York Times Magazine 2003
- Yuval Levin in Imagining the Future: Science and American Democracy. New Atlantis Books, 2008.
We are looking forward to our next SCMA meeting in the Spring of 2017 when we will welcome Dr Treloar who will address our group on the topic of ‘Dementia: Hope on a difficult journey’. We extend our heartfelt thanks to Mary-Frances Dysko for an excellent talk in the close of 2016.