Should palliative care erase all suffering?
Den Hartogh says end-of-life studies cite Cassell but then measure suffering like a symptom list; dying well can require respecting some suffering, not only removing it.
Source
Suffering and dying well: on the proper aim of palliative care
What they did
He samples empirical papers on suffering at the end of life, all of which cite Cassell’s definition, then shows they pay lip service: they add psychological and social items but still treat them as removable symptoms. Fatigue is his example of why ‘importance’ ratings misfire.
What they found
Physical symptoms of terminal illness often should be soothed because they no longer help. But not every element of suffering is like a distressing symptom it is always in the patient’s interest to eliminate. Within constraints of realism, support should help find an appropriate attitude. Paradoxically, some suffering should be respected as part of dying well.
The limits
What it doesn't show
This is a philosophical reading of a literature sample, not a new hospice trial. It does not say clinicians should withhold analgesia. ‘Dying well’ is a normative claim, not an outcome measure.
Key terms
- Cassell’s suffering
- Suffering as more than pain: a threat to the person, with psychological, existential and social dimensions.
- Lip service
- Citing Cassell while still treating suffering as a list of removable symptoms.
- Dying well
- An appropriate, realistic attitude toward dying, not a zero-symptom score.
- Constraints of realism
- Support and consolation should not sell an attitude that denies the situation.
Flashcards
Research intelligence for this paper
See its role on concept claims, tensions it is part of, placement history, and related discoveries.
Quiz yourself
Empirical papers often?
Common questions
Do the empirical papers follow Cassell fully?
They accept that suffering is more than pain, but otherwise often only pay lip service.
Should all suffering be removed?
Soothe pointless physical symptoms; do not treat every element on that model.
What is the paradoxical claim?
Some suffering should be respected as an integral part of dying well.
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