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separation between the observer and the observed. Empathy is
the best we can manage, and if we can muster it to action, that
is good enough.
I believe that the capacity for suffering is the precursor of
natural morality. I stand with numerous scientists and ethicists,
some cited here, to declare that empathy and the understanding
of suffering, however elusive they may be, are the moral obligation
of the pain practitioner. The pain patient has a reciprocal
obligation. Honesty and trust go both ways. Patients deceive
their physicians for a host of reasons, some intentional, some
not. Mistrust at the outset of the relationship thwarts communication.
Mistrust is prejudicial and ethically corrosive. The
moral role of the pain practitioner is to trust the patient’s
reports and expressions of suffering. We cannot measure suffering,
nor can we even be certain of its presence. But we can
explore with the patient the habits, goals, desires, expectations,
roles, attachments—in short, any and every facet of the
patient’s life, some hidden from awareness, that are threatened
by the experience of pain. The treatment of diseases and
injuries includes the treatment of pain. The treatment of pain
is all about suffering.
The author acknowledges the help of Linda Sutton in the preparing
the manuscript and of Russell Stevenson and James Giordano in
formulating and organizing the ideas in it.
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PETER A.
MOSKOVITZ, MD
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