The question of suffering and its relation to organic illness has rarely been addressed in the medical literature. This article offers a description of the nature and causes of suffering in patients undergoing medical treatment. A distinction based on clinical observations is made between suffering and physical distress. Suffering is experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity. Suffering can include physical pain but is by no means limited to it. The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians' failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.
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Buiting, H M, Gevers, J K M, Rietjens, J A C, Onwuteaka-Philipsen, B D, van der Maas, P J, van der Heide, A, van Delden, J J M
(2008). Dutch criteria of due care for physician-assisted dying in medical practice: a physician perspective. J. Med. Ethics
34: e12-e12
[Abstract][Full Text]
Lanken, P. N., Terry, P. B., DeLisser, H. M., Fahy, B. F., Hansen-Flaschen, J., Heffner, J. E., Levy, M., Mularski, R. A., Osborne, M. L., Prendergast, T. J., Rocker, G., Sibbald, W. J., Wilfond, B., Yankaskas, J. R., on behalf of the ATS End-of-Life Care Task Force,
(2008). An Official American Thoracic Society Clinical Policy Statement: Palliative Care for Patients with Respiratory Diseases and Critical Illnesses. Am. J. Respir. Crit. Care Med.
177: 912-927
[Full Text]
Adunsky, A., Zvi Aminoff, B., Arad, M., Bercovitch, M.
(2008). Mini-Suffering State Examination: Suffering and Survival of End-of-Life Cancer Patients in a Hospice Setting. AM J HOSP PALLIAT CARE
24: 493-498
[Abstract]
Mitchinson, A. R., Kim, H. M., Rosenberg, J. M., Geisser, M., Kirsh, M., Cikrit, D., Hinshaw, D. B.
(2007). Acute Postoperative Pain Management Using Massage as an Adjuvant Therapy: A Randomized Trial. Arch Surg
142: 1158-1167
[Abstract][Full Text]
Kazanowski, M., Perrin, K., Potter, M., Sheehan, C.
(2007). The Silence of Suffering: Breaking the Sound Barriers. J Holist Nurs
25: 195-203
[Abstract]
Chochinov, H. M.
(2007). Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ
335: 184-187
[Full Text]
O'Mara, A. M.
(2007). "Will I Suffer?". JCO
25: 1645-1646
[Full Text]
Wilson, K. G., Chochinov, H. M., McPherson, C. J., LeMay, K., Allard, P., Chary, S., Gagnon, P. R., Macmillan, K., De Luca, M., O'Shea, F., Kuhl, D., Fainsinger, R. L.
(2007). Suffering With Advanced Cancer. JCO
25: 1691-1697
[Abstract][Full Text]
Sacks, J. L., Nelson, J. P.
(2007). A Theory of Nonphysical Suffering and Trust in Hospice Patients. Qual Health Res
17: 675-689
[Abstract]
Aminoff, B. Z.
(2007). The New Israeli Law "The Dying Patient" and Relief of Suffering Units. AM J HOSP PALLIAT CARE
24: 54-58
[Abstract]
Schulz, R., Hebert, R. S., Dew, M. A., Brown, S. L., Scheier, M. F., Beach, S. R., Czaja, S. J., Martire, L. M., Coon, D., Langa, K. M., Gitlin, L. N., Stevens, A. B., Nichols, L.
(2007). Patient Suffering and Caregiver Compassion: New Opportunities for Research, Practice, and Policy. Gerontologist
47: 4-13
[Abstract][Full Text]
Forbes-Thompson, S., Gessert, C. E.
(2006). Nursing Homes and Suffering: Part of the Problem or Part of the Solution?. Journal of Applied Gerontology
25: 234-251
[Abstract]
Moeschler, J. B., Shevell, M., and the Committee on Genetics,
(2006). Clinical genetic evaluation of the child with mental retardation or developmental delays.. Pediatrics
117: 2304-2316
[Abstract][Full Text]
Chochinov, H. M.
(2006). Dying, Dignity, and New Horizons in Palliative End-of-Life Care.. CA Cancer J Clin
56: 84-103
[Abstract][Full Text]
Pronk, K.
(2005). Role of the doctor in relieving spiritual distress at the end of life. AM J HOSP PALLIAT CARE
22: 419-425
[Abstract]
Aminoff, B. Z., Adunsky, A.
(2005). Dying dementia patients: Too much suffering, too little palliation. AM J HOSP PALLIAT CARE
22: 344-348
[Abstract]
Chochinov, H. M., Hack, T., Hassard, T., Kristjanson, L. J., McClement, S., Harlos, M.
(2005). Dignity Therapy: A Novel Psychotherapeutic Intervention for Patients Near the End of Life. JCO
23: 5520-5525
[Abstract][Full Text]
Albert, S. M., Rabkin, J. G., Del Bene, M. L., Tider, T., O'Sullivan, I., Rowland, L. P., Mitsumoto, H.
(2005). Wish to die in end-stage ALS. Neurology
65: 68-74
[Abstract][Full Text]
Blinderman, C. D, Cherny, N. I
(2005). Existential issues do not necessarily result in existential suffering: lessons from cancer patients in Israel. Palliat Med
19: 371-380
[Abstract]
Hutchinson, T. A
(2005). Transitions in the lives of patients with End Stage Renal Disease: a cause of suffering and an opportunity for healing. Palliat Med
19: 270-277
[Abstract]
Mak, Y. Y. W., Elwyn, G.
(2005). Voices of the terminally ill: uncovering the meaning of desire for euthanasia. Palliat Med
19: 343-350
[Abstract]
Hayeems, R Z, Geller, G, Finkelstein, D, Faden, R R
(2005). How patients experience progressive loss of visual function: a model of adjustment using qualitative methods. Br. J. Ophthalmol.
89: 615-620
[Abstract][Full Text]
Ferrer, R. L., Hambidge, S. J., Maly, R. C.
(2005). The Essential Role of Generalists in Health Care Systems. ANN INTERN MED
142: 691-699
[Abstract][Full Text]
Katz, J D
(2004). Pain does not suffer misprision: an inquiry into the presence and absence that is pain. Med. Humanities
30: 59-62
[Abstract][Full Text]
Bedell, S. E., Graboys, T. B., Bedell, E., Lown, B.
(2004). Words That Harm, Words That Heal. Arch Intern Med
164: 1365-1368
[Full Text]
Aminoff, B. Z., Adunsky, A.
(2004). Dying dementia patients: Too much suffering, too little palliation. AM J ALZHEIMERS DIS OTHER DEMEN
19: 243-247
[Abstract]
Vig, E. K., Pearlman, R. A.
(2004). Good and Bad Dying From the Perspective of Terminally Ill Men. Arch Intern Med
164: 977-981
[Abstract][Full Text]
Bernick, L.
(2004). Caring for older adults: practice guided by Watson's caring-healing model.. Nurs Sci Q
17: 128-134
[Abstract]
Lesho, E. P.
(2003). When the Spirit Hurts: An Approach to the Suffering Patient. Arch Intern Med
163: 2429-2432
[Full Text]
Arman, M., Rehnsfeldt, A.
(2003). The Hidden Suffering Among Breast Cancer Patients: A Qualitative Metasynthesis. Qual Health Res
13: 510-527
[Abstract]
Parisod, E., Murray, R. F., Cousins, M. J.
(2003). Conversion Disorder After Implant of a Spinal Cord Stimulator in a Patient with a Complex Regional Pain Syndrome. Anesth. Analg.
96: 201-206
[Abstract][Full Text]
Jacobson, P. L., Mann, J. D.
(2003). Evolving Role of the Neurologist in the Diagnosis and Treatment of Chronic Noncancer Pain. Mayo Clin. Proc.
78: 80-84
[Abstract]
JONAS, W. B.
(2002). Policy, the Public, and Priorities in Alternative Medicine Research. The ANNALS of the American Academy of Political and Social Science
583: 29-43
[Abstract]
Silvestri, G. A., Sherman, C., Williams, T., Leong, S.-S., Flume, P., Turrisi, A.
(2002). Caring for the Dying Patient With Lung Cancer*. Chest
122: 1028-1036
[Full Text]
Bascom, P. B., Tolle, S. W.
(2002). Responding to Requests for Physician-Assisted Suicide: "These Are Uncharted Waters for Both of Us. . . .". JAMA
288: 91-98
[Abstract][Full Text]
Cowell, D. D., Farrell, C., Campbell, N. A., Canady, B. E.
(2002). Management of Terminal Illness: A Medical School-Hospice Partnership Model to Teach Medical Students About End-of-Life Care. Acad. Psychiatry
26: 76-81
[Abstract][Full Text]
Chochinov, H. M.
(2002). Dignity-Conserving Care--A New Model for Palliative Care: Helping the Patient Feel Valued. JAMA
287: 2253-2260
[Abstract][Full Text]
Charon, R.
(2001). Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA
286: 1897-1902
[Abstract][Full Text]
Kravitz, R. L, Melnikow, J.
(2001). Engaging patients in medical decision making. BMJ
323: 584-585
[Full Text]
Doutrich, D., Wros, P., Izumi, S.
(2001). Relief of Suffering and Regard for Personhood: nurses' ethical concerns in Japan and the USA. Nurs Ethics
8: 449-458
[Abstract]
Committee on Psychosocial Aspects of Child and Fam, , Task Force on Pain in Infants, Children, and Adole,
(2001). The Assessment and Management of Acute Pain in Infants, Children, and Adolescents. Pediatrics
108: 793-797
[Abstract][Full Text]
Block, S. D.
(2001). Psychological Considerations, Growth, and Transcendence at the End of Life: The Art of the Possible. JAMA
285: 2898-2905
[Abstract][Full Text]
Wrede-Seaman, L. D.
(2001). Treatment options to manage pain at the end of life. AM J HOSP PALLIAT CARE
18: 89-101
[Abstract]
Emblen, J., Pesut, B.
(2001). Strengthening Transcendent Meaning: A Model for the Spiritual Nursing Care of Patients Experiencing Suffering. J Holist Nurs
19: 42-56
[Abstract]
Loewy, E. H.
(2001). Terminal Sedation, Self-Starvation, and Orchestrating the End of Life. Arch Intern Med
161: 329-332
[Full Text]
Larson, D. G., Tobin, D. R.
(2000). End-of-Life Conversations: Evolving Practice and Theory. JAMA
284: 1573-1578
[Abstract][Full Text]
Baines, B. K., Norlander, L.
(2000). The relationship of pain and suffering in a hospice population. AM J HOSP PALLIAT CARE
17: 319-326
[Abstract]
Gantt, E. E.
(2000). Levinas, Psychotherapy, and the Ethics of Suffering. Journal of Humanistic Psychology
40: 9-28
[Abstract]
Emanuel, L.
(2000). How living wills can help doctors and patients talk about dying. BMJ
320: 1618-1619
[Full Text]
Kane, J. R., Barber, R. G., Jordan, M., Tichenor, K. T., Camp, K.
(2000). Supportive/palliative care of children suffering from life-threatening and terminal illness. AM J HOSP PALLIAT CARE
17: 165-172
Quill, T. E., Byock, I. R., for the ACP-ASIM End-of-Life Care Consensus Panel,
(2000). Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids. ANN INTERN MED
132: 408-414
[Abstract][Full Text]
Morin, K., Miles, S. H., for the Ethics and Human Rights Committee*,
(2000). The Health Effects of Economic Sanctions and Embargoes: The Role of Health Professionals. ANN INTERN MED
132: 158-161
[Abstract][Full Text]
Rasmussen, B. H., Jansson, L., Norberg, A.
(2000). Striving for becoming at-home in the midst of dying. AM J HOSP PALLIAT CARE
17: 31-43
[Abstract]
Waldron, D., O'Boyle, C. A., Kearney, M., Moriarty, M., Carney, D.
(1999). Quality-of-Life Measurement in Advanced Cancer: Assessing the Individual. JCO
17: 3603-3611
[Abstract][Full Text]
Seely, J. F., Mount, B. M.
(1999). Palliative medicine and modern technology. CMAJ
161: 1120-1121
[Full Text]
Cassell, E. J.
(1999). Diagnosing Suffering: A Perspective. ANN INTERN MED
131: 531-534
[Abstract][Full Text]
Shaughnessy, A. F.
(1999). Alternative Views on Alternative Medicine. ANN INTERN MED
131: 229-229
[Full Text]
Carver, A. C., Vickrey, B. G., Bernat, J. L., Keran, C., Ringel, S. P., Foley, K. M.
(1999). End-of-life care: A survey of US neurologists' attitudes, behavior, and knowledge. Neurology
53: 284-284
[Abstract][Full Text]
Foley, K.
(1999). A 44-Year-Old Woman With Severe Pain at the End of Life. JAMA
281: 1937-1945
[Full Text]
Alpers, A., Lo, B.
(1999). The Supreme Court Addresses Physician-Assisted Suicide: Can Its Rulings Improve Palliative Care?. Arch Fam Med
8: 200-205
[Abstract][Full Text]
Epstein, R. M., Quill, T. E., McWhinney, I. R.
(1999). Somatization Reconsidered: Incorporating the Patient's Experience of Illness. Arch Intern Med
159: 215-222
[Abstract][Full Text]
Coker, E.
(1998). Does Your Care Plan Tell My Story? Documenting Aspects of Personhood in Long-Term Care. J Holist Nurs
16: 435-452
[Abstract]
Byock, I. R, Merriman, M. P
(1998). Measuring quality of life for patients with terminal illness: the Missoula-VITAS(R) quality of life index. Palliat Med
12: 231-244
[Abstract]
KRISTJANSDOTTIR, G.
(1997). The Relationship Between Pains and Various Discomforts in SchoolChildren. Childhood
4: 491-504
[Abstract]
Shapiro, S., Angus, L., Davis, C.
(1997). Identity and Meaning in the Experience of Cancer: Three Narrative Themes. J Health Psychol
2: 539-554
[Abstract]
Foley, K. M.
(1997). Competent Care for the Dying Instead of Physician-Assisted Suicide. NEJM
336: 53-58
[Full Text]
Morrison, R. S., Meier, D. E., Cassel, C. K.
(1996). When Too Much is Too Little. NEJM
335: 1755-1759
[Full Text]
Thomasma, D. C.
(1996). When Physicians Choose to Participate in the Death of Their Patients: Ethics and Physician-Assisted Suicide. J Law Med Ethics
24: 183-197
Maugans, T. A.
(1996). The SPIRITual History. Arch Fam Med
5: 11-16
[Abstract]
Peteet, J. R.
(1994). Treating Patients Who Request Assisted Suicide: A Closer Look at the Physician's Role. Arch Fam Med
3: 723-727
[Abstract]
Rudick, R. A., Miller, D., Clough, J. D., Gragg, L. A., Farmer, R. G.
(1992). Quality of Life in Multiple Sclerosis: Comparison With Inflammatory Bowel Disease and Rheumatoid Arthritis. Arch Neurol
49: 1237-1242
[Abstract]
Gregory, D., Longman, A.
(1992). Mothers' Suffering: Sons who Died of AIDS. Qual Health Res
2: 334-357
[Abstract]
Steeves, R. H., Kahn, D. L., Benoliel, J. Q., Ferrell, B. R.
(1990). Nurses' Interpretation of the Suffering of Their Patients. West J Nurs Res
12: 715-731
Goldworth, A., Stevenson, D. K.
(1989). The Real Challenge of "Baby Doe": Considering the Sanctity and Quality of Life. CLIN PEDIATR
28: 119-122
O'Connor, P.
(1988). The role of spiritual care in hospice: Are we meeting patients' needs?. AM J HOSP PALLIAT CARE
5: 31-37
MacAdam, D., Smith, M.
(1987). An initial assessment of suffering in terminal illness. Palliat Med
1: 37-47
[Abstract]
Byock, I. R.
(1986). Growth: The essence of hospice: From a physician' s point of view. AM J HOSP PALLIAT CARE
3: 16-21
Buchholz, W. M.
(1985). Medical Eschatology: Combined role for caregiver and scientist. AM J HOSP PALLIAT CARE
2: 22-24
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