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Bioethicist asks: Should medicine's ultimate goal be preventing death or enhancing life?

Life or Death


At the Richmond Bioethics Forum's annual meeting, the featured speaker will be Eric Cassell, M.D., a retired internist and well-known speaker and author. His works consider moral problems in medicine, the nature of suffering and care of the dying. Dr. Cassell is Clinical Professor of Public Health at Weill Medical College of Cornell University. He currently serves as a member of the President's National Bioethics Advisory Commission.

1. You have written books and articles about suffering, and your address to the Richmond Bioethics Forum is titled, "Why Do We Fail to Attend to Suffering?" How did you become interested in this topic?

You know, there used to be a myth that [the United States] was a death-denying society. But look at the violence on TV, the living gore. You can't watch TV without seeing guts spread all over. It's sex first, then death. It's really pornographic, this preoccupation with death. But it's not seen [in the context of] human suffering. It's not death-denying per se, it's a denial of suffering. ... Pain and suffering are not the same.

2. How do you distinguish between the two?

Look at it this way: Two people have what appears to be the same kind of pain, but one says he's "feeling pain," the other is "suffering." People suffer because of things, because of the pain. Number one, the meaning of it to the person determines the nature of the suffering, so what the pain means to the person can make it very different from a stitch in the side. Number two, the time period of the pain, what will happen in the future? Will I be able to take it then? Our bodies have noxious stress, but our bodies don't have meanings and futures; afflictions have to do with the whole person. Suffering is a special distress [that happens] when people think that themselves as persons are going to disintegrate or come apart from the pain, the illness. They think. "I won't be me." And so people suffer until the pain goes away or they are able to be made whole again.

3. Your recent book is "Doctoring: The Nature of Primary Care Medicine." What does the doctor need to do for a patient to relieve suffering?

Well, you need to take time to find out who and what the person is. Learn to listen to language cues, for one thing. People say. "I was eating and feeling fine, etc., until this cancer, disease, whatever. You can't eat and you are tired, etc." You see, people switch to third person-pronouns in order to distance themselves. It's not my breast any longer when she's got breast cancer. It becomes "the breast." Doctors have to hear that [attempt to distance] in patients' language and allow the distancing. Like with the woman with the Stage 4 cancer. You say, "We are going to work together through the chemotherapy," not, "I'll help you," but "we." And if the statistics are only 10 percent survival rate, you say, "Why can't we be the ones?" You make things happen in persons, not just in bodies.

4. How well do you think medicine and medical training is doing in treating the whole person and actually relieving suffering?

Well, we've got all this science and technology and its wonderful benefits. But we've got this idea that death is always the ultimate enemy, that the only important thing is not to die. There's a lot more to living than not dying. Take the ICU. It's a temple of care of individual physiological symptoms, not to taking care of the whole person.

5. Where do you stand on end-of-life issues?

Our society is into individualism, no limits on free will. Then how come when we want to die, we can't? We give people choices right up to the end. Why don't we trust people to make decisions about dying? People don't want not to live when they are living, but they may not feel they are living when they have a terminal illness. It's not suicide in the same sense as when there's not a terminal illness. It's not the same thing.

The meeting is open to all interested people at no charge. The annual meeting of the Richmond Bioethics Forum will be held in the Kraus Auditorium of Chippenham Medical Center, 7101 Jahnke Road, on Thursday, Sept. 30, 1999. The business meeting begins at 6:30 p.m. Dr. Cassell's address is at 7 p.m.

For further information, call the RBC voice mail at 287-7450.

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