Bueno-Gómez Noelia
Department of Philosophy and Research Center Medical Humanities, University of Innsbruck, Innrain 52d, A6020, Innsbruck, Austria.
Philos Ethics Humanit Med. 2017 Sep 29;12(1):7. doi: 10.1186/s13010-017-0049-5.
This article aims to contribute to a better conceptualization of pain and suffering by providing non-essential and non-naturalistic definitions of both phenomena. Contributions of classical evidence-based medicine, the humanistic turn in medicine, as well as the phenomenology and narrative theories of suffering and pain, together with certain conceptions of the person beyond them (the mind-body dichotomy, Cassel's idea of persons as "intact beings") are critically discussed with such purpose.
A philosophical methodology is used, based on the review of existent literature on the topic and the argumentation in favor of what are found as better definitions of suffering and pain.
Pain can be described in neurological terms but cognitive awareness, interpretation, behavioral dispositions, as well as cultural and educational factors have a decisive influence on pain perception. Suffering is proposed to be defined as an unpleasant or even anguishing experience, severely affecting a person at a psychophysical and existential level. Pain and suffering are considered unpleasant. However, the provided definitions neither include the idea that pain and suffering can attack and even destroy the self nor the idea that they can constructively expand the self; both perspectives can b e equally useful for managing pain and suffering, but they are not defining features of the same. Including the existential dimension in the definition of suffering highlights the relevance of suffering in life and its effect on one's own attachment to the world (including personal management, or the cultural and social influences which shape it). An understanding of pain and suffering life experiences is proposed, meaning that they are considered aspects of a person's life, and the self is the ever-changing sum of these (and other) experiences.
The provided definitions will be useful to the identification of pain and suffering, to the discussion of how to relieve them, and to a better understanding of how they are expressed and experienced. They lay the groundwork for further research in all these areas, with the twofold aim of a) avoiding epistemological mistakes and moral injustices, and b) highlighting the limitations of medicine in the treatment of suffering and pain.
本文旨在通过提供对疼痛和苦难这两种现象的非本质且非自然主义的定义，来促进对它们更好的概念化。为此，对经典循证医学的贡献、医学中的人文转向，以及苦难和疼痛的现象学与叙事理论，连同它们之外的某些关于人的概念（身心二分法、卡塞尔将人视为“完整存在”的观点）进行了批判性讨论。
采用一种哲学方法，基于对该主题现有文献的综述以及支持所发现的关于苦难和疼痛更好定义的论证。
疼痛可以从神经学角度进行描述，但认知意识、解释、行为倾向以及文化和教育因素对疼痛感知具有决定性影响。苦难被定义为一种不愉快甚至痛苦的体验，在心理 - 生理和生存层面严重影响一个人。疼痛和苦难被认为是不愉快的。然而，所提供的定义既不包括疼痛和苦难会攻击甚至摧毁自我的观点，也不包括它们能建设性地扩展自我的观点；这两种观点对于管理疼痛和苦难都可能同样有用，但它们并非同一事物的定义特征。在苦难的定义中纳入生存维度，突出了苦难在生活中的相关性及其对个人与世界的依恋（包括个人管理，或塑造它的文化和社会影响）的影响。提出了对疼痛和苦难生活经历的一种理解，即它们被视为一个人生活的方面，而自我是这些（以及其他）经历不断变化的总和。
所提供的定义将有助于识别疼痛和苦难，有助于讨论如何缓解它们，并有助于更好地理解它们是如何表达和体验的。它们为所有这些领域的进一步研究奠定了基础，具有双重目标：a）避免认识论错误和道德不公，b）突出医学在治疗苦难和疼痛方面的局限性。
