Abstract

The starting point of my dissertation is a traditional goal of medicine, the relief of suffering. The central question that I dealt with is the appropriate clinical response to a patient's suffering. An underlying assumption in the answer that I provide is that a physician's clinical response must be guided primarily by the principles of beneficence and respect for patient autonomy. I argue that both principles require the physician to respond in a proportionate manner with medically appropriate care, which has the backing of relevant scientific and clinical data, and must be provided in a manner deemed acceptable by the patient. ;Central to the process of providing medically appropriate care aimed at the relief of suffering is an understanding of suffering itself. To develop that understanding, I studied the works of Freud, Bakan, Frankl, and Cassell. I concluded that suffering is primarily an existential problem associated with the whole person, in contrast to physical pain, which is primarily a neurophysiological problem associated with the body. I define suffering itself as a state of emotion, consisting in an unrelenting tension between hope and despair, caused by a serious and unacceptable disruption in important personal matters. As Frankl put it, when one suffers, one perceives a gap between the way important personal matters are at the moment as compared to how such matters ought to be