The Nature of Suffering and the Goals of Medicine

Cassell, Eric J.

doi:10.1093/acprof:oso/9780195156164.001.0001

Cited by 453 publications

(175 citation statements)

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“…Science explains disease, while physicians treat patients. Cassell (1991) writes: 'the scientific basis of medicine does not recognise nor provide a methodology to deal with such individual variations on the level of patient-doctor interactions ' (p. 20). Doctors' own accounts of illness including their experiences as patients concur with this differentiation: their narratives punctuate the uniqueness of experience that medicine, in general terms, ignores in its classificatory project.…”

Section: Resultsmentioning

confidence: 99%

Medically unexplained symptoms and the disease label

Jutel

2010

Soc Theory Health

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Medically unexplained symptoms are a source of frustration for clinician and patient alike. They simultaneously test the credibility of the doctor and the patient; the former, for his or her inability to label the patient's complaint, and the latter, for the ignominy of being perceived to have a factitious symptom. This review explores the discursive construction of such symptoms in the medical literature in order to appreciate the context in which medicine understands and manages non-diagnosed complaints. It uses medically unexplained symptoms as a heuristic for understanding the role of classification in constituting medicine as a social authority. In the absence of diagnostic category, medically unexplained symptoms are recast as a discrete category of their own. However, this category implies the infallibility of the physician and the relevance of the medical model in all circumstances. It transfers responsibility for the disorder to the patient in a way that may hinder resolution, and it ignores socio-historical practices that influence when and why patients consult a physician.

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Section: Resultsmentioning

confidence: 99%

Medically unexplained symptoms and the disease label

Jutel

2010

Soc Theory Health

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“…Definitions of suffering and clear articulation of the aspects of suffering targeted by individual measures are essential. The multidimensional and individual nature of suffering should be taken into account when considering its assessment, as should its variance dependent on culture and context (Cassell, 1982;Wein, 2011). Many authors have noted the importance of context, including cultural, historical, and social factors that impact on the meaning an individual gives to an experience (Barton-Burke et al, 2008;Chio et al, 2008;Williams, 2004).…”

Section: Discussionmentioning

confidence: 99%

Assessment of spiritual suffering in the cancer context: A systematic literature review

et al. 2014

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Objective: An important goal of cancer medicine is relief of patients' suffering. In view of the clinical challenges of identifying suffering patients, we sought to identify valid instruments for assessing the spiritual suffering of people diagnosed with cancer.Method: A systematic review of the literature was conducted in the Medline, Embase, the Cochrane Library, and PsycINFO databases seeking assessment instruments that measure either suffering or one of its synonyms or symptoms. The psychometric properties of the identified measures were compared.Results: A total of 90 articles were identified that supplied information about 58 measures. The constructs examined were: suffering, hopelessness/demoralization, hope, meaning, spiritual well-being, quality of life where a spiritual/existential dimension was included, distress in the palliative care setting and pain, distress or struggle of a spiritual nature. The Pictorial Representation of Illness and Self Measure (PRISM) (patient completed) was the most promising measure identified for measuring the burden of suffering caused by illness due to its ease of use and the inclusion of a subjective component.Significance of Results: Although the appropriateness of any measure for the assessment of spiritual suffering in cancer patients will depend on the context in which it is intended to be utilized, the PRISM is promising for measuring the burden of suffering due to illness.

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“…The features of the medical encounter and the illness experience emphasised by medical phenomenologists and proponents of a more ''humane'' medicine suggest the need to reconsider what constitutes the goals of medicine (Cassell, 1982;Toombs, 1995; and flip EBM's hierarchy of evidence on its head. The quantitative measures and generalisations that come out of controlled trials and biostatistical analysis are not conducive to the questions of meaning that medical phenomenology wants to address and make central to medicine.…”

Section: Phenomenological Implications For Evidence-based Medicinementioning

confidence: 99%

On evidence and evidence-based medicine: Lessons from the philosophy of science

Goldenberg

2006

Social Science & Medicine

323

248

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The evidence-based medicine (EBM) movement is touted as a new paradigm in medical education and practice, a description that carries with it an enthusiasm for science that has not been seen since logical positivism flourished (circa 1920-1950). At the same time, the term ''evidence-based medicine'' has a ring of obviousness to it, as few physicians, one suspects, would claim that they do not attempt to base their clinical decision-making on available evidence. However, the apparent obviousness of EBM can and should be challenged on the grounds of how 'evidence' has been problematised in the philosophy of science. EBM enthusiasm, it follows, ought to be tempered.The post-positivist, feminist, and phenomenological philosophies of science that are examined in this paper contest the seemingly unproblematic nature of evidence that underlies EBM by emphasizing different features of the social nature of science. The appeal to the authority of evidence that characterizes evidence-based practices does not increase objectivity but rather obscures the subjective elements that inescapably enter all forms of human inquiry. The seeming common sense of EBM only occurs because of its assumed removal from the social context of medical practice. In the current age where the institutional power of medicine is suspect, a model that represents biomedicine as politically disinterested or merely scientific should give pause. r

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The Nature of Suffering and the Goals of Medicine

Cited by 453 publications

References 0 publications

Medically unexplained symptoms and the disease label

Medically unexplained symptoms and the disease label

Assessment of spiritual suffering in the cancer context: A systematic literature review

On evidence and evidence-based medicine: Lessons from the philosophy of science

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