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Clinical Bioethics

“Every sentient being knows what is meant by pain, but the true significance of pain eludes the most sapient. For philosophers, pain is a problem of metaphysics… for clinicians a symptom to be understood and an ill to be relieved.” —C.F. Illingworth1

GiordanoThe Problem of Pain
I have recently addressed the intellectual virtues and domains of knowledge that are meaningful, if not essential, to the practice of pain medicine.2 For, if this practice is to be focally dedicated to right and good care of persons in pain, then it is imperative to 1) pursue knowledge of the mechanisms and effects of the disorder that has rendered them to be patients, and 2) recognize and acknowledge that the uniqueness of pain as sensation and experience is inextricably bound to these neural event(s). In this essay I argue that these facts establish the progressive epistemological basis for the philosophical premises that inform and sustain both the direction for ongoing research, and the anthropologic and ethical dimensions of pain medicine.

Some forty seven years ago, British scientist and novelist C.P. Snow described what he believed was a deeply entrenched, widening rift between the “two cultures” of modern society – the sciences and the humanities.3 Yet, one of the most significant accomplishments of contemporary neuroscience has been to make ardent strides toward what biologist E.O. Wilson calls consilience – “…a jumping together of knowledge by the linking of facts and fact-based theory across disciplines to create a common groundwork for explanation.”4 Wilson speaks to the unity of purpose for both philosophy and science, and addresses how such intellectual fusion (albeit from divergent perspectives) has reconciled particular dialectics and expanded the perspectives both within and between fields. I agree with Wilson, and believe that the relation of science and the humanities is not new, novel, nor insanable. Philosophical questions have classically provided the impetus and initiative direction for much of scientific study, and reciprocally, scientific discovery has afforded information that has not simply answered, but frequently furthered philosophical inquiry. Recent advances in the ever-growing disciplines that are nested within the rubric of neuroscience (and/or perhaps neurophilosophy) reflect an intellectual inertia of an international “think tank” atmosphere that has allowed a broader, more comprehensive, and philosophical approach to studying the brain, mind and pain.5 So it is that we confront the question of pain with persistent urgency; as science and philosophy become ever more consilient as we continue to ponder the question of “what is pain?”

The apparent simplicity of this question veils the fact that there is not a singular answer, for pain is inveterately complicated. It is a physiological event, subtended by distinct systems in the peripheral and central nervous systems in response to insult, injury or as an independent, distinct pathology. At the same time, it is a psychological event, evoked by the co-activation of neural systems that subserve cognition, emotion and behaviors. This neuropsychological foundation instills pain as an event of phenomenal conscious processes, reflecting alteration of the perceived internal dimensionality of the lived-body that is construed as the ‘self.’ Attempts at explaining the neural event of pain cannot ignore the experiential dimension(s), and any description of the phenomenal embodiment of pain must account for the role of brain-mind in consciousness.

Please refer to the Sept 2006 issue for the complete text. In the event you need to order a back issue, please click here.

Last updated on: February 22, 2011
First published on: September 1, 2006