Bioethics and Intractable Pain

Words are a powerful form of expression. It has been argued that language is both the basis and outward representation of human consciousness. As such, it is a vector to make our inner states, personal meaning, and intention(s) transparent to others.¹ Words can hurt and words can help, and in this way form a foundation of our interpersonal relationships. Often, it is through words that we seek those whose intentions are resonant with our own, and who can accommodate our needs and desires, whether it be for simple conversation, emotional exchange, or an interaction of deeper solidarity. Thus, words are used as a declaration and representation of what we do and who we are.

Words and the Intersecting Worlds of the Clinician and Patient
The person who declares to be a practitioner of pain medicine represents themselves as having the knowledge, skills and commitment to care for those in pain.² As an act of profession, it invites the trust of those persons who are made vulnerable by pain and who are seeking care. This is the domain of the medical relationship. Upon entering this relationship, the patient uses words to describe their pain: its history, effects, and meaning through the weaving of facts into narrative. The pain practitioner, as a steward of knowledge, must assimilate the qualitative description of the patient’s experience with quantitative findings to objectify the subjective phenomenon that is pain.³ This step, the formulation of diagnosis, conjoins the patient to the professional identity of the clinician, since from the diagnosis arises the clinician’s self-reflective question: Can I help this patient?⁴

The Basis and Meanings of a Diagnosis
It is through diagnosis that the patient and clinician are reciprocally brought together toward a definable end: a right and good provision of care.⁴ Thus, diagnosis establishes the basis and possible trajectory of the subsequent clinician-patient relationship.⁵ For both clinician and patient, it is an act of definition, description and determination. For the clinician, the diagnosis defines an explanatory model and provides a descriptive basis for understanding the manifestations of a disorder in a specific patient. It also provides a starting point from which to determine what constitutes a technically right and beneficently good treatment.

Please refer to the Nov/Dec 2005 issue for the complete text. In the event you need to order a back issue, please click here.