Background Individuals living with multimorbidity and/or mental health issues, low education, socioeconomic status, and polypharmacy are often called complex patients. The complexity of their health and social care needs can make them prone to disease burden and suffering. Therefore, they frequently access health care services to seek guidance for managing their illness and suffering. Aims The aim of this research was to describe the approaches used by nurses to alleviate the suffering of individuals with multimorbidity and complex (...) needs in acute care settings. Research Design A qualitative descriptive approach. Participants and Research Context Semi-structured interviews were conducted with 19 nurses working in general, medical-surgical, specialized, and intensive care settings across five hospitals in Pakistan. Reflexive thematic analysis was used for analysis. Ethical Considerations Ethical approval was obtained from the Ethical Committee of Al-Nafees Medical College Islamabad, Pakistan. Findings Four themes were generated: Deeper Exploration of Patients’ Health-Illness Situation and Complexity, Prioritizing Patient Psychosocial and Emotional Needs, Instilling Hope and Encouragement in Patients, and Creating a Comforting Environment to Foster Sharing of felt needs. Discussion Nurses emphasized the need of deeper inquiry into patients illness situation and complexity to discern the impact of determinants on their well-being and develop care plans that are tailored to address psychosocial, emotional, and physical suffering of this patient population. Conclusions Alleviation of patient suffering is integral to compassionate nursing care. Nurses use a multifaceted approach entailing sensitive understanding, recognizing sociocultural and structural determinants impact on patient situation, and individual and interdisciplinary altruistic actions to alleviate patient suffering. (shrink)

The word “epidemic” seems inadequate to describe the spread of the HIV virus in sub-Saharan Africa. The latest estimates suggest that 28.5 million people in this region are infected, including 5 million in South Africa alone. The HIV and AIDS pandemic, with infection rates of over 20 percent in seven African countries, rivals the worst of history's disease outbreaks, including the bubonic plague of medieval times. The devastating effects of the disease on the continent are compounded by extreme poverty in (...) the region and the lack of medical infrastructure essential for delivering the full range of available treatments for HIV infection, AIDS, and the opportunistic infections associated with the disease. Of the 40 million people infected with HIV worldwide, only 730,000 receive combination antiretroviral therapies. In the entire African continent, only 30,000 infected people currently receive such forms of treatment. (shrink)

BackgroundHumanitarian crises and emergencies, events often marked by high mortality, have until recently excluded palliative care—a specialty focusing on supporting people with serious or terminal illness or those nearing death. In the COVID-19 pandemic, palliative care has received unprecedented levels of societal attention. Unfortunately, this has not been enough to prevent patients dying alone, relatives not being able to say goodbye and palliative care being used instead of intensive care due to resource limitations. Yet global guidance was available. In 2018, (...) the WHO released a guide on‘Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises’—the first guidance on the topic by an international body.AimsThis paper argues that while a landmark document, the WHO guide took a narrowly clinical bioethics perspective and missed crucial moral dilemmas. We argue for adding a population-level bioethics lens, which draws forth complex moral dilemmas arising from the fact that groups having differential innate and acquired resources in the context of social and historical determinants of health. We discuss dilemmas concerning: limitations of material and human resources; patient prioritisation; euthanasia; and legacy inequalities, discrimination and power imbalances.ImplicationsIn parts of the world where opportunity for preparation still exists, and as countries emerge from COVID-19, planners must consider care for the dying. Immediate steps to support better resolutions to ethical dilemmas of the provision of palliative care in humanitarian and emergency contexts will require honest debate; concerted research effort; and international, national and local ethical guidance. (shrink)

Fully embracing one's embodied suffering, rather than denying it or mentally explaining it away, can open an individual to a broader sense of interbeing, to the ability to endure, survive, and move through pain and toward a deeper sense of compassion, peace, joy, and liberation. The self benefits from exploring interbeing using an environmental metaphor to consider the human body: the body as terroir. Terroir is analogous to the specific microclimate and natural environment in which quality wine is (...) produced. Appreciation of oneself as a unique mobile terroir can reveal estranged aspects of the host/guest relationship of interbeing within the individual body/self. Perhaps this is what those who practice interbeing in the real world have come to understand. (shrink)

When people suffer they always suffer as a whole human being. The emotional, cognitive and spiritual suffering of human beings cannot be completely separated from all other kinds of suffering, such as from harmful natural, ecological, political, economic and social conditions. In reality they interact with each other and influence each other. Human beings do not only suffer from somatic illnesses, physical pain, and the lack of decent opportunities to satisfy their basic vital, social and emotional needs. They (...) also suffer when they are not able to experience and grasp any meaning of life even if such suffering is not quite as obvious as most forms of physical, social and emotional suffering. Suffering from the lack for the sense of the meaning of life is a special form of emotional, cognitive, and spiritual suffering. Although all human beings share the same basic human need for some meaning of life, the fulfilment of this need is highly individual and personal. Although all forms of human suffering can be a challenge to the meaning of life, the personal conditions of suffering usually are a stronger challenge for the meaning of life. Among the personal conditions of human suffering, the Grenzsituationen cannot be cancelled or raised at all, but only accepted and coped with as existential aspects of the conditio humana. According to Karl Jaspers these are: death, suffering, struggling, guilt, and failing. The challenge for human beings to cope with these Grenzsituationen is a way to move from the mere Being-there to true human Existence. (shrink)

Résumé Cet article applique l’approche de l’économie existentielle aux enjeux de la distribution collective des soins de santé et de la place de la responsabilité personnelle au sein des politiques de santé. Après avoir esquissé une perspective existentielle sur la vie économique, selon laquelle la rationalité économique est sous-tendue par la quête fondamentale des agents d’une immortalité ancrée dans un profond déni de la mort, nous proposons une analyse critique de la logique du capitalisme contemporain puis appliquons ces idées à (...) la question de la responsabilité individuelle dans les systèmes contemporains de soins de santé. Dans le contexte d’une inégalité croissante engendrée par un système économique gouverné par une anxiété existentielle omniprésente, l’idée d’une responsabilité individuelle à travers des incitations financières s’avère extrêmement injuste. En effet, les mêmes peurs existentielles fondamentales qui nous rendent tous soit compulsifs et imprudents, soit hypocondriaques et obsessionnellement prudents, se traduisent par des situations économiques fortement différentes, en fonction de notre résilience pro-systémique personnelle à la peur. Nous pouvons donc tous partager la même condition humaine, et porter en nous la même terreur plus ou moins consciente de la fragilité, de la souffrance et de la mort, mais au sein du système économique cette condition partagée peut s’accompagner de situations socioéconomiques immensément différentes, car tout dépend de la manière dont les répercussions à travers le système de toutes les peurs individuelles se distribuent entre agents. L’idéologie ambiante des incitations et de la responsabilisation du patient revient à stigmatiser une catégorie spécifique de la population pour les effets trop visibles de son anxiété existentielle, tout en valorisant par les mécanismes marchands les anxiétés d’autres catégories, tout aussi impliquées dans le système de santé. Nous aboutissons à la proposition de repenser la notion de responsabilité à la lumière de Foucault et Illich, en insistant sur les idées clé d’autonomie et de lucidité existentielle. (shrink)

The focus falls within the boundaries of what happens to persons and to a person's sense of identity when confronted by pain, suffering, and death. ...

Individual, family, economic, and other forms of people suffering impact organizations. Suffering in the workplace is probably a more common occurrence than expected in everyday life, and opposite to health and employee wellbeing. According to the World Health Organization, 300 million people worldwide struggle with depression and close to 800.000 people die due to suicide every year. The European Survey on Working Conditions in the European Union gathers the most varied aspects of working conditions, such as the (...) duration of the working day, relationships between collaborators in organizations, or healthy work habits. Among the results of that survey it is noteworthy that almost half of the close to twenty-two thousand workers surveyed in the 27 member countries stated that they felt uneasiness due to the conditions of their work. (shrink)

This article argues that Buddhist social thought offers valuable insight into debates about cosmopolitan solidarity by raising cosmopolitanism's need to explore more deeply the relationship between the nature of self and the politics of solidarity. It suggests that a radical ‘socio-existential’ account of the individual, which rejects a conception of the self as autonomous and separate from others, mitigates categories of exclusion and offers a robust account of the possibility of solidarity with strangers. Buddhist thought theorises a movement from (...) suffering to solidarity that does not recognise borders or boundaries as containing inherent ethical value. (shrink)

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood (...) as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ecological Suffering:From a Buddhist PerspectiveSulak Sivaraksa“There will be great suffering caused by our human-created climate change, but we may need to go through this process in order to see the ‘light.’”—Nigel Crawhall (IUCN, CEESP representative, South Africa)Ecological suffering is the result of centuries of abuse of our Earth and environment. It is the effects of numerous overlapping developments that are unsustainable for the most part. It (...) results from violent actions, whether in the shape of colonialism, industrial development, wars, economic growth, the arms race, or capitalist competition between states. More importantly, it is a flaw inherent in the global capitalist system—which is nevertheless seen as the best system to organize human life—and will bring down both capitalism and human survival if we act as if we don’t know about it. I explicitly name capitalism because without doing so any critique will be simply abstract, moralistic, and toothless—such as blaming greed in general or on particular greedy individuals, on human nature, on civilization, and so on. No. Ecological suffering is the result of systemic violence rooted in the global political economy. Although our world cherishes diversity and choice, it is increasingly intolerant of any form of living that resists free market fundamentalism. Ecological suffering is happening on a daily level even if we feel that nothing is happening. Ecological suffering sustains the normalcy of our everyday life as we drive to work, eat our lunch, talk on our mobile phones, connect to the Internet, and so on. It is woven into our daily existence. As such, we don’t want our daily life to be disturbed and often act as if we don’t know about ecological suffering. But it is also experienced unevenly: the poor majority more so than the rich minority, who for now could still buy their way out of the problem; developing societies more than developed ones; and so on.One thing is certain: Our ecosystem is crashing. What should be a circle of life, of interconnected life forms, has already started to work as individual parts going in different directions, leading to malfunctions and negative consequences in many parts [End Page 147] of the system. At the Inter-Religious Dialogue on Climate Change and Biodiversity Conservation in September 2012, a conclusion that was arrived at the conference was a simple but profound one: It is all connected; we are all connected. As I mentioned in my latest book, Wisdom of Sustainability,1 our world and nature works in the same way as the wheel of Dhamma. The wheel of Dhamma can be used to countenance the wheels of state and systemic violence. This is why tackling the environmental problem needs a religious or spiritual dimension.Below, I will reflect on the problems and challenges we face in coping with the impending ecological catastrophe. I link the postponement of the crisis and sustainability with the cultivation of spirituality in ourselves—that is, to search for what has been uprooted and what we need to reclaim or retrieve. Bringing in Buddhist ethics, I will tease out how an interfaith approach to problem solving can benefit our environment by pointing to some concrete suggestions.The starting points of this talk are drawn from The Wisdom of Sustainability and the conference overview of the Inter-Religious Dialogue on Climate Change and Biodiversity Conservation, and I will alternate between these two points, which also structure my talk. The dialogue was held in Sri Lanka in September 2012, at the Islander Center. It was organized by the International Network of Engaged Buddhists (INEB), the Sewalanka Foundation, International Union for the Conservation of Nature (IUCN) Sri Lanka National Office, and Commission on Environmental Economic and Social Policy (CEESP). At this conference faith leaders, environmental and climate scientists, conservationists, and social activists from all over the world gathered to collaboratively explore the scientific foundations of climate change and biodiversity loss; its social, political, and economic drivers; the impacts of climate change on human societies and the environment; and the underlying human behaviors that contribute to climate change.2The conference used three levels of engagement to frame the creation of a roadmap for action... (shrink)

This book exploits the power of phenomenological methods to access and describe lived moral experiences of pain and suffering for patients, their families and the wider community. Creating new fields of communication for patients, their family members and health professionals in shared decision making processes, this book builds on knowledge about suffering to help and guide correct action in preventing and relieving chronic pain and improving systems of care. It offers a new phenomenology for understanding moral experience in (...) serious illness and suffering, and its implication for policy, practice and research. A series of applied chapters, looking at individual experiences of suffering and care experiences, present some areas of ethical inquiry, including: pain and suffering maternal care ethics evaluation and moral deliberation about treatment options decision-making and moral agency end-of-life experiences of care. Exploring how moral phenomenology could provide fruitful alternatives to traditional frameworks in bioethics, this is an important addition to the literature. It will be of interest to scholars and students of bioethics and phenomenological methods in the health and human services. (shrink)

This article explores the defense Indian Buddhist texts make in support of their conceptions of lives that are good for an individual. This defense occurs, largely, through their analysis of ordinary experience as being saturated by subtle forms of suffering . I begin by explicating the most influential of the Buddhist taxonomies of suffering: the threefold division into explicit suffering , the suffering of change , and conditioned suffering . Next, I sketch the three (...) theories of welfare that have been most influential in contemporary ethical theory. I then argue that Buddhist texts underdetermine which of these theories would have been accepted by ancient Indian Buddhists. Nevertheless, Buddhist ideas about suffering narrow the shape any acceptable theory of welfare may take. In my conclusion, I argue that this narrowing process itself is enough to reconstruct a philosophical defense of the forms of life endorsed in Buddhist texts. (shrink)

Suffering Art Gladly is concerned with the ostensibly paradoxical phenomenon of negative emotions involved in the experience of art: how can we explain the pleasure felt or satisfaction taken in such experience when it is the vehicle of negative emotions, that is, ones that seem to be unpleasant or undesirable, and that one normally tries to avoid experiencing? The question is as old as philosophical reflection on the arts, beginning with Plato and Aristotle, and subsequently addressed by Hume, Burke, (...) Diderot, Kant, and Schopenhauer, among others. Moreover, it is still an important and unresolved question in contemporary philosophy of art, where the discussion has been notably enlivened by recent research on the nature of imagination, cognition, and the emotions. Suffering Art Gladly comprises essays of two kinds, though the division between them is not airtight. The first kind are essays with a primarily historical focus, examining the problem of negative emotion from art as treated by important figures in the history of aesthetic thought, including Aristotle, Hume, Diderot, Kant, and Schopenhauer. The second kind are essays with a primarily contemporary focus, in which the methods and tools of contemporary analytic philosophy are much in evidence. In addition to the thirteen essays forming the heart of the book there is a general introduction by the editor, motivating the basic problem with which the essays are variously concerned and identifying the presuppositions or assumptions that are involved in different solutions to the problem. The individual essays are wide-ranging, dealing with a variety of artforms, negative emotions, and specific works of art, and the contributors, all recognized scholars in the field of aesthetics, are a mixture of junior and senior figures representing seven nationalities. (shrink)

In his theory of social freedom, Axel Honneth argues that freedom can only be realized in and through social cooperation. Accordingly, a theory of freedom must therefore start from an analysis of socially instituted forms of cooperation. This approach not only allows for a reconstruction of normative ideals within modern institutions but also aims at revealing obstacles to their full realization. However, in contrast to his earlier theory of recognition, Honneth now assumes that problematic social developments do not necessarily result (...) in individual suffering. Against this backdrop, the article argues that Honneth’s theory of social freedom needs to account for at least mild forms of social suffering. To achieve this, the article explores a line of argumentation that Honneth's recent approach has left underdeveloped. It will be argued that individuals must be able to interpret their needs and interests without constraints to determine if they can be met through social cooperation. The article develops two possibilities, hinted at in Honneth's theory, to illuminate such practices of self-interpretation: Parsons’ theory of value internalization and Honneth's earlier theory of recognition. Both argue that the ability to interpret one’s needs and interests rests on a psychological foundation laid during early primary socialization. Social misdevelopments and pathologies that distort the understanding and articulation of those needs thus must lead to frustration and, consequently, social suffering. However, since both internalization and recognition theory have clear deficits in the context of a theory of social freedom, the article concludes by calling for further conceptual work on social freedom and suffering. (shrink)

The concept of suffering is discussed among those who are cognitively aware and verbally capable to express their suffering. Due to immaturity, preterm infants’ abilities to express suffering are limited. Relieving suffering is an ethical and juridical demand of good nursing care. The purpose of this study is to describe nurses’ perceptions of the suffering of preterm infants. A descriptive qualitative approach was selected. Data were collected from essays written by nurses (n = 19) working (...) in the neonatal intensive care unit. Inductive content analysis guided by the research question was performed. The nurses described individually determined suffering of the preterm infants according to four categories: suffering ruled by maturation, existence of suffering, individual threshold of suffering and interpreting the cues of suffering. Suffering of preterm infants is manifested by population-specific features, emphasising the need to develop sensitive interventions for relieving their suffering. (shrink)

I present and explore a new version of the Person-Affecting View, according to which reasons to do an act depend wholly on what would be said for or against this act from the points of view of particular individuals. According to my view, (i) there is a morally requiring reason not to bring about lives insofar as they contain suffering (negative welfare), (ii) there is no morally requiring reason to bring about lives insofar as they contain happiness (positive welfare), (...) but (iii) there is a permitting reason to bring about lives insofar as they contain happiness. I show how my view solves the non-identity problem, while retaining the procreation asymmetry and avoiding implausible forms of antinatalism. We can be morally required to ensure that the quality of life of future people is higher rather than lower when this involves bringing about (worth living) lives that would contain less suffering rather than bringing about different (worth living) lives that would contain more suffering. (shrink)

Suffering from Vulnerability. On the Relation Between Law, Contingency and Solidarity The COVID-19 crisis has produced or amplified disruptive processes in societies. This article wants to argue for the fact that we understand the meaning of the COVID-19 crisis only if we relate it to the fundamental vulnerability of modern life and the awareness of vulnerability of whole societies. Vulnerability in modernity are expressions of a reality of freedom that is to some extent considered contingent and therefore unsecured. It (...) is true that law is understood today as the protective power of freedom. The thesis of the article, however, boils down to the fact that the COVID-19 crisis has resulted in a new way of thinking about the protection of freedom. This also means that the principle of solidarity must be assigned a new social role. Individual and societal vulnerability refer thereafter to an interconnectedness, dependency, and a future perspective of freedom margins that, in addition to the moral one, can also indicate a need for legal protection. In this respect, law has not only a function of delimitation, but also one of inclusion. (shrink)

Name der Zeitschrift: Zeitschrift für kritische Sozialtheorie und Philosophie Jahrgang: 3 Heft: 2 Seiten: 379-417.

In lieu of an abstract, here is a brief excerpt of the content:14 Feminist Studies 46, no. 1. © 2020 by Feminist Studies, Inc. Melissa Oliver-Powell Beyond the Spectacle of Suffering: Agnès Varda’s L’Unechante,l’autrepas and Rewriting the Subject of Abortion in France In the spring of 1971, three years after the revolutionary fervor of May 1968 in France, 343 women put their names to a courageous manifesto announcing that they were criminals of a particularly gendered nature. The authors of (...) Manifeste des 343 (Manifesto of the 343) comprised a large group of culturally eminent French women and activists declaring that they had all illegally undergone abortions, which at this point, despite growing decriminalization throughout much of Western Europe, were still outlawed within their republic. Though many of the revolutionary fires had now eased to embers, French feminists demonstrated that reproductive rights were still a vital and unresolved topic of social justice. Including names as weighty as Simone de Beauvoir, Jeanne Moreau, and Catherine Deneuve, the manifesto brought together exceptional women from the fields of academia, law, theater, film and literature, alongside grassroots activists. Their action was a bold challenge to the French authorities, daring them to arrest some of the country’s brightest thinkers and cultural innovators under a law the signatories felt was deeply unjust, sexist, and antithetical to the values of individual liberty and citizenship. It was a case of those with the broadest shoulders weaponizing their privilege to present a robust front line in the wider struggle for women’s rights. One of the signatories was filmmaker Agnès Varda. Her name, like those of several others on the list, demonstrates the symbiosis between Melissa Oliver-Powell 15 cultural production and gender politics that has often characterized French feminist thought. From the multidisciplinary writings of Beauvoir, to the novels of the écriture féminine movement, to the lyrical academic prose of Hélène Cixous, Luce Irigaray, Julia Kristeva, and others, French and Francophone feminist writers have tended to connect art and politics with a great deal of fluidity. As a committed activist and a filmmaker, Agnès Varda falls very much within this tradition, often adopting and developing feminist practices within her cinema. This article examines how Varda’s 1977 film, L’Une chante, l’autre pas (One Sings, The Other Doesn’t) interacts with and participates in the feminist political project of reproductive rights as well as the ongoing intellectual and moral debates over abortion taking place in France throughout the late 1960s and 1970s. I look particularly at the adversarial construction of abortion narratives within these debates and the location of victimhood therein. Within mainstream cultural representations in and beyond France, abortion is typically constructed as either a traumatic or a transgressive moment. The same is often true on either side of political and social debates on abortion, which have tended either to characterize the women who get abortions as irresponsible and amoral or as sympathetic victims in need of protection. Though the transgressive element persists, it is the interaction with representations of trauma that interests me here. In approaching discussions of gendered injustice, it is common for feminist writers and activists to leverage pathos as a rhetorical strategy. While suffering can be a highly effective and galvanizing expression of oppression, such discourses also run the risk of producing excessive depictions of victimhood, which can displace the capacity for action from the subject of hardship onto the privileged oppressor. This risk is particularly at stake within the cultural form of film, as its visuality and identificatory mechanics have the potential to spectacularize the female victim and make her relatable only through suffering. This was often the case in earlier French films that featured abortion such as Les Mauvaises rencontres (1955), Des gens sans importance (1956), Journal d’une femme en blanc (1965), and Une femme en blanc se révolte (1966), all of which made their subjects sympathetic by entwining them in long narratives of victimization ending in death or disgrace. This article looks at how Varda’s L’Une chante, l’autre pas disengages from the spectacle of suffering that so often characterizes representations of women’s experiences 16 Melissa Oliver-Powell and rejects the idea that abortion narratives must... (shrink)

In a recent article, Tyler Tate argues that the suffering of children — especially children with severe cognitive impairments — should be regarded as the antithesis of flourishing, where flourishing is relative to one’s individual characteristics and essentially involves receiving care from others. Although initially persuasive, Tate’s theory is ambiguous in several ways, leading to significant conceptual problems. By identifying flourishing with receiving care, Tate raises questions about the importance of care that he does not address, giving rise (...) to a bootstrapping problem. By making flourishing relative to an individual’s circumstances, Tate is forced to confront questions about exactly how relative it can be, suggesting the possibility that, on his view, to flourish is simply to be however one is. In an attempt to surmount these problems, I offer a revision and restatement of Tate’s view that defines the relationship between individualized flourishing and the more conventional, species-relative concept, and describe more clearly the role that care should play with respect to flourishing — one that is instrumental and not merely constitutive. Even this restated view, however, fails to answer difficult questions about how one should respond to the medical needs of some children, highlighting the fact that a conceptual analysis of suffering may do little, in the end, to untangle ethical dilemmas in the care of severely ill children. (shrink)

This article presents a theodicy based on a revision of the popular concept of God’s benevolence. If we follow the Protestant tradition by assuming that God is the exclusive source of virtue, the benevolence of God has to be radically different from the benevolence of a human being. A benevolent and almighty God who wishes to reward virtue and punish evil would design the world order similar to that in the allegory of the long spoons. Divine punishment is unforgiving, merciless, (...) individually non-retributive, holistically retributive, and quantitatively unpredictable. All sufferings are divine punishment. Several popular arguments from evil, including animal suffering, victims of evil deeds, natural disasters, and children’s diseases, can be resolved within this framework. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Anthropology's approach to answering the question of the role of suffering in our lives is limited to empirical data and at best describes an individual's capability to endure it and make sense of it. Levinas was at odds to find meaning in suffering once it had exceeded certain proportions. Various cultures demonstrate greater and lesser capacities for integrating corporate suffering when it has crossed a significant threshold. What is the role of ritual and productive suffering (...) in revealing meaning in suffering? Some examples are drawn from the experiences of pilgrims on the Camino de Santiago de Compostella. Drawing from Dr. Eleonore Stump's exploration of second-person narratives and relationships, a Christian philosophical-theological response is provided. (shrink)

Human beings have a moral duty to intervene to prevent or to mitigate the suffering of free-living animals. This article focuses on that duty, particularly as it exists when an animal asks for help and when animals who need help are within the zone of a person’s ability and willingness to help. As such, people should be free to help if they choose to do so, unencumbered by legal restrictions that outlaw such conduct. However, federal and state laws in (...) the United States remain an obstacle, because they designate some activities that are necessary to help free-living animals as unlawful. Laws should not interfere with human beings’ benign interactions with nature and, in particular, people should be legally permitted to help free-living animals. People should actually assist the individual animals who want or need help, rather than trading individual assistance in favor of ecosystem “management,” policy concerns that favor expediency and budget limitations, or any other tangential issues. (shrink)

Climate change and other harmful large-scale processes challenge our understandings of individual responsibility. People throughout the world suffer harms—severe shortfalls in health, civic status, or standard of living relative to the vital needs of human beings—as a result of physical processes to which many people appear to contribute. Climate change, polluted air and water, and the erosion of grasslands, for example, occur because a great many people emit carbon and pollutants, build excessively, enable their flocks to overgraze, or otherwise (...) stress the environment. If a much smaller number of people engaged in these types of conduct, the harms in question would not occur, or would be substantially lessened. However, the conduct of any particular person (and, in the case of climate change, of even quite large numbers of people) could make no apparent difference to their occurrence. My carbon emissions (and quite possibly the carbon emissions of much larger groups of people dispersed throughout the world) may not make a difference to what happens to anyone. When the conduct of some agent does not make any apparent difference to the occurrence of harm, but this conduct is of a type that brings about harm because many people engage in it, we can call this agent an overdeterminer of that harm, and their conduct overdetermining conduct. In this essay we explore the moral status of overdetermining harm. (shrink)

Kant’s theory of friendship is crucial in defending his ethics against the longstanding charge of emotional detachment. But his theory of friendship is vulnerable to this charge too: the Kantian sage can appear to reject sympathetic suffering when she cannot help a suffering friend. I argue that Kant is committed to the view that both sages and ordinary people must suffer in sympathy with friends even when they cannot help, because sympathy is necessary to fulfill the imperfect duty (...) to adopt others’ merely permissible ends, and we ought to take friends’ MPEs as our own. MPEs are individuated in terms of concepts which include marks of the first person, and no marks of law other than permissibility. To adopt ends of others individuated in terms of such concepts rather than merely promote them as means to different ends, those concepts must engage with one’s feelings in a way that requires sympathy. (shrink)

When someone is trying to teach us mathematics, he will not begin by assuring us that he knows that a + b = b + a. —Wittgenstein Wittgenstein reminds us that the avenue toward belief isn’t through logic alone. We do not know those things that we have only reasoning to support. We feel sure of those things which by experience, and belief have come to exist within us, with an ‘absence of doubt.’ To consider the impact of knowing on (...) behavior, it could be said that we act, from what we know. The purpose of this paper is to consider how we come to know on a multi-model level, as exemplified by both a semiotic theory base and a situated example of how the notion of an individual Umwelt can house particular ‘knowledge’ and act upon it. PTSD, or Posttraumatic Stress Disorder, is a diagnosis, which can be given when individuals suffer negative and long lasting effects that stem from traumatic experience. (shrink)

The object of a critical theory of society is Man [_Menschen_] in her historically specific forms of life. The article argues against ontological conceptions of social labour and of economy. Instead it insists that historical materialism far from being a materialism of nature and history, is fundamentally a critique of the objectivity of the capitalist economic categories. For a critical theory of society, the economic concept, capital as a process of the valorisation of value, is not a natural thing but (...) a social relationship between persons that is mediated through things. The fetishism of commodities is real. In the mediated world the social individuals appear as personifications of the economic object; and yet there would be nothing without their social practices—of self-preservation. Human suffering is objectively mediated. The article concludes that suffering is the non-conceptual content of the concept of society as a process of valorisation. The sheer unrest of life is the social constituent of the economic object. (shrink)

Jukka Varelius1 ,2 and others3 have advocated that medically assisted dying should be made available on request to competent individuals experiencing ‘existential suffering’. Unlike Cassell and Rich, Varelius believes that existential sufferers do not have to be terminally ill before being helped to die. He does not regard ‘existential suffering’ on its own as sufficient to justify voluntary medically assisted dying, but believes it to be one of a set of jointly sufficient conditions . In ‘Medical expertise, existential (...) suffering and ending life’, however, he aims only to show that if physicians have the expertise required to assess when suffering consequent upon illness or injury is unbearable, that they can equally have that expertise when confronted with ‘existential suffering’. In what follows, I will neither be endeavouring to refute his more general claim , nor his argument in the present paper. Rather, I will offer two reasons for thinking that even if it is sound it is of limited practical significance.First, Varelius outlines his position without reference to relevant political considerations. He distances himself from what he terms the ‘conventional view’, namely, that voluntary medically …. (shrink)

Suffering is an unavoidable reality in health care. Not only are patients and families suffering but also the clinicians who care for them. Commonly the suffering experienced by clinicians is moral in nature, reflecting the increasing complexity of health care, their roles within it, and the expanding range of available interventions. Moral suffering is the anguish experienced in response to various forms of moral adversity including moral harms, wrongs or failures, or unrelieved moral stress. Confronting moral (...) adversity challenges clinicians' integrity: the inner harmony that arises when their essential values and commitments are aligned with their choices and actions. The most studied response to moral adversity is moral distress. The sources and sequelae of moral distress, one type of moral suffering, have been documented among clinicians across specialties. Recent interest has expanded to include a more corrosive form of moral suffering, moral injury. Moral resilience, the capacity to restore or sustain integrity in response to moral adversity, offers a path designing individual and system solutions to address moral suffering. It encompasses capacities aimed at developing self- regulation and self-awareness, buoyancy, moral efficacy, self-stewardship and ultimately personal and relational integrity. Moral resilience has been shown to be a protective resource that reduces the detrimental impact of moral suffering. Clinicians and healthcare organizations must work together to transform moral suffering by cultivating the individual capacities for moral resilience and designing a new architecture to support ethical practice. Used worldwide for scalable and sustainable change, the Conscious Full Spectrum Response, offers a method to solve problems to support integrity, shift patterns that undermine moral resilience and ethical practice, and source the inner potential of clinicians and leaders to produce meaningful and sustainable results that benefit all. (shrink)

Ong, Caroline Whilst the reason and purpose of suffering may never be fully understood, there are ways of enduring, transcending and growing resilience to how it affects us. Our experience of suffering lies in the web of perceptions that involve our physical, spiritual and cosmological beliefs. Referencing Pain Seeking Understanding: Suffering, Medicine and Faith, edited by Margaret E. Mohrmann and Mark J. Hanson, this article gives a brief exploration of some propositions as to why an all-powerful, good (...) God would allow suffering to exist. From these various perspectives and using examples cited in the book, the article proposes that the healing art of medicine, honed through years of experience, knowledge and wisdom, can help individual patients endure and transcend suffering, and be whole once again. (shrink)

The Nature of Suffering underscores the change that is taking place in medicine from a basic concern with disease to a greater focus on the sick person. Cassell centers his discussion on the problem of suffering because, he says, its recognition and relief are a test of the adequacy of any system of medicine. He describes what suffering is and its relationship to the sick person: bodies do not suffer, people do. An exclusive concern with scientific knowledge (...) of the body and disease, therefore, impedes an understanding of suffering and diminishes the care of the suffering patient. The growing criticism that medicine is not sufficiently humanistic does not go deep enough to provide a basis for a new understanding of medicine. New concepts in medicine must have their basis in its history and in the development of ideas about disease and treatment. Cassell uses many stories about patients to demonstrate that, despite the current dominance of science and technology, there can be no diagnosis, search for the cause of the patient's disease, prognostication, or treatment without consideration of the individual sick person. Recent trends in medicine and society, Cassell believes, show that it is time for the sick person to be not merely an important concern for physicians but the central focus of medicine. He addresses the exciting problems involved in such a shift. In this new medicine, doctors would have to know the person as well as they know the disease. What are persons, however, and how are doctors to comprehend them? The kinds of knowledge involved are varied, including values and aesthetics as well as science. In the process of knowing the experience of patient and doctor move to center stage. He believes that the exploration of the person will engage medicine in the 21st century just as understanding the body has occupied the last hundred years. (shrink)

ABSTRACT Based on Honneth's distinction of recognition in love, respect and social esteem, the social suffering of refugees is criticized in this contribution as an experience of disrespect. In the first part, I will address the fact that moral claims to recognition have a temporal dimension. Then I will ask what role the duration of their flight, the waiting in camps and until admission play for the social suffering of refugees. I will highlight the particular vulnerability of refugees (...) during this time and distinguish different forms of disrespect - with regard to love, social esteem, and respect and rights - faced by them. In the final section, I pose the question which individuals and institutions are responsible for enabling conditions of recognition for refugees. (shrink)

In the pure powers ontology (PPO), basic physical properties have wholly dispositional essences. PPO has clear advantages over categoricalist ontologies, which suffer from familiar epistemological and metaphysical problems. However, opponents argue that because it contains no qualitative properties, PPO lacks the resources to individuate powers, and generates a regress. The challenge for those who take such arguments seriously is to introduce qualitative properties without reintroducing the problems that PPO was meant to solve. In this paper, I distinguish the core claim (...) of PPO: (i) basic physical properties have dispositional essences, from a hitherto unnoticed assumption: (ii) the dispositional essences of basic physical properties exclusively involve type-causal relations to other basic physical properties. I reject (ii), making room for a structuralist ontology in which all basic physical properties are pure powers, individuated by their places in a causal structure that includes not only other powers, but also physically realized qualitative properties such as shapes, patterns and structures. Such qualities individuate pure powers in the way that non-mental input and output properties individuate realized mental properties in functionalist theories of mind, except that here it is basic physical powers that are individuated by relations to realized non-powers. I distinguish one Platonic and two Aristotelian version of this theory, and argue that the Aristotelian versions require that grounding is not always a relative fundamentality relation, because the powers ground the qualities that individuate them. By considering ontic structural realism, I argue that symmetric grounding is the best way to make sense of relational individuation in structuralist ontologies, and is therefore no additional commitment of the one proposed here. (shrink)

In this article, we present findings from a qualitative study examining how young women experience being long‐term bedridden with myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), during childhood and adolescence. The aim is to explore how young women who fell ill with ME/CFS during childhood and adolescence look back on their lived experience of being long‐term bedridden from the vantage point of being fully or partially recovered. Informed by a phenomenological theoretical perspective, the researchers applied a narrative (...) methodological approach involving the analysis of interviews with 13 women, aged 16–29 years at the time of the interview. Attention was particularly paid to how participants structured their narratives and to the events (telling moments) they identified as important. Four major storylines were developed: Ambivalent responses to the presence of others; A body on the edge of life; An eternity in the dark; and Recasting painful memories of being bedridden and alone. Based on our findings, we argue that the experience of being long‐term bedridden with ME/CFS during childhood and adolescence can be understood and communicated as a plot in which individuals find themselves pushed to the extreme limit of suffering and loneliness. (shrink)

Moral life often presents us with trade-offs between the sufferings of some individuals and the sufferings of others. Researchers may need to consider, for example, whether the suffering imposed on animals by a certain line of medical experimentation justifies the relief that the resulting discoveries may bring to others. Often in such cases, the suffering of some individuals is incomparable with—that is neither greater than nor less than nor equal to—the suffering of others. While this complicates moral (...) decision-making across species, it does not undermine it. (shrink)

The difference between partially and completely eliminating an individual’s state of consciousness through the use of pharmacological agents seems particularly significant in the final phases of dying. Remediating pain and suffering by means of palliative sedation and the complete shutting down of consciousness raises ethical and spiritual concerns about categorically precluding participation in one’s own death. Given that, at the end of life, suffering almost invariably imposes itself on us in some form, we are challenged to reflect (...) on how our dying process should appropriately incorporate and take cognizance of that suffering, even as we acknowledge the value and importance of palliative steps to remediate the suffering. (shrink)

Though much is written about animal suffering, little is said about the nature of suffering itself. Without any clarity about its conceptual nature, discussions concerning detection, prevention and reduction of suffering are seriously hampered. This paper considers – and rejects – some of the more usual understandings of suffering. Instead, an alternative understanding of suffering is proposed, namely that suffering is the experiencing of one's life as going badly. This notion is tied to the (...) loss of individuals' central life projects. It is suggested that non-human animals' central projects are their evolved survival skills. This alternative view of suffering has major implications for animal welfare. (shrink)

Engaging the thought of the Danish thinker Søren Kierkegaard, I challenge a tendency within the analytic tradition of philosophy on the subject of meaning in life. Taking as a starting point Kierkegaard's insights about meaning in life, the striving needed to attain an imagined ideal self, and his paradoxical conception of the perfection available to human life, I claim that meaning in life is a function of an individual's striving for an ideal self. This continuous effort to achieve myself (...) is marked by suffering, an indispensable part of Kierkegaard's project of identity formation. The imagined grasp of a possible ideal self is essential to this process but insufficient for it because the imagination can only ever glimpse a kind of static perfection, not the lived perfection that only results from willed actualization of an ideal self. The meaning of a human life, then, consists in the suffering that results from a struggle to actualize the ideal I aspire to become in the process of identity formation. I contrast this view with a tendency shared by many contemporary analytic philosophers of meaning in life, for whom meaning in life is constituted by achievement of valued goods, without much attention to one's relation to the process of achieving them. In that respect, I will focus on the position of Iddo Landau. After clearing a number of his misconceptions about Kierkegaard's philosophy, I claim that, for a life to be meaningful, valued goods in life must be complemented by a conscious enactment of the process of the formation of one's identity that includes striving to attain a kind of perfection. I conclude that Kierkegaard's paradoxical account of perfectionism makes him more of an ally to Landau than an opponent. (shrink)

Conserving the vitality of suffering: addressing family constraints to illness conversationsWhen persons are confronted with life‐threatening or chronic illness, there is always a possibility that family members other than the person experiencing the illness also suffer as they attempt to manage their own distress. This paper describes exemplars from a hermeneutic study that explored therapeutic conversations between nurses and families who were living with a member experiencing ischaemic heart disease. These conversations uncovered the complexity of both individual and (...) family suffering following acute cardiac illness events, and called attention to nursing practices that addressed some of the ways that family members were constrained from having conversations about the illness. When spaces were created for these conversations to occur, possibilities for making sense of illness and suffering were revealed as vital. These understandings support the efforts of family members to sustain and conserve family relationships in the face of illness and suffering, and inform both the professional and personal lives of nurses. (shrink)

From a theoretical standpoint, the problem of human suffering can be understood as one formulation of the classical problem of evil, which calls into question the compatibility of the existence of a perfect God with the extent to which human beings suffer. Philosophical responses to this problem have traditionally been posed in the form of theodicies, or justifications of the divine. In this article, I argue that the theodical approach in analytic philosophy of religion exhibits both morally and epistemically (...) harmful tendencies and that philosophers would do better to shift their perspective from the hypothetical “God’s-eye view” to the standpoint of those who actually suffer. By focusing less on defending the epistemic rationality of religious belief and more on the therapeutic effectiveness of particular imaginings of God with respect to suffering, we can recover, (re)construct, and/or (re)appropriate more virtuous approaches to the individual and collective struggle with the life of faith in the face of suffering. (shrink)

This paper explores the ways in which a fuller attention to suffering in the tradition of the early Frankfurt School might valuably inform international political thought. Recent poststructural writing argues that trauma is silenced to prevent it disrupting narratives of order and progress and instead advocates a continual ‘encircling’ of trauma that refuses incorporation into a broader historical narrative. This paper welcomes this challenge to mainstream international ethics: attention to particular suffering provides an important challenge to the abstraction, (...) instrumentalism and universalism of modernity. However, if we simply mark trauma and refuse to incorporate it into any kind of narrative, we cannot profit from the ways in which suffering can illuminate the structures and ways of thinking that create it. Drawing on Adorno's negative dialectics, the paper argues that a dialectical understanding of the relationship between universalising order and disrupting particularity can lead from individual suffering towards a political re-engagement with the universal. (shrink)

In this communication recent evidence from cognitive neuroscience is presented showing that believing is a fundamental brain function. It integrates the perception of information from the environment with personal perspective taking (“what does it mean to me?”) as the basis for predictive coding of action. Observing that another person becomes injured can make one believe that the pain in the injured person is similar to pain that oneself has experienced previously. This first-person perspective has been called empathy and includes primal (...) beliefs about potentially pain eliciting objects and painful events in the sense of “what does it mean to you?”. Furthermore, observing other people to suffer involves the conceptual belief that their condition is aversive and burdensome. Believing in love and peace involves the perspective of “what does it mean to us?”. Contradictory events may cause the sensation of pain and suffering in the afflicted individuals resulting in mutual distrust and eventually disruption of social bonds. In conclusion, beliefs play an important, though long underestimated role in cognitive neuroscience of pain and suffering and more generally for the cultural notions of deities and evil. (shrink)

Karl Marx's Capital is critique of the capitalistically organised social relations of reproduction. It recognises economic categories as perverted social categories and asks about the manner in which human social practice manifests itself in the form of independent economic categories and laws that unfold as if governed by invisible principles. He says, the capitalist relations are beyond human control and he argues that the indi-viduals act under economic compulsion and are controlled by the products of their own labour. His critique (...) says, in the capitalist social relations the individuals act as personification of economic categories. The immense wealth of capitalist society is abstract, it appears in the form of money as more money. In these wealth-relations, time is money, the satisfaction of human needs a mere sideshow. Yet, the economic categories are purely social forms. Critique of political economy is social critique of economic inversion, it is about the sheer unrest of live as the hidden misery of economic things. (shrink)

Purpose: To analyze how individual characteristics and the social context are associated with mental distress symptoms in the Brazilian population.Method: A multilevel cross-sectional study with data from the 2013 National Health Survey. There were two dependent variables: decreased vital energy and somatic symptoms, the presence of depressive thoughts. The independent variables were biological characteristics, education and income, habits and lifestyle, and context variables. Bivariate analysis was performed, and Prevalence Ratios calculated in a Poisson Regression. A multilevel Poisson Regression was (...) performed to verify the effect of individual and contextual variables.Results: Regarding depressive thoughts, young and middle-aged individuals, low education, women, absence of partner, smokers or former smokers, and absence of health insurance were the categories at highest risk; belonging to classes D-E and living in states with lower expected years of schooling proved to be protective factors. Similar results were found for the second outcome.Conclusions: Symptoms of mental distress were associated with the individual characteristics and contextual aspects of the federation unit. These findings indicate the importance of strengthening psychosocial care aimed at vulnerable groups. (shrink)