Is Pain a Moral Good?

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Here’s an absolutely fascinating article, “The Day Pain Died,” about the first medical operation to use anesthetic.

Can you guess what year it happened?

The answer is 1846. But within that answer lies a bizarre history.

The article is by Mike Jay, and is drawn from his new book called The Atmosphere of Heaven.

The gist is that anesthesia itself was hardly new in the 19th century, but that a moral objection prevented its use. Why? Because pain was considered an integral and necessary part of life, and the removal of pain was the work of either a charlatan or a Satan:

As far back as 1525, the Renaissance physician Paracelsus had recorded that it made chickens “fall asleep, but wake up again after some time without any bad effect,” and that it “extinguishes pain” for the duration. …

Before 1846, the vast majority of religious and medical opinion held that pain was inseparable from sensation in general, and thus from life itself. Though the idea of pain as necessary may seem primitive and brutal to us today, it lingers in certain corners of healthcare, such as obstetrics and childbirth, where epidurals and caesarean sections still carry the taint of moral opprobrium. …

Most doctors still believed it was only pain that kept patients alive through the trauma of operations. System failure due to shock was a frequent cause of death during surgery, and the loss of sensation was believed to make it more likely. A screaming patient, however tormented, had a better prognosis than a limp and lifeless one. …

Despite its successes, resistance to the idea didn’t vanish overnight. Until the end of the century, some doctors would maintain that pain had a necessary role in the preservation of life, but from 1846 onward they were outnumbered by those who insisted that it was the job of a physician to inflict as little of it as possible. Some religious voices would hold out for a good deal longer: Pope Pius XII would confirm that “the Christian’s duty of renunciation and of interior purification is not an obstacle to the use of anesthetics” only in February 1957.

I learned of this article via Market Design, the blog of the always-interesting Al Roth. His headline was striking: “Anesthesia Was Once Repugnant.” There’s no way, I thought, that he could be right on this one (even though he has always been right in the past). But after reading Jay’s article, I was thoroughly convinced. Like most good arguments, it is not only convincing but humbling: how could we not have seen this earlier?

Even more interesting to me is that, the widespread use of anesthesia aside, there still seems to be a prominent streak in modern humanity that continues to see pain (or suffering, or angst, or call it whatever you want) as an elemental property that we must embrace, not just endure. For the record, I am not down with that. Just because life can be full of pain does not mean that it should be categorized as a moral good any more than, say, warfare should be considered a moral good simply because it has been an inevitable result of human interaction.


Jake

Finally an explaination for the average business meeting.

RNB

"the removal of pain was the work of either a charlatan or a Satan"
Yes, despite the church accepting a little reason in 1957, they have been fairly consistent in their desire to inflict pain upon humanity for centuries.

"Because pain was considered an integral and necessary part of life"
Just as relevantly today, because pain is still considered an integral and necessary part of death. "DNR" is a sick and sadistic compromise to religious sensibility to let an imagined deity decide upon point of death rather than allowing the patient to make her own choice.

Mike C

There must certainly be at least a relationship between this historical view of the ethical necessity of pain and the proscription of the marketing of certain narcotic drugs beginning with the Harrison Narcotics Tax Act in 1914.

Aaron

The reason pain has always been considered a moral good is because it provides a necessary juxtaposition to peace and well-being. The idea is that we don't know the good if we don't know the bad. Obviously, physical pain is analogous to most people for emotional, psychological, or economic pain.

It's not that objectionable from an economics standpoint either. Look at Prospect Theory. It tells us that people only value gains or losses from their relative starting position. If everything is painless, then nothing is valuable to us.

kaloniki

"So discredited had narcotic drugs become by the middle of the seventeenth century that when Nicolas Bailly, a barber-surgeon of Troys, administered a narcotic potion to a patient before an operation, the venture aroused widespread condemnation. Bailly was arrested and fined for practicing witchcraft. The stupefaction of patients by administration of herbal remedies was then forbidden in France under heavy penalty."

(Victor Robinson, M.D.: Victory Over Pain. A History of Anesthesia, London: Sigma, 1947. p.40)

Boris

Given that general anesthesia is not as safe as people would like to think (even ignoring allergies to the anesthetics, which claim a number of lives each year, anesthesiologists do screw up), the question becomes one of tradeoffs.

Similar for epidurals, and even more so c-sections. For many women, giving vaginal birth is actually safer in terms of things like blood loss, infection risk, etc (though yes, more painful during the procedure) than a c-section would be. Granted that tends to be the "young and healthy" demographic. And yes, incidence of c-sections in that demographic is lower. There's also post-procedure pain with a c-section, of course, just like there's post-partum pin with a vaginal birth; I haven't seen any studies comparing the two.

As far as epidurals go, they do decrease pain (usually; not always), but also tend to prolong labor, increase the risk that intervention will be needed, increase the risk of needing an episiotomy (with resulting increase in post-partum pain). Again, tradeoffs depending on the particular person are involved.

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blue92

"The reason pain has always been considered a moral good is because it provides a necessary juxtaposition to peace and well-being."

Plus there's the deep satisfaction of inflicting pain on those who so obviously deserve it. That's why we torture our convicts.

Wait, what's that? We *don't* torture because pain breeds fear and resentment more easily than it does rational avoidant behavior? There's a divide between reptile-brain activity and rational, thoughtful activity in humans. We are capable of both and have a tendency to flip back and forth, but which is more useful? Without understanding the target's brain, the required corrective behavior is rather difficult to determine, and while it works as direct feedback from the physical world ("your hand is burning on the frying pan"), pain seems very much a blunt instrument when applied to ethics.

"It's not that objectionable from an economics standpoint either."

Not that you don't have a point, but it is also objectionable in the same way -- that inflicting unnecessary pain in many cases is counterproductive. If surgery saves lives, then additional pain would provoke avoidance of surgery contrary to its good. If government provides a social good, then taxes should also be extracted in as pain-free a way as possible. We should not need to experience anarchy first-hand to understand this.

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Matt

"Just because life can be full of pain does not mean that it should be categorized as a moral good any more than, say, warfare should be considered a moral good simply because it has been an inevitable result of human interaction."

I think most folks today agree that pain is not a moral good, but ABSENCE of pain may be a moral evil (or at least moral hazard). This is our slippery slope. Few argue that taking aspirin for a headache is bad. Or that taking opiates immediately following major surgery. But what about people who have chronic pain? Why do so many look on them as morally weak if they want to use pain medications permanently? Why do so many medical caregivers still administer inadequate pain medication to patients? (Just google "inadequate pain control" to see how many studies, year after year, show that we are failing patients in this regard.)

Then you start getting into non-physical pain. Emotional pain. People who are clinically depressed we see as rightly deserving medical correction of their depression. But someone who is going through some hard times ... well, we think they should just "tough it out." Why? Why is numbing the emotional suffering from say, a death in the family, a divorce, a job less wrong but numbing the physical suffering from surgery or blunt trauma is OK? Broken bones but not broken hearts?

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Rob

could you liken pain during child birth to fraternity hazing... i.e experiencing pain in child birth may strengthen your bond to the new born?

This leads me to another interesting question - do women who have more painful labor processes feel closer bonds to their children? - due to some type of cognitive dissonance reaction.

Matt

...a job LOSS, that is. If you need antidepressants to make it through your job, you should first consider a career change.

AaronS

Pain is not a moral good or moral evil. But our causing of it, allowing it, or reaction to it, can be a moral event. I recently experienced extreme pain which was remedied by a doctor's prescription of pain medication. I could not help but think that he had done a wonderful thing for me--which means, it would seem, that the bringing about of the alleviation of pain is a moral good.

As a Christian, I am still surprised by the utterly "unChristian" thinking that has permeated our history. I mean, didn't Jesus Himself say that He had come to "bind up the brokenhearted, to heal the sick," and so forth? That would seem to give us to CLEAR indication that while God may USE pain to accomplish some good, His ultimate purpose is to bring about relief, to alleviate these pains of a fallen world.

And so I remain grateful for the pain that has, at times, made me a better, more persevering man...and for the alleviation of pain that has made me more grateful and reflective of how good life can be.

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Gabe

Perhaps the surgical techniques of the present day are a lot more pain-inducing than the more simple (and less invasive) procedures of 150 years ago?

So, with more pain comes more of a need for something to remove that pain.

Shulamit Widawsky

It is an interesting question, though...like living in a "too clean" environment causing one's immune system to be weak and susceptible, could experiencing no pain have a down-side?

I've partaken of full anesthesia a few times in my life, twice for surgeries right in the front of my neck. I'll keep the choice of being "knocked out" and pain free (both physical and emotional) during such surgeries!

But the underlying question remains...Are there benefits to experiencing real pain, and are there drawbacks to avoiding it?

Hard to imagine that doctors who took the oath to "Do no harm" allowed their patients to be in excruciating pain, when they knew they could limit or eliminate the pain of surgery.

KarenS

I agree with Boris #6, about C Sections. Recovery times for women who had C-Sections is on average considerably longer than than women who gave birth vaginally. Many women will opt for a greater intensity of pain vs an extended recovery period.

Renee

Check out Gretchen Rubin's opinion on that - basically it's that you never really appreciate the absense of something (like not being depressed) until you know what it's like to have it.

frankenduf

there was also an historical argument which speculated that anaesthesia didn't kill pain, it just killed the ability to respond to it- this led to the nightmare scenario of being fully awake during all the surgery/pain, but being paralyzed to do anything about it- this has actually been verified in some cases empirically, via anaesthesia error and poisonings (see serpent and rainbow for movie portrayal)

L

"if the account of the man experiencing no agony during the operation were true, the fact was unworthy of their consideration because pain is a wise provision of nature, and patients ought to suffer pain while their surgeon is operating." source: http://psychclassics.yorku.ca/Boring/controversy.htm

Kate Woods

It would be fool-hardy to equate one's desire to engage in natural childbirth without the use of epidural as a simple relic leftover from historic religious theory. Life, the good and the bad, the painful and the pleasurable is always lived on a continuum. There is unnecessary pain - e.g. extraction of a tooth without novicaine, unavoidable pain - e.g. suffering trauma in an accident with no medications/drugs on hand at the moment, and the free acceptance of some pain for some higher reward - e.g. childbirth without use of epidural. Giving birth to a child without epidural does hurt but as soon as the labor is over the pain pretty much stops - not so with labor under epidural. Likewise, necessity of episiotomy is less likely (I have given birth to 4 children - no episitomy) and likelihood of side effects or after effects due to adverse drug reaction is obviously limited (e.g. no headaches). Most importantly, when everything goes well and emergency procedures or medications are not required during labor, the biggest payoff is being present in the moment, being fully cognizant of the creation of life and being intimately connected to the moment that that life is brought into full being into this world. A woman in labor whose senses in addition to her pain are dulled by medications cannot fully be in that moment as some of her faculties are necessarily slowed (which is certainly a choice a woman is allowed to make and no one should be looked at askew for so choosing). For return on investment and pain minimizer there is simply no drug on earth (natural or synthetic) that provides the "high" that comes from being acutely mentally, physically, and emotionally present at the moment of birth. Furthermore, unlike he pain relief/"high" provided and felt from other prescribed medications however useful, this is a birth "high" that can be recalled and viscerally felt at later points in time -
I encourage every woman to make her own choices about style, locale, and amount of times of childbirth. However, I also encourage society to be mindful of biases against people who choose to experience life in all its pain and glory - not all of us want to dull our senses or walk through life as if in a daze. While undue pain may no longer be a societally recognized "good" certainly, we may still live room for personal choice in regards to the cognition level at which an individual chooses to live her or his own life.

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Duh

Religion has caused immeasurable pain to civilization.

Kevin H

I think that we must tread lightly when speaking in absolutes. It's well known that having too little pain is extremely deadly.

Children born with an insensitivity to pain often have painless, but exceedingly short life spans. Common causes of death include bedsores, because the child feels no need to roll over in sleep when one position would become uncomfortable to a normal child.

Obviously, the idea of pain as either a moral good, or a state to be avoided at all costs is flawed. The proper question is, what is a reasonable amount of pain that a person should experience?

In that sense, I will agree that surgery without anesthesia would fall outside of that reasonable range, but there may be some danger is the ability to eliminate pain at will.