Suffering and palliative care

Question 1

Describe hippocratic and asklepian traditions, describe palliative and curative medicine

Answer 1

The Hippocratic Tradition:
- Rational, scientific approach focused on disease.
- Linked with curative medicine and death denial in modern culture.

The Asklepian Tradition:
- Holistic, focusing on illness and suffering.
- Healing is seen as an internal process.
- Associated with palliative medicine, acknowledging mortality.

The Ends of Medical Practice

Curative Medicine:
- Aims to return patients to their lives, allowing them to pursue their priorities independently.

Palliative Care:
- Focuses on assisting patients in living their lives and supporting their priorities with the time they have left e.g. meeting life milestones, seeing or doing things before they pass

Both curative medicine and palliative care aim to alleviate suffering. Curative medicine tends to be proactive, addressing the suffering associated with acute illness and pain, often before suffering in a broader sense begins. It maintains the person from a distance. Palliative care, however, often engages with those already suffering in a way that cannot be fully relieved, supporting the individual and their family more directly in pursuing aspects of their lives.

Question 2

Distinguish between pain and suffering

Answer 2

• Similar but not synonymous
• It is possible to experience pain without suffering
• It is also possible to suffer without experiencing (physiological) pain
• Suffering is typically unending: relieved e.g. with diagnosis and recognition

Question 3

Describe Cassell’s perspective on suffering

Answer 3

Cassell’s Perspective:
- Suffering is a complex experience that cannot be fully understood through the dualism of mind/body.
- It involves the perception of an imminent threat to the person’s integrity, extending beyond physical distress.
- Embodied people, not simply bodies

Key Points:
- Suffering is linked to the threat of personal disintegration.
- Recovery or alleviation occurs when this threat is addressed or when personal integrity is restored by other means.

Question 4

Describe medical or otherwise interventions at the end of life

Answer 4

Intractable Symptoms at the End of Life:

Suffering at the end of life can include pain, breathlessness, delirium, and existential suffering. The latter, a fear heightened by the proximity of death, raises the question of whether continuous deep sedation is a justifiable response for those with severe refractory pain or existential distress.

An Emerging Modality:

Research into psychedelics like psilocybin and LSD suggests potential benefits for end-of-life care, particularly for patients experiencing existential distress. These substances might offer psychotherapeutic ‘quick fixes,’ facilitating emotional and intellectual relief and enabling patients to connect and communicate more profoundly with others. However, concerns about the authenticity of the spiritual experiences they induce and their impact on personal identity remain.