Never in human history has suffering been more readily relieved than today. And yet, paradoxically, we have never been more afraid of suffering. 

Our forebears would find this very odd. For them, horrendous suffering was ubiquitous, the bane of rich and poor alike. For example, before anesthesia, the agony of surgery may have killed more patients than surgical procedures helped. As Thomas Dormandy put it in his splendid medical history, The Worst of Evils: The Fight Against Pain, “the searing pain of knife and saw” almost always caused patients to fall “into a state of shock on the operating table . . . Speed was essential. Prolonged pain not only hurt. It also killed.” No wonder John Adams, after witnessing the searing agony of his daughter’s one-and-a-half hour mastectomy, said he felt “as if he were living in the Book of Job.”

Pain was an integral part of life: If a man suffered appendicitis, he died in agony. If a man contracted bone cancer, he died in agony. If a man became infected with tuberculosis, he died in agony. Then there were the non-terminal illnesses and injuries like gout, carbuncles, migraines, arthritis, and broken limbs. Suffering was the hard price one paid for being alive.

Happily, those bad old days are mostly long gone, at least in the developed world. Thanks to tremendous breakthroughs in modern medicine, suffering has been pushed largely into the shadows. Surgeries no longer kill from the pain. Hospice and palliative care offer tremendous relief for even the most painful chronic and terminal diseases. The problem today isn’t primarily one of preventing agony, but rather, our sometimes inadequate delivery of efficacious and timely palliation.

Ironically, our many medical triumphs and the consequential receding of serious suffering from everyday experience created a concomitant terror of travail that threatens the morality of society. For example, when people actually did die in agony, there was little agitation for euthanasia. Yet today, when writhing demises are entirely preventable—even if it occasionally requires sedation—many support voluntary killing as the best solution to incurable disease and disability.

That paradox used to make me wonder: Why euthanasia now, when there is less “need” for such drastic action than ever before in human history? The bioethicist Yuval Levin provided a very plausible answer in his 2008 book, Imagining the Future, in which he makes a fascinating observation about suffering and culture:

The worldview of modern science sees health not only as a foundation but also a principal goal; not only as a beginning but also an end. Relief and preservation—from disease and pain, from misery and necessity—become the defining ends of human action, and therefore of human societies.

This is a crucial point, because as Levin also notes, “Any society’s understanding of the foundational good necessarily gives shape to its politics, its social institutions, and its sense of moral purpose and direction.”

And therein we face a significant ethical menace: Once avoiding suffering becomes the primary purpose of society, it too easily mutates into license for eliminating the sufferer. More, the meaning of “preventing suffering” itself becomes elastic. Thus, we increasingly hear advocacy for ending the lives of cognitively devastated patients, not because they are in pain, but to relive the anguish of their families. Some have even argued that there is an explicit “duty to die” to protect loved ones from the emotional and financial consequences of disability, illness, or age-related debilitation. I have also seen promotion of death as a way of preventing the empathetic suffering that doctors and nurses experience when caring for devastated patients.

More broadly still, assisted suicide has been promoted to ameliorate the suffering of society. Thus, Derek Humphry, founder of the Hemlock Society, touted medical cost containment as the “unspoken argument” in favor of legalizing physician-assisted suicide (PAS). “There will likely come a time,” he predicted, “when PAS becomes a commonplace occurrence for individuals who want to die and feel it is the right thing to do by their loved ones,” a policy, he opined, that would free “hundreds of billions of dollars” for the “benefit [of] those patients who not only can be cured but who also want to live.”

It isn’t just euthanasia. Consider the exploitative practice of buying kidneys from the destitute in poor countries like Pakistan and the Philippines, commerce that can leave sellers with destroyed health, continuing pain, and shortened lives. Even more insidiously, some well-off exploiters of the powerless purchase organs in China despite knowing that their “donors” were most likely political or criminal prisoners tissue-typed and killed so buyers can avoid transplant waiting lines.

How bad is it in China? A recent study noted that few Chinese donate their organs after death, and yet, organ transplants increased there from 18,500 between 1994 and 1999, to 60,000 between 2000 and 2005. “Where do the organs come from for the [additional] 41,500 transplants?” the authors ask pointedly. “The allegation of organ harvesting from Falun Gong practitioners provides an answer.”

True, these practices remain “black market.” But our any-means-necessary-to-avoid-suffering attitudes risk making such biological colonialism respectable. Not only do organ purchasers generally receive scant condemnation—if any at all—but they are sometimes positively celebrated. Thus, when Daniel Asa Rose wrote Larry’s Kidney about buying an organ in China, he was embraced by reviewers. Typically, the May 1, 2009 Library Journal complimented:

This book is a side-splitting tour de force that whisks readers off to China on a quest to get a transplant for the author’s cousin Larry. Second-time memoirist Rose recounts their exploits with an insuperable wit that will appeal to readers who crave unrelenting humor. In a more serious vein, Larry’s challenging journey to China will resonate with readers who are rightfully concerned about the plight of American patients who may be relegated for years to an organ transplant waiting list.

No doubt, family members of the (probably) murdered kidney vendor were also very amused.

So, how should society best continue the struggle against “the worst of evils?” Rather than a headlong neurotic flight from pain, it seems to me that we should instead refocus our energies and emphases. By all means, combat suffering—but do so morally, by recommitting ourselves to the higher calling of righteousness and virtue as the “defining ends of human action, and therefore of human societies.”



Thomas Dormandy, The Worst of Evils: The Fight Against Pain

David McCullough, John Adams

Yuval Levin, Imagining the Future: Science and American Democracy

David Matas and David Kilgour, Report Into Allegations of Organ Harvesting of Falun Gong Practitioners in China

Derek Humphry and Mary Clement, Freedom to Die: People Politics and the Right-to-Die Movement


Articles by Wesley J. Smith


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