Authentic Compassion: Pain Treatment at the End of Life

Opinion   |   Denise Hunnell, M.D.   |   May 2, 2012   |   11:21AM   |   Washington, DC

In 1994, Dr. Charles Cleeland authored a study that found that 42% of cancer patients with pain were receiving inadequate therapy for their pain. This led to the Health and Human Services (HHS) guidelines for more aggressive pain management and the ubiquitous question about your level of pain “on a scale of 1 to 10” every time you visit the doctor for any reason.

The interest in pain management was actually a response to the push for legalized assisted suicide. Advocates of assisted suicide claimed that uncontrolled pain justified aiding cancer patients to end their lives. At the time, there were proclamations by medical experts that 90% of pain could be easily treated and there was no risk of addiction for those who were actually in pain.

So where are we nearly two decades later? A new study just published in the Journal of Clinical Oncology finds that while pain management has improved, a significant number of cancer patients are still suffering. Dr. Michael Fisch and his colleagues looked at over three thousand patients with breast, lung, prostate, or colorectal cancer. Of the two thousand patients who complained of pain, roughly one-third were receiving inadequate therapy for their pain. The reasons for this failure to adequately alleviate pain are varied and complex. Physicians cited concerns about raising red flags for excessive use of pain relievers monitored by the Drug Enforcement Agency (DEA) as a reason for using suboptimal doses of opiod analgesics. Patients resisted the use of pain medicine, fearing these powerful drugs would adversely affect their level of functioning. Some patients had a cultural stoicism that made it difficult for them to admit they had pain and needed medication. Many patients did not speak English well and had a difficult time communicating their need for pain relief to their physicians. In 50% of all patients with inadequate pain relief, oncologists treating the patient did not deem the pain to be related to cancer and therefore, did not aggressively pursue therapy to alleviate the pain.

Those who promote assisted suicide and euthanasia no longer limit their justifications to simply dealing with chronic pain; they now include depression and other mental illnesses, loss of cognitive abilities, and loss of independence as reasons for ending life. In light of this recent study, however, one wonders if these purveyors of death were correct twenty years ago to claim that intractable pain in cancer patients made life not worth living and gave rise to the need for legalization of assisted suicide?

Clearly, the Fisch study is not an indictment of life with cancer. The presence of suffering does not make death preferable to life. What this study does tell us is that in a significant number of patients with cancer, relief of pain is not a simple issue. Both physicians and patients create obstacles to optimal pain therapy. The answer is not to get rid of the patients in order to get rid of the pain: The answer is to address the impediments that hinder successful pain management.

Even more importantly, this study tells us is that in spite of the best efforts of medicine, there are still people among us who are suffering. Seeing others who are ill or hurting often makes us uncomfortable because it brings our own mortality to the forefront of our consciousness. Yet as Christians, we are called to suffer with those who are in pain – literally, to be compassionate. Someone you know may very well be hurting. He needs you to comfort him, listen to him, pray with him, or at least pray for him.

I remember the first time I got sick after leaving home to go to medical school. I was alone in my apartment. The fever, the aches, and the general misery were magnified by my isolation. My mother was not there to offer a cool cloth for my brow or soothing words to help me sleep. While it is important to offer and utilize medical treatments that ease suffering, no pill will ever replace the consolation provided by human presence.



Turning to assisted suicide or euthanasia as a solution for suffering says that we as a society cannot be bothered with authentic compassion. It says that we want what is easy and expedient rather than what requires effort and time. It says the healthy and powerful can decide whether the weak and vulnerable live or die. Therefore, legislative efforts to protect the disabled, the sick and the suffering from becoming victims – particularly given certain ominous elements of the Affordable Care Act – are necessary. But legislation alone will not build a culture of life.

Each of us must take the time to recognize the pain and suffering of our child, our spouse, our neighbor, and even the strangers who momentarily cross our paths each day. Compassion may mean sitting at a bedside. It may mean an unrushed conversation over coffee or taking a casserole to the family next door. It may just mean a kind word or a smile for someone who looks like they are having a bad day. Each of these small acts affirms that we are a community instead of just a collection of individuals. An authentically compassionate community desires that no one ever suffers alone, and does not seek death as the solution to pain.

LifeNews Note: Denise Hunnell, MD, is a Fellow of HLI America, an educational initiative of Human Life International. She writes for HLI America’s Truth and Charity Forum.