Existing conceptions of suffering

Discussions on the nature of suffering often carry a normative weight that underscores the relevance of its conceptual analysis: suffering is intrinsically and prima facie bad, which yields a stringent moral obligation to do what one can to alleviate people’s suffering.Footnote ^{2 ,} Footnote ³ In the healthcare context, this means that a patient’s medical suffering (i.e., a suffering caused by ill-health) provides reasons grounding moral obligations for healthcare professionals to relieve it. While, on the one hand, such moral obligation can, in certain cases, even be legally imposed, it is also, on the other hand, not an absolute, unfettered obligation that does not accommodate exceptions (e.g., one does not have an obligation to alleviate someone else’s suffering by causing harm and violating the dignity of the sufferer or of one’s own).

Debates about the nature of suffering have long oscillated between subjective and objective accounts. Is suffering merely what it feels like from the inside—distressFootnote ⁴, anguish, pain? Or is it something that can be identified from the outside—the absence of those goods or conditions that enable a life to flourish? To put it another way: Is suffering fundamentally a subjective experience—tied to personhood, individual values, and emotions—or an objective condition, identifiable through impersonal criteria and present in the world regardless of conscious awareness?

The limits of both sentience-based and objective accounts

This conceptual distinction bears important practical implications: as Tate highlights,Footnote ⁵ if suffering is purely subjective and therefore an agent-dependent, first-person experience, then we exclude all those who lack a sense of self and sentience (i.e., capacity for subjective experiences).Footnote ⁶ This would entail that we could not say that infants, people with severe intellectual disabilities,Footnote ⁷ or patients who are minimally conscientious, unconscious,Footnote ⁸ or in a permanent vegetative state (PVS) can suffer.Footnote ⁹ For those upholding the objective accounts of suffering, these exclusions cannot be reasonably justified. This is because anyone who is found in a situation where there is a “gap between how things are, and how things ought to be”Footnote ¹⁰ for the attainment of a good, flourishing life, is suffering and therefore merits our immediate moral attention.Footnote ¹¹

Objective accounts are therefore broader and more inclusive: they consider all human beings equally, irrespective of their capacity for or level of sentience, awareness, or consciousness. All human beings suffer some form of impediment to their full flourishing at some point in their course of their lives. We all suffer, one way or another, sooner or later, sometimes for short, sometimes for long periods of time—and some of us (e.g., with chronic illnesses and disabilities) for our entire life! Though in different degrees, manner, and intensity, the objective reality is this: all human beings suffer. That is a fact. Suffering is, then, a universal phenomenon—not as abstraction, but as the lived reality of finite, vulnerable beings.

And yet, suffering is a profoundly personal experience. Subjective accounts remind us that suffering is not just the absence of flourishing in abstract terms, but the disruption of what this particular person, in this specific context, holds dear or needs to live a fulfilling life. It is tied to agency, memory, relationships, and meaning. The pain of bereavement, the anguish of betrayal, or the fear of death—these are irreducibly first-person.

Toward a holistic account: The Personalistic view

This leads one to understand that both objective and subjective features are necessary and complementary, yet not alone sufficient to fully explicate the complex nature of suffering. A holistic understanding of suffering, as Tate calls for, relies on seeing it both as an objective impediment to a good life and as a subjective experience. While the former allows one to name harm, injustice (both interpersonal and institutional/structural),Footnote ¹² and absence of love, the latter keeps one attuned to the unique character of each person’s wounds. I call such holistic view “Personalistic” because it affirms that human goods are both universal and personal: objective in kind, but particular in form.

Two objections

While a holistic theory that considers both the objective and subjective aspects of suffering as an impediment to flourishing is a more inclusive and attentive approach—one that takes seriously the unique wounds of each sufferer—two important objections arise.

Objection 1: Conceptual inflation

The first objection is that in combining both the objective and the subjective components of suffering, this holistic account becomes unreasonably expansive. So much so, my opponent would argue that it falls into the unsolvable problem of conceptual inflation: if suffering is defined so broadly that it encompasses everything, it becomes meaningless.Footnote ^{13 ,} Footnote ¹⁴

Few would deny that conceptual clarity is vital, especially in moral contexts with life-and-death implications such as those encountered in healthcare.Footnote ¹⁵ However, I want to challenge the assumption that the holistic view of suffering necessarily renders it ineffective. The relevant question is: too broad for what purpose, and in which context? While certainly overly broad and underspecified to serve as a reliable foundation for laws or public policies that establish MAiD, the concept of suffering as impeded flourishing remains essential in clinical and communal settings. In these contexts, medical suffering calls not for institutional proceduralism and top-down protocolization but for relational understanding and shared meaning-making.

For instance, consider a patient with advanced ALS, fully conscious but unable to move or speak. Their suffering cannot be fully grasped by pain scales or physiological metrics. What matters most may be their caregiver’s presence, their gaze, their moments of shared memories, evoked through touch and music. Such meaning-making is relational, not procedural.

That is to say, the encounter with each sufferer requires healthcare professionals to go beyond the performance of objectively prescribed actions and bedside manners: a deep encounter with the sufferer depends on being attentive and present to that person as they try to make sense of their uniquely perplexing situation. This necessitates what both the objective and subjective accounts of suffering offer. Rather than being unhelpful or empty of meaning, the holistic reading of suffering—in offering a combination of both dimensions—guides the sufferer and those who accompany them in how to make sense of a presumably senseless situation. Here, a second objection may be raised.

Objection 2: Virtuous suffering

In making sense of suffering and finding ways that show how suffering can also become a path to growth in virtue, this “virtuous suffering,” as Brady calls it, is actually flourishing and not suffering. For Brady, these are intrinsically good types of suffering that do not impede but instead enable flourishing and growth. Examples here would be birth pain, remorse, or grief after the loss of a loved one. Though difficult, they could be classified as “virtuous suffering” that facilitate flourishing. But if so, the objection goes, then suffering cannot be understood as an impediment to flourishing. For Brady, if these are instances of genuine suffering, they cannot also be intrinsically good, virtuous responses.Footnote ¹⁶

Indeed, suffering can be a site for the cultivation of virtue—especially the virtue of love. There is, in this sense, such a thing as suffering well, as part of living well. However, I would not be so quick in saying that suffering (of any kind) is good in and of itself. Suffering is not intrinsically good. Suffering is, after all, objectively bad: something to be objectively avoided or alleviated, and something that grounds our moral responsibility to act upon and remedy. By affirming the badness of suffering, I am not, however, denying its transformative potential toward the good. Typically, birth pain is healthy and indicative of normal functioning; likewise, remorse and grief are proper responses to inflicted harm and death, respectively. These instances of sufferingFootnote ¹⁷ can certainly be appreciated as pathways to the good: the good of new life and the good of repentance and reconciliation, for example.

What this entails is that flourishing and suffering are not mutually exclusiveFootnote ¹⁸. On the one hand, suffering has an objective, universal component (all human life includes some sort of suffering at some point in one’s existence), and this suffering will impede flourishing in some way or another—for example, by disrupting things like enjoyment, relationships, and work that are central parts of a flourishing life. On the other hand, this objectively bad and difficult situation also offers a particular way forward to that person toward her flourishing in and with her community.

Take, for instance, a cancer patient who loses their work to illness and who then finds new purpose in mentoring others in her profession. Their suffering remains a loss—there is no erasing it—but through communal bonds, it becomes bearable and even transformative.

Hope in suffering

The way forward is hopeFootnote ¹⁹ built through communal meaning-making. Crucially, it is the capacity to interpret one’s suffering and integrate it into a larger moral or narrative framework.Footnote ²⁰ Since this is often unavailable to the sufferer—especially when the sufferer is at his lowest point of anguish—it is the task of his community to build this meaning with him. This capacity for meaning-making may be completely absent in infants and those with severe disabilities and diminished levels of sentience.Footnote ²¹ It may also collapse under the weight of severe trauma or despair. In all of these cases, the task of meaning-making is primarily communal.Footnote ²² Others must carry the hope the sufferer cannot bear. This is not a call to romanticize suffering but to recognize that the way forward with suffering is not only—or primarily—relief (sometimes there is no way out or cure) but relationship: a shared construction of meaning that restores agency and dignity.Footnote ²³ So, for example, when a dementia patient can no longer recall their identity, their family’s stories, photographs, and songs become not just memory aids but acts of shared agency: a narrative scaffolding that holds the person in place when memory fails. Dignity is not restored by removing suffering, but by refusing to let it isolate the sufferer.

My working definition of suffering is then the following: Suffering is best understood as an impediment to human flourishing—in the Aristotelian sense—that arises from the absence of love or the violation of justice. Yet it is not only an obstacle; it is also an ethical summons: an invitation to communal meaning-making. While it obstructs the full realization of human potential and relational life, it also calls forth presence, attention, accompaniment, solidarity, and a deeper engagement with what it means to live well with and for others. This dual nature—as both disruption and summons—places suffering at the heart of ethical life.

Concluding remarks

If suffering is both a universal human reality and a deeply personal experience, then its ethical implications cannot be reduced to individual resilience or clinical intervention alone. It asks more of us: not merely to alleviate, but to accompany; not simply to manage, but to interpret.

A Personalist account foregrounds this ethical task: the communal responsibility to build meaning where meaning has been shattered and to sustain hope when the sufferer cannot do so alone.

Suffering is neither merely a biomedical event nor a private interior state. It is a shared moral space—a site of encounter where the sufferer and the community are bound in mutual responsibility. This space offers no consoling illusions, nor does it sentimentalize excruciating experience. Suffering is bad. But when reframed as a shared moral endeavor, the question becomes: What can we make of it together? And if there is no way out, how might we live through it—without abandoning each other to it?

From this vantage point, the Personalist account yields three central insights:

1. (i) Suffering and flourishing are not opposites. Though suffering impedes flourishing, it can deepen it—not despite pain, but through the moral clarity it demands.

2. (ii) Both are universal and objective. Suffering and flourishing are not confined to those with full sentience; they pertain to all human lives in their vulnerability and potential.

3. (iii) Both are personal and communal. Suffering is experienced individually, but it can never be addressed in isolation. Its response is necessarily relational—grounded in presence, responsibility, and meaning.

This final insight carries normative weight. Our response must not be procedural or atomized, but relational, embodied, and ethically attuned. The Personalist view reframes suffering not as a detour from moral life, but as its crucible—where dignity is affirmed, agency is shared, and community is enacted.

This is not a call to optimism, nor a denial of harm. It is a vision of grounded hope:Footnote ²⁴ one that is realistic in its view of pain, yet unwavering in its commitment to meaning. Even when suffering cannot be cured or understood, it can be accompanied—with presence, integrity, and a commitment to lives lived in relation and shared purpose.