Ethicists frequently suppose that suffering has special moral significance. It is often claimed that a main goal of medicine—perhaps its primary goal—is the alleviation of human suffering. Following Eric Cassell and others, this essay considers suffering understood as the experience of distress—negative emotions—in response to threats to something that one cares about. It examines whether, on this value-based account of suffering, we should accept the claim that suffering has special moral significance. It argues that we should not: suffering does not add significantly to the value of other human interests and rarely changes our moral obligations itself; it merely seems to have strong moral relevance because it often attends to interests that matter. This is because negative emotions themselves have only limited moral significance, which is due to the fact that their primary mental role is to indicate to us the relative importance of non-emotional goods.

There is an ongoing debate in bioethics regarding the nature of suffering. This conversation revolves around the following question: What kind of thing, exactly, is suffering? Specifically, is suffering a subjective phenomenon—intrinsically linked to personhood, personal values, feelings, and lived experience—or an objective affair, amenable to impersonal criteria and existing as an independent feature of the natural world? Notably, the implications of this determination are politically and ethically significant. This essay attempts to bring clarity to the subjective versus objective debate in suffering scholarship by examining the history of the concept of “objectivity,” and putting that history in conversation with physician Eric Cassell’s famous theory of suffering. It concludes with a novel, albeit tentative, definition of suffering: suffering is the experience of a gap between how things are and how things ought to be.

Within bioethics, two issues dominate the discourse on suffering: its nature (who can suffer and how) and whether suffering is ever grounds for providing, withholding, or discontinuing interventions. The discussion has focused on the subjective experience of suffering in acute settings or persistent suffering that is the result of terminal, chronic illness. The bioethics literature on suffering, then, is silent about a crucial piece of the moral picture: agents’ intersubjectivity. This paper argues that an account of the intersubjective effects of suffering on caregivers could enrich theories of suffering in two ways: first, by clarifying the scope of suffering beyond the individual at the epicenter, i.e., by providing a fuller account of the effects of suffering (good or bad). Second, by drawing attention to how and why, in clinical contexts, the intersubjective dimensions of suffering are sometimes as important, if not more important, than whether an individual is suffering or not.

This essay argues that suffering in persons with dementia is more than a matter of personal experience. It is knowable by others and does not need to rely on the reports of the patient to affirm it. It is even possible for a person to claim not to be suffering—“I’m doing fine”—but for others to conclude to the contrary—“You are suffering.” A key property of this objective account is the caregiver observes the suffering. This observation is a product of the work of caregiving and this work relies on perceiving and supporting the mind of the person living with dementia. When that work of mind support is successful, it creates a feeling of being at home. When it is not, suffering ensues.

This essay argues that what distinguishes a negatively valenced phenomenal experience from suffering is an ability to make meaning of the experience. In this sense, intellectual ability influences the extent and nature of suffering. But this connection is not a straightforward one, since intellectual ability cuts both ways. On the one hand, those with higher levels of intellectual functioning are better able to make meaning of negative experiences, thereby reducing their suffering. On the other, intellectual ability can influence the depth and breadth of one’s negative experiences, thereby increasing suffering. This means that we cannot make any assumptions about a person’s susceptibility to suffering based on their level of intellectual functioning alone.

Research suggests that caregivers of patients with disorders of consciousness such as minimally conscious states (MCS) believe they suffer in some way. How so, if they cannot experience sensations or feelings? What is the nature of their suffering? This paper explores non-experiential suffering (NES). It argues that concerns about NES are really concerns about harms (e.g., dignity-based harms), but still face problems. Second, it addresses the moral importance of bearing witness to suffering. It explores several possible accounts: epistemic (bearing witness generates important knowledge), consequentialist (witnesses’ interests also matter), and deontological (there is a duty to bear witness). It argues that witnessing suffering creates epistemic advantages and disadvantages for determining a patient’s interests; that clinicians’ interests to not bear witness may have considerable moral weight; and that the obligation to bear witness to NES is unclear.

Increased interest in suffering has given rise to different accounts of what suffering is. This paper focuses the debate between experientialists and non-experientialists about suffering. The former hold that suffering is necessarily experiential—for instance, because it is necessarily unpleasant or painful; the latter deny this—for instance, because one can suffer when and because one’s objective properties are damaged, even if one does not experience this. After surveying how the two accounts fare on a range of issues, the paper presents a decisive argument in favor of experientialism. The central claim is that non-experientialist accounts cannot accommodate cases of suffering that are virtuous and that directly contribute to some objective good.

While the Big Bang was cooling and the laws of physics were congealing, authorities remained undecided whether God would provide comfort against the expanding darkness. To answer the question, one planet was seeded with humans equipped with conviction receptors tweaked either to an absolute faith in or complete denial of God. If, after a suitable period of mingling between the two groups, believers prevailed over doubters, God would be established in the firmament. If not, God would be scrapped.

Delisted in the building directory, my name stripped from my cramped quarters just off the corpus callosum, I am impossible to find. In petitioning for official reinstatement, I have agreed to the humiliating lab investigations required for documentation. I have waved, howled, screamed, pleaded, and moaned into the latest scanners, and generally made a fool of myself. But researchers, after extensive soul-searching, and being unable to capture me as pixels and waveforms, have moved on to greener pastures. So be it. I accept official non-existence.

Based on Nathan Goldstein’s case report, “But I have a pacer…there is no point in engaging in hypothetical scenarios”: A Non-imminently Dying Patient’s Request for Pacemaker Deactivation, it is reasonable to conclude that it was, all-things-considered, ethically appropriate to grant the patient’s request to deactivate her pacemaker. Philosophically, and as a clinical bioethicist, I support the team’s decision to honor the patient’s request for pacemaker deactivation. However, it is worth exploring a bit further whether the distress on the part of the outside hospital’s ethics committee and providers—who declined to honor the patient’s request for pacemaker deactivation—may actually track something of moral significance. Might their discomfort around deactivation be “truth-tracking” in moral terms?

Recent studies highlight the need for ethical and equitable digital health research that protects the rights and interests of racialized communities. We argue for practices in digital health that promote data self-determination for these communities, especially in data collection and management. We suggest that researchers partner with racialized communities to curate data that reflects their wellness understandings and health priorities, and respects their consent over data use for policy and other outcomes. These data governance approach honors and builds on Indigenous Data Sovereignty (IDS) decolonial scholarship by Indigenous and non-indigenous researchers and its adaptations to health research involving racialized communities from former European colonies in the global South. We discuss strategies to practice equity, diversity, inclusion, accessibility and decolonization (EDIAD) principles in digital health. We draw upon and adapt the concept of Precision Health Equity (PHE) to emphasize models of data sharing that are co-defined by racialized communities and researchers, and stress their shared governance and stewardship of data that is generated from digital health research. This paper contributes to an emerging research on equity issues in digital health and reducing health, institutional, and technological disparities. It also promotes the self-determination of racialized peoples through ethical data management.