Author

Keri Oxley

Date of Award

January 2011

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Robert J. Levine

Subject Area(s)

Medicine, Philosophy, Philosophy of science

Abstract

From antiquity, one of the primary goals of medicine has been the alleviation of patients' suffering. Despite remarkable advances in modern science and technology, patients continue to experience suffering, which is frequently unnoticed and unaddressed by physicians.

Phenomenology incorporates an understanding of illness-as-lived, which provides the physician with a view more expansive than the purely biomedical model of disease. There exists a decisive gap between the way a physician thinks about disease and the way illness is experienced by the patient. As a result, there is a separation between the "lifeworlds" of the physician and patient. A fuller description of suffering in illness offers the physician an expanded paradigm of illness to enable her to narrow the gap between her own lifeworld and that of the patient. This thesis employs a clinically based phenomenological approach, observing the phenomena of disease and illness as they are encountered in the clinical setting, the nucleus of which is the doctor-patient relationship.

Suffering is certainly something that should be eliminated by all reasonable means and costs. It is also clear, however, that sometimes suffering is unavoidable in the patient's experience of illness. We hold these two truths in tension. On the one hand, it is a duty for physicians to try to alleviate unnecessary suffering. But what about inescapable suffering, particularly in cases of chronic and terminal illness?

Viktor Frankl notes that meaning can be a powerful avenue to the elevation of the human person in moments of unavoidable suffering. This thesis proposes that suffering can be transfigured by way of meaning and that physicians can play a powerful role toward this end. The will to meaning is a means to gains such as love, self-transcendence, achievement of a good, and the dignity of the person amid the losses experienced in suffering. This work offers a novel contribution to the medical literature by demonstrating that unavoidable suffering potentially can be transformed into a positive experience and that the doctor-patient encounter can be instrumental in this pursuit.

Rather than waiting for systemic changes in health care or medical education, this thesis argues that physicians can be instrumental in the alleviation and transformation of suffering simply by adopting phenomenological personalism in the practice of medicine. Premised on a heightened attentiveness to the patient's lifeworld, phenomenological personalism serves as a catalyst for the patient's discovery of meaning in unavoidable suffering. This approach does not exclude the biomedical model, but rather expands the lifeworld of the physician so that she is able to acknowledge and address the uniqueness of the patient's experience of suffering in illness. Thus, in moments of unavoidable suffering, a personal tragedy is transfigured into a human triumph.

Comments

This is an Open Access Thesis.

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