Suffering

Cicely Saunders has proposed four components of suffering and it’s only been in the last three or four years that good empirical data supports this ontology.

Components of Suffering	Patient Example
Physical	Mr. Benton had terrible nausea, vomiting, and severe abdominal pain. He was diagnosed with proximal bowel obstruction secondary to intra-abdominal metastases.
Emotional	He had been a very aggressive executive, he had just left his career and retired, he had recently remarried, he had bought a large farm in rural Wisconsin, and he was planning to settle down into retirement with his new wife. He was involved in an intense custody battle for his children from his previous marriage, and he wanted to see that resolved. All the pain medication in the world had nothing to do with the emotional dimension of his suffering.
Social / Practical	He lived in rural Wisconsin, yet he was in downtown Chicago for his health care because that was where he got his oncological care, as he wanted the “best possible care” in a tertiary care hospital.
Spiritual	He had been aggressive all his life and now he was ill in bed. One of the main issues for this high functioning and successful man is that he had lost his sense of meaning. If his whole life was about doing, and he couldn’t do anymore, he either wanted to be restored to doing, or he wanted the physician to help him “die right away”.
Sources: Saunders C. The evolution of palliative care. Patient Educ Couns 2000 Aug 1;41(1):7-13. Also published in: Saunders C. The evolution of palliative care. J R Soc Med 2001 Sep;94(9):430-2 Saunders C. A personal therapeutic journey. BMJ 1996 Dec 21-28;313(7072):1599-601

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