TO THE EDITOR: Quill and Byock’s paper (1) is a significant contribution to the end-of-life care discussion. However, I continue to question the use of the phrase terminal sedation by the medical profession, particularly in light of Quill and Byock’s paper favoring this treatment. Whether used to describe the purposeful administration of sedation under the clinical guidelines summarized in this...

In the twentieth century the knowledge regarding pain, especially at the neurophysiological level, and in particular neuropathic pain, has increased. But more knowledge and analgesic medication devalued the doctor-patient relationship, sometimes ignoring the complexity of human suffering, far beyond pain. This is associated with a huge investment in biochemical research at the expense of traini...

Erick Turner Emma Veitch cites my PLoS Medicine Essay [1] about how the Food and Drug Administration’s (FDA’s) review of documents can serve as a source of clinical trials data, but she follows it up with the statement, “However, it is diffi cult to have confi dence in data released by sponsors when the data have not been subjected to external, independent peer review. Furthermore, this informa...

The suffering caused by infertility in a man can have multiple aspects. It can display a narcissistic dimension, an objectal dimension (object-libido) turned toward others or/and an identity dimension. Two clinical case reports were used here to (i) illustrate all these aspects of infertility suffering, (ii) to evidence the difficulty for infertile men to speak about their infertility and (iii)...

2. J. Kilner, R. Orr, J.A. Shelly (eds.), The Changing Face of Health Care (Grand Rapids: Eerdmans/London: Paternoster, 1998). 3. N.P. Wolterstorff, 'The Role of Religion in Decision and Discussion of Political Issues', in: R. Audi and N.P. Wolterstorff, Religion in the Public Square (Lanham: Rowman & Littlefield, 1997), 67-120. 4. J.A. Shelly, 'Working Toward Shalom: The Core of Nursing Practi...

All animals face hazards that cause tissue damage and most have nociceptive reflex responses that protect them from such damage. However, some taxa have also evolved the capacity for pain experience, presumably to enhance long-term protection through behavior modification based on memory of the unpleasant nature of pain. In this article I review various criteria that might distinguish nocicepti...

Advanced and progressive illnesses bring existential suffering to patients as an inevitable consequence of the disease and its treatment. Physicians need a typology of existential distress to aid its recognition and improved management. The major forms of existential challenge include (1) death anxiety, (2) loss and change, (3) freedom with choice or loss of control, (4) dignity of the self, (5...