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An intellectual history of suffering in the Encyclopedia of Bioethics, 1978–2014
  1. Charlotte Duffee
  1. University of Toronto Institute for the History and Philosophy of Science and Technology, Toronto, Ontario, Canada
  1. Correspondence to Mrs Charlotte Duffee, University of Toronto Institute for the History and Philosophy of Science and Technology, Toronto, ON M5S 1K7, Canada; charlotte.marcotte.toale{at}


Suffering is an important theme in many bioethical debates, yet little historical research is available to contextualise ideas about it. My article proposes a preliminary intellectual history of suffering in bioethics using the field’s most trusted tertiary work, the four editions of the Encyclopedia of Bioethics (1978–2004), later renamed Bioethics (2014). In the first edition, I find suffering roughly conceptualised as either the negation of a good or as a pain. The former acquired a technical connotation beginning in the second edition, when physician Eric Cassell refined the negative aspects of suffering into a full-fledged theory. Now, suffering no longer marked the loss of just any good but instead threatened one’s purpose in relation to that good. Cassell also strongly distinguished suffering from pain which, when combined with his theory of suffering, hardened earlier distinctions between pain and suffering that were present but weak in the first encyclopedia. Both Cassell’s theory and his strong distinction impacted how other contributors moralised suffering in the later encyclopedias, although his influence was not total: utilitarians continued to moralise suffering in ways that still roughly construed it as pain. Consequently, Cassell and the utilitarians conflicted conceptually. Nevertheless, this tension went unfelt in the encyclopedias for reasons I describe. I close by suggesting areas for further historical research and argue for their relevance to bioethical enquiries into suffering.

  • history
  • medical ethics/bioethics
  • end of life care
  • narrative medicine

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  • Contributors CD is the sole contributor to this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study.