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Examining the Link Between Physical Pain and Requests for Hastened Death: Different Results or Different Values?
Stephen J. Ziegler, JD, MA
Nicholas P. Lovrich, Jr., PhD
Washington State University
July 2, 2002

What connection is there between having to endure prolonged physical pain and a patient's request for a hastened death? For the past several years, advocacy groups have taken opposite views about whether a link exists between physical pain and a terminally ill patient's request for a hastened death. Some groups argue that it is not pain itself, but rather the state of depression brought on by pain that leads some terminally ill persons to seek a hastened death. Advocates for the aggressive management of pain and the provision of choice to terminally ill persons often argue that intractable pain is indeed the principal reason that dying patients seek to end their lives. They argue further that, in light of our respect for patient autonomy, a terminally ill patient should be permitted to end a painful existence and to determine the timing and manner of their own death. Whereas it should come as no surprise that rival advocacy groups and politicians might take opposing views on this issue, why is it that scientists are not of one mind on the link between physical pain and requests for hastened death? The answer to that question lies within the nature of the controversy, and reflects the inherent limitations of science.

Without a doubt, the topic of hastened death in our religiously, racially, and ethnically heterogeneous society has and will remain controversial. As with abortion, the topic of hastened death goes to the very core of our values concerning personal liberty and the role of the government in a free society. When these issues enter the public arena they become characterized as "morality politics," an area of public affairs where the issues become highly salient and the battle over competing values become a "zero-sum game" with little room for compromise among the participants. However, whereas we would expect advocacy groups and grand-standing politicians to frame the issue in terms most beneficial to their own respective agendas by arguing that pain either does or does not play a role in a patient's request for suicide, why do some scientists disagree on whether such a link is present? Two principal reasons come to mind; first, studying human behavior is an extremely complex undertaking, and secondly it is the case that at times our values may contaminate our work even when we are engaged in the pursuit of scientific truth.

The purpose of science is to improve people's lives, and scientists, whether trained in the natural or social sciences, seek to systematically understand the world in which we live. To accomplish this form of understanding we typically make an educated guess about a relationship based on relevant theory and whatever prior research may exist, we design a study, and most importantly, we strive mightily to eliminate error in our information gathering and in our analysis of evidence. However, whereas sources of potential error can be controlled to a substantial degree under laboratory conditions, placing controls on humans living in free societies is strongly frowned upon (and rightfully so). Nevertheless, scientists studying human behavior strive to at least reduce error as much as possible in their scientific work. Error can come in many forms, and when humans conduct research on other humans error can stem from patient variation as well as from the researcher induced influences. After all, scientists, as with their subjects under study, are human and fallible - and at times they may unconsciously permit their personal values to influence their research.

For instance, researchers trained in psychiatry tend to find that depression is the primary reason why the terminally ill seek to hasten their own death, while social psychologists and sociologists are inclined to argue that family isolation is the true reason for such death ending wishes. But aside from their disciplinary training bias, we also suspect that something more than just their training influences the results of a scientist's work. Specifically, there have been times where we knew the results of a particular study by merely noting who the author was. Consequently, it seems apparent that on some occasions a scientist's own values had played a key role in characterizing the meaning of scientific research being reported - particularly with respect to work reported on a topic as controversial as hastened death.

Now, we do not imply that any of our colleagues in the scientific community intentionally found a particular favored result consistent with their values and argued in support of it; that behavior would constitute advocacy, not science. In point of fact scientists, by dint of their training and professional socialization, fully realize that they must control for multiple sources of error in their work - including errors stemming from personal bias or value preferences., We ourselves are not immune from such error. However, because the goal of science is to improve people's lives, it is likely that our own humanness sometimes gets in the way of our own objective assessment of evidence.

So, are any of the studies available on this controversial topic reliable? Yes, in fact we would go so far as to say that all of them published in peer-reviewed journals are reliable - as reliable as humanly possible. Consequently, when one empirical study finds that there is a link between pain and a desire for a hastened death and another does not, chances are the variation is due to both the inherent variation of the humans under study and, to a lesser degree, due to the frailties of the humans conducting the study. Accordingly, it remains essential that all such research must be viewed with an attentive and critical eye because evaluating, critiquing and replicating published research is the way science advances. In the end, it may be best to assume that there is a link between physical pain and requests for hastened death. After all, if such a link does obtain, could anyone think of a better reason to eliminate the barriers to pain relief in our society?

Stephen Ziegler is a PhD candidate and Nicholas Lovrich is the Claudius O. and Mary W. Johnson Distinguished Professor of Political Science and director of the Division of Governmental Studies and Services at Washington State University in Pullman. They are both Mayday Scholars with the American Society of Law, Medicine and Ethics (ASLME). For information about ASLME pain policy projects, go to ASLME.