This essay argues that what distinguishes a negatively valenced phenomenal experience from suffering is an ability to make meaning of the experience. In this sense, intellectual ability influences the extent and nature of suffering. But this connection is not a straightforward one, since intellectual ability cuts both ways. On the one hand, those with higher levels of intellectual functioning are better able to make meaning of negative experiences, thereby reducing their suffering. On the other, intellectual ability can influence the depth and breadth of one’s negative experiences, thereby increasing suffering. This means that we cannot make any assumptions about a person’s susceptibility to suffering based on their level of intellectual functioning alone.

This essay argues that suffering in persons with dementia is more than a matter of personal experience. It is knowable by others and does not need to rely on the reports of the patient to affirm it. It is even possible for a person to claim not to be suffering—“I’m doing fine”—but for others to conclude to the contrary—“You are suffering.” A key property of this objective account is the caregiver observes the suffering. This observation is a product of the work of caregiving and this work relies on perceiving and supporting the mind of the person living with dementia. When that work of mind support is successful, it creates a feeling of being at home. When it is not, suffering ensues.

Consider a simple argument that worshipping God is wrong. This world is not a nice place. Not only do humans persecute and inflict other evils on each other, but millions of people suffer and die every year from preventable poverty-related causes, and it seems that few, if any, deserve their plights. It is unclear that we should want to be associated with, never mind worship, a being with the capacity to make the world a much better place but whose beneficence (or knowledge) permits things to go on in the ways that they do. At first blush, contempt is a more fitting response to God than worship. But, assuming God exists, perhaps we have reason to accept, if not worship, him in any case. Humans are comparably limited. We do evil unto each other, and, insofar as millions of deaths are preventable, our failure to prevent them is a failure of humans as well as of God. If we could (and should) have saved many lives and have not, our moral failings present us with our own, human, problem of evil and suffering. So, if we should reject God because so many people suffer, then we should reject ourselves when we could avoid evil and help others too. However, this article argues that we have practical, moral, and epistemic reasons to accept rather than reject ourselves, and similarly we have reasons to accept God. And if we have reason to accept God, then we have some reason to worship God. Worship is a way of acknowledging our own limitations and can help us survive, flourish, and help others in the face of the problems of human evil and suffering.

Within bioethics, two issues dominate the discourse on suffering: its nature (who can suffer and how) and whether suffering is ever grounds for providing, withholding, or discontinuing interventions. The discussion has focused on the subjective experience of suffering in acute settings or persistent suffering that is the result of terminal, chronic illness. The bioethics literature on suffering, then, is silent about a crucial piece of the moral picture: agents’ intersubjectivity. This paper argues that an account of the intersubjective effects of suffering on caregivers could enrich theories of suffering in two ways: first, by clarifying the scope of suffering beyond the individual at the epicenter, i.e., by providing a fuller account of the effects of suffering (good or bad). Second, by drawing attention to how and why, in clinical contexts, the intersubjective dimensions of suffering are sometimes as important, if not more important, than whether an individual is suffering or not.

Increased interest in suffering has given rise to different accounts of what suffering is. This paper focuses the debate between experientialists and non-experientialists about suffering. The former hold that suffering is necessarily experiential—for instance, because it is necessarily unpleasant or painful; the latter deny this—for instance, because one can suffer when and because one’s objective properties are damaged, even if one does not experience this. After surveying how the two accounts fare on a range of issues, the paper presents a decisive argument in favor of experientialism. The central claim is that non-experientialist accounts cannot accommodate cases of suffering that are virtuous and that directly contribute to some objective good.

There is an ongoing debate in bioethics regarding the nature of suffering. This conversation revolves around the following question: What kind of thing, exactly, is suffering? Specifically, is suffering a subjective phenomenon—intrinsically linked to personhood, personal values, feelings, and lived experience—or an objective affair, amenable to impersonal criteria and existing as an independent feature of the natural world? Notably, the implications of this determination are politically and ethically significant. This essay attempts to bring clarity to the subjective versus objective debate in suffering scholarship by examining the history of the concept of “objectivity,” and putting that history in conversation with physician Eric Cassell’s famous theory of suffering. It concludes with a novel, albeit tentative, definition of suffering: suffering is the experience of a gap between how things are and how things ought to be.

Ethicists frequently suppose that suffering has special moral significance. It is often claimed that a main goal of medicine—perhaps its primary goal—is the alleviation of human suffering. Following Eric Cassell and others, this essay considers suffering understood as the experience of distress—negative emotions—in response to threats to something that one cares about. It examines whether, on this value-based account of suffering, we should accept the claim that suffering has special moral significance. It argues that we should not: suffering does not add significantly to the value of other human interests and rarely changes our moral obligations itself; it merely seems to have strong moral relevance because it often attends to interests that matter. This is because negative emotions themselves have only limited moral significance, which is due to the fact that their primary mental role is to indicate to us the relative importance of non-emotional goods.

This article explores Eric Mascall’s contribution to theodicy and (possibly) providence. It offers a taxonomy of Christian responses to the problem of evil: those which see suffering as instrumental to the purposes of God, those which see suffering as inevitable within the purposes of God, and those which see suffering as inimical to the purposes of God. It offers a critique of all three families of such responses. It then locates Mascall’s theodicy on that ‘map’. It argues that Mascall’s proposal, if accepted, removes the main argument against the inimical family of responses, which it sees as fitting best with the healing ministry of Jesus, as being most unambiguously committed to the goodness of God, and as being the most pastorally sensitive of the three categories. It also raises, without advocating, the possibility that all divine action may be indirect, thus safeguarding the non-coerciveness of God without compromising eschatological hope.

According to the Bayesian brain hypothesis, the brain can be viewed as a predictive machine, such that predictions (or expectations) affect how sensory inputs are integrated. This means that in many cases, affective responses may depend more on the subject’s perception of the experience (driven by expectations built on past experiences) rather than on the situation itself. Little research to date has applied this concept to affective states in animals. The aim of this paper is to explore how the Bayesian brain hypothesis can be used to understand the affective experiences of animals and to develop a basis for novel predictions regarding animal welfare. Drawing from the literature illustrating how predictive processes are important to human well-being, and are often impaired in affective disorders, we explore whether the Bayesian brain theories may help understanding animals’ affective responses and whether deficits in predictive processes may lead to previously unconsidered welfare consequences. We conclude that considering animals as predictive entities can improve our understanding of their affective responses, with implications for basic research and for how to provide animals a better life.

In Canada, there is interest in expanding medical assistance in dying (MAID) to include advance requests (AR) for people living with dementia (PLWD). However, operationalizing the intolerable suffering criterion for MAID in ARs for PLWD is complicated by the Canadian legal context—in which MAID is understood as a medical intervention and suffering is conceptualized as subjective—and the degenerative nature of dementia. ARs that express a wish to receive MAID when the PLWD develops pre-specified impairments are problematic because people are unlikely to accurately predict the conditions that will cause intolerable suffering. ARs that express a wish to receive MAID when the PLWD exhibits pre-specified behaviors that likely represent suffering are problematic because they are inconsistent with the subjective conceptualization of suffering. Further research is required to determine whether adopting an objective conceptualization of suffering is justified in these cases and, if so, how to reliably identify intolerable suffering in PLWD.