Mr. Murphy, the 76-year-old patient with lung cancer, died about 1:45 pm in his room on a medical floor at Montrose Memorial Hospital. His wife of 51 years, Lynette, threw herself on her husband's chest, and shuddered, moaned, and wept. The nurse, entering the room, saw Lynette's suffering, and saw that her two daughters were holding each other, sobbing. "Would your mother like something to help her with her pain?" the nurse asked the eldest daughter. The daughter stared blankly at the nurse. Two minutes later the nurse returned with six physician-authorized tablets for the Murphys, along with the necessary forms regarding personal belongings and mortuary designation that would need the family's signatures.

This nurse is "medicalizing" the emotional pain of Mr. Murphy's family, treating their suffering with drugs and serving the interests of institutional efficiency. On the surface, the nurse seems to be providing good palliative care, managing the pain and symptoms of Mrs. Murphy and her daughters. In the current context of escalating demands for health-care providers to provide more pain and symptom control to suffering persons, however, this nurse's welding of compassion to the medical model shows the dark side of palliative care.

Palliation — the art and science of alleviating the suffering of the sick — is a central goal and duty of medicine. Medicine's primary mission is to cure the sick, and restore their abilities to function. When the disease or injury is incurable, medicine's sole mission is palliation: mitigating pain and suffering as much as possible.

The term "palliation" comes from the same root as "pallor" and "pallbearer," connoting the act of "covering over" or "making palatable" on the surface that which, beneath the surface, is beyond human control. The World Health Organization defines palliative care as "active, total care of patients whose disease is advanced, irreversible and non-responsive to curative treatment," and "the management of physical and emotional symptoms, as well as the provision of social and spiritual support for both patient and family during the course of progressive illness that is beyond the reach of cure."¹

Palliative care initiatives — supported by foundations, professional medical associations², and federal agencies — are proliferating in hospitals and health-care systems nationwide. The federal government is preparing to approve guidelines for Medicare to reimburse physicians and hospitals for palliative-care treatments. For terminally ill persons and the fragile elderly, the re-emergence of palliative care represents a viable alternative to the options of high-tech rescue medicine, and physician-assisted death. Palliative care has been neglected for too long.

Not all pain is physical, nor is it confined to the sick. For family members and professional caregivers, the universal human experience of pain and suffering associated with significant loss — especially when patients die — is more of the soul than the body. Alleviating this suffering calls for something more than "covering over" or enshrouding the pain, and eliminating grief's symptoms. Grief is not a sickness to be "fixed," but a healing process to be acknowledged and nurtured.

Modern hospitals, employing scientific medicine and institutional efficiency, often view grief as a threat and disruption. When other forms of eliminating expressions of grief fail, tranquilizers and sedatives are frequently employed as a way of maintaining order and control. The pain of loss is quickly covered over, the symptoms reduced and eliminated. This type of palliation is inappropriate.

Sufferings of the soul cannot be addressed nor ameliorated by chemicals and distractions. In fact, mourning is the beginning of an inner restorative and healing process. Instead of using more appropriate curative or therapeutic measures, attempts to palliate inner suffering can actually disconnect the sufferer from pain and from the healing process of grief.

Dosing grieving family members with tranquilizers numbs their perceptions, and postpones pain and grief. This type of palliation may even intensify the grieving process by delaying it to a time when family and friends may no longer be available for support. In this way, the "successful" palliation of patients' and families' can amount to inflicting unnecessary pain upon them, which violates the ethical duty to prevent or minimize unnecessary harm.³

Religion, like medicine, embodies a deeply human drive to wholeness, which pain and suffering fragment or diminish. All religions provide a wealth of resources (wise counsel, stories, rituals) to endure suffering. For instance, the "noble truths" at the foundation of Buddhism acknowledge: (1) Existence is pain. (2) The cause of pain is attachment to that which passes. (3) Release from pain consists in detachment. (4) The middle way between the extremes of self-indulgence and self-denial is the path to bliss.

Similarly, the central symbol of Christianity — the death and resurrection of Jesus — clearly presents an image of spiritual well-being that acknowledges the universality and centrality of suffering. In many religious traditions, the potential for expanded self-understanding, deepened relations with others, and even intimacy with God are all affirmed as possible with suffering.

The great world religions emphasize that compassion helps cure the suffering soul. Compassion or "suffering with" is fundamentally different from palliation. Instead of covering up symptoms, compassion seeks connection with the sufferer, without seeking to negate the suffering. Compassion aids in the genuine healing that comes from grieving and mourning. Palliation is a caring, appropriate response to the suffering of the sick. Compassion is a caring, appropriate response to the emotional and spiritual suffering of persons that accompanies human experiences of significant loss.

Faith-based hospitals, medical centers, and health-care systems embody both medicine's commitment to palliation, and religion's support of the natural healing process of grieving. That means accepting its expressions — beginning with tears. Crying is the body's most effective means of excreting toxic chemicals and alleviating the emotional tension and pain accompanying such loss. Tissues, not tranquilizers, fulfill the ethical obligation of health-care professionals to alleviate suffering. Making room for crying and other forms of grieving behavior (e.g., compassionate listening, assistance with practical needs, arranging space for families to be with one another) assist the healing process. In a word, pastoral care, not palliative prescription, is the best medicine for the pains of the soul.

Health-care professionals who attend churches, mosques or synagogues might well experience dissonance at work if they succumb to institutional pressures to tranquilize patients' and families' experiences of loss. The wisdom of their religious traditions (e.g., "Happy are those who mourn, for they shall find comfort"—Matt. 5:4) is at odds with our widespread current scientific-medical ethos. A hospital, medical center or health-care system interested in keeping palliation in its place will sustain a vigorous and present pastoral care team, whose staff bring the compassion that heals to those experiencing loss.

If Mr. Murphy's nurse is too uncomfortable or too busy to sit with his wife and daughters, to accept their tears and listen to their stories and give them tissues and time, she should ask pastoral care staff to offer this kind of support to them. Time, validation, and compassion, not palliation in service of a quick fix, help suffering souls begin their healing.