Overcoming Cartesian Utilitarianism in Pain Medicine

Abstract: The opioid crisis, which derived in part from physicians’ overprescribing pain medications, points to the need for contemporary American medicine to reevaluate its approach to pain. In this presentation, I will argue that the primary historical-philosophical sources for the way physicians approach pain are Cartesian dualism and moral utilitarianism. First, although 20th-century pain science intended explicitly to repudiate Descartes, who hypothesized that all pain begins in peripheral nociceptors, it merely relocated pain to the brain from elsewhere in the body and posited mechanisms for it that, while more complicated, were no less mechanistic than Descartes’s own. As a result, pain science has difficulty accounting for the various individual and cultural meanings that pain can have and thus fails to understand how these interpretations influence the perception of pain. Second, physicians in the 19th century were influenced by the ambient utilitarianism of Western culture in that era, which reduced various kinds of negative experience to pain as the basis for a “scientific” morality. Consequently, physicians and others treated pain as a problem demanding not discernment but simply extirpation. I will explain how these ideas influenced policies and practices in the 20th century that contributed to the expansion of opioid prescriptions. I will then suggest how an alternative philosophical foundation in phenomenology, which rejects Cartesian dualism in favor of a more holistic conception of what it means to be human, may create possibilities for remedies beyond medications and procedures.