Chapter 9 Pain and Ethics

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subjective, unique to each perceiver. After all, it is notorious that I can’t know what you perceive. You may not see red as I do, or hear sounds as I do. How then, do we ever get to an "objective" world by summing a whole bunch of inherently subjective perceptions and experiences?”

This, of course, is an argument for solipsism that few if any scientists worry about when they attempt to explain the nature and causes of disease, earthquakes, atomic and subatomic phenomena, mind, and so forth. Why don’t they worry about it? Because both of the concerns detailed above are, like the existence of God or of an immaterial soul, ultimately metaphysical hypotheses, which gathering data or doing experiments can never refute or confirm, and scientific activity is archetypically tethered, however indirectly, to what can be confirmed by observation and experiment.

Why go off on this tangent? Very simply, because the thesis that only linguistic beings can feel pain or be aware of pain or give us evidence that they have pain is precisely such a metaphysical thesis as well, to which no amount of data is ultimately relevant.

We all recognize that when we judge that another person feels pain, we are making a fallible claim. The person (i.e., the linguistic being) may be malingering, faking, or acting. So we seek other evidence: signs of injury; knowledge that the injury or condition in question produces pain generally; we check our ability to lessen the pain with anesthetics or analgesics; we look for involuntary moans and groans that the person may emit when fully or partially asleep; and so on. Like all empirical claims, judgments that someone is in pain are in principle falsifiable. The presence of language is certainly not definitive, as language can be used to mislead and befuddle, as well as to inform. In practicing science or medicine, we go with the weight of evidence: the presence of inflammation, guarding of a limb, change in pallor, reluctance to eat, and so forth. No scientist of any credibility would affirm that he or she is withholding judgment that another person feels pain in such circumstances just because the scientist cannot, in principle, feel the same feeling the other person experiences, or perhaps does not at all. In good scientific fashion, one goes with the weight of evidence, not with skepticism based in untestable metaphysical possibilities. Doing the latter would be exactly like a scientist rejecting another scientist’s experimental data solely on the grounds of the metaphysical claim that he or she cannot be sure that the other person perceives at all, or perceives as we do because we cannot experience their perception.

If science proceeds, then, by weight of empirical evidence in general and in the attribution of felt pain in particular, and does not allow theses based in metaphysical possibilities of solipsism (lack of absolute certainty that anyone else perceives as I do, etc.), then it is equally a major logical error to deny felt pain to nonlinguistic beings a priori, regardless of what physiological, behavioral, factual, or theoretical evidence exists to vouch for such felt pain!

Certainly, that evidence is abundant in our experience with animals, so much so that ordinary experience, common sense, and language do not infer (or reason) that an animal is in pain, but perceive it immediately. If a dog is run over by a car, is not unconscious, has a compound fracture jutting out of his skin and a crushed limb, is howling and whining and shivering, we automatically assume he is in pain. If someone asks, “But how do you know?”, we assume that he is either demented or making a bad joke.

No one knows better than pain scientists that this powerful, unshakeable, common sense response is strongly buttressed by myriad scientific evidence such as the following: that animal pain physiology and neuro-anatomy is essentially the same as human well down the phylogenetic level; that pain biochemistry – including the emergence of endogenous opiates after trauma and the presence of such chemicals as bradykinin and substance P in painful areas – is similarly phylogenetically continuous; that pain behavior and signs of pain, while certainly different in some marked ways across species, is no more different than it is across human cultures and subcultures, and is very similar in many ways (punch a Doberman pinscher, a tiger, a buffalo, a shark, and a gangbanger in the mouth and see the reaction, if you still doubt me; recall the guarding of limbs across species, etc.); that Darwinian evolutionary continuity makes the emergence of felt pain in humans alone highly suspect, especially given the above-mentioned similarities; that if animals did not feel pain, they could not serve as pain models for humans in pain and analgesia studies; that anesthetics and analgesics seem to have the same beneficial effects on animals as in humans, from quieting signs of suffering to accelerating healing; that preemptive analgesia works the same in humans and (at least) in mammals.

Indeed, let us recall that one eminent pain physiologist, the late Dr. Ralph Kitchell, co-editor of the American Physiological Society symposium volume on animal pain, has argued for the possibility that animals in general, feel pain more acutely than humans. According to Kitchell, response to pain is divided into a sensory-discriminative dimension and a motivational-affective dimension. The former is concerned with locating and understanding the source of pain, its intensity, and the danger with which it is correlated; the latter with escaping from the painful stimulus. Kitchell speculates that since animals are more limited than humans in the first dimension, since they lack human intellectual abilities, it is plausible to think that the second dimension is correlatively stronger, as a compensatory mechanism. In short, since animals cannot deal intellectually with danger and injury as we do, their motivation to flee must be correlatively stronger than ours –in a word, they probably hurt more.

There is no question in my mind that what we call language is unique to humans, and, very speculatively, something approximating language to a few other species, perhaps great apes and dolphins. That does not mean, however, as Descartes and our current Cartesians conclude, that language is the only sure way we can know that a being is in pain, fear, anxiety, distress, joy, sexual excitement, and other fundamental and basic modes of awareness. I have argued elsewhere against the traditional belief that there is a clear and unbridgeable gulf between the sort of meaning we find in natural signs (e.g., clouds mean rain or smoke means fire) and the sort of meaning we find in conventional (or man-made) signs, such as the word “cloud” in English means,…“visible condensed water droplets.” As philosopher George Berkeley affirmed, nature is full of meaning, and science can be viewed as, in his metaphor, learning to read the language of nature. Animals, although presumably lacking language, find meaning in the world (e.g., a scent meaning prey) and also impart meaning to other animals and humans (e.g., threats).

It is possible to suggest that a being with language can communicate better about the nature of pain than one lacking language, but even if this is true, that does not mean that one cannot communicate the presence and intensity of pain without language, by natural signs. Recall that language does not help us much in describing our pain to others; verbal reports are notoriously unreliable. Recall too that in addition to helping us communicate, language helps us prevaricate and conceal. The posture and whimpering of an injured animal or the groans of an injured person are, in my mind, far more reliable indicators of the presence and intensity of pain than are mere verbal reports. Let us further recall that the natural signs we share with animals are far more eloquent and persuasive signs of primordial states of consciousness like love, lust, fear, and pain then is Shakespearean English – words fail in the most fundamental and critical areas (as when a physician asks you to describe your pain).

It has sometimes been suggested that the possession of linguistic concepts is related to pain in the following way: Only a being with language, and the temporal concepts provided by language, can project ahead into the future or backwards into the past. Much of our pain is associated with such projection – the pain of a visit to the dentist is surely intensified by the magnified recollections of previous pain, filtered through imaginative anticipations of horrific future scenarios informed by having seen the movie Marathon Man, wherein one’s dentist turns out to be (literally) a Nazi war criminal. In the absence of concepts of past and future, animals cannot recollect or anticipate, being, as it were, stuck in the now. Thus, the claim is that their pain is considerably more trivial than ours.

Aside from the obvious objections – if animals have no access to the past, how can they learn (which they clearly do); if animals have no concept of the future, how can a dog beg for food or a cat wait patiently for a mouse (which they clearly do) – there is a much more profound issue raised by this argument. If animals are indeed inexorably locked into what is happening in the here and now, as the above argument suggests, we are all the more obliged to try to relieve their suffering, because they themselves cannot look forward to or anticipate its cessation, or even remember, however dimly, its absence. If they are in pain, their whole universe is pain; there is no horizon; they are their pain. So, if this argument is indeed correct, then animal pain is terrible to contemplate, for the dark universe of animals logically cannot tolerate any glimmer of hope within its borders.

In less dramatic and more philosophical terms, Spinoza pointed out that understanding the cause of an unpleasant sensation diminished its severity, and that, by the same token, not understanding its cause can increase its severity. Common sense readily supports this conjecture; indeed, this is something we have all experienced with lumps, bumps, headaches, and most famously, suspected heart attacks which turn out to be gas pains.

Spinoza’s conjecture is thus borne out by common experience and by more formal research. But this would be reason to believe that animals, especially laboratory animals, suffer more severely than humans, since they have no grasp of the cause of their pain, and thus, even if they can anticipate some things, have no ability to anticipate the cessation of pain experiences outside their normal experience.

We further know that humans who cannot feel pain, even though they have the full nociceptive machinery, do not fare well as far as survival is concerned. Whether the inability to feel pain is a genetic anomaly or a result of diseases like Hansen’s disease or diabetes, such human lose limbs, contract infection, and have truncated lives. Is it really plausible to suggest that all animals without language are permanently in that state? And if they are, how do they thrive?

One final argument against making the possession of language a necessary condition for feeling pain: Philosopher Thomas Reid pointed out, quite reasonably, that since babies are not born linguistic beings, they must acquire it. Even if Chomsky is correct that the skeleton for language is innate, it must still be actualized by experience of some language. This in turn entails that people must be capable of experience before they have language, else they could not learn it (or actualize their innate capacity for it). But if nonlinguistic (or prelinguistic) experience is possible, surely one of the most plausible candidates for such experience is pain, first of all because it is so essential to survival, and secondly, because we have so much evidence (discussed earlier) that nonlinguistic beings in fact experience pain!

For all of these reasons, then, including linguistic ability in the requirements for feeling pain or attributing pain to another represents a combination of bad science and bad philosophy.

I went on to argue that this definition leads to bad ethics among scientists in ignoring treatment of pain in non-linguistic beings, and also a bad picture of science to society, something very undesirable at a historical moment wherein society has lost the old utopian confidence in science and scientists. Presumably, some sense of the moral/political climate drove IASP to modify this definition in 2001 in a minimalistic way. In a note, the definition now affirms that:

The inability to communicate verbally does not negate the possibility [emphasis mine] that an individual is experiencing pain and is in need of appropriate pain-relieving treatment.
This sounds far more like a concession to political reality than the embracing of a major conceptual upheaval.

In any event, the attitude exhibited in the IASP definition is perfectly consonant with what we have documented about human pain and, given the situation with human pain, the reader can guess how cavalierly animal pain was treated.

Indeed, for younger people trained before the late 1980s, it is difficult to fathom the degree to which the denial of consciousness, particularly animal consciousness and particularly pain, was ubiquitous in science. In 1973, the first U.S. textbook of veterinary anesthesia was published, Lumb and Jones. Although the book gave numerous reasons for anesthesia (to keep the animal from hurting you; to keep it from injuring itself; to allow you to position the limbs for surgery) the control of felt pain was never even mentioned. When I went before Congress in 1982 to defend our laboratory animal legislation, I was advised to demonstrate that such laws were needed. To accomplish this goal, I did a literature search on laboratory animal analgesia and, mirabile dictu, found only one or two references, one of which argued that there should be such knowledge!

In 1983, the crescendo of concern among the public about animal pain was so great that the scientific community felt compelled to reassure the public that animal pain was indeed an object of study and concern, so they orchestrated a conference on pain and later published a volume entitled Animal Pain: Perception and Alleviation. Despite the putative purpose of the volume, virtually none of the book was devoted to perception or alleviation of felt pain. As a result of scientific ideology, pain was confused with nociception, so that the volume focused on the neurophysiology and electrochemistry of pain, what I at the time called the “plumbing of pain”, rather than the morally relevant component of pain, namely that it hurts.

Most surprising to members of the general public is the fact that veterinarians were as ignorant and skeptical about animal consciousness, even animal pain, as any scientist. To this day, and certainly in the 1980s, veterinarians called anesthesia “chemical restraint” or “sedation” and performed many procedures, e.g., horse castration, using physical restraint, what was jocularly called “bruticaine,” or using paralytic drugs like succinylcholine chloride, which is a curariform drug inducing flaccid paralysis, not anesthesia. Indeed, one veterinary surgeon told me that, until he taught with me, it never dawned on him that the horse being castrated under succinyl hurt!

This sort of absurdity also occurred in physiological psychology. I have already mentioned the psychological community’s rejection of animal consciousness. Yet the same community regularly performed stereotaxic brain surgery and brain stimulation using succinylcholine without anesthesia, because the psychologists wanted the animals “conscious.”

That ideology could trump logic and even reason was manifest in this area. In the late 1970s, I debated a prominent pain physiologist. His talk expounded the thesis that since the electro-chemical activity in the cerebral cortex of the dog (his research model for studying pain) was different from such activity in the human, and since the cortex was the seat of processing information, the dog did not (really) feel pain the way humans did. His talk took an hour, and I was expected to rebut his argument. My rebuttal was the shortest public statement I ever made. I said, “As a prominent pain physiologist, you do your work on dogs. You extrapolate the results to people, correct?” “Yes,” he said. “Excellent”, I said. “Then either your speech is false or your life’s work is!”

In a similar vein, I experienced the following incident. In the mid 1980s, I was having dinner with a group of senior veterinary scientists, and the conversation turned to the subject of this chapter; namely, scientific ideology’s disavowal of our ability to talk meaningfully about animal consciousness, thought, and awareness. One man, a famous dairy scientist, became quite heated. “It’s absurd to deny animal consciousness,” he exclaimed loudly. “My dog thinks, makes decisions and plans, etc., etc.,” all of which he proceeded to exemplify with the kind of anecdotes we all invoke in such common-sense discussions. When he finally stopped, I turned to him and asked. “How about your dairy cows?” “Beg pardon?” he said. “Your dairy cows,” I repeated; “do they have conscious awareness and thought?” “Of course not,” he snapped, then proceeded to redden as he realized the clash between ideology and common sense, and what a strange universe this would be if the only conscious beings were humans and dogs, perhaps humans and his dog.

A colleague of mine, who was doing her PhD in the mid-1980s in anesthesiology, was studying anesthesia in horses. The project involved subjecting the animal to painful stimuli and seeing which drugs best controlled the pain response. When she wrote up her results, her committee did not allow her to say that she “hurt” the animals, nor could she say that the drugs controlled the pain – that was ideologically forbidden. She was compelled to say that she subjected them to a stimulus and to describe how the drugs changed the response.

There were many rationalizations ingrained in researchers and veterinarians buttressing the formidable ideological denial of pain in animals. For example, it was dogma among surgeons that the post-surgical whimpering, shivering, crying that I saw as indicative of pain in post-surgical animals was not pain at all, but after-effects of anesthesia as mentioned earlier. When pressing for analgesia, I was told that the pain was necessary to keep animals still after surgery or injury. In actual fact of course, animals are smart enough to avoid exertion when sick or injured. It is humans who keep working or playing. Furthermore, as we know from our own experiences of analgesia it does not eliminate pain, rather it raises our pain-tolerance threshold, so that we do not suffer as much.

Still others affirmed that cattle did not need post-surgical pain control because they “eat right after surgery” and thus could not possibly be in pain. Because of such stoic behavior, some veterinarians still do spays (and of course castrations) on cattle with no anesthesia. The answer, of course, is that stoic behavior does not prove that the animals are not feeling pain. We need to recall that cattle are a prey species, and in nature, herds of cattle are always accompanied by circling predators, ever-vigilant to signs of weakness or debilitation. Any cow that did not therefore behave normally when painful would be quickly culled by predation.

It was claimed that dogs did not hurt after abdominal surgery for anatomical reasons—their viscera are suspended in a mesenteric sling. Similarly, one heard that dogs were alert and wagging their tails post-surgically so they surely did not hurt. Various researchers have done much to dispel such myths. Veterinarian Dr. Bernie Hansen has regularly pointed out that the presence of humans in a post-surgical ward significantly skews the animals’ behavior, and that one sees a different story when one videotapes the animals in the absence of humans. In one particularly dramatic tape, Hansen shows a Malamute dog who had experienced major disk surgery, yet in the presence of people, sat up putatively bright and alert, and never even lay down to rest. The taping provided dramatic new evidence. When people were not present, the dog would involuntarily start to sink into a sleeping position. But his back hurt so much that any attempt to lie down would awaken him, as evidenced by a pathetic series of cries and whimpers!

As mentioned earlier, the Federal legislation did much to eliminate agnosticism about, and denial of, felt pain in research animals and to force its use even by those who remain agnostic, federal law being one of the few levers powerful enough to overturn ideology. Papers on analgesia and pain have proliferated, and in general the analgesia requirements are quite well enforced by Animal Care and Use Committees. Since most veterinarians in academe do research, they have communicated the need for and methods of pain control to their students, who in turn take this knowledge, plus the social-ethical imperative to control pain, into their jobs after they graduate.

Equally important, with the extraordinary augmentation of the emotional role that companion animals play in people’s lives, public demand for pain control for their animals has become loud and forceful. This not only has forced veterinarians in practice to set aside their denial of pain, it has again led to increased academic attention to pain control. Once again, social ethics drives transcendence of ideology.

In addition, there is suddenly a huge market for pain control in animals, and the drug companies were not slow to acknowledge this. Particularly relevant to our discussion is the story of Pfizer and Rimadyl®. Rimadyl® is the trade name for carprofen, a non-steroidal anti-inflammatory drug used for analgesia in skeleto-muscular problems. Originally developed as a human drug, carprofen showed no great advantages over other anit-inflammatories, and thus was not marketed. However, someone at Pfizer thought of trying it on dogs, where it gave spectacular pain control results. Pfizer began a successful advertising campaign showing older dogs unable to romp because of skeleto-muscular pain and affirming that Rimadyl® could control such pain. Shortly thereafter, I was approached by Pfizer representatives who told me that the biggest obstacle to marketing the drug was veterinarians, whose ideology-based denial of animal felt pain prevented them from prescribing pain control! In what was surely a first for a philosopher, I worked with Pfizer to help lay bare these ideological presuppositions and overcome them. In the end, Rimadyl®, it is rumored, sold close to $1 billion in one year soon after being marketed.

One can argue that, in terms of rate of change, the control of animal pain probably proliferated far more rapidly than what we have indicated about human pain. I largely credit the Federal law and the animal research community, who “recollected” common sense and common decency about animal pain when faced with the law. With no law driving control of pain in babies, children, or the disenfranchised, change has been slower. On the other hand, aggressive social concern about pain has created increasing amounts of attention to it. Both human and veterinary medicine now specifically address pain management in the process of accrediting hospitals.

One need only look at the over-the-counter medication for sale in any pharmacy to realize that, at the present, we are not a culture that makes a virtue of stoic enduring of pain and suffering. This is not only true of physical pain—commercials relentlessly press mood-altering drugs, male erectile enhancers, and cures for the “heartbreak of toe-nail fungus” (I am not making this up!). The Spartan ideal of stolid acquiescence while a fox disembowels you is a source of amazement in all but farm kids, athletes, and some military professionals. Pectoral implants and calf implants, simulating musculature in men without the hard work, are among the fastest growing procedures in plastic surgery.

Though I cannot prove this claim, it seems fairly evident that the neglect of felt pain in human and veterinary medicine has drawn people to alternative medicine. Alternative practitioners, if nothing else, are generally highly sympathetic and empathetic. Whether their treatment modalities work or not, they project care and concern, which people sometimes forget is not a substitute for effective treatment. Purveyors of effective treatment, possessed by scientific ideology, may be guilty of lack of empathy, and may focus only on the disease. The result is an extraordinary groundswell of support for alternative medicine, including modalities that have been shown not to work or cannot possibly work (e.g., homeopathy) if modern science is true!

This may appear unintelligible to scientists—after all, how can people opt for what doesn’t work over what works. The key point, though, is to remember what people mean by “what works.” When ordinary people say assuredly that someone is a “good doctor” or a “good vet” they do not mean that they have studied the practitioners’ cure rate or educational credentials—they mean that they are empathetic and seem to
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