Rem B. Edwards

In this article I clarify the concepts of ‘pain’, ‘suffering’. ‘pains of body’, ‘pains of soul’. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis. treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfihing these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if anv, should override the right to refuse treatment where pain relief is of paramount concern.

The theses of this paper are that: 1. the attempt to found absolute norms on rationality presupposes the availability of a single universal absolute conception of rationality, but no such conception is available; and 2. any conception of rationality which might be available for justifying one's ultimate normative commitments is itself evaluative. “Rationality” itself is a value-laden concept, as are all its philosophical sub-divisions—logic, ethics, aesthetics, axiology, etc. Choosing ultimate value principles under conditions of freedom, enlightenment, and impartiality presupposes that one positively values such things. Rationality is an inescapably evaluative concept, not a value neutral concept.