Everyday Ethics

I’m no fan of going to the dentist, mostly based on having a storehouse of painful memories involving my childhood dentist forcibly removing countless teeth from my tiny jaw without providing sufficient anesthesia.  As a result, I put off having my wisdom teeth removed for approximately ten years.  When I finally decided to have them removed last Wednesday, I was terrified at the prospect of what I expected to be the most painful experience of my life.

The experience could not have differed more from my expectations.  I was under IV sedation, and was also given local anesthesia because, as the oral surgeon pointed out, “we want to do more than just put you to sleep; we want you to not feel this.”  Considering that he had just finished informing me of how difficult this particular extraction was going to be, and that it would include two bone grafts in order to maintain the structural integrity of my jaw, I considered his affinity for shielding me from pain to be good news and a welcome strategy.

The result of this double dose of anesthesia was a largely pain-free procedure that left me in much better shape than I would’ve expected.  Thus far, my recovery has also included minimal pain, as the pain medication I was prescribed has been more than adequate.  The combination of a skillful surgeon and a commitment to sufficient treatment of pain has made this experience much better than I would’ve expected.

There has, however, been an interesting philosophical side effect of this procedure.  I’m not sure what to think about the reality of pain in this particular case.  Had I not received any anesthesia, this would have been an incredibly painful procedure.  Since I was properly anesthetized, it was not.  I had no felt experience of pain.  Does this mean I was not in pain, or merely that my pain experience was blocked?  Can this procedure be called painful if there was no pain experience?  Can we rightly call something painful in the absence of a felt experience of pain?  I honestly have no idea.

Pain has at least two components.  First, it is a physiological phenomenon.  Certain receptors in the brain are triggered by neurotransmitters that are released in response to painful stimuli.  But pain is also a phenomenal experience.  Pain feels bad.  An essential aspect of pain is that it hurts.  The interesting philosophical question is whether both components are necessary in order for pain to be present.

My wisdom teeth experience suggests one interpretation.  I did not actually feel any pain during my procedure, and this fact alone makes it seem crazy to claim that I was in pain even though I didn’t feel any pain.  Even if the physiological phenomenon of pain was occurring, the felt experience of pain was absent.  This suggests that the felt experience of pain is a necessary condition for pain, while the physiological phenomenon of pain is necessary but not sufficient.  This interpretation is neutral with regard to whether felt experience is a sufficient condition for pain.

Fibromyalgia, a painful medical condition whose source is unknown, supports a different interpretation of pain.  Fibromyalgia sufferers report severe physical pain despite the absence of the physiology associated with felt pain experience.  This suggests that the felt experience of pain is a necessary and sufficient condition for pain, while the physiology of pain is neither necessary nor sufficient.  What’s not clear is whether the necessary and sufficient conditions of pain are better represented by my wisdom teeth extraction, fibromyalgia, or something else entirely.

We are thus left with no clear account of the necessary and sufficient conditions for pain.  In some cases, we have the physiology of pain, but no felt experience.  In other cases, we have the felt experience, but no physiology.  And in both cases, it’s not at all clear what is sufficient for attributing pain to a given scenario.  This is problematic from a medical standpoint because it’s not clear how to understand conditions that exhibit only some of the factors that are typically associated with pain.

We will not attempt to resolve this question here, though from an ethical standpoint it is tempting to claim that the felt experience of pain is sufficient for attributing pain to an experience, regardless of what is happening at the physiological level.  Felt pain experience is morally significant because it hurts.  As a philosopher, it’s important to be able to recognize the real-world implications of philosophical questions.  But pondering these questions can become a distraction, which impairs our ability to recognize the right thing to do.

While it is both worthwhile and philosophically interesting to try to establish the necessary and sufficient conditions for pain, I think my oral surgeon actually has the right idea.  As he rightly put it, “we want you to not feel this.”  As the beneficiary of this attitude toward pain, I’m inclined to agree.

About the Author

Elijah Weber is a graduate student at Bowling Green State University. He holds a Master's degree in philosophy from Colorado State University, and Bachelor’s degrees in sociology and philosophy from Chapman Univerity. He currently lives in Bowling Green, Ohio with his wife Laura, his newborn son Brandon, and his feline life-partner Monte.