The Pain Principle

Abstract

Here, we illustrate what we mean by speaking of therapeutic futility and therapeutic fury. The latter concept is widely used in the Latin-speaking countries and is usually confused with the concept of futility; instead, it must be properly associated with the concept of damage or pain unfairily caused. Starting from these two definitions, let’s analyze the main criteria on which it is decided whether futility or fury are present: the principle of best interest, the harm principle, and the principle of double effect. Finally, we introduce a new concept, the pain principle. According to this principle, treatment is unfair when it is useless; but it is also unfair when it causes pain that can be objectively highlighted, is not required, and cannot be overcome; when this is present, the treatments currently in progress must be modulated or suspended. If pain is not present, treatment can be continued unless it is useless. Of course, we cannot accept the idea that a treatment is useless if it allows the life of a disabled child, though very damaged but without present or future pain. Nonetheless, severely mentally impaired children, who have no social interaction, will not enjoy the continuation of life at the cost of pain, so if any pain is present in these children, present treatments can be discontinued in favor of less invasive though less effective ones. This principle overcomes the risk of therapeutic abandonment and vitalism, and is simpler and more objective to apply than the principle of best interest.