The ends of medicine and the crisis of chronic pain.

Pellegrino and Thomasma have proposed a normative medical ethics founded on a conception of the end of medicine detached from any broader notion of the telos of human life. In this essay, I question whether such a narrow teleological account of medicine can be sustained, taking as a starting point Pellegrino and Thomasma's own contention that the end of medicine projects itself onto the intermediate acts that aim at that end. In order to show how the final end of human life similarly alters intermediate ends, such as the end of medicine, I describe Thomas Aquinas's concept of pain and explain how his remedies for pain derive from his account of the telos of human life. In turn, this account has implications for the way in which physicians who accept such a telos would manage their patients' pain. If a comprehensive telos for human life is necessary to make sense of even such a routine aspect of medical care, then medical ethicists may not be able to sidestep questions about the good life for human beings.