Prolong

When I come to think of it, the ideas of Daniel Kahneman are not only applicable to economics and psychology; they challenge many of the common concepts that we hold for clinical medicine.

One notable example is the assessment of suffering. Kahneman's theory is simple: the subjectively experienced degree of suffering has nothing to do with the "area-under-the-curve" amount of pain or other unpleasant feelings, but is determined only by two factors: the maximum degree of suffering during that period, and the degree at the end of the period. In short, by and large, all that ends well feels well.

And, this phenomenon would make a whole lot of difference to the practice of palliative care. For example, the orthodoxical teaching is Do not prolong the suffering. But, if the duration is not a problem, a palliative treatment that prolongs a suffering life is, arguably, not undesirable as long as the finale is not that miserable. On the other hand, if, for example, a treatment of cancer can extend the survival by, say, 6 months, but, at the same time, induces a transient but intense adverse effect, then, assuming there is no change in the suffering before the eventual death, the treatment is valuable according to the traditional view, but it would not be welcome by the patient.

For obvious reasons this theory needs further testing in clinical setting. I must say the cold water immersion experiment presented by Daniel Kahneman is, from a physician's point of view, child's play. Patients may view suffering very differently when we talk about real diseases.