Against compulsion - in defence of tension: Ethical evaluation of pain from its natural functions to a prospective moral purpose in anticipation of genetic modulation

Abstract

Faculties necessary for living a moral life have their origin in biology. This work follows pain, a primordial motivational force directed towards new purposes in the course of the evolutionary story. The empathic disposition, establishing of social bonds, and altruistic behaviour can be partially traced back to the modulation of the neurological pain mechanism. The prospect of genetic pain alleviation is explored focusing on considerations around a hypothetical pre-emptive reduction of experienced intensity. Connections between pain-related natural processes and subsequently emerged social structures and normative framings are discussed leading up to an examination of the proposed moral functions of pain and suffering. The detectable natural priorities embedded in the mechanism of pain are contrasted with opposing moral frameworks to illustrate the questionable moral standing of natural intuitions. Yet, such built-in motivations and generators of emotional stir are conceivably necessary for the refinement of social norms as well as personal growth.

Full text

Against compulsion – in defence of tension
Ethical evaluation of pain from its natural functions to a prospective
moral purpose in anticipation of genetic modulation
Joel Janhonen
2021
King’s College London
Dissertation for MSc Bioethics and Society
Word Count: 12,000
This dissertation is submitted as part of a MSc degree in Bioethics and
Society at King’s College London. I certify that the work submitted
herewith is my own and that I have duly acknowledge any quotation from
the published or unpublished work of other persons.

2
Because I am here and supplied with the necessary means, he can be
saved, while otherwise he would have fallen a victim to the torture. This
does not mean merely that I can save his life. We must all die. But that I
can save him from days of torture, that is what I feel as my great and
ever new privilege. Pain is a more terrible lord of mankind than even
death himself.
- Albert Schweitzer (1922)
It is only suffering which has created every enhancement in man up to
now. That tension of a soul in misery which develops its strength, its
trembling when confronted with great destruction, its inventiveness and
courage in bearing, holding out against, interpreting, and using
unhappiness, and whatever has been conferred upon it by way of
profundity, secrecy, masks, spirit, cunning, and greatness - has that not
been given to it through suffering?
- Friedrich Nietzsche (1886)

3
Against compulsion – in defence of tension
Ethical evaluation of pain from its natural functions to a prospective
moral purpose in anticipation of genetic modulation
Abstract
Faculties necessary for living a moral life have their origin in biology. This work follows pain,
a primordial motivational force directed towards new purposes in the course of the
evolutionary story. The empathic disposition, establishing of social bonds, and altruistic
behaviour can be partially traced back to the modulation of the neurological pain
mechanism. The prospect of genetic pain alleviation is explored focusing on considerations
around a hypothetical pre-emptive reduction of experienced intensity. Connections between
pain-related natural processes and subsequently emerged social structures and normative
framings are discussed leading up to an examination of the proposed moral functions of pain
and suffering. The detectable natural priorities embedded in the mechanism of pain are
contrasted with opposing moral frameworks to illustrate the questionable moral standing of
natural intuitions. Yet, such built-in motivations and generators of emotional stir are
conceivably necessary for the refinement of social norms as well as personal growth.

4
Table of contents
Abstract ................................................................................................................................................................... 3
Table of contents .................................................................................................................................................... 4
Concept definitions ................................................................................................................................................. 5
1. Introduction.................................................................................................................................................... 6
2. The biological origin of pain ........................................................................................................................... 8
Genetic basis ....................................................................................................................................................... 8
Resistance to the guidance of pain ..................................................................................................................... 9
3. Extended functions of pain .......................................................................................................................... 11
Pain expression ................................................................................................................................................. 11
Mirroring, sharing, and bonding ....................................................................................................................... 12
Danger signals at the social level ...................................................................................................................... 14
Pain and suffering ............................................................................................................................................. 15
4. Construction towards the moral dimension ................................................................................................ 17
Generation of advantage .................................................................................................................................. 17
Artificial interventions ...................................................................................................................................... 19
Reforming potential .......................................................................................................................................... 20
Moral anchor .................................................................................................................................................... 22
Worst possible misery for everyone ................................................................................................................. 23
5. Beyond natural priorities .............................................................................................................................. 25
Self-prioritisation and self-sacrifice .................................................................................................................. 25
Natural vitalism ................................................................................................................................................. 26
Limitations of hedonism ................................................................................................................................... 28
6. Exploring the cancellation of unwanted pain ............................................................................................... 30
Unforeseen alterations and outcomes ............................................................................................................. 31
Liberation from pain ......................................................................................................................................... 32
Past wisdom of repugnance ............................................................................................................................. 34
Fallibility and refinement of moral intuitions ................................................................................................... 35
Meaningful narrative ........................................................................................................................................ 38
7. Roles played by pain ..................................................................................................................................... 41
8. Conclusion .................................................................................................................................................... 43
References ............................................................................................................................................................ 44
Appendix ............................................................................................................................................................... 51
Prospective genetic targets .............................................................................................................................. 51

5
Concept definitions
Conscious A creature is conscious when there is ‘something that it is like’ to be it; how
the world appears and is experienced from a subjective point of view
(Nagel, 1974). The definition is important for arguing in favour of the moral
significance of experience’s quality.
“There are elements which, if added to one's experience, make life better;
there are other elements which if added to one's experience, make life
worse. But what remains when these are set aside is not merely neutral: it
is emphatically positive. The additional positive weight is supplied by
experience itself, rather than by any of its consequences.” (Nagel, 1979).
Utilitarianism A consequentialist ethical theory that prioritises the amount of overall
good. Sub-theories differ in regard of the specific factor that should be
maximised, unlike with preference utilitarianism that defines ‘good’ as the
satisfaction of preferences, this work adopts Jeremy Bentham’s hedonistic
viewpoint that directly focuses on the subjective experience, i.e. pain and
pleasure. Although modulated by emotional dispositions and cognitive
preferences, the actualisation of value is determined only to occur through
experience. The idea of utilitarian calculus (or calculus of happiness) is
alluded to when emphasising the rational character of this theory.
Well-being Including yet extending beyond conscious sensations, a state characterised
by a comprehensively positive perception of one’s life. More complex
experiential phenomena – e.g. the sense of meaning – are thus included.
The dispositions responsible for conceptions that improve the state of
wellness by appearing valuable are nevertheless not evaluated (or
validated as good) in isolation but according to their overall impact on the
quality of experience.
Fitness The aggregated ability to survive and reproduce in a given environment,
which on average determines genetic success. It may be attained either via
exploitative or inclusive means; by zero-sum competition over mates and
resources or by uniting the interests of genes and creatures, respectively.
Archetypal Images of the collective unconscious. The overarching and recurring
patterns, characters, or motifs (narrative elements) amongst literary and
oral traditions. Represented forms of innate and shared ancestral
knowledge, as well as their adjacent modes of behaviour, were deemed
central for personal sense-making by Carl Jung (1968). A relevant concept
when addressing the human dispositions for detecting meaning and
discussing the narrative approach to the management of pain.

6
1. Introduction
As presented in this work, many elements deemed relevant for moral life have their roots in
underlying biological processes. In line with the meta-ethical conception of ethical
naturalism, all discussed moral properties are perceived to be reducible to natural
processes; which arguably is an unavoidable premise for bio-ethical analysis. Characteristics
that are more likely to be passed on to the next generation propagate and determine the
direction of evolution, in time establishing the interactive mechanisms between creatures
and the environment. This work lays out how natural selection of traits and functions
prioritises the forwarding of genetic information over the lived experience of the mortal
creature or person hosting the immortal hereditary material. For evolutionary fitness,
obnoxious or ecstatic experiences are merely motives for producing the outcome that
increases the probability of genetic transmission. There is apparent misalignment between
the gradually refined values of humanity and the embedded objectives and expressed
priorities of mechanisms promoting survival. To draw a clear distinction, the utilitarian
maxim – “the greatest good for the greatest number” – is adopted as a proxy for a non-
vitalist non-egotist ethical framework. In order to provide a pronounced counter for nature’s
exploitative stance towards subjective experience, hedonism’s tenet on the intrinsic value of
the quality of experienced sensations is critically discussed in connection to artificial
modulation of pain. The case exploration on pain was selected because it well portrays the
conflict between the maximisation of well-being and the present biological programming
that only recognizes the instrumental value of experience. A parallel disagreement between
naturalistic and normative theories of health is discussed in relation to the interplay
between the embedded wisdom of nature and reason-based critical reflection that enables
dynamic and context-specific reorientation.
Given the prospect of artificially increasing control over pain, an ethical exploration around
the trend of elevating influence over natural dispositions is necessary to critically evaluate
the merits of bypassing a primordially established motivational mechanism and its extended
behavioural functions. The prospect for gene-level pain management is presented and
ethical justifications for hypothetical pre-emptive severity modulation are discussed. The
utilitarian case for undercutting a biological anchorage of suffering is critically analysed by

7
exploring the perceivably invaluable developmental, social, and moral reverberations of the
aptitude to experience pain. The known critic of divorcing experience from underlying
motives and behavioural mechanisms, Friedrich Nietzsche, has handed on a unique
vindication of the value and purpose of suffering. A supposed moral function of pain might
not be intelligible through an ethical theory that aims to maximise positive sensations; moral
growth might be dependent on travail. Hypothetical means of preserving generative tension
in the absence of pain sensations are discussed. Observations are presented in a narrative
style, which appeared appropriate for a topic pertaining to subjective human experience.

8
2. The biological origin of pain
The sensation of pain – as an indicator of physical harm – is present in all complex animals,
evidently demonstrating its significance to the survival of life. The evolutionary story of pain
began with the emergence of nociception (Latin. Nocēre; hurt, harm) far in the prehistoric
past; associated brain structures are shared by humans and fish alike (Pitts, 1994). Detected
noxious stimuli are transferred from a specific type of sensor to the brain via nerve fibres.
The survival benefit of detecting occurring harm for enabling an evasive response is difficult
to overstate (Smith & Lewin, 2009). Pain is a protector of life.
Several theoretical frameworks of pain have been developed, but only the more active
model of pain neuromatrix properly incorporates contributions from genetic, hormonal, and
neural mechanisms in addition to describing mere sensory transmission (Melzack, 2001). The
theory provides the means to explore the impact of psychological stress and cyclic brain
processing that may create the neural patterns bringing about the state of chronic pain. The
important functional distinctions between acute and chronic pain carries ethical importance
regarding justifications for novel interventions and will be revisited later. According to the
neuromatrix model, triggering of pain experience via activation of the responsible
neurosignature patterns may occur independently from external inputs. This point is
important to consider when exploring the perception of externally observed pain as well as
the potential to make such activation independent from the occurrence of actual harm.
Genetic basis
The biological characteristics of all living things are shaped by the inherited units of genetic
information. Novel variation in a form of random changes in the sequence can either be
neutral, maladaptive, or in rare occasions adaptive for the survival and reproduction of the
creature carrying and expressing the hereditary information. Selective pressures of the
natural environment serve to maintain evolutionary fitness; the passing on of genetic
material thus dictates the prevalence of specific variants in the population and the
observable traits of host organisms (Gregory, 2009). According to this gene-centred view of
trait evolution; the density of pain sensors, their activation threshold as well as other factors
that eventually affect the experienced severity – have been fine-tuned to maximise the odds

9
of survival. Among all potential characteristics, the trait of evolutionary fitness is exceptional
hence it determines the passage and resultant frequency of all other traits according to the
degree of genetic covariance – i.e. how much a trait is influenced by the selection of another
(Orr, 2009).
The selective pressures of nature have in time adjusted the sensory thresholds and
established the standard responses for particular incoming signals by the central nervous
system to a level that maximises the probability of persisting in an environment full of
potential harm. Thus, survival and reproduction probabilities have shaped the experience of
pain; fitness being the natures gatekeeper of change. Throughout most of history, bodily or
sensory impairments were deeply expensive to one’s reproductive chances; hence, the
trigger thresholds get reduced until arriving at an evolutionary equilibrium with maladaptive
oversensitivity or physiological damage (see Baliki, et al., 2008). The elevation of intensity
only serves fitness if it successfully evokes a beneficial response; genetic predisposition for a
paralysing fear over injury would likely be a liability. The capacity to manage ever greater
transitory pain had to increase concurrently to the elevated intensity. In a later section,
social mechanisms that modulate pain are explored, yet the advantages of selective pain
resistance are initially worth exploring from an evolutionary perspective.
Resistance to the guidance of pain
The emergence of pain tolerance demonstrates that total avoidance is not the optimal
strategy, there is undeniable case-specific utility in the capacity to resist. Nociception and
the neuromatrix of pain encompass the natural wisdom about what a creature of our
physical constitution should generally avoid and what should never be tolerated no matter
the trade-off. Yet, observed instances of selective down-regulation demonstrate the shifting
landscape of optimal pain modulation (see Eigenbrod, et al., 2019); correspondingly
responses need revision to remain advantageous. Adaptations at the biological level
generally require vast amounts of time, a degree of neurological flexibility to deliberately
endure noxious sensations enables more adaptive behavioural responses.
Patterns of successful human pain-behaviour have been pressure tested through the
generations by a great variety of natural environments. In time, the types of perceived

10
human virtue have come to include some forms of ‘intentional undermining’ of the natural
avoidance of pain. This demonstrates an understanding, that given appropriate
circumstances pain’s motivational force is pushing into an objectionable direction; hence the
archetypal images of self-sacrifice are included in archaic narratives exploring ethical
questions. The ‘moral of the story’ – i.e. lesson about how a human should operate – has
been recognised to at times run counter to the built-in natural wisdom. The unprecedented
prospect of a decisive form of resistance partially motivated this exploration.

11
3. Extended functions of pain
Approximately half of the observed variation in experimental pain measures is accounted to
genetics (Fillingim, 2008). Despite some diversity, the ethically significant potential for
excruciating mental states to arise is seemingly universally shared. However, some
remarkable exceptions have been discovered. Cases of absolute insensitivity caused by
single-gene mutations exist, which is extremely important for the prospect of genetic
modulation; this topic will be reopened while discussing novel approaches for pain
management. The virtually universal sensitivity to noxious sensations demonstrates the
preserved utility of pain to human survival; if insensitivity would have provided a fitness
advantage the trait would have likely become more prevalent (Rahim-Williams, et al., 2012).
In addition to the direct avoidance of immediate harm, pain also assists in minimising
hypothetical harm. A challenge to acquire risk-avoiding behaviour without the guidance of
pain was noted by researchers of genetic pain insensitivity by describing a fatal incident; an
affected child was killed after routinely performing ‘pain defying’ acts by jumping from a roof
of a building (Cox, et al., 2006). The tragic example illustrates the value of being educated by
pain about one’s physiological limitations. In the absence of forceful negative feedback for
detrimental actions, one can get deceived by seeming personal invincibility. Yet, the
functions of pain extend far further.
Pain expression
The initial experience of pain and the resulting behaviour can be both conceptualised as
messages with specific targets. The functional objective of the experienced pain is to bring
about harm preventing action or omission, through now present or memorised past pain. In
turn, pain-behaviour via means of expression targets surrounding subjects to solicit
attention and assistance – either consciously or not. The pain and the resultant behaviour
when giving birth have been argued to perform this function thus increasing the odds of
maternal and post-natal survival (de Williams, 2002). Barbara Finlay and Supriya Syal have
proposed that the severe pain of cervical dilation has been evolutionarily intensified in
humans due to the benefit of assistance during birth (2014). The experience of pain has no

12
intrinsic utility for survival and is only adaptive due to resultant actions or more complex
behavioural patterns that produce the evolutionary advantage.
The complex medium of social signalling via cues like facial expressions enables gaining
advantage through exaggerated pain behaviour, intentional suppression, or in turn the
ability to accurately detect deception. The capacity to modulate the expression of pain
among social animals increases the probability of being assisted or decrease the probability
of being exploited (de Williams, et al., 2016). Performed modelling of the related behaviours
within a simulated population has provided information about stable hypothetical balances
between different behavioural strategies. The 2016 study concluded that the benefits of
signalling and responding to others’ pain offset the adjacent costs, associated behaviours
only vanished within an extremely benign environment. Detailed understanding of the
dynamics between pain expressions, responses, and the environment would help to
illuminate the extended influence of pain and possibly the prospective outcomes of its
artificial modulation. Within an incessantly dangerous environment, induced insensitivity to
pain could perceivably negate the value attained via its fine-tuned expression. Regardless of
its relatively simple sensory origin, the complex phenomenology surrounding nociception
with identifiable quality domains suggests an advantage in distinguishing between noxious
sensations (Victor, et al., 2008). Such intricacy has perceivably enabled better targeted and
more detailed pain expression and subsequently motivated behaviour. The diversity of
detected pain phenotypes, experiential multidimensionality, and performativity elucidate a
rich foundation for social construction.
Mirroring, sharing, and bonding
In addition to the primary function of pain responses to promote individual survival, similar
neurological responses have been observed to occur when witnessing somebody else’s pain.
The capacity to empathise also has a long evolutionary history (Decety, et al., 2016); hence
co-experiencing and social coping with noxious sensations has been built-in to humanity
from the beginning. The capacity of the pain neuromatrix to get triggered merely from the
anticipation of pain indicates a faculty for socially learning appropriate pain behaviour,
concurrently illuminating the natural origin of empathy. A neurological mechanism called a
pain somatic resonance system maps external stimulus onto the motor system of the

13
observer (Avenanti, et al., 2005). Researchers importantly note that a distinct and more
complex form of empathy presumably guides the creation and evaluation of social
connections.
Indeed, affective component of the pain matrix can be triggered via ‘mirror-matching’, such
areas are implicated in emotional reactions and qualitative evaluations of good and bad
(Danziger, et al., 2006). Conceivably this mechanism is preserved even in the absence of
personal pain experience. Facial expressions and vocal cries conveying the experience of
pain – either actual or imagined – are evolutionarily refined to fit into the neurological
keyhole for emotional empathy. The neurological connection between the processing of
privately experienced and externally witnessed pain is well demonstrated by experiments
that have observed decreased levels of empathy after administrating placebo analgesia;
research among non-human species has also illustrated the long evolutionary history of the
affective resonance and its pro-social outcomes (Decety, et al., 2016). The broader human
ability of ‘emotional contagion’ likely links affective empathy to the recognition of others’
uniqueness via the adoption of their emotional perspectives, thus approximating the basis of
narrative framing (Gallagher, 2012).
The connections between emotional empathy and altruistic behaviour, pro-social
dispositions, and even moral judgements – have been detected many decades ago
(Mehrabian, et al., 1988). The neural mechanisms that have evolved to modulate nociceptive
signalling are hypothesised to play a critical part in the formation of social bonds. The brain
opioid theory of social attachment proposes that the released opioids at the moment of
bond-building create a feeling of contentment thus promoting attachment (Inagaki, et al.,
2016). Social traits that are more recent on the evolutionary timeline largely rely on
antecedent structures, receptors, and neurochemicals. The observed relationship between
human pain tolerance and sociality provides support to the conception of elaborated
function (Johnson & Dunbar, 2016). Social modulation of pain is thus made possible through
underlying biological structure.
To summarise, embodying the pain of others serves fitness by enhancing personal ability to
avoid harm, whilst also extending to more complex social sharing of one another’s
experiences. Among humans, the affective determinations between pleasurable or

14
obnoxious experiences have even reached the level of intuitions about the normative value
of the phenomenological states and their presumed causes. Regarding potential
interventions, superimposed traits may vastly complicate outcomes necessitating ethical
deliberation to assess potential trade-offs between intended medical – and potential social
outcomes.
Danger signals at the social level
Complexity at the level of social interactions is partly due to the unfortunate fact that
successfully conveying and construing information about internal experiences is challenging,
even with a shared language. The present ambiguity permits one to achieve an advantage by
exploiting the social benefits linked to motivations such as emotional empathy. Even in the
absence of foul play, accuracy in detecting the distress of others and success in producing a
useful response are not guaranteed, due to the limited grasp on the external world.
The true potential of social collaboration is only achievable by establishing a shared manner
of operating. One evolutionary account for the advantage of dispositional emotions and
socially shared norms concerns the shift in selective pressures during the Late Pleistocene
(Mameli, 2013). According to this idea, collaboration and resource pooling that were
necessary for effectively hunting big game – were made plausible by a set of proto-moral
dispositions, i.e. anger towards violators of practical demands. Thus, the discovered norms
bound members of the group together through authority independent demands on
behaviour, subsequently consolidating emotional dispositions towards the conduct of
oneself and others. Such reliance on structured pro-social behaviour conceivably made our
species perceive the world in moral terms. Normative dispositions can therefore be crucial
for social functioning and relate to specific practical demands. As stated afore, the process
that repurposes primal motivations into novel social purposes has made the mechanism of
pain heavily modulated. Due to the opioid connection between pain modulation and social
bonding, proto-moral dispositions that utilise social rewarding and punishing to control
behaviour are conceivably also connected to the experience of pain. The ethically important
process of revising habitualised responses and its connection to emotional empathy is
discussed in a later section of the work.

15
Pain and suffering
In order to enter an examination of the hypothetical moral value of suffering, a helpful
theoretical distinction is presented, and the word suffering is defined for the present work.
In his anthropological exploration of the rationalisation of suffering, James Davies
distinguishes between a positive and a negative model, the key difference being suffering’s
presumed purpose (2011). Post-enlightenment, the focus of deliberation around suffering
shifted from the framings of morality and philosophy towards biological reductionism, thus
affecting the experience and potentially self-fulfilling the negation of its meaning. This
supposed absence of derivable value or insight is contrasted with a claim by Nietzsche about
its capacity to remake and strengthen (1886), preceded by a description of a related
psychological phenomenon by Elaine Scarry.
Briefly addressing the conceptual difference between being in pain and suffering is
necessary for the ensuing ethical deliberation. If adopting the view that suffering is one’s
emotional and psychological reaction to pain, these domains may be perceived to advance
the arisen alarm signal by converting the motivation into other forms of mental content that
ultimately reduces harm or produces some beneficial outcome. Supposedly the discovered
means to anesthetise pain, situated it as a feature of the body hereby medicalising it and
creating a divergence between pain and a concept more appropriate to describe the
phenomena of the psyche, suffering (Garland-Thomson, 2012). But like the drug class of
antidepressants well demonstrates, the boundary between the physical body and intangible
mind is fickle and the advance of medical ability might in time pinpoint all sources of
suffering as understood and treatable issues of the underlying biology. Major advances in
understanding the multidimensionality of pain and the subsequent aim to encourage
broader assessment of experiential content have prompted the International Association for
the Study of Pain to revise their definition (de Williams & Craig, 2016). In addition to its
sensory quality, the relevance of emotional, cognitive, and social characteristics are being
recognised. Hence, the extended definition of pain reconverges with the aforesaid
conception of suffering.
An alternative definition offered by Daniel Dennett depicts a more cognitive state where
imposed circumstances undo a vision of the future with no necessary link to physical pain

16
(1991, p. 449). Such description of the internal tension relates well to the proposed moral
function of pain and therefore the term ‘suffer’ is reserved to describe the extended conflict.
Assessing the ethical value of undergoing an obnoxious (Latin. Ob - Noxa; towards harm)
mental state requires clearly distinguishing the conscious experience from the mechanism –
former being the subjective qualia, latter the underlying and quantifiable state of the
material body. The present work utilises ethical argumentation reliant on the moral weight
of experience, the hypothesised moral misalignment being best portrayed in the
contradictory prioritisation of experience – its value being either instrumental or intrinsic.

17
4. Construction towards the moral dimension
Joanna Bourke describes social modulation of pain by stating that “pain does not emerge
naturally from physiological processes, but in negotiation with social worlds” (2013). A
naturalistic conception can fully agree with the significance of sociocultural influences on the
experience of pain, yet originally nociception did emerge from nature alone. Shades of
unpleasant human sensations exist in a great number of forms; however, pain is
extraordinary as a predecessor of both humans and the emergence of complex social
behaviour. Furthermore, the social words themselves are only allowed to exist on the basis
of providing a natural advantage – prior to human actions amending the natural selection
criteria. ‘Socialisation of sentience’ via modulation of archival sensory processes abides by
the rule of fitness until biological change is no longer dictated by natural pressures. Yet it is
impractical to explore interactions at the social level without adopting an appropriate
language system for describing psychological, cultural, and ethical phenomena.
Pain’s intersectional position between the biology of the body and the webs of social
discourse is portrayed in the book ‘Pain and Emotion in Modern History’ (Boddice, 2014).
Unlike with the transmission of other sensory signals, complex modulation mechanisms have
been discovered to depress the nociception pathways; functional parallels reaching
approximately half a billion years back into the evolutionary past (Walters & Williams, 2019).
The wide variety of detected social influences on the pain experience demonstrate the
interconnectedness of biological and social; one in fact being erected on top of the other.
Even the colour of placebo analgesics has an effect on their perceived efficacy to relieve pain
(de Craen, et al., 1996), an attempt to decisively differentiate the responsible intrinsic
psycho-physiological dispositions from socially learned ones would likely only result in
confusion. Forthcoming sections explore pain modulation by contrasting naturally reached
advances to ones overriding nature.
Generation of advantage
Within the vast cultural landscape, detection of general or near-universal trends related to
pain could imply the presence of social adaptations that have provided a likely advantage
against the outcompeted groups lacking them. The perceived aim of the social group has

18
been observed to modulate the degree of tolerated pain by e.g. framing it as an indicator of
progress or via social mechanisms like stigmatisation of frailty (Tarr & Thomas, 2021).
Adaptive means to transcend the avoided and feared sway of pain could have either
improved coping or provided raw material for value construction. As pain affects all life
domains central to its quality, means of addressing and managing it correspondingly exist in
multiple forms (Siler, et al., 2019).
Diverse factors like the broader religio-cultural context, aims and values of the in-group,
interpersonal co-experiences, and personal-level coping strategies – make the
multidimensional landscape of non-medical pain modulation a difficult space to navigate.
Reviewed research on religious coping strategies has highlighted the importance of applying
a holistic approach to pain management, withal contemplating on personal ‘meaning-
making’ (Dedeli & Kaptan, 2013). Historical coping advantage of religiosity might have
affirmed the related dispositions; additionally, if pain severity were correspondingly
elevated, a sudden absence of religious modulation could result in issues with excess pain.
In her insightful paper, Catherine Botha examines Nietzsche’s naturalistic ethic and its
connection to evolutionary theory (Botha, 2001). To appreciate his argument against
utilitarianism – i.e. the pursuit of well-being that seeks to do away with suffering (1886) –
some key ideas need to be presented. Nietzsche describes the human characterisations of
order and structure as necessities rather than laws; according to Daniel Dennett this well
follows the scientific genealogy of morals (1995). According to this conception nature
continually repurposes the raw material of ‘whatever exists’ in the organic world into novel
adaptations, thus obliterating the previous ‘meaning’ in favour of a new interpretation. A
growing degree of social organisation provides an advantage while creating previously
unencountered practical demands, which are then met by repurposing and expanding the
behaviour modulating systems.
The chaotic nature of the world demands dynamic reorientation towards the presently
operational necessities, as opposed to the inert perpetuation of laws. Nevertheless, novel
interpretations that provide an advantage should not be deemed morally appropriate in
their own right. Increases in fitness – either via biological or social means – do not (at least
by themselves) determine the ethical standing of the assessed feature according to any

19
framework that places value on the conscious experience. Because typically the approaches
with a fitness advantage have prevailed, the discovered solutions are by their nature
pragmatic and relative to genetic, environmental, and social background. Although any ethic
evinced by naturally emerged mechanisms is not based on theoretical considerations, such
systems of value nevertheless contain wisdom about indispensable priorities – manifested
by the viable solutions of the past.
Artificial interventions
In the modern era, the capacity to manage pain has increased in waves of pharmaceutical
innovation. The treatment portfolio been extended from modest herbal medicine to a broad
spectrum of powerful opioids. Analgesics and anaesthetics have provided the means to
expel pain at command, even to the amazing degree of removing organs and limbs without
sensation or response from the subject. A review article of the problems in pain assessment
and treatment at emergency departments discovered that adequate management of pain is
generally hindered by biases in drug administration and reservations about the overuse of
opioids, indicating a demand for effective alternatives (Motov & Khan, 2009). Novel
technologies of the genetic age enabled by the ongoing interpretation of life’s source code
have provided additional means to intervene and perform selective operations at the
genetic level. The general trend to strive towards increased control over natural processes
with ever-advancing tools is unlikely to cease, civilization eradicating catastrophes
notwithstanding. Even if the experience of pain is a multidimensional product of a vast
network its severity may nevertheless be adjustable with relatively straightforward means.
As mentioned afore, some single-gene disorders are known to disrupt the neural
transmission of pain resulting in absolute insensitivity. Channelopathy-associated
insensitivity that is caused by loss-of-function variants (gene SCN9A) results in the absence
of pain sensations (Peddareddygari, et al., 2014). Most such variants are known to produce a
syndromic phenotype with adjacent negative health implications, however in rare instances
subjects have lacked additional neurological disturbances and appeared physically and
mentally normal (Cox, et al., 2006). An observed spectrum of tolerance including exceptional
cases of absolute insensitivity indicate potential for genetic modulation. Despite the
complexity of human pain pathways, simple changes in key genes could explain the

20
threshold variation across individuals and provide a simple lever for external modulation
(Cox, et al., 2006), some are furtherly described in the appendix.
Medicalisation of pain has drastically altered our relationship with it. When perceived as an
actionable medical anomaly, pain evokes an effort to inhibit it instead of the predominant
pre-modern response to accept it (Garland-Thomson, 2012). Varying cultural expectations
surrounding pain have been observed to result in significant differences in the proclivity to
seek treatment or alternatively to perceive the sensation of pain as a normal component of
life and ageing (Peacock & Patel, 2008). Commonplace and active coping with unavoidable
pain in the absence of potent treatment options among rural communities portrays a stark
contrast to modern life, where the experience of pain is perceived more as an unacceptable
exception than a morally neutral part of the human story. A potential method would be to
observe the historical evolution in pain metaphors and other indicators of its perceived value
and function. Acclimations in the perception of pain brought about by the progressing
advances in its management could provide an evaluative viewpoint for assessing the
proposed negative outcomes and other arguments that oppose exerting control over the
contents of consciousness.
Regarding any naturally emerged phenomena, the biological depth of its roots and the
weight of all dependent structures – not to mention the ethical ramifications of alterations –
should be critically evaluated in order to rationally implement a prospective intervention.
For the purposes of this work, the wide spectrum of potential topics demands radical
focusing, at this point of the exploration. Rather than attempting to address multiple
potential value connections, the present work aims to distinguish the primary risk of genetic
pain modulation, which – as subsequently presented – could relate to the foundation of
moral deliberation. A brief description of a proposed feature is subsequently provided to
illustrate an intriguing psychological potential – deeply connected to one’s model of the
world and conceptions of value.
Reforming potential
An idea amazingly described by Elaine Scarry in her book ‘The Body in Pain’, states that pain
has a ‘world and self-destroying power’ which suggests there to be potential psychological

21
applications for it (1985). The elaborate methodology of inducing pain during torture and
the tellingly connected religious transformation rites, both conceivably hint at deploying and
operationalising this potential – to either deform or reform the subject. If pain can bring
about a deep and lasting transformation by dismantling the hard-set predispositions and the
possibly pathological model of the world, it could indeed have utility as an instrument of
rebirth. The deliberate inducement of pain in an attempt to redo a person could be
understood as exploiting the sentience to impact the self. The experienced pain being a
universal motivator among all who are under its influence, it has the potential to outshine all
intimate and moral obligations, impale the self, and cover the entire consciousness; even
ones who desire death dread the depth of pain. Should such mechanism of influence be
preserved and possibly utilised or is the responsibility of exerting it beyond the humanly
bearable. Besides, rather than being strictly dependent on the pain experience, the prospect
of re-imagining oneself can be initiated without an externally inflicted duress. Potential
methods for generating alike internal tension to challenge predispositions include
contemplation, archetypal narratives, and psychedelic agents.
While arguing against Scarry’s portrayal of pain as a fact instead of a mere interpretation,
Joanna Bourke instead puts forward a social constructivist notion denying the existence of a
‘pain-entity’ outside of perception (2013). She critiques the depiction of inflected pain
actively destroying the structure of language, resulting in cries comparable to the prelingual
period, as inappropriate literalisation and reification of a metaphor. From a naturalistic
perspective, it is difficult to appreciate what Bourke means by impugning pain to be an
‘independent agent’; due to the recognition of interdependence through interactive
relationships between all things rooted in natural processes. The causal chain of events that
precedes the emergence of conscious pain phenomena surely conveys force, strong enough
to humble any ‘agency’ set against it and deconstruct the world. The underlying process that
is perceived as pain motivates the response – indeed in a highly perceptually malleable
manner – but not interminably so. Greater its force, likely less modulation can the
disintegrating structure sustain over it. Pain is a describable phenomenon of the physical
world long before entering the conscious arena, hence understanding its effect – perceived
or not – requires taking its origin, evolution, and functions seriously. Including the
prospective potential to reset cognitive patterns.

22
The moral value of the suggested potential for initiating reorientation – which challenges the
habitualised and unexamined responses to ethically relevant actions – will be reopened later
in this work when discussing the wisdom of repugnance. In addition to the passed-on
knowledge about the effective pain behaviour or responses to pain in others, human efforts
to cope with the concrete sources and the more abstract origin of pain – practically and
existentially – have connected the topic of mental anguish to the core of moral sense-
making. Subsequent examples of religious constructions connected to pain tie the
exploration into the ensuing in-depth ethical discussion about the manifested values and
detectable moral framings of pain, the agent.
Moral anchor
Within our species, the elaborations of pain are not limited to neurological or even social
modulation but extend to culture, religion, and drama. Such adaptive sociocultural strategies
of coping, managing, and embracing have in time transcended a neurochemical warning
mechanism into a key component of ethical and religious deliberation, e.g. in Christianity
completing the narrative arc from the realisation of vulnerability and the initial punishment
(interestingly re childbirth) to the redemptive death. Theological tradition of Theodicy
(Greek. Theos, dikē; justifying God) that in part seeks to make sense of the ‘natural evils’
responsible for suffering as well as the Buddhist noble truth about life’s innate character, are
merely two examples of the richness of philosophical deliberation existentially grappling
with the seemingly inescapable reality of obnoxiousness.
Divine punishment and other religious motifs have throughout history impelled idealised
behaviour, in general fostering altruistic habits and opposing self-prioritisation. Some form
of pain-imbued afterlife is included in many of the prevailing religious traditions, possibly
inferring that a moral cosmos requires the potential for justified obnoxious experience, or
alternatively that an ultimate explanation of reality needs to allocate the undeniable
presence of pain into a morally acceptable context. Whether ‘hell’ – the eternal presence of
justified suffering – is as vital to the shared morality as the West has traditionally believed,
should not be dismissed as a nonsensical question. Yet, partaking in suffering might not
categorically denote external compulsion.

23
Encapsulated morals of the generated archetypes codify the established normative standing
of well-functioning responses as resultant social norms. Emotional transportation into
narratives can prompt empathetic responses in the absence of actual harm, e.g. emerging
subjects into simulated social environments through fiction literature has been observed to
induce empathic emotions and through subsequent reliving and internalisation expand the
conception of self (Bal & Veltkamp, 2013). The moral significance of narratives has been
recognised among bioethicists, who underline the importance of offering a co-human
presence, reciprocally sharing testimonies of encountered suffering, and thus making sense
of seemingly senseless events and experiences (McCarthy, 2003). Possessing a sense of
someone else’s unique story has been observed to increase the strength of the empathic
response, suggesting that in addition to neurological mirroring or motor resonance the
understanding of empathy requires a degree of narrative competency; the ability to be
moved by a story and identify its central message (Gallagher, 2012). Empathic responses
that are not dependent on witnessing actual anguish enable a more continuous process of
moral reflection through preserved accounts of past suffering, partaking in communion, as
well as contemplation of formed archetypal images. The narrative potential will be later
revisited.
Worst possible misery for everyone
A contemporary thought experiment is subsequently presented to frame the alleged moral
significance of suffering in a more academic style. The philosophical defence of universal
morality and moral realism includes the so-called WPME-argument introduced by Sam
Harris. The logic states that by establishing a continuum of possible experiences from
obnoxious to ecstatic, any moves away from a state of the world where the overall conscious
anguish is maximised are by definition good (Harris, 2010, pp. 39-40). Such realistic
conception of morality perceives ethical deliberation as a methodology to solve the problem
of navigating towards ever-higher peaks on a non-uniform moral landscape. It is important
to clarify, that this demonstration is concerned with the totality of misery, i.e. there is no
subsequent upside that would justify it.
The experience of pain perceivably provides the clearest example of a morally unacceptable
state when pushed to the extreme. Trepidation over analogous images of ‘hell’ rooted in the

24
built-in agreement over the ‘badness’ of anguish, has thus been argued to demonstrate how
humanity – by its shared nature – is anchored to a foundation for mutual normative
judgements. Therefore, a powerful reminder of our common biological origin might be
essential for addressing the problem of moral grounding. Regardless of the elaborate coping
mechanisms, practically everyone has an available pain continuum extending from the
unnoticeable past the unbearable. The prospect of intolerable misery undoubtedly fortifies
cross-personal agreement on the moral erroneousness of torture – sooner or later in the
process. The undeniable significance of the occurring anguish reminds that the negative
outcomes of actions extend back to – and are made real in consciousness. If the potential for
suffering motivates behaviour to avoid it, individual’s moral development might to some
degree be reliant on it. How ethically important is the vested interest in normative social
conduct that hinges on the shared capacity to experience irrefutably negative sensations?
Without the obnoxious segment of the experience-continuum, the task of navigation and
logical rules would still remain; yet narrowing the spectrum of negative experiences might
either enable more flexible navigation or in turn decimate any chances for ever agreeing
over a direction.

25
5. Beyond natural priorities
Pain signals and the resultant behaviour enact a certain kind of ethic based on a fitness-
determined system of value. The dynamic balance of competing strategies – including
behaviours deemed significant to morality – does not head towards any absolute ideal but
instead retains its relativity. There are nevertheless distinguishable features of defined
ethical framings in the operation of the natural mechanism. By examining such systems of
manifested prioritisation, their misalignment with human values and conceptions of the
good become apparent.
Self-prioritisation and self-sacrifice
According to the selfish-gene theory of evolution, the foundational motivation for all living
things is to ensure the passage of their genetic material into the next generation. Ethical
confusion caused by the value-laden word ‘selfishness’ has created a false conception of
humans as categorically egoistic consequently concealing the natural origin of altruism
(Nesse, 2000). The philosophical theory of egoism perceives the self as – ideally or de facto –
the source and target of actions; as an opposite to altruism it would be erroneous to claim
that natural processes operate by only considering the individual. Nevertheless, primal
motivations to prioritise oneself and one’s immediate kin generally overrule altruistic
considerations towards strangers. The more specific concept of egotism, defined as the
overvaluation of one’s importance well parallels the defining genetic objectives of self-
preservation and attaining genetic success (Moseley, 2005).
The theory put forward by Jonathan Haidt portrays the conflict between social and
physiological motivations as well as the trade-off between prioritising oneself and investing
in social relationships (2007). Morality can thus be understood as an adaptive mechanism for
controlling the excesses of self-interest, which would otherwise undercut the distinctly
human ability to cooperate in relation to practical demands through formed social bonds.
Such tension of motivations connects to the afore neurological descriptions of pain and
bonding; the ‘ego-preserving’ mechanism of harm avoidance being intersected by the pro-
social opioid rewarding mechanism (Inagaki, et al., 2016). Equivalent evasions of more
primitive motivations could prove to constitute the chemical compass for ethical navigation.

26
Because the neurological systems for social attachment are built-up from prior behaviour
regulating mechanisms (Decety, et al., 2016), pro-social co-opting of the self-prioritising pain
signalling has provided an alternative to ‘natural egotism’ and an inclusive way to increase
fitness, i.e. genetic success derived from altruistic behaviour. Despite the traditional ethical
emphasis on self-sacrifice, it has stayed relatively uncharted within the study of moral
psychology, yet a general preference for sacrificing oneself over exploiting others has been
observed (Sachdeva, et al., 2015).
Motivations controlled by the genetic incentive to prioritise, preserve, and reproduce the
creature (i.e. the units of its genotype), can impede altruistic actions when they require
sacrificing ‘natural priorities’. In the event of an emergency, the willingness to attempt
rescue always needs to surpass the threat of pain from a potential injury, while the victim’s
genetic and social distance from the pondering saviour modulate the degree of motivation.
Holding one’s little finger in fire – even to save the world – could conflict with the self-
protective natural guidance to an intolerable extent. Egotistic considerations run counter to
the utilitarian principle of impartiality; compliance to ethical equality initially requires a
cognitive effort until it is automatised as a personal habit or a social norm. While natural
motivations have retained influence, their outcomes are not inherently aligned with evolving
social norms or the contemporary behavioural optimum for increasing overall human
flourishing. The degree to which natural influences on altruistic dispositions – like the sense
of kinship – should be allowed to guide ethical decision-making away from true impartiality
brings up the unthinkable task to appraise the value of social constructions grounded on
primal motivations and dependent on social partiality e.g. human parenthood. The related
difference between ethics at the individual and ‘global level’ will be revisited.
Natural vitalism
Survival of the body is a prerequisite for genes to pass on copies, therefore the embodied
imperative to persist by avoiding physical harm aims to induce necessary responses
irrespective of the severity of the experienced distress. The moral idea acted out in an
aforementioned manner resembles the ethical view of vitalism, which perceives the value of
life as absolute (Keown, 1998). According to vitalism, failures to maintain and extend life are
morally wrong if a potential intervention or course of action exists that might delay death;

27
there is no upper threshold for adjacent costs or the elongation of pain experience. Akin to
vitalism, nature’s approximate method of fostering life via a gradient of noxious sensations
fails to account for the integrated network of ethical values beyond a single isolated
consideration. Due to the genetic focus on survival, the exhibited natural vitalism misses the
ethical mark from the viewpoint of conscious experience, by trading quality for quantity and
increased reproductive odds whenever possible. Besides, because the guidance of pain is
based on past survival probabilities it can only function in a non-case specific manner and
therefore even endanger the life of a creature or its biological offspring; a limited capacity to
endure painful sensations even if the stakes would include survival can negate the
underlying purpose of the harm prevention mechanism. Analogous to ‘rule utilitarianism’
this ethic could be termed ‘rule vitalism’. An extreme choice between one’s limb and life
would be an exception that a non-specific disposition against harm could not correctly
motivate for. In the absence of context-dependent dynamic modulation – beyond
straightforward response patterns like ‘Fight or Flight’ which decreases the perception of
pain (Liang, et al., 2021) – trade-off situations can make the process of rational self-
orientation starkly conflict with the built-in obligation to avoid tissue damage.
The processes that select which genetic variants continue to the subsequent generation do
not value the degree of subjective well-being but instead only promote it indirectly by
selecting for health, pro-social aptitude, and higher position in the mating hierarchy. The
recognition of the intrinsic value of experience required subjects to decline from being mere
means to a natural end. Any ethic compiled by a conscious being expectedly accounts for the
intrinsically valuable state of being. The near-universal potential of humans to experience
unbearably negative – and restrictedly helpful – sensations arguably negates the primacy of
any individual self, as well as the absolute value of maintaining life irrespective of its quality.
Assuming that the phenomenon of conscious experience has any ethical weight, natural
mechanisms that merely use sensations for their instrumental value and motivational
functions need to be ethically juxtaposed with a framework that emphasises the negative
value of all obnoxious states. The included quote from Albert Schweitzer well portrays the
moral responsibility to alleviate pain, torture unlike dying being evitable.

28
Limitations of hedonism
Normative hedonism is an ethical theory that makes the most direct case against the
sensation of pain, perceiving it as having no intrinsic value (Weijers, 2021). Regardless of the
image of hedonists as short-sighted and spontaneous indulgers, delaying pain at the cost of
overall pleasure actually conflicts with both forms of normative hedonism: egoistic as well as
utilitarian. The proclaimed absence of other types of value apart from the quality of
experience would readily justify all interventions attempting to tone down the severity of
pain – presuming that no function instrumental to the promotion of positive sensations
would be disturbed, thus negating the obtained overall improvement in human experience.
The undoubtedly real experience of suffering from losing a loved one is not arising from
triggered nociceptive sensors but instead from a definitive and redefying undoing of
loadbearing socio-emotional order. Yet, any hypothetical gene-edit able to neutralise such
pain would possess high instrumental value according to the hedonistic perspective,
however, most persons would surprisingly find themselves in agreement with Friedrich
Nietzsche that problems of enjoyment are not the most fundamental ones and such naïve
prioritisation of contingent and secondary issues would halt all human advance in moral
progression (1886). Perfectly actualised well-being or the total absence of experiences that
feel prima facie undesirable and bad, would according to this criticism, be the end of any
enhancement in creative, inventive, and interpretive potential attained only through
adversity, whilst possibly also undercutting any such previous advancement. If indeed
suffering holds special value as the internal tension that develops the soul in profundity and
strength, would decreasing the control of pain over human experience and behaviour,
obstruct the moral function of the creative anguish. A counter to Nietzsche’s argument
would be to challenge the absolute success of suffering to generate such value by
distinguishing between futile and fecund experiences of emotional pain – paralleling the
gradient of harm-preventing success of the sensations of physical pain.
Athletes and dancers in general do not perceive all pain as negative, but as a sign of
improvement. The drive to cross the barrier of pain separating the recalcitrant self from the
aspired ideal, was even described in moral terms during a recent qualitative study (Tarr &
Thomas, 2021). Possessed medical knowledge and gained experience were observed to

29
make the views on pain more nuanced, learning to distinguish between pain sensations
inseparable from physical activity and signals of injury takes time and perhaps a single
severe misestimation. Limits of one’s malleability and potential are discoverable by learning
to listen to the varying types and durations of somatic messages. An appropriately named
article ‘A life without pain? Hedonists take note’ – discussed the promising scenarios for
pharmaceutical and genetic control over pain, yet with important caveats (Young, 2008). The
study portrayed patient accounts of self-mutilating injuries as well the aforementioned case
of death. Author included a fitting quote from Aristotle which in addition to the physiological
level of learned harm avoidance could also apply to the development of a moral character,
“we cannot learn without pain”. If some form of experienced negative feedback is likewise
necessary for cultivating discernment about more abstract limits for appropriate behaviour
through continuous self-reflective reorientation, would detaching a person from the control
of underlying neurological mechanisms also revoke the means to mature in spirit. Therefore,
coping ability and even the sense of meaning – that are included in the broader definition of
well-being – would be undercut by a lifetime of pure genetically ensured pleasure.

30
6. Exploring the cancellation of unwanted pain
In outlaying the issues deemed ethically most relevant from genetic and neurological
mechanisms, complexities of social modulation, inducers of pro-sociality, to abstracted
motifs – the far penetrating influence of a prehistoric sensory mechanism was illustrated –
finally extending to the conceptual sphere of ethical frameworks. Instead of assessing the
hypothesised genetic intervention through a set of ethical principles, the supposed origin of
the ethical conflict was explored by comparing the manifested priorities of the assessed pain
mechanism to its direct ethical opposite. This conceptual work has prepared a foundation for
discussing the moral misalignment, re-evaluation of natural wisdom, and the substitution of
intuitive guidance with cognitive evaluation.
Genetic modulation of pain would not directly fit into either category of genetic prevention –
‘genotypic prevention’ nor ‘preventive strengthening’ – due to their focus on diseases rather
than symptoms or the resultant sensations (Juengst, 2021). Ethical deliberation and the
resulting policies based on relevant distinctions between such definitions would therefore
not address perhaps the most efficacious option for alleviating pain. The enacted natural
disregard for the conscious experience is detectable in the medical knowledge constructed
around the domains of health, biomedical models of disease generally prioritise ability over
subjective experience (Powell & Scarffe, 2019). Therefore, conditions that may impair
natural functioning but still be absent of any diminishing effect on subjective well-being may
nevertheless be defined as diseases. Yet, the etymological origin of the key concept for
disease association in genetic medicine – pathogenicity (Greek. Páthos; suffering,
experience) – in turn conveys an experience focused image of suffering (Encyclopædia
Britannica, Inc., 2021). This emphasis on the conscious outcome prompts a further challenge
to the occurring deliberation that relies on the contested definition of disease; the
alleviation of pain addresses suffering while directly opposing a natural function.
Research demystifying the biological connection of pain and empathy has been proposed to
furtherly increase control over pro-social tendencies and to possibly enable intercepting
psychopathological neurodevelopment (Decety, et al., 2016). Anti-sociality and egotism
might in time be treated medically, which emphasises the moral obligation to get the
disease definition right. The understandable concerns over subjective value judgements

31
resulting in genetic discrimination make a case for holding on to the naturalistic model of
health, free of normative preferences. However, such moral timidity ignores the
misalignment presented in this work by validating the natural vitalism and prioritisation of
function, thus disregarding the moral weight and intrinsic value of experience. While the
previously held qualifications for moral consideration have been progressively challenged,
the ethical emphasis has shifted away from addressing malfunctions to respecting the
diversity of conscious subjects and elevating their respective forms of well-being (Kittay,
2005). The extending sphere of consideration increases the number of accountable factors
for together mindfully navigating the moral landscape, while concurrently exposing the
moral confusion handed down by the nature-originated prioritisation of kin, in-group, and
able.
Unforeseen alterations and outcomes
The primary targets for genetic pain alleviation are the victims of chronic pain who do not
respond to available forms of treatment. Formulating an appropriate ethical justification for
the use of targeted somatic gene therapy to address sources of already present and
seemingly useless pain – e.g. during palliative care – is relatively straightforward with a little
difference to pharmaceutical interventions. Pre-emptive or heritable applications would in
turn raise more pressing ethical concerns. In contrast to acute pain, many forms of chronic
pain are classified as diseases (Treede, et al., 2019). Undoubtedly additional pain phenotypes
will follow when detected and defined as deleterious. The potential utility of chronic pain is
a vigorously debated topic; its adaptative value has been explained as a constant reminder
of vulnerability thus discouraging risk behaviour in a compromised physical state.
Alternatively, chronic pain has been argued to result from an unnatural sedentary recovery
(Walters & Williams, 2019). Compared to the natural state, a painful reminder of decreased
mobility has probably lost most of its advantage; if this explanation is correct it well
demonstrates the presently skewed priority and high conscious price of the protective
mechanism.
A study conducted with subjects affected by congenital insensitivity explored the impact of
absent personal experience on the ability to empathise with the pain of others (Danziger, et
al., 2006). According to its title, the study attempted to illuminate if personal experience of

32
pain is the price of empathy. Unlike with the control group, pain judgements significantly
correlated with the differences in the measured trait of emotional empathy among subjects
lacking personal experience of pain. Results suggested that the ability to empathise with a
casualty of a perceived painful event is not reliant on personal experience, nevertheless
absent somatic resonance mechanism (mapping of sensory information) may lead one to
significantly underestimate the severity of the witnessed pain in the absence of clear
emotional cues. Without somatic empathy, the trait of emotional empathy appears to be
strongly determinative of the pain judgements. Yet importantly, emotional empathy is not
understood at the genetic level, presently lacking any known associations (Woodbury-Smith,
et al., 2020). Because of its suggested stand-in for absent somatic empathy and connection
to moral intuitions, a deeper understanding of the trait is required prior to any intervention
targeting the underlying pain-empathy mechanism. Further empirical research among
people affected by pain insensitivity could help to assess the potential social outcomes of
genetic pain modulation.
Liberation from pain
The pain-free post-operation recovery and childbirth of a woman affected by gene-based
pain insensitivity portray an intriguing prospect of pre-emptive pain liberation (Ducharme,
2019; Habib, et al., 2019). If the pain of giving birth indeed is intensified due to its socially
attained benefit for fitness, should such a natural mechanism maintain in operation till
perpetuity? In the modern world, the probability of receiving assistance during labour is no
longer dictated by the volume of pain expression. However, if the intensified severity
increases post-natal survival by discouraging intentionally giving birth in solitude – which is
the norm among other primates – and in turn encourage help-seeking behaviour (Finlay &
Syal, 2014), implications of modifying the natural severity of pain might evoke instances of
risk-taking. Significant changes at the biological level – like the invention of reliable birth
control – have in the past challenged sociocultural conceptions and societal organisation.
Such change can undoubtedly result in an overwhelmingly positive overall outcome, specific
reverberations are however difficult to predict. Control over biology enables the elevation of
other considerations and values to accompany fitness as additional gatekeepers of change.
Yet, interference with the order of nature risk upsetting established balances, increasing

33
human control and influence over natural processes has undeniably resulted in indications of
the elevating tension.
In a potential future where a portion of the population has gained a more relaxed
relationship with pain e.g. due to a genetic modulation of its severity, the moral duty to give
consideration to others’ pain experience could be hampered by the lack of experiential
intersection. Although, arguing against the modulation on the grounds of an ethically
problematic transitional period prior to universal access would not likely carry comparable
weight to the potential future, liberated from unnecessary conscious anguish. In a world
absent of excessive pain there would not be a comparable need for empathising its
casualties, nevertheless partially defeating the purpose of cue recognition could have an
impact on psychological development; atypical neural processing and resultant disregard of
pain cues has been associated with antisocial behaviour and psychopathy (Decety, et al.,
2016). Could the social reality of others’ pain critically contribute to the generation of
faculties necessary for moral development, such as guilt, remorse, and cognitive empathy?
The suggested potential of disability to generate meaning through narrative and ethical
means resembles the presented objection against the abolishment of suffering (Garland-
Thomson, 2012). Assessing the absolute value of pain merely based on prima facie
experiences fails to grasp the extent of its protective and generative potential as well as the
profundity of an expressly human ability to willingly accept and partake in the shared
suffering. Yet, the uncoverable meaning should not necessarily be perceived as ethically
validating the retaining of avoidable anguish; the disposition to detect it – like pain and
emotional empathy – also has a non-moral natural origin and only performs as a fallible
guide. Justifying inaction against suffering by referencing its elaborated value contributions,
would in hedonistic terms assert that the secondary positive experience of generated
meaning surpasses the primary negative experience of suffering.
The advantage of higher pain tolerance in sports has been argued to make genetic
modulation unjustified in the context of a constructed competition due to its constitutive
role in endurance sports (Camporesi & McNamee, 2012). The dramatic value of the pursuit –
overcoming oneself and others – is therefore deemed to be dependent on the adjacent
conscious anguish, yet fully fictional narratives can arguably prompt even stronger states of

34
emotional immersion. In this context, there would appear to be a trade-off; if subtracting
from the conscious experience of pain would undermine the admiration of the prevailed
competitors and the fundamental meaning of the pursuit, then would not its intentional
intensification correspondingly elevate them? Meaning is thus created through misery and
the ‘spirit of sport’ appears as an allegory for acknowledging the standard sacrifice for
attaining progress. Irrespective of the heightened risk for serious physical injury, combative
genetic enhancement of athletes would undoubtedly – as a performance of transhuman
ability – also generate meaningful experiences for participants and their witnesses.
‘Overcoming’ can take many – more or less innoxious – forms and the means of generating
meaning are amendable, which emphasises the value of a more stable moral aim and
rational navigation.
Past wisdom of repugnance
In order to address the naturalistic fallacy regarding pain modulation, a parallel between the
guidance of pain and moral intuitions should be recognised. In his well-known article, Leon
Kass argued for intentionally limiting the extent of human control over natural processes
(1998). The depth and profundity of human norms rooted in the natural ground are beyond
the grasp of reason and should therefore remain unexplained and beyond hubristic attempts
for hypothetical improvements. According to Kass, the human disposition to respond with
negative emotion towards perceived violations of the natural order manifest built-in wisdom
that implicitly protects the core of humanity. However, presuming that the branch of homo
stems from a shared natural origin with all terran life, the only ever-stable features are the
original selfishness and original hunger – to paraphrase Alan Watts (2004). Assuredly the
emergent qualities that have come to define humanity remark great progress, yet arguably
are confined by the ‘fallen nature’. The instrumental purpose and value of generated norms
and complimentary motivational systems to meet practical demands – as previously
presented – is easy to recognize. Yet the human potential to re-envision the relationship
with the prevailing order by mapping and refiguring causal relationships, grants onus over
the avoidable suffering. By stating “shallow are the souls that have forgotten how to
shudder”, Kass places appropriate weight on moral intuition, however tension should only
be the beginning of ethical deliberation. When repugnance is triggered by an action crossing

35
a set alarm wire, a description of its function is needed in order to ethically assess the merit
of resultant revulsion. As laid out by the present work, accepting the embedded natural
wisdom without critical reflection impedes necessary reorientation.
Successful patterns of behaviour habitualised under evolutionary pressure and their later
incorporation to the socially constructed model of the world only illustrates what has
worked in the past. The same applies to the internal conceptions of the world. Changing
environment and varying contemporary circumstances continuously question the value of
specific natural motivations. In order to revise the outdated internal guidance and altogether
assist with the reality of continuous change, the cognitive capacity for rational reorientation
has emerged.
Fallibility and refinement of moral intuitions
An argument against moral reliance on empathic responses provoked by experiencing the
pain of others has been laid out by Paul Bloom in a controversial book titled ‘Against
Empathy: The Case for Rational Compassion’ (2016) and a subsequent article (2017).
According to Bloom, the innumeracy and partiality of emotional empathy – due to the
narrowed focus on the experience of a single target – make it a biased source of moral
motivation. Therefore, an emotion-evoking narrative or image of a suffering child can induce
an unrivalled response, whilst a concurrent genocide may be all but ignored. Alternatively,
an impartial utilitarian approach could be adopted to better distribute the aid and thus
maximise the overall benefit. Then again, the degree of emotional empathy has been
detected to correlate with higher parental investment and emotional openness (Mehrabian,
et al., 1988). Relying on a mechanism that has initially been fine-tuned for maternal or in-
group bond-building to address population-level as well as global issues over-extends the
underlying intuitions and should instead rely on rational deliberation and assessable
predictions.
The hypothesised interplay between emotional responses, habitualisation, and critical
cognition to the formation of moral judgements have been well presented by Corey Steiner
(2020). The Internal conflict model he puts forward suggests that an emerging misalignment
between an emotional response and a formerly habitualised response sparks self-reflective

36
cognitive processing to resolve the encountered inner conflict within a broader context of
upheld concerns and values. The model emphasises the vital function of the experienced
ethical tension as a promoter of deliberation, making such interruptions to the entrenched
habits a key component of moral life. Reflection creates a potential entry for reason to alter
dispositions that miss the ethical mark. An interplay of emotive turmoil and calm
deliberation would thus be required for revising the previously habitualised – or for that
matter primal – inferior responses to present challenges. Emotional responses that enable
ethical reorientation might not always directly indicate proximity to a moral wrong,
nevertheless instigation of reflection is vital for making moral progress and promotes one to
live an examined life.
Thus described, the role of moral reflection connects to the distinction made between prima
facie principles and rational inspection (Hare, 1981). Agents limited in understanding of the
available actions and their outcomes require simplifications and generalisations to act in a
complex world. However, nor natural or learned intuitions should dictate one’s behaviour
without critical reflection based on a continuously refined model of the world. A mechanism
that triggers the assessment of actual value that is achievable through the prospective
courses of action, nevertheless, has its basis in neurochemistry. Without the presence of a
conflicting emotional process – be it either empathy or anxiety – the potentially pathological
pattern of behaviour might not ever get challenged, assessed, and revised. Unquestioned
habitualised responses manifest comparably deprived self-governance than yielding under
pressure.
In order to elevate the discussion into the social sphere, the proposed evolution of moral
norms is revisited. The described dispositions that direct anger towards violators of the
binding social demands, enact a kind of deontological absolutism towards the codified
norms. Elevating normative judgements beyond the authority of any human stabilises them,
by in turn rendering moral imperatives incontestable. Traditional ethical theories perceive
morality as a deductive process of behaviour optimisation in accordance with a precept like
the ‘Golden Rule’ (Sullivan, 2000). As previously explored, such precepts might nonetheless
have been originally formulated through inductive abstraction from naturally emerged
practical demands. Norms and other social constructions that have come to encompass

37
meaning are evidently revisable, successful social reorientation thus perceivably functions to
narrow the misalignment. Regarding the disposition to avoid pain, optimised social
modulation could likewise have a significant impact in refiguring its influence, however
biological roots likely set an absolute limit for making resultant intuitions more moral. On
the contrary, genetic interventions enable access directly to the source code.
Findings suggest that the emotional disposition and stated motivation to experience
empathy are connected to one’s political identity (Hasson, et al., 2018). In general, liberals
surpass conservatives in empathy across cultural contexts; notably, subjects in both groups
wanted to feel more empathy towards members of their group compared to ideological
adversaries. Authors emphasised the modulating influence of context and the personal
willingness to experience empathy. Varying preferences about the appropriate targets could
likewise be perceived as dispositions; bias towards the ideological in-group certainly appears
more automatic and naturalistic, than a product of critical assessment. If supposing that
emotional empathy is more of a hindrance to ethical decision-making than a prerequisite,
the prospective human influences on the underlying mechanism might be desirable even if
the capacity to feel empathy would be affected. In contrast, by conceiving the political divide
as a manifestation of an evolutionarily emerged balance of dispositions whose interaction
has managed to elevate the inclusive fitness of human collectives, disturbing the natural
distribution of empathy might perceivably produce some unintended consequences. Past
social reformations and adjacent moral reorientations have arguably been greatly powered
by empathetic motives rather than reason alone. The proclivity for moral absolutism reliably
evokes suspicion towards sentiments impugning the established norms. However, shifting
practical demands urge recurrent societal revision.
Ethical conflicts between outdated norms and the maximisation of human flourishing are
only resolvable by distinguishing the underlying practical demands, responsible natural
mechanisms, and the prospective outcomes of alterations. Similarly, to appropriately
explore the ethical dimension of any natural motivation, the underlying neurochemistry
needs to be exposed with an appropriate degree of detail. Described attributes and features
that may appear trivial in a social science context may nevertheless be crucial for a
bioethicist; critical evaluation of the embodied ethic partly relies on technical understanding.

38
Apparent misalignments of value between built-in motivations and ethical theories may only
be resolved at the base of their foundation, not by relying on moral intuitions or ethical
heuristics; e.g. the alleged ethical line between treatment and enhancement – crossed by
pre-emptive interventions – should not function as a deontological stand-in for the
naturalistic fallacy.
Study data demonstrating the modulation of moral intuitions via pharmaceutical
interventions point to a fundamental connection between neurochemical states and affinity
towards particular moral viewpoints. One such study induced pro-utilitarian decision-making
after administering an anxiety-reducing agent (Perkins, et al., 2013); inhibiting the
emergence of involuntary negative emotional reaction towards the idea of causing direct
harm thus enables more calculative prioritisation of the greater good. Authors concluded
that reduced perception of threat severity makes harming others – either directly or through
endorsement – more probable. Alleviating the anxiety over endured or caused harm to a
comparable extent by unintentionally decreasing the level of empathy as a side effect of
pain modulation, could shift moral intuitions at the societal level away from the embedded
wisdom of repugnance and towards more rational, utilitarian, and ruthless.
Meaningful narrative
Key characteristics of humanity should not be altered merely for the sake of outcome, Kass
argues that issues rooted in the natural ground are more fundamental than mere social
constructions and should therefore be regarded as matters of ontological meaning (Kass,
1998). Indeed, also pain has reliably evoked questions and answers about the existential
meaning hiding behind it. The desire to make sense of suffering has sprouted out religious
descriptions embedded with meaning that have provided means to some extent improve
coping (Dedeli & Kaptan, 2013). Yet presently, the naturalism-based dismissal of the
emblematic purpose and the archetypical dimension of suffering have created a void of fixed
luminaries for personal orientation.
The traditional bioethical approach to medical decision-making utilises the four principles of
biomedical ethics to assess the validity of an intervention. Regarding the management of
pain, Mark Sullivan has argued that the valuable starting point of a principle- or rule-based

39
framework needs to be supplemented with more individualised and interpersonal methods
(2000). Subsequently, he has argued against the conception that pain reduction is a panacea
for improving the quality of life of patients suffering from chronic pain, partly due to
difficulties in adjusting the opioid dosage in accordance with physical pain rather than the
generally present psychiatric comorbidities (Sullivan & Ballantyne, 2016). Health conditions
where pain itself has become the specified problem nevertheless seem to connect to the
absence of perceived meaning in the form of depression. If a narrative approach can make
sense of seemingly senseless forms of suffering, maybe it could provide a counter to the
pharmaceutical modulation of the opioid system, possibly also via psychoactive
pharmaceutical agents. Although, potentials to frame the past and actively modulate the
present should not be confused nor overstated. Alternatively, should a genetic intervention
– justified by the gained comprehension of the now obsolete role that the chronic pain ones
played – target the fundamental level behind the phenomena. Results will speak for
themselves.
Agreeing with Mark Sullivan; despite the usefulness of ethical generalisations like rules,
principles, or virtues – regarding the experience of pain such templates require a more
individualised viewpoint. Even while arguably being the most appropriate ethical theory at
the level of humanity, for the intimate purpose of sense-making utilitarianism is all but
impotent. In addition to the general preference for pleasure, the desire for uncovering and
experiencing meaning is inherent and therefore essential for human well-being. In the words
of Nietzsche, “If we possess our why of life, we can put up with almost any how” (1976, p.
468). Well-being is not easily reducible for a single hedonistic dimension of sensation;
besides if the generation of meaning is included in its definition, it should not be henceforth
described as something necessarily ‘comfortable’ (Oxford University Press, 2021). As noted
by Dennett, a tension resembling physical anguish can be sparked by the undoing of the
supportive structure, necessitating one to re-evaluate the meaning of past emotions and
experiences. Sense-making imposes a narrative structure that merges together different and
opposing elements, the prima facie negativity of some components is thus surpassed and
possibly transcended by the storyline as a whole. Such unification can serve the utilitarian
end by granting enjoyment and motivating altruism through the embedded meaning, or –
given an erroneous model of the world – solidify delusion and misdirect natural dispositions.

40
Construing pain as punishment might be sensible for someone after absolution, yet also
prevent from pursuing alleviation. The narrative arc from the viewpoint of a protagonist in
time generally bends towards acceptance and humility, the human share has historically
been demarcated by forces and processes beyond our understanding or influence. Yet, the
overarching narrative pattern of humanity has been to displace the old gods. Biological
reductionism that has deemed suffering to lack purpose (negative model), should however
not dismiss the value of ‘perceived purpose’ that enables the integration of obnoxious
experiences into a coherent personal account. Genetic interventions might risk furtherly
rationalising suffering, hence diminishing weight given to issues of personal meaning.

41
7. Roles played by pain
Knowledge about the genetic basis of pain should be complemented with mapping of its
extended influence, including emotional empathy, pro-sociality, and psychological
development – before large-scale or heritable gene-editing may appropriately take place.
The two distinguishable roles of pain – guide and teacher – provide a narrative approach to
evaluate potential interventions aiming to ease its hold on the human experience. If these
functions are undercut, they should either be proved false or unnecessary, otherwise
prospective alternatives should be introduced to offset the functional deficit.
Guide, i.e. direct assistance for harm prevention. Because individuals and even societies can
be catastrophically wrong about the correct means to produce the ‘greatest good’ – or what
ratio of well-being and ‘will to power’ correctly establish it – the guidance of nature through
pain, anxiety, and empathy continue to hold value prior to a world populated by fully
rational agents. Alternatively, non-genetic modulation of natural dispositions with optimised
social norms and improved methods for cultivating meaning, could harness the built-in
motivational mechanisms to advance rationally evaluated objectives. Perhaps only then, the
remaining gap – impossible to align with social means – reaches the ethical justification for
treating the genetic roots.
Teacher, i.e. long-term assistance for reaching one’s limit. The capability of pain signals to
instruct one in uncovering and reaching the boundary of the possible, would be difficult to
find a substitute for. A sustained strive towards a physical ideal requires a powerful
counterforce to remind one of the limits of the natural body. Furthermore, if the driving
motivation away from the moral stagnation of hedonism is indeed sparked within tension
and adversity, such a state needs to be achievable without noxious sensations to justify the
undercutting of pain mechanism. As a counter, it could be argued that the narrowed focus
under severe pain actually impairs the reflection and reorientation, thus possibly stifling the
creative tension. The process of discovering the balance between a stifling burden and
languid stasis might require a rationally calibrated teacher, one that no longer motivates
through the use of irresistible force. The compulsion of pain should in time be superseded,
an acceptance is no longer an ethical panacea when the capability to intervene and
appropriate comprehension of the extended functions have been obtained.

42
The moral work taken on by a mind in turmoil holds the key to progress and growth, yet if
achievable without a personal experience of obnoxity, its value and function would be
preserved. The explored connections and resemblance between pain, the empathic
intuition, the tension described by Nietzsche, and the participation in suffering, may hint at
an analogous function of initiating reorientation deemed necessary by the embedded
wisdom. The description of biologically distant phenomena like grief or heartbreak with the
term ‘pain’ as well as their inclusion in the spectrum of suffering might infer similarity of
their respective purposes.

43
8. Conclusion
The process that produces the motivating sensation of pain is ethically exceptional due to its
potential to overrule other motivations. When its enacted emphasis on the survival of the
self conflicts with pro-social or ethical motivations, the unbearable force of pain can reduce
any complex, socialised, and altruistic person into an imploded non-moral creature. In
severe anguish, the collapsing structure of the constructed world model buries eventually all
sources of value and reduces the agent into a single wish for unconscious oblivion. Thus, the
mechanism that emerged to protect life can turn a sentient mind against living. Human
values beyond mere survival and reproduction are at a stark disadvantage when made to
compete in the conscious arena where a predominantly context-independent motivator can
induce an unbearable experience that narrows the cognitive focus, deploying all existing
means into ceasing it. Pain being a fallible guide, the limited potential to resist the noxious
signal can in specific cases give an advantage or even protect life. Yet under the hold of pain,
a being that is more correct about the rightness of an action than the embedded natural
wisdom may still lack the necessary mental strength to follow through.
Increasing control over pain – either by decreasing its intensity or improving the capacity to
cope – is ethically justified once the impelling natural rule of pain is excelled by reason-
guided behaviour and ethical navigation by individuals. The value of salutary guidance for
evading personal harm and appropriately relating to witnessed harm needs to be assuredly
undercut by pain’s context-independence, misaligned priorities, and the inadequate faculty
to resist it when morally vital. Presuming that ethical navigation relies on natural facts,
intentions to redirect or intercept a primordial force need to recognise the preserved utility,
relationality, and extent of the motivational mechanism whilst challenging its moral
infallibility. Ethical revision should in time extend beyond addressing subjective tension and
perhaps align the natural world itself.

44
References
Avenanti, A., Bueti, D., Galati, G. & Aglioti, S., 2005. Transcranial magnetic stimulation
highlights the sensorimotor side of empathy for pain. Nature Neuroscience, 8(7), pp. 955-
960.
Baliki, M., Geha, P., Apkaria, V. & Chialvo, D., 2008. Beyond Feeling: Chronic Pain Hurts the
Brain, Disrupting the Default-Mode Network Dynamics. The Journal of Neuroscience, 28(6),
pp. 1398-1403.
Bal, M. & Veltkamp, M., 2013. How Does Fiction Reading Influence Empathy? An
Experimental Investigation on the Role of Emotional Transportation. Plos One, 8(1), p.
e55341.
Bloom, P., 2016. Against Empathy: The Case for Rational Compassion. New York: Ecco Press.
Bloom, P., 2017. Empathy and Its Discontents. Trends in Cognitive Sciences, 21(1), pp. 24-31.
Boddice, R., 2014. Pain and Emotion in Modern History. London: Palgrave Macmillan.
Botha, C., 2001. Nietzsche and evolutionary theory. Phronimon, 3(1), pp. 1-21.
Bourke, J., 2013. What is pain? A history the prothero lecture. Transactions of the Royal
Historical Society, Volume 23, pp. 155-173.
Camporesi, S. & McNamee, M., 2012. Gene Transfer for Pain: A tool to cope with the
intractable, or an unethical enduranceenhancing technology?. Genomics, Society and Policy,
8(1), pp. 20-31.
Cox, J. et al., 2006. An SCN9A channelopathy causes congenital inability to experience pain.
Nature, Volume 444, pp. 894-898.
Danziger, N., Prkachin, K. & Willer, J.-C., 2006. Is pain the price of empathy? The perception
of others’ pain in patients with congenital insensitivity to pain. Brain, Volume 129, pp. 2494-
2507.

45
Davies, J., 2011. Positive and Negative Models of Suffering: An Anthropology of Our Shifting
Cultural Consciousness of Emotional Discontent. Anthropology of Consciousness, 22(2), pp.
188-208.
de Craen, A., Roos, P., de Vries, L. & Kleijnen, J., 1996. Effect of colour of drugs: systematc
review of perceived effect of drugs and oftheir effectiveness. BMJ, Volume 313, pp. 1624-
1626.
de Williams, A., 2002. Facial expression of pain: An evolutionary account. Behavioral and
Brain Sciences, Volume 25, pp. 439-488.
de Williams, A. & Craig, K., 2016. Updating the definition of pain. The Journal of Pain, Volume
157, pp. 2420-2423.
de Williams, A., Gallagher, E., Fidalgo, A. & Bentley, P., 2016. Pain expressiveness and
altruistic behavior: an exploration using agent-based modeling. PAIN, 157(3), pp. 759-768.
Decety, J., Bartal, I., Uzefovsky, F. & Knafo-Noam, A., 2016. Empathy as a driver of prosocial
behaviour: highly conserved neurobehavioural mechanisms across species. Philosophical
Transactions of the Royal Society, 371(1686), p. 20150077.
Dedeli, O. & Kaptan, G., 2013. Spirituality and religion in pain and pain management. Health
Psychology Research, 1(e29), pp. 154-159.
Dennett, D., 1991. Consciousness Explained. New York: Little Brown Publishing.
Dennett, D., 1995. Darwin's Dangerous Idea: Evolution and the Meanings of Life. New York:
Simon & Schuster.
Duan, G. et al., 2018. A variant in the SCN10A enhancer may affect human mechanical pain
sensitivity. Molecular Pain, Volume 14, pp. 1-10.
Ducharme, J., 2019. How a Scottish Woman Endured Burns, Broken Bones, Childbirth and
Surgeries Without Ever Feeling Pain. Time Magazine, 28 March.

46
Eigenbrod, O. et al., 2019. Rapid molecular evolution of pain insensitivity in multiple African
rodents. Science, 364(6443), pp. 852-859.
Encyclopædia Britannica, Inc., 2021. Merriam-Webster. [Online]
Available at: https://www.merriam-webster.com/dictionary/pathos
[Accessed 25 July 2021].
Fillingim, R., 2008. Genetic contributions to pain: a review of findings in humans. Oral
Diseases, 14(8), pp. 673-682.
Finlay, B. & Syal, S., 2014. The pain of altruism. Trends in Cognitive Sciences, 18(12), pp. 615-
617.
Gallagher, S., 2012. Empathy, Simulation, and Narrative. Science in Context, 25(3), pp. 355-
381.
Garland-Thomson, R., 2012. The Case for Conserving Disability. Journal of Bioethical Inquiry,
Volume 9, pp. 339-355.
Gregory, R., 2009. Understanding Natural Selection: Essential Concepts and Common
Misconceptions. Evolution: Education and Outreach, Volume 2, pp. 156-175.
Habib, A. et al., 2019. Microdeletion in a FAAH pseudogene identified in a patient with high
anandamide concentrations and pain insensitivity. British Journal of Anaesthesia, 123(2), pp.
e249-e253.
Haidt, J., 2007. The New Synthesis in Moral Psychology. Science, 316(998).
Haller, J. et al., 2013. The effects of anandamide signaling enhanced by the FAAH inhibitor
URB597 on coping styles in rats. Psychopharmacology, 230(3).
Hare, R., 1981. The Archangel and the Prole. In: Moral Thinking: Its Levels, Method, and
Point. Oxford: Clarendon Press, p. 44.
Harris, S., 2010. Moral Truth. In: The Moral Landscape: How Science Can Determine Human
Values. Ney York: Free Press, pp. 39-40.

47
Hasson, Y. et al., 2018. Are Liberals and Conservatives Equally Motivated to Feel Empathy
Toward Others?. Personality and Social Psychology Bulletin, 44(10), pp. 1449-1459.
Inagaki, T. et al., 2016. Opioids and social bonding: naltrexone reduces feelings of social
connection. Social Cognitive and Affective Neuroscience, 11(5), pp. 728-735.
Johnson, K. & Dunbar, R., 2016. Pain tolerance predicts human social network size. Scientific
Reports, 6(25267).
Juengst, E., 2021. “Prevention” and Human Gene Editing Governance. AMA Journal of Ethics,
23(1), pp. e49-54.
Jung, C., 1968. The Archetypes and the Collective Unconscious. London: Routledge.
Kass, L., 1998. The Wisdom of Repugnance: Why We Should Ban the Cloning of Humans.
Valparaiso University Law Review, 32(2), pp. 679-705.
Keown, J., 1998. The Legal Revolution: From "Sanctity of Life" to "Quality of Life" and
"Autonomy". Journal of Contemporary Health Law & Policy, 14(2), pp. 253-285.
Kittay, E., 2005. At the Margins of Moral Personhood. Symposium on Disability, 116(1), pp.
100-131.
Liang, F. et al., 2021. Emotion Induced Monoamine Neuromodulator Release Affects
Functional Neurological Disorders. Frontiers in Cell and Developmental Biology, 9(633048).
Mameli, M., 2013. Meat made us moral: a hypothesis on the nature and evolution of moral
judgment. Biology and Philosophy, Volume 28, pp. 903-931.
McCarthy, J., 2003. Principlism or narrative ethics: must we choose between them?. Medical
Humanities, 29(2), pp. 65-71.
Mehrabian, A., Young, A. & Sato, S., 1988. Emotional empathy and associated individual
differences. Current Psychology, Volume 7, pp. 221-240.
Melzack, R., 2001. Pain and the Neuromatrix in the Brain. Journal of Dental Education,
65(12), pp. 1378-1382.

48
Moreno, A. et al., 2021. Long-lasting analgesia via targeted in situ repression of NaV1.7 in
mice. Science Translational Medicine, 13(584), p. eaay9056.
Moseley, A., 2005. Internet Encyclopedia of Philosophy. [Online]
Available at: https://iep.utm.edu/egoism/
[Accessed 13 July 2021].
Motov, S. & Khan, A., 2009. Problems and barriers of pain management in the emergency
department: Are we ever going to get better?. Journal of Pain Research, Volume 2, pp. 5-11.
Nagel, T., 1974. What Is It Like to Be a Bat?. The Philosophical Review, 83(4), pp. 435-450.
Nagel, T., 1979. Death. Mortal Questions, pp. 1-10.
Nesse, R., 2000. How selfish genes shape moral passions. Journal of Consciousness Studies,
7(1/2), pp. 227-231.
Nietzsche, F., 1886. Part VII - Aphorism # 225. In: Beyond Good and Evil. s.l.:Simon &
Schuster, p. 225.
Nietzsche, F., 1976. Maxims and Arrows. In: The Portable Nietzsche. New York: The Viking
Press, p. 468.
Orr, A., 2009. Fitness and its role in evolutionary genetics. Nature Reviews Genetics, 10(8),
pp. 531-539.
Oxford University Press, 2021. LEXICO. [Online]
Available at: https://www.lexico.com/definition/well_being
[Accessed 16 August 2021].
Peacock, S. & Patel, S., 2008. Cultural Influences on Pain. Reviews in Pain, 1(2), pp. 6-9.
Peddareddygari, L., Oberoi, K. & Grewal, R., 2014. Congenital Insensitivity to Pain: A Case
Report and Review of the Literature. Case Reports in Neurological Medicine, 2014(141953).

49
Perkins, A. et al., 2013. A Dose of Ruthlessness: Interpersonal Moral Judgment Is Hardened
by the Anti-Anxiety Drug Lorazepam. Journal of Experimental Psychology: General, 142(3),
pp. 612-620.
Pitts, G., 1994. An Evolutionary Approach to Pain. Perspectives in Biology and Medicine,
37(2), pp. 275-284.
Powell, R. & Scarffe, E., 2019. ‘Rethinking “Disease”: a fresh diagnosis and a new
philosophical treatment’. Journal of Medical Ethics, Volume 45, pp. 579-588.
Rahim-Williams, B., Riley, J., Williams, A. & Fillingim, R., 2012. A Quantitative Review of
Ethnic Group Differences in Experimental Pain Response: Do Biology, Psychology and Culture
Matter?. Pain Medicine, 13(4), pp. 522-540.
Sachdeva, S., Iliev, R., Ekhtiari, H. & Dehghani, M., 2015. The Role of Self-Sacrifice in Moral
Dilemmas. Plos One, 10(6), p. e0127409.
Scarry, E., 1985. The Body in Pain: The Making and Unmaking of the World. New York:
Oxford University Press.
Schroeder, C., Doering, C., Zamponi, G. & Lewis, R., 2006. N-type Calcium Channel Blockers:
Novel Therapeutics for the Treatment of Pain. Medicinal Chemistry, Volume 2, pp. 535-543.
Schweitzer, A., 1922. January to June, 1914. In: On the Edge of the Primeval Forest. London:
A & C Black, pp. 69-93.
Siler, S., Borneman, T. & Ferrell, B., 2019. Pain and Suffering. Seminars in Oncology Nursing,
35(3), pp. 310-314.
Smith, E. & Lewin, G., 2009. Nociceptors: a phylogenetic view. Journal of Comparative
Physiology A, Volume 195, pp. 1089-1106.
Steiner, C., 2020. Emotion’s influence on judgment-formation: Breaking down the concept of
moral intuition. Philosophical Psychology, 33(2), pp. 228-243.
Sullivan, M., 2000. Ethical Principles in Pain Management. Pain Medicine, 1(3), pp. 274-279.

50
Sullivan, M. & Ballantyne, J., 2016. Must we reduce pain intensity to treat chronic pain?.
PAIN, Volume 157, pp. 65-69.
Tarr, J. & Thomas, H., 2021. Good Pain, Bad Pain: Dancers, Injury, and Listening to the Body.
Dance Research Journal, 39(1), pp. 53-71.
Treede, R.-D.et al., 2019. Chronic pain as a symptom or a disease: the IASP Classification of
Chronic Pain for the International Classification of Diseases (ICD-11). PAIN, 160(1), pp. 19-27.
Victor, T. et al., 2008. The Dimensions of Pain Quality: Factor Analysis of the Pain Quality
Assessment Scale. The Clinical Journal of Pain, 24(6), pp. 550-555.
Vučković, S. et al., 2018. Cannabinoids and Pain: New Insights From Old Molecules. Frontiers
in Pharmacology, 13(9), p. 1259.
Walters, E. & Williams, A., 2019. Evolution of mechanisms and behaviour important for pain.
Philosophical Transactions of the Royal Society B, 374(20190275).
Watts, A., 2004. Out of Your Mind: Essential Listening From the Alan Watts Audio Archives -
The Web of Life. [Sound Recording] (Sounds True).
Weijers, D., 2021. Internet Encyclopedia of Philosophy. [Online]
Available at: https://iep.utm.edu/hedonism/
[Accessed 19 July 2021].
Woodbury-Smith, M., Paterson, A., Szatmari, P. & Scherer, S., 2020. Genome-wide
association study of emotional empathy in children. Scientific Reports, 10(7469).
Young, F., 2008. A life without pain? Hedonists take note. Clinical Genetics, Volume 73, pp.
31-33.

51
Appendix
Prospective genetic targets
SCN9A and SCN10A. The discovered variation in genes responsible for the expression of
sodium channels has provided novel targets for both pharmaceutical and genetic
interventions (Duan, et al., 2018). The resulting non-opioid analgesics that perform as
sodium channel blockers aim to inhibit the transmission of pain signals to the brain.
Considerable challenges in creating selective inhibitors to avoid unwanted effects have
prompted a recent effort to instead repress the targeted channel via CRISPR-based gene-edit
(Moreno, et al., 2021). A resultant gene-editing platform for long-lasting analgesia has
recently been proved effective in vivo (i.e. with animal models) thus indicating a promising
new avenue for pain management.
FAAH. The endocannabinoid signalling system responsible for a variety of regulatory
functions may provide an alternative medical approach for the genetic management of pain.
The conclusion from a related study states that modulation of this mechanism could
influence coping strategies by inducing adaptive and active ways to manage stress as
alternatives to anxiety or depression (Haller, et al., 2013). A hypothetical genetic
intervention could artificially increase the endocannabinoid concentration by modifying the
underlying genes (Vučković, et al., 2018). The lowered activity of FAAH has in vivo been also
produced additional outcomes including increased healing of wounds and decreasing of
conditioned fear responses (Habib, et al., 2019). A gene-based alternative to the utilisation
of medical cannabis would likely exhibit some of its known side effects, interestingly the
female subject affected by pain insensitivity – mentioned in the main work – also reported
frequent lapses of memory.