Our conclusions are consonant with our individual life journeys. One of us spent decades as a pediatric oncologist and clinical scientist focused on chil- dren with catastrophic diseases. Pain and suffering were natural extensions of these disease processes and evoked sympathy and compassion from health care providers, families, and communities. But those experiences also made clear that while pain can often be controlled, it frequently cannot be eliminated, and when that is the case, it becomes more dominant for the individual than her or his underlying disease.