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Pain Pract. 2015 Jul;15(6):497-508. doi: 10.1111/papr.12207. Epub 2014 Apr 28.

Does the Golem Feel Pain? Moral Instincts and Ethical Dilemmas Concerning Suffering and the Brain.

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Department of Cell & Developmental Biology, Institute of Life Sciences and Center for Research on Pain, The Hebrew University of Jerusalem, Jerusalem, Israel.
3 Lamerhav St., Ramat Hasharon, Israel.
Department of Neurosurgery, Rabin Medical Center, Petah Tiqva, Israel.


Pain has variously been used as a means of punishment, extracting information, or testing commitment, as a tool for education and social control, as a commodity for sacrifice, and as a draw for sport and entertainment. Attitudes concerning these uses have undergone major changes in the modern era. Normative convictions on what is right and wrong are generally attributed to religious tradition or to secular-humanist reasoning. Here, we elaborate the perspective that ethical choices concerning pain have much earlier roots that are based on instincts and brain-seated empathetic responses. They are fundamentally a function of brain circuitry shaped by processes of Darwinian evolution. Social convention and other environmental influences, with their idiosyncrasies, are a more recent, ever-changing overlay. We close with an example in which details on the neurobiology of pain processing, specifically the question of where in the brain the experience of pain is generated, affect decision making in end-of-life situations. By separating innate biological substrates from culturally imposed attitudes (memes), we may arrive at a more reasoned approach to a morality of pain prevention.


end-of-life; ethics; mirror system; moral instinct; pain pathways; sociobiology; suffering; terminal sedation; vegetative

[Indexed for MEDLINE]

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