An Ethics of Care, Relational Suffering, and Contested Invisible Disability.

Suffering is an elusive aspect of healthcare, erroneously assumed to be located solely within the patient in the clinical encounter-an assumption that fails to acknowledge the pervasiveness of suffering endured by the physician. This flawed perception is morally problematic in the context of treating contested invisible disabilities (CIDs), which are often associated with medical ambiguity and uncertainty. In this paper, we argue for a relational reconceptualization of suffering in the context of CID to promote more effective care and improved physician-patient relationships. We propose, through the lens of an ethics of care, that a relational ontology of suffering makes salient certain aspects of patient-physician relationships that co-produce suffering, such as professional incompetence, empathetic distress, and epistemic and hermeneutic injustice, rendering the experience of having and treating a CID more visible. We then discuss the important implications of this understanding for this invisibly disabled identity and the therapeutic alliance between physician and patient and explore the potential of narrative-based medicine to better equip physicians with the knowledge, guidance, and skill to fulfil their ethical responsibility to care for and respond to not only the suffering of this population, but their own suffering as well.