The book begins with a detailed account of the nature of suffering and how to measure it. In the fifth chapter, Mayerfeld provides his justification for the prima facie duty to relieve suffering: “because suffering is bad and ought not to occur…. Its occurrence makes the world that much worse” (p. 111). In the last several chapters he discusses limits to the prima facie duty to end suffering, but he concludes in the end that, “at a modest sacrifice, fortunate individuals can prevent an enormous amount of suffering…. Failure to do this is unjustifiable” (p. 224).

Mayerfeld's treatment leaves a number of interesting features of this topic unexplored. The book is not so much about political theory as it is about identifying a moral duty. The political questions that arise from recognizing the existence of such a duty remain unconsidered.

First, we might inquire about the origins of suffering, a topic that is not much discussed here. Mayerfeld is eager that we not focus too much upon evil doing as the source of suffering lest we will think that if we have not committed the evil, then we are not responsible for the suffering or its prevention. Mayerfeld suggests that our failure to follow the precept to prevent and reduce suffering “results largely from a mixture of inattention and indifference. Partly, it results from ignorance or confusion about the meaning and moral significance of suffering” (p. 224). He does not care to pursue the natural, economic, personal, or political causes of suffering any farther. It does not matter to him why there is suffering; the fact that it exists is enough for us to try to prevent or reduce it. As do so many liberal theorists, Mayerfeld seems to think that ignorance alone is responsible for what is wrong in the world; that there might be evil doers who are responsible for this suffering is not the issue. That people obviously also find reasons for inflicting suffering on others, or for ignoring it, cannot be accounted for. Mayerfeld also does not imagine that human actions, even those designed to eliminate suffering, can have harmful unintended consequences. Postmodernists might see in his approach a return to an Enlightenment optimism about the possibility of the mitigation of suffering.

Second, Mayerfeld is so eager for us to recognize suffering per se that a reticence to make judgments about the topic creeps into his writing. The discussion is fairly abstract, and his examples (ranging from slamming one's finger in a door to torture) are not richly described. Such distance is undoubtedly calculated, as it avoids the harm of using others' suffering for exoticism or titillation. Mayerfeld provides ways to compare different kinds and amounts of suffering, but he refrains from making any broad judgments. He stresses the importance of torture, but he is willing to grant that each of us will decide what form of suffering matters the most to us, that for each of us, relieving suffering “will soon take on the character of a personal project” (p. 208). This overall view seems to be that if enough people (all people?) are willing to accept their duty to relieve suffering, then the burden will not be too onerous for any one person in particular (pp. 206–7). Mayerfeld allows that “we would need some mechanism to insure that the appropriate division of labor was actually observed, but I assume that in a world where every one was committed to the prevention of the worst cumulative suffering, this would not be an insurmountable problem” (p. 206). He makes this claim as if this political process could be taken for granted.

Mayerfeld's argument begins from moral intuitions and ends up being able to do little else except try to convince each, individually, to accept this moral starting point for how we might live our lives. Yet, Mayerfeld also shows that two complications make it unlikely that, short of political action, there is any way to achieve this result. First, it is almost impossible for people to perceive the suffering of others and remain focused on it. Second, the duty to relieve suffering is “not as transparent as, say, the prohibition against killing,” so that the duty to relieve suffering requires that “we need to calculate what would actually be required to prevent the worst possible suffering” (p. 120). For both of these tasks, to keep focused on suffering and to make calculations about what is required to prevent it, some forms of political institutions and processes are necessary, but Mayerfeld does not want to consider such questions here.

Mayerfeld has done a great service by drawing our attention to suffering. His arguments are careful and thoughtful, and this book should become the standard work on the topic. If only the problem of human suffering were as susceptible to human reason as Mayerfeld thinks it is.