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Pain Management

steve_pain-managementThe Center for Ethical Solutions wishes to contribute to society’s understanding of permissible and ethical parameters for pain medications within different contexts. Specifically, the Center proposes to focus on two sub-sets of the patient population which are ethically distinct within the context of pain medication standards: (1) patients at the end of life and (2) chronic pain sufferers.

The Center for Ethical Solutions wishes to investigate whether and to what extent patients facing extreme end-of-life pain and serious chronic pain should be differentiated from the general population as being eligible for use of opiates for alleviating pain. Society’s concerns for addiction and recreational use and medical abuse are contextually based; therefore people facing the end of life and people with chronic pain who otherwise cannot function without pain medication are different patient sub-populations that may require a different ethical analysis.

Problems to Explore

Debilitating pain, left undertreated, can result in suffering that can affect a whole family. Depression, suicide and premature death from pain and panic are among the serious medical problems resulting from pain. And witnessing a loved one in excruciating pain can be a traumatic experience. The Center for Ethical Solutions wishes to explore the ethical parameters of pain medication to alleviate chronic pain and suffering and to educate the public as to its findings, and to contribute to the further development of appropriate policies.

  • The ethical concern about addiction is appropriate when considering the affects of addiction on a patient with a chance of recovery. But when a patient is terminally ill or in chronic incurable pain, how do the ethical and societal concerns differ? And can society’s fear of addiction and over-use be adequately addressed while setting these different standards for the use of pain medication?
  • Should families, and not society, be in control of the amount of pain medication for end-of-life patients?
  • Whether justified or not, there is a stigma attached to taking “addictive drugs” even at the end of life, and some people care about what others think if they take or their relatives take opiates no matter what the circumstances.
  • Some pain medications are believed to hasten death, and currently there is a prohibition of medications that might shorten longevity. However, society’s concern about premature death caused by pain medication may shift when considering the level of pain experienced by a patient who has a few hours or days left to live.
  • Other aspects of end of life pain management are also controversial — Palliative sedation has become a controversial option as has the voluntary refusal of food and water. This obviously also touches upon the ‘Aid in Dying” debate. The public needs help sorting out what is fact and what is fiction with respect to these options and the laws that restrict or promote them.
  • The DEA has been arresting physicians who prescribe “too many” pain meds, and state and federal authorities are battling over the use of medical marijuana. However, these controversies often overlook the distinct issues faced by chronic pain sufferers. Someone suffering from chronic plain wants the pain to disappear but cares more about quality of life than people usually do at the end of life. They want to lead as normal a life as possible and the range of permitted pain medications can have a significant impact on what their life, not their death, will be like. How can this population’s need be clearly articulated such that they are not overlooked in the current debates?
  • How can the public be educated around the different conceptual frameworks for understanding when pain medication is necessary and appropriate? How should we develop new conceptual frameworks so that family, loved ones, and friends can cope with and explain a decision for pain medication?
  • At the same time, overmedication is a serious problem. We need legal and social standards for acceptable amounts of pain medication. How should society define these standards and how can we ensure compliance by the medical profession?
Fact Sheet on Chronic Pain

The Center for Ethical Solutions is a non-partisan, non-profit, 501(c)(3), tax-exempt charity dedicated to educating the public on patient-care issues in medicine. The Center's financial statement (990EZ IRS annual tax filling) is available upon written request from the Center or from the Commonwealth of Virginia Office of Consumer Affairs.