Title: Ethics of Pain Management UTTyler 041709
1Ethics of Pain ManagementUT-Tyler 041709
Larry C. Driver, MD Professor, Department of Pain
Medicine Adjunct Ethicist, Clinical Ethics
Consultation
2What is Ethics?
- Ethics is a branch of philosophy
- Ethics is the formal, rational, systematic
examination of the rightness and wrongness of
human actions.
Pellegrino E Toward a Reconstruction of Medical
Morality The American Journal of Bioethics
2006665-71
3Why treat pain?
- Control of pain is important for
- Optimizing patient outcomes and satisfaction
- Compliance with guidelines and standards
- Moral and Ethical reasons
- (Blau, SMJ, 1999)
4Clinical Ethical Issues
- What are the clinicians obligations based on
the principles - If there is a conflict of principles, which one
takes precedent? - For example the patient demands treatment that
the clinician feels is harmful or the patient
refuses treatment that is known to be life
savings? (Non-maleficence and autonomy
5Clinical Ethical Issues
- Risks, harms, burdens of disease
- Risks, harms, burdens of treatment
- Potential Benefits of treatment
- Best interests of the patient
- Clinician perspective
- Patient Perspective
- Goals of therapy
6Thinking Ethically
- Principles and Duties
-
- Calculating Consequences
- Comparing Cases
7Value-laden Situations
- Between Professionals and Patients
- Patient refusal of recommended treatment
- Patient demand for specific Rx/treatment
- Patient demand for medically futile treatment
- Between Patients and Surrogates
- Conflicted understandings of a patients advance
directive - Absent/Unclear surrogate decision maker
- Among Professionals
- Nurse/Physician(s) disagree re treatment plan
- Disagreement about what a patient or family
member should be told
8Medical Decision MakingWhat Do Patients Want
and Expect from their clinician?
- Respect as an individual
- Understanding and care
- Not to be abandoned
Kagawa-Singer
9Medical Decision MakingRole of Societal Values
- Societal values vary among cultures
- Independence -- Collectivism
- Self-reliance -- Interdependence
- Autonomy -- Community
Kagawa-Singer
10Medical Decision MakingWestern Cultural Values
- Life is sacred
- Patient autonomy in decision-making
- No one should suffer
Kagawa-Singer
11Six Behaviors of Professionalism
- Altruism best interests of patients, not self
- Accountability fulfilling the multiple levels
of the contract of the clinical relationship, to
the profession and society - Excellence exceed ordinary expectations
- Duty free acceptance of commitment to service
- Respect for others patients, staff, et al
- Honor Integrity highest standards of behavior
and the refusal to violate ones personal and
professional codes
12Professional Responsibilities
- Commitment to professional competence
- Commitment to honesty with patients
- Commitment to patient confidentiality
- Commitment to maintaining appropriate relations
with patients - Commitment to improving quality of care
- Commitment to improving access to care
- Commitment to just distribution of finite
resources - Commitment to scientific knowledge
- Commitment to maintaining trust by managing
conflicts of interest - Commitment to professional responsibilities