Ethics and Health Policy: Realizing the "Promise" of Pain Management and
by James Giordano, PhD and Gerhard H÷ver, PhD
Professional Responsibility of Pain Care
Technological advancements within science and medicine have enabled prolongation of the
lifespan for those patients with incurable diseases. Yet, at the same time, such relative
successes have fostered an increased prevalence of chronic illness and subjective
suffering—including intractable pain—due, in part, to the inability to
completely eradicate symptoms and to the progressive use and sometimes exhaustion of
therapeutic and economic resources available to the patient. This has compelled an
increased impetus for medicine to develop those dimensions of practice that seek to heal
what cannot be cured. To a significant extent, pain medicine and palliative care have
arisen from, and seek to meet, this need.
The obligation to treat pain and suffering, while inherent to all of medicine, is by
definition most fundamental to the profession of pain medicine and palliative care.1
Clearly, pain management can be, and often is, necessary albeit not sufficient for
rendering sound, palliative care. But technically effective pain care must also be
rendered in ways that uphold the moral affirmations of medicine and, while certain ethical
(and legal) frameworks exist to guide the tenor, scope and limits of the profession, the
actual implementation of care is reliant upon the physician. In this way, the physician is
both a therapeutic and moral agent given that any (if not all) clinical decisions affect
the vulnerability of the patient, reflect the asymmetries of knowledge and power between
physician and patient, and impact trust within the medical relationship.
The complexity of pain and pain care is such that a simple “one-size fits
all” approach to management is not practical—and probably not ethically
justifiable.2 An integrative use of interventional, pharmacologic, physiatric,
and psychiatric pain management may represent a viable option—both early in and
throughout the care of long term and terminal pain patients. In this context,
interventional techniques may be especially useful because of their capacity to
effectively reduce pain, make patients more amenable to other therapeutics, and enhance
patients’ quality of life.
Please refer to the April 2010 issue for the complete text. In the event you need to order a back issue, please click here.
— April 2010
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