Essay Sample on Ethical Issues in Pain Management

Introduction

Pain is a personal, multidimensional, subjective, complex and unique experience for each patient. The reactions that the pain triggers in a person can give rise to a series of alterations, which will be decisive in the recovery and subsequent evolution of the patient, due to the morbidity and mortality that the pain situation itself presents. Inadequate control of acute pain can progress irretrievably towards its own chronification, as occurs with post-thoracotomy or post-mastectomy pain, or that of the phantom limb (Bernhofer, 2011). For the ethical management of pain, it is useful to know the physiology of the pain, the type of pain, the adequate approach to it and the monitoring of the condition in order to determine the appropriate treatment; Only if these steps are followed can the dignity and integrity of the patient be maintained (Carvalho et al. 2018) The true ethical attitude makes nurses feel supportive of the patient who suffers and pushes us to put all available means and knowledge to eliminate the pain, whether or not it is within our reach because if we do not have the necessary knowledge, we must send the patient to those who have them.

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There are several guidelines that need to be followed in managing pain ethically. First, nurses should recognize the rights of patients to proper pain assessment and management. Secondly, nurses should proceed to assess the existence of pain and, if appropriate, its nature and intensity, in all patients. Third, nurses should record the results of the evaluation, in order to facilitate its re-evaluation and follow-up. Fourth, nurses should educate patients and their families about the effective treatment of pain and talk about the needs of patients in the management of symptoms, during the process of discharge from the institution (Ferrell et al., 2001). Hospitals need to determine and guarantee the competence of their nurses in the evaluation and management of pain, as well as include it in the training of new members. They should also establish policies and procedures that promote the adequate prescription of effective pain medications. These standards are based on the right of every patient to evaluate and treat their pain in an appropriate way.

There are several ethical principles that should be followed in pain management. The principle of autonomy is represented by the request, sometimes imperious, that the patient makes to the nurse, to treat his/her pain, sometimes for him/her severe and unbearable. The request of the patient suffering from his/ her pain should be respected. It is something own, subjective, not transmissible (Bernhofer, 2011). The testimony of the patient must be accepted, in fact so subjective, and the therapeutic response will be based on the integral knowledge of the person. If the cause has a clear rationale, the nurse must respond to this demand by trying to benefit the patient. It is the principle of beneficence. The best analgesia must be provided, balancing efficacy and risk, which in greater or lesser degree entails each treatment (Hicks, 2000). There are opportunities in which effectiveness and risk come close. In these cases, a careful assessment must be made of the cause of the pain and the conditions of the person who suffers it, so that the use of the drug or the therapeutic measure must be with the knowledge and informed consent of the patient and/or close relatives, if the patient is not competent.

The principle of non-maleficence must always be considered, which is even imposed on the two previous ones. The use of analgesia or other measures to treat pain should be proportional to the cause and conditions of the patient, seeking the greatest benefit, but always considering not to harm. The analgesic treatments that prevent the suffering of the person are always obligatory and suspending them is unethical (Rich, 2000). There are special situations that must be considered. One of them is intolerable pain and lethal risk analgesia, in which morphine or derivatives should be used, for example, to calm pain or make it at least tolerable. The therapeutic safety margin of morphine is broad; however, there are situations in which the added effect of the drug can lead to a decrease in consciousness and respiratory function, constituting an abbreviation for life. Here the intention, no doubt legitimate, is not to shorten life, but to alleviate suffering and its main cause, that is, pain, the other being an unintended consequence. These are borderline situations that can be touched with the so-called "indirect active euthanasia", which as such is understood does not deserve any objections (Carvalho et al. 2018). The last principle is that justice includes the nurse and the patient, but especially the society and the state. The obligation of the latter is to procure sufficient resources so that everyone has easy access to health, regardless of their social or economic situation or where they are located. The sick person must have access to the basic measures to treat their illness and, as an outstanding expression of these, to treat pain.

Conclusion

It is important to remember that ethics qualify the human act in terms of the end; That allows having adequate bases such as knowledge of the pathophysiology of pain, its correct evaluation, classification and classification, nurses can provide comprehensive management, with the medical freedom to choose the treatment or drug that is considered appropriate for the patient with pain, with the knowledge of the responsibility that comes with the nurses' decisions. Allowing a person to suffer pain, when there are the necessary means to avoid it in its entirety, as in the case of unnecessary pain, or to alleviate it as much as possible, being fully aware of such fundamental rights of the person, is an immoral medical practice. Avoiding pain and suffering is the first moral and professional obligation, not only of the doctor and nurses, but of everyone involved in patient care.

References

Bernhofer, E. (2011). Ethics: ethics and pain management in hospitalized patients. Online journal of issues in nursing, 17(1), 11.

Carvalho, A. S., Pereira, S. M., Jacomo, A., Magalhaes, S., Araujo, J., Hernandez-Marrero, P., ... & Schatman, M. E. (2018). Ethical decision making in pain management: a conceptual framework. Journal of pain research, 11, 967.

Ferrell, B. R., Novy, D., Sullivan, M. D., Banja, J., Dubois, M. Y., Gitlin, M. C., ... & Livovich, J. (2001). Ethical dilemmas in pain management. The Journal of Pain, 2(3), 171-180.

Hicks, T. J. (2000). Ethical implications of pain management in a nursing home: A discussion. Nursing Ethics, 7(5), 392-398.

Rich, B. A. (2000). An ethical analysis of the barriers to effective pain management. Cambridge Quarterly of Healthcare Ethics, 9(1), 54-70.