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Pain and the ethics of pain management

1984; Elsevier BV; Volume: 18; Issue: 6 Linguagem: Inglês

10.1016/0277-9536(84)90010-8

1873-5347

Rem B. Edwards,

Mental Health and Psychiatry

In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern.After clarifying the concepts of "pain", "suffering", "pain of body", and "pain of soul", the author presents a humanistic ethic of pain management based on the premise that the patient has a strong "prima facie" right to freedom from unnecessary pain. This premise imposes two moral obligations upon medical professionals: (1) the duty not to inflict unnecessary pain and suffering upon the patient, and (2) the duty to do whatever is possible to alleviate pain and suffering. Both the questions of informed consent to treatment of pain and the right to refuse pain relief are addressed.