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Ethics in the Management of Chronic Pain
J. K. Lilly, MD MSClinical Professor of Anesthesiology
And Pain MedicineRobert C. Byrd Health Sciences Center of
West Virginia University/Charleston Division
Ethics Principles in Pain Management• Disclosure and
Informed Consent• Benefit verses Burden• Autonomy &
Surrogacy • Pro Patria -
Professionalism• Double Effect –
Greater Good• See Handout for Expanded
Explanation
Case Study #1
A 40 year old HIV sero-positive, estranged woman with drug resistant cryptococcal meningitis and anemia. Her son and sister disagree on the “the right thing to do.” She cries from head & body pain, is intermittently oriented & refusing medications, says…”I deserve to die for my sins.” What to do?
Ethics Principles in Pain Management
• Identifiy the ethics principles involved• Identify the cultural, social and
personal dilemmas in this circumstance
• Develop talking points for resolutions• Expect confusion, provide sensibility
& professionalism
“Now, The Rest of the Story”• Abused as a girl • Several Psych
Admissions • IV drug abuse Hx• 25 yr old Son “…
sick and tired of this”
• 39 yr old sister is also disabled on SSI
Case Study #2
A 51 year old medically retired coal miner, s/p four laminectomies, walks with two canes, reports constant, severe burning pain in all extremities. Local physician declines initiation of narcotics and co-analgesics. “I only give those drugs to terminally ill patients! Go to Pain Clinic”. What to do?!
Ethics Principles in Pain Management
• Identifiy the ethics principles involved• Identify the cultural, social and
personal dilemmas in this circumstance
• Develop talking points for resolutions• Expect confusion, provide sensibility
& professionalism
“Now, for the Rest of the Story.”• Sister is Deputy Sheriff
in their community …many drug-related arrests, both youth and adult…”very anti-drug”
• Brother detox’d x2• Patient is “Family
Leader” for his and his brother’s kids
• High Medication Requirements for Relief