Pain management involves administering analgesic drugs to relieve nociceptive stimuli released due to tissue damage as a result of trauma or inflammation. Pain management has become a central focus of palliative care due to an ever-rising burden of chronic illnesses. Postoperative patients also benefit from pain management. However, the risk of addiction among patients has presented a hurdle in pain management. The analgesics most commonly associated with addiction are opioids. According to the 2018 National Survey on Drug Use and Health , The United States of America faced an opioid crisis reporting that there were close to 9.9 million prescription analgesia abusers. Because of this dilemma, the following paper aims to address how the ethical issues presented in pain management of an addicted patient can be overcome using ethical theory models and the four principles of ethics.
Positive reinforcement is one of the preliminary stages of addiction. At this level uptake of the analgesia offers a form of pain relief. However, with time, the body develops a dependence on the drug. Negative reinforcement refers to drug uptake to avoid withdrawal effects. Patients at this stage experience fevers and tremors, hallucinations and spend most of their income on purchasing drugs to sustain their dependency. If such a patient requires analgesics for medical purposes the principles of ethical practice have to be applied. In such a scenario to act morally the health practitioner has to give the patient what befits them as a person. This requires a holistic view of the person in question (Sparadeo, 2017). For instance, looking beyond the patient’s addiction and indication for analgesia, factors such as their age, clinical indication and prognosis may inform how the health practitioner will act.
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Therefore, in full awareness of what befits a particular patient one should then apply the four principles of ethical practice, which are justice, non-maleficence, beneficence and autonomy (Patel & Wright, 2019). Justice involves giving what is due to someone. By offering individual justice to an addicted patient the health practitioner is obliged to manage their addiction by enrolling them into addiction therapy in addition to managing their pain. Beyond individual justice, the health worker thinking broadly can further push for distributive justice from the government in financing the management of addiction or offering alternative pain medication.
The principle of beneficence implies doing what is best for the patient. An eight-year-old female with stage four triple-negative breast cancer and a history of opioid addiction is managed differently from a thirty-year-old post-surgical patient with a history of opioid addiction. In case 1 offering addiction therapy and tapered doses are not what is best for the patient. In the management of end of life care, the primary goal to be achieved is pain management. In the second case, the patient may endure more pain and benefit from the restriction of opioid administration.
Non-maleficence implies no harm to the patient (Patel & Wright, 2019). The pharmaceutical companies are constantly lobbying doctors to prescribe their newly developed drugs. At times these drugs have not undergone the necessary trials and may not offer any therapeutic advantages over previously used drugs. Health care workers should refrain from prescribing such as prescription medication to already addicted populations. The patient’s ability to choose how to care be provided is also a principle of ethics. However, this ends if it contradicts any of the other principles of ethics.
Alternatively, according to Daniel Macguire’s On Moral Grounds, an ethical decision model can be used. In this model, we assess the entirety of a scenario from the place, person, reason, the time of occurrence and object of the action. The second level assesses whether there are any predictable consequences and if so are there any better alternatives to the action? To the result of our questioning, we evaluate it against nine parameters that are authority, principles, reason analysis, affectivity, individual experience, group experience, comedy, tragedy and creative imagination (Darsi, 2019).
The decision model allows one to assess the plurality of moral decision making. In the first process, we ask reality revealing questions such as the patient’s age, gender, socioeconomic status, how they got addicted in the beginning and what clinical indication are they presenting with at the moment. In the second stage, we apply the nine parameters. Creative imagination allows us to see beyond the reality of an addict to the possibility of wellness in a person. Affectivity offers the health practitioner the knowledge and emotional know-how of morality. This allows for probing into the underlying cause of addiction before management with analgesics (Carvalho et al., 2018).
Parameters of reason and authority allow the practitioner to discern blurred areas such as giving high dosage analgesia to terminally ill patients despite their addiction (Darsi, 2019. A majority of those who get addicted to pain medications are young with mental health problems. Group experience allows the practitioner to discern this and administer low dose non-opioid analgesia to such groups as well as prescribe cognitive therapy. Individual experience allows the practitioner not to act in bias despite having group knowledge.
In conclusion, addicted patients face numerous physical challenges such as tremors and fevers, psychological challenges such as hallucinations and dependency results in poor financial decision making. However, certain scenarios such as a pre-existing chronic illness or surgical intervention make the patient eligible for pain management. In order to discern this eligibility, ethical decision models or principles of ethics coupled with clinical knowledge can be used.
References
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Carvalho, A.S., Pereira, S.M., Jácomo, A., Magalhães, S., Araújo, J., Hernández-Marrero, P., Gomes, C.C. and Schatman, M.E. (2018). Ethical decision making in pain management: a conceptual framework. Journal of pain research , 11 , p.967.
Darsi, D. (2019). Epikeia and Gradualness: Effective Tools for Discernment and Mercy in a Contemporary Pastorally Oriented Ethics.
Macguire, D. C. (1991). On moral grounds: The art/science of ethics . Crossroad.
Overton, H.N., Hanna, M.N., Bruhn, W.E., Hutfless, S., Bicket, M.C., Makary, M.A., Matlaga, B., Johnson, C., Sheffield, J., Shechter, R. and Nguyen, H. (2018). Opioid-prescribing guidelines for common surgical procedures: an expert panel consensus. Journal of the American College of Surgeons , 227 (4), pp.411-418.
Sparadeo, F. R. (2017). Pain in the Addiction Rehabilitation Patient. In Comprehensive Pain Management in the Rehabilitation Patient (pp. 195-205). Springer, Cham.
Patel, V. M., & Wright, T. B. (2019). Ethics of Pain Management and Research. In Pain (pp. 105-107). Springer, Cham.
