This paper is a research critique of an article exploring the moral experience of patients with chronic pain. Over the past few decades, effective pain management has been a trending topic among researchers in the nursing profession. Pain management has been perceived as both a fundamental human right and a moral imperative (Edwards et al. 2014, p.364). According to the article, the successive management of chronic pain requires collaboration between the practitioner and the patient with active participation and engagement of the patient. The article aims at describing a conceptual model for the ethical management of chronic pain where both the practitioner and the patient are enabled to recognize their moral agency through their different perspectives. The title of the article states that the study aims to bridge the gap between first and third person ethics. The terms, first and third person perspective, have been used as the conceptual representatives of phenomenology perspectives and empirical sciences attitudes. The study contributes to expanding nursing literature on pain management ethics.
The authors of the article review two different strands of literature, which outline the contributions of phenomenology in an attempt to develop an understanding of the experiences of people with chronic pain. The first strand of literature entails the literature of interpretative phenomenological analysis and the study of the lived experience of the person with chronic pain. The second literature strand involves the contribution of phenomenology in various discourses in the field of ethics and in particular its role in the development of the neo-Aristotelian virtue ethics. The first strand of literature entails a review of IPA studies conducted between the year 2009 and 2013. IPA is a type of qualitative research that seeks to investigate personal meaning in context to develop an understanding and differentiate 1st person perspective from a 3rd person perspective. The method involves the use of intersubjective inquiry and analysis. All of the reviewed literature had a research focus on the experiences of patients living with chronic pain. The literature was researched in several databases including Psychinfo, Web of Science, and Medline. A total of 448 articles were found and narrowed down to six empirical studies, which entailed the use of an IPA methodology.
Delegate your assignment to our experts and they will do the rest.
The second strand of the review focuses on the contribution of phenomenology in Neo-Aristotelian virtue ethics. Virtue ethics were the dominant approach to ethics leading up to the enlightenment when secular humanism was adopted, followed by utilitarianism and deontology. According to the article, the modernist virtue ethics alongside utilitarianism and deontology make up the 3rd person ethical approach. Two strands of ethics associated with a reconsideration of Aristotelian teaching, also known as neo-Aristotelian are explored in this section. Neo-Aristotelian ethics are defined as 1st person ethics. The literature reviewed in this section is recent too.
The study is based on a theoretical framework that states: 1st person ethics are a shared enterprise between the patient and the practitioner, and it actively contributes to chronic pain management. A 1st person ethics is a vehicle through which patients are assisted in the exercise of their capabilities in narratives and agency senses. According to the study, a 1st person ethics can effectively inform 3rd person ethics and can, therefore, be used to address more structural, ethical issues associated with inequalities and disparities of care. The study explores the importance of shared decision making between the patient and the practitioner and proposes that mutual recognition by each party is necessary for the relevance and fairness of the decisions being made. The study also includes the ethical reasoning bridge, which is a moral reasoning framework that was derived from the research of the decision making of expert physical therapists. The context describes a movement between 1st person and a 3rd person ethics. The framework is also used to develop KM Hunter's description of the task of a medical practitioner (Reynolds et al. 2008, p.390). In this case, the task of a practitioner is perceived as crossing from one side of the bridge where the information sought is known and shared by almost all patients, to another side where the information sought is about a case unique to a particular patient.
The findings from the IPA studies reviewed in the article present chronic pain patients as individuals who not only struggle to live with their pain but are also struggling to maintain a sense of their integrity. These patients also feel that their very existence is often delegitimized by those around them, including the health professionals that provide care. The studies revealed that such experiences are not inevitable, and given a chance of pain relief through multimodal management, the chronic pain patients regained confidence and hope. According to Zheng and Stahl (2010) narrative reasoning within a framework of 1st person, ethics provides an approach of addressing the ‘selfhood' of the chronic pain patients selves and its needs. Among the ethical issues identified in the literature, there are several issues of justice that are highlighted, For instance, fighting disparities in the access to pain care for some groups in the society, educating both the public and qualified health providers about pain medicine and chronic pain for the purpose of preventing stigmatization, among others (Ware et al. 2011,p 25-30).
The authors use the reviewed body of literature to develop and propose strategies through which ethical issues in pain management can be addressed. For instance, the authors suggest that it is insufficient for health providers to offer care without including additional efforts to expand the patient's agency, including their ability to navigate and engage their environment and the health system.
One of the main strengths of the study is the extensive use of literature, which shows the different perspectives of different researchers on the issue. The literature also identifies a wide range of emerging ethical issues in pain management and how they can be addressed. Although the study focused on chronic pain management, the research is applicable to the entire field of nursing, specifically to the area of pain management. The conclusion of the study restates its purpose and summarizes the findings of the review. The study entailed two different strands of literature review: Phenomenology and cognitive science and the study of life experiences of patients with chronic pain; and the contribution of phenomenology in the area of neo-Aristotelian virtue ethics. The research and findings of the study are significant to the field of nursing. The study reviews recent research studies in the field of pain management in an aim to define the moral experience of the patients living with chronic pain. This is important as it helps health professionals to know that effective pain management depends on the collaboration of both the patient and the practitioner.
References
Edwards, I., Jones, M., Thacker, M. and Swisher, L.L., 2014. The moral experience of the patient with chronic pain: bridging the gap between first and third person ethics. Pain Medicine , 15 (3), pp.364-378.
Reynolds, K.S., Hanson, L.C., DeVellis, R.F., Henderson, M. and Steinhauser, K.E., 2008. Disparities in pain management between cognitively intact and cognitively impaired nursing home residents. Journal of Pain and Symptom Management , 35 (4), pp.388-396.
Ware, L.J., Bruckenthal, P., Davis, G.C. and O'Conner-Von, S.K., 2011. Factors that influence patient advocacy by pain management nurses: Results of the American society for pain management nursing survey. Pain Management Nursing , 12 (1), pp.25-32.
Zheng, Y. and Stahl, B.C., 2010, December. Capabilities, critique and ICTD. In Poster for the International Conference on Information and Communication Technologies and Development ICTD 2010 .
