Beneficence

Ethical clinical obligations which include helping a patient negotiate between pain and suffering and are no different than those imperatives associated with caring for patients with other medical conditions. In addition to facilitating informed consent and autonomous decision-making, clinicians have a responsibility to offer treatment recommendations that are in the best interests of the patient—to do their best to “do good” for the patient. This means making recommendations which have the greatest likelihood of targeting the individual’s pain relative to their unique life context, alleviating their suffering, maintaining or improving their level of function, and having a positive impact on their overall quality of life. This chapter details the role that beneficence plays in the delivery of pain care, including underscoring the importance of open and honest communication that accurately captures the patient’s narrative, and identifies the role of mutually-determined realistic goals and expectations of pain treatment in providing beneficent pain care. The significance of incorporating this ethical principle into the pain assessment process is discussed, not only with the goal of helping to foster a trusting patient-clinician relationship, but also in helping to facilitate adherence to the pain treatment plan as well. Additionally, this chapter discusses potential influences of “best interests” of stakeholders other than the patient can complicate how pain is assessed and beneficently treated, including those from clinicians themselves, regulators, payers, community members, and society at large.