Ethical Decision Making in Pain Management

Despite its high prevalence, pain often takes a “back seat” in the minds of many frontline practitioners and other relevant stakeholders. This chapter explores the intersection of utilizing an algorithmic approach to pain care, how pain is prioritized by involved stakeholders, and ethical decision making when caring for those in pain. The dynamic nature of pain management discussed in earlier chapters has in some cases resulted in a disconnection between pain care and ethical pain care. This chapter will detail specific characteristics and responsibilities of the clinician-patient relationship from an ethical perspective when pain is assessed and treated, including the importance of bidirectional communication, the development of a trusting relationship, identifying accountability, and capturing the patient’s narrative as part of the pain assessment process. Also, as mentioned in earlier chapters, this chapter will discuss the potential impact of educational deficits among clinicians and how fear of regulatory scrutiny can affect the ethical delivery of pain care. The core ethical principles of autonomy, beneficence, maleficence, and justice will be defined and described in the context of pain management, setting the stage for upcoming chapters which will deal with these principles in greater detail.