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American Pain Society
4700 W Lake Ave
Glenview, IL 60025
David A. Williams, PhD, Department Editor
Allen Lebovits, PhD
The Ethics Special Interest Group (SIG) held its inaugural meeting during the 1999 APS annual meeting in Ft. Lauderdale. Starting out with 13 members of various disciplines discussing what they felt were the important ethical issues facing pain practitioners, the Ethics SIG grew to 30 participants at the next APS meeting, the 2000 meeting in Atlanta.
The November 2000 meeting began with an introductory presentation by the APS president, Michael Ashburn, MD, emphasizing the importance and need for ethical discussion in any profession. Jan Frandsen, MSN CRNP, spoke of the possible inclusion by the Ethics SIG of ethical discussions on the APS Web site. Two issues of concern raised by SIG members were the increasingly common use of overly aggressive pain modalities in management today and the issue of whether we practice what we say we do. Are our pain centers truly multidisciplinary, or are different specialists each doing their own thing? The meeting was highlighted by the two clinical presentations of challenging ethical cases. Ronald Kulich, PhD, of Tufts University School of Medicine and School of Dental Medicine, Boston, presented a patient referred for psychological evaluation that highlights the potential conflicting role of treating clinician and expert witness. This is not an uncommon occurrence for psychologists working with pain patients who are often in litigation. For the mental health clinician, testifying in such cases can result in a potential ‘dual relationship’ or conflict of interest where the clinician takes on the role of ‘treating clinician’ and ‘court expert.’ This prompted much discussion, as did the next case presented by W. Thomas Edwards, MD PhD, from Harborview Medical Center, Seattle. Dr. Edwards presented a case often seen in pain centers, the pain patient with a significant history of drug abuse. The ethical issues that elicited much reaction from SIG members included the use of methadone in pain patients at levels frequently used in maintenance as well as the issue of blind dosing that is the basis of the often used ‘pain cocktail.’
The Ethics SIG met again at the APS meeting in Phoenix on April 19, 2001, to hear presentations on two more ethically challenging cases. Judith Scheman, PhD, of the Cleveland Clinic Foundation, discussed a patient evaluated for surgery clearance who was on high doses of opioids. The ethical discussion that followed revolved around the ethical issues raised by withholding treatment based on an addictive or psychiatric disorder. Donna Zhukovsky, MD, of the University of Texas MD Anderson Cancer Center, Houston, reviewed a case of a terminally ill patient with pain whose spouse refused opioids for her husband while initiating herbal therapy from a physician in China. Dilemmas discussed, and commonly encountered by members of palliative care teams, included whose directives are followed (patient or spouse) and what the stance is toward alternative modalities.
An electronic mailing list for the Ethics SIG has been established, with approximately 52 members now participating. The Ethics SIG is open to all APS members. For information about joining the Ethics SIG or to provide suggestions or comments, contact Allen Lebovits, PhD, at 212/263-7316, e-mail allen.lebovits@med.nyu.edu or call the APS national office at 847/375-4715. I hope to see you in Baltimore!
Allen Lebovits is an associate professor in the departments of anesthesiology and psychiatry and codirector of the NYU Pain Management Center at NYU Medical Center.
