Publications
APS Bulletin • Volume 10, Number 1, January/February 2000
Ethics in Pain Management
Ethics in Pain Management: A Progress Report
Michel Y. Dubois, MD, Chair, AAPM/APS Ethics Task Force
Identification of objectives
The AAPM/APS Ethics Task Force has been meeting for more than a year. During this period, it has focused on the specific objectives that were established at its inception. All task force members have become familiar with the current ethical guidelines that may be found in other healthcare associations and with basic documentation on techniques used in the field of bioethics to study the ethical issues of actual cases. The task force also tried to identify the most significant issues related specifically to the practice of pain management. Both AAPM and APS are now officially committed to working jointly on these issues with the aim of providing members with instruments that can help them in their daily practices. To this end, a professional development course on ethics in pain management was presented in October at the APS 18th Annual Scientific Meeting in Fort Lauderdale, FL.
Member survey
One of the task force’s objectives is to identify the clinically based ethical issues that are commonly encountered in the practice of pain management. To determine the issues that are important to AAPM and APS members, the task force sent a survey to the members of both organizations in August. Participants were asked to do the following:- Identify what they considered to be the most important ethical dilemmas encountered in the daily practice of pain management.
- Rate their level of competency in dealing with ethical dilemmas.
- Suggest the types of resources that AAPM and APS should provide to assist members in these areas.
More than 1,100 surveys were returned, representing a response rate of approximately 30%. Demographics indicated that although all disciplines were represented, members with clinical responsibilities were more motivated to respond than those without clinical exposure. The majority of the respondents were physicians who have been in practice at least 15 years and who have dealt with pain management for more than 10 years. The ethical dilemmas considered most important had to do with familiar issues, such as the management of pain at the end of life and the undertreatment of pain, especially for elderly patients and children. Other issues, usually poorly addressed from an ethical point of view but foremost among the survey responses, included the impact of managed care on pain treatment, the barriers to patients’ access to pain treatment, the appropriate use of “high-tech” medical procedures, and disagreements among professional colleagues regarding pain treatment. Survey respondents rated their perceived level of competence in dealing with these issues as very low.
Suggestions for resources
Respondents indicated they would like to have access to resources such as policy statements regarding common ethical dilemmas in pain management; discussions or presentations of clinical cases in pain bulletins or journals; brief guides to ethical decision making; symposia on ethics at the annual meetings of AAPM and APS; and a resource center on ethics and pain. Members offered many other suggestions; more than one third of the survey respondents submitted comments that either presented cases they would like to discuss or raised general issues that they commonly encounter in their practices.
The results of the survey constitute a precious resource that will undergo thorough analysis. The responses will provide guidance for the future direction of the task force. The opinions expressed in the survey clearly demonstrate the enormous interest among many pain practitioners in identifying, discussing, and solving the numerous ethical issues associated with their practices.