Publications
APS Bulletin • Volume 10, Number 4, July/August 2000
Special Interest Groups
David A. Williams, PhD, Department Editor
Ethics Special Interest Group:
Development and Facing Challenges Ahead
Allen H. Lebovits, PhD
The Ethics Special Interest Group (SIG) was recently formed by American Pain Society (APS) members interested in the challenging ethical dilemmas faced by today’s pain practitioner. It was formed as a direct result of the excellent work of the APS/American Academy of Pain Medicine (AAPM) Ethics Task Force, chaired by Michel Dubois, MD, which generated much interest in ethical and moral challenges by raising our consciousness to these issues. The APS/AAPM Ethics Task Force held a professional development course at the 1999 APS annual meeting in Fort Lauderdale, FL, and surveyed the entire APS and AAPM membership about the importance of specific ethical issues. The Ethics SIG held its inaugural meeting during the APS annual meeting in Fort Lauderdale, FL. Present at that meeting were Jane Collins, MS; Nance Cunningham, MA; Norwinda Reyes Distor; Michel Dubois, MD; W. Thomas Edwards, MD PhD; Nancy Goff, MS RN OCN; Jan Jahner, CRNT; Ron Kulich, PhD; Allen Lebovits, PhD; Dawn Porte, RN; Patricia Robinson, PhD; Mark Sullivan, MD PhD; and Donna Zhukovsky, MD. Self-introductions reflected a wide variety of experiences with and education about ethical issues in pain assessment and treatment.
The following mission statement for the APS Ethics SIG was adopted by SIG members to guide its activities:
- To promote discussion and communication among pain specialists and researchers about ethical issues pertaining to the practice of pain management and pain research
- To interact with and make recommendations to the APS/AAPM Ethics Task Force as well as other APS committees
- To interact with the American Society for Bioethics and the Humanities as well as national patient advocacy organizations
- To act as a resource center for articles and books about pain and ethical issues
- SIG members identified ethical questions of greatest concern to them. Concerns included the following:
- When should terminal sedation be used to treat intractable pain? How should terminal sedation be defined?
- How can patients with substance abuse problems be treated ethically, e.g., treating “shooter’s abscesses” or pain associated with HIV/AIDS when patients are current drug abusers?
- How can vulnerable populations be protected from undertreatment or overtreatment of pain? What are the economic incentives and pressures in each case?
- Are patients given authority over decisions regarding their pain management?
- Can patients’ general ability to give informed consent to continuing issues of care be compromised by treatment or lack of treatment of pain? Can patients’ ability to give consent for specific treatments for pain also be compromised in this way?
- How do caregivers’ unacknowledged feelings of vulnerability affect their ability to sort out patients’ capability to give consent?
- What should caregivers do about colleagues who do not assess or treat pain effectively?
- How can those on the pain service keep some physicians from equating referral to the pain service with failure or loss of control over the patient? What should be done about patients who feel “abandoned” on their arrival to the pain service?
- Will the new Joint Commission on Accreditation of Healthcare Organizations guidelines on pain really solve issues of access to good pain treatment?
- Is the positive contribution of corporate sponsors so great that clinicians and researchers should ignore traditional concerns about conflicts of interest?
Since that meeting, the Ethics SIG has grown to more than 30 members. An electronic mailing list has been established to identify and discuss ethical challenges and resources. Planned projects for the future include an increased presence on the Web site as well as planning for our next meeting at the APS 19th Annual Scientific Meeting in Atlanta. We hope to have a more formal program planned. The Ethics SIG is open to all APS members. For information about joining the Ethics SIG, contact Allen Lebovits, PhD, at 212/679-9741, e-mail alebovits@anes.med.nyu.edu or the APS national office at 847/375-4715.