Publications
APS Bulletin • Volume 12, Number 4, July/August 2002
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) held its fourth annual meeting at the APS meeting in Baltimore on March 15, 2002. It was attended by more than 40 participants. Two SIG members presented ethically challenging cases that evoked much discussion.
Alex Cahana, MD DAAPM, director of the Interventional Pain Program at the Geneva University Hospital in Geneva, Switzerland, discussed “Is Optimal Pain Relief Always Optimal?” (See APS Bulletin, May/June 2002, p. 1.) He outlined three brief clinical vignettes of patients with cancer pain who experienced significant pain relief with implantation of an intrathecal pump or a continuous epidural catheter, but with resultant increased emotional distress. The animated discussion that ensued included comments such as “the magic bullet can open up a can of worms” and revolved around issues such as preparing patients for death and caregiver burnout. These cases pointed out the need for a thorough multidisciplinary evaluation of patients before implantation as well as the necessity of psychological follow-up.
Mary Baluss, JD, director of the Pain Law Initiative in Washington, DC, discussed “The Prescription of Opioids: A Doctor in Trouble.” This was the case of a family practitioner who began to incorporate opioid therapy into his treatment of chronic pain patients but eventually ran into significant difficulties with regulatory agencies. Ethical issues discussed included to what extent does the physician have to police patient behavior, what are the demarcations between abandonment and patient policing, is the physician responsible for what the patient does with the drugs, and the need to distinguish between ethical and political issues. A parallel was drawn to the family doctor who prescribes antidepressants and the suicidal patient. Feelings regarding the Drug Enforcement Administration and its role in policing the prescription of opioids were expressed as well.
An electronic e-mail list for the Ethics SIG has been established; we encourage members to submit ethical issues or cases for group discussion. The Ethics SIG is open to all APS members. For information about joining the Ethics SIG or any suggestions or comments at all, contact Allen Lebovits, PhD, at 646/459-8500, e-mail allen.lebovits@med.nyu.edu or the APS national office at 847/375-4715. I hope to see you at the 2003 APS meeting in Chicago!