Ethical aspects in the treatment of pain

Abstract

Commonly pain has been seen as a warning sign reacting to a source of pain. This process displays the wisdom of the body and its ability to function well. But this concept cannot necessarily be upheld when, due to illness, integrity of the body can be neither the presupposition nor the goal of treatment. The ethical question is not to decide which perspective (pain as a vital sign or pain as catastrophe) is the dominant one. Medical ethics must acknowledge pain as a process of human destruction, and it must interpret the treatment of pain as an endeavour which makes life possible again, or strengthens its remaining elements. When pain goes beyond the resources of the human being to form his/her life, the border between meaningful and meaningless pain is crossed. A case from an obstetrical ward is used to demonstrate three central principles of the treatment of pain: (1) Understanding the pain as the end of all interests, as making life a burden or as evacuating the ego. 2. Respect of the autonomy of the patient by informing him/her about the experiences which he/she gets rid of during analgesia, or by establishing the possibilities that PCA or time-contingent medication offer. 3. The multidimensional therapy of pain: i.e. all groups of caregivers must be involved, because it is not important to know which perspective is the best, but that no single perspective can stand alone. These principles must be taken into account even when the possibilities of effective pain relief are exhausted. Sometimes the debate on the practice of euthanasia seems to replace the medical goal of honest treatment of the patient's pain.