Pain management and potentially life-shortening analgesia in the terminally ill child: the ethical implications for pediatric nurses.

Abstract

Optimal pain control in the dying child often requires aggressive opioid therapy that exceeds recommended parameters and may hasten death caused by respiratory depression. For pediatric nurses caring for the dying child, the administration of potentially life-shortening analgesia gives rise to a number of ethical issues. Pediatric nurses often express concern that aggressive pain control is a form of euthanasia or fear the child will develop a drug dependence. Lack of clarity about the ethical obligations and professional responsibilities of nurses who administer potentially life-shortening analgesia may also contribute to the dilemmas surrounding such situations. If left unresolved, these issues can interfere with the nurse's ability to implement an appropriate pain regimen. To provide adequate pain control, pediatric nurses who care for dying children must accomplish the following: critically examine ethical issues and underlying principles; understand the phenomena of addiction, tolerance, and physical dependence; and identify the boundaries of acceptable nursing practice when administering potentially life-shortening analgesia to terminally ill children.