Pain Management in a Terminally Ill Patient with a Surrogate Decision-maker: A Challenge.

Tausif Syed,Richard Alweis,Abdullah Abdullah,Pratyusha Tirumanisetty,Susan Mansourian

doi:10.7759/cureus.5429

Tausif Syed, Richard Alweis + Show 3 more

Open Access

https://doi.org/10.7759/cureus.5429

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Abstract

When health care proxies are in charge of pain management, it may become very difficult to address the patient’s pain if the health care proxy has misconceptions about analgesics.We report a case of an 87-year-old lady who was found to be pulseless, and after successful cardiopulmonary resuscitation (CPR), was intubated and remained so for over a month in the intensive care unit (ICU). The medical team could not provide the patient with pain medication, as the daughter who was the surrogate decision-maker did not allow the administration of any pain medication in the false belief that it would kill the patient.This case helps us to shed light on the surrogate decision-maker and pain management and how medical professionals can solve similar issues in the future. Early consultation with palliative care may be beneficial. For continued disagreement, the ethics committee should be consulted.

Highlights

Pain management remains one of the most important, yet controversial, factors in high-quality, evidence-based patient care
When health care proxies are in charge of pain management, it may become very difficult to address the patient’s pain if the health care proxy has misconceptions about analgesics [2]
Medical providers must seek to understand the reasoning behind the health care proxy refusing pain medication and address any concerns and misconceptions

Summary

Introduction

Pain management remains one of the most important, yet controversial, factors in high-quality, evidence-based patient care. Pain management is a multifactorial process with contributions from patients, families, and healthcare providers while the role of regulators and hospital policy must be considered [1]. Multiple meetings between the daughter, other members of the family, the ICU team, and the palliative team failed to convince the daughter that while intubated, the patient could be in true pain and require pain management. The other family members, including the patient’s son, came to the meeting They were of the opinion that the patient should receive the pain medication but since the daughter was the sole health care proxy, the final decision was with the daughter. The patient remained full code, intubated, partially awake, and in what the medical team felt was obvious pain for over a month in the ICU before passing away

Discussion

Conclusions

Disclosures