RESUMO
The purpose of this study was to survey the membership of the American Pain Society and the American Academy of Pain Medicine to determine their beliefs about ethical dilemmas in pain management practice. Respondents rated ethical dilemmas for their importance as well as their own competence in dealing with these ethical issues. The survey also included an open-ended question that asked respondents to describe clinical situations in which they had encountered ethical dilemmas. A total of 1,105 surveys were analyzed, with physicians (N = 612), nurses (N = 189), and psychologists (N = 166) representing the professions with the greatest response. Management of pain at the end of life, general undertreatment of pain, and undertreatment of pain in the elderly were the most frequently encountered dilemmas. Qualitative data were analyzed to identify ethical issues in the case examples provided by the respondents. Major themes included inappropriate pain management, barriers to care, interactions and conflicts with others, regulatory/legal issues, euthanasia, assisted suicide, and research issues. We conclude that ethical dilemmas are common in pain management practice and that resolution of these dilemmas requires commitment by individual professionals as well as health systems.
RESUMO
The responsibility for ethical behavior in medical care has been described historically as evolving through 3 stages: personal responsibility, professional group responsibility, and organizational responsibility. Together these 3 forms provide a system of accountability that works better than any one form alone. Today we have added a fourth stage, societal responsibility, in which oversight of managed care practices is maintained by external review organizations. Managed care organizations and their medical directors can work with physicians, professional societies and oversight organizations to develop a working healthcare system that protects the ethical rights of individual patients and populations of patients.
