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30 - Pain in medical illness: ethical and legal foundations

from SECTION X - SYSTEMS OF CARE

Published online by Cambridge University Press:  06 July 2010

By
PAULINE LESAGE  and
RUSSELL K. PORTENOY
Edited by
Eduardo D. Bruera  and
Russell K. Portenoy
PAULINE LESAGE
Affiliation:
Beth Israel Medical Center
RUSSELL K. PORTENOY
Affiliation:
Beth Israel Medical Center and Albert Einstein College of Medicine
Eduardo D. Bruera
Affiliation:
University of Texas, Houston
Russell K. Portenoy
Affiliation:
Albert Einstein College of Medicine, New York
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Summary

No moral impulse seems more deeply embedded than the need to relieve suffering…it has become a foundation stone for the practice of medicine, and it is at the core of the social and welfare programmes of all civilized nations.

Daniel Callahan

Introduction

By introducing major modifications in the historical constructs underlying medical treatments, science and technology have created a certain “chaos” in the care of seriously ill patients. What might have been considered good medical practice for advanced disease before the “biological revolution” is now questioned. Where to draw the line? Where to set limits? Many variables now must be considered in the management of patients with advanced illnesses, including the recognition of ethics as a foundation for clinical practice, the acknowledgment of new rights, and social changes related to health care. Ethical and legal considerations now must constantly inform decision making. Medicine has been caught in a difficult dilemma: Not only does it have to consider its own complexities, but it also has to face a much different social context than existed just a short time ago.

Numerous ethical guidelines and recommendations have been proposed by diverse authorities to help clinicians in their decision making. Recommendations can be found in reports of special presidential or national commissions, in major congressional reports, in policy statements of national organizations, in guidelines from bioethics institutes, and in professional journals.

Type
Chapter
Information
Cancer Pain
Assessment and Management
 , pp. 553 - 567
Publisher: Cambridge University Press
Print publication year: 2009

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