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A crisis in chronic pain care: an ethical analysis. Part two: proposed structure and function of an ethics of pain medicine.
Pain Physician. 2008 Sep-Oct; 11(5):589-95.PP

Abstract

In this paper, we propose a constructive approach to an ethics of pain medicine that is animated by a core philosophy of medicine as specific and focal to the uniqueness of pain, the pain patient, and the pain clinician. This philosophy of pain medicine 1) defines the nature of pain, 2) recognizes the variability and subjectivity of its expression in the pain patient, 3) acknowledges and explicates the vulnerabilities rendered by pain, 4) describes the inherent characteristics and asymmetries of the patient-clinician relationship, and 5) defines the ends of pain care. That these ends entail the provision of "good" care links the epistemic domains of pain medicine to its anthropologic focus and ethically sound conduct. We posit that an ethics of pain medicine should define the profession and sustain the practice. Facts establish (the need for) certain duties and rules of pain medicine. These emphasize the duty to self and others, and an appreciation for relational asymmetries, and dictates that those who enter the profession of pain medicine should be generally aligned with this set of core practical and ethical affirmations and duties. To maintain contemporary relevance, rules, duties, and moral reasoning must adjust to changing conditions. Applied ethics shape the practice within the infrastructure of core rules and duties of the profession. An applied ethics of pain medicine must be pragmatic, and therefore, cannot rely upon, or be reduced to, a single principle or ethical system. A number of ethical systems (such as the use of principles, utilitarianism, casuistry, feminist/care orientations) all have relative merit and potential limitations. We argue that the obligation to recognize ethical issues, and utilize knowledge to best reflect appropriate moral values rests upon the clinician as a moral agent, and therefore advocate the relevance and importance of an agent-based virtue ethics, recognizing that virtue ethics cannot stand alone, but must be employed within a larger system of ethical intuition. Yet, if such a structure of normative and applied ethics is to be realized, moral consideration must guide evaluation of the current system of pain care, and provide direction for the development and implementation of therapeutically and ethically integrative pain medicine for the future.

Authors+Show Affiliations

Deparment of Medicine, Georgetown University, Medical Center, Washington, DC 20057, USA. jg353@georgetown.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

18850024

Citation

Giordano, James, and Michael E. Schatman. "A Crisis in Chronic Pain Care: an Ethical Analysis. Part Two: Proposed Structure and Function of an Ethics of Pain Medicine." Pain Physician, vol. 11, no. 5, 2008, pp. 589-95.
Giordano J, Schatman ME. A crisis in chronic pain care: an ethical analysis. Part two: proposed structure and function of an ethics of pain medicine. Pain Physician. 2008;11(5):589-95.
Giordano, J., & Schatman, M. E. (2008). A crisis in chronic pain care: an ethical analysis. Part two: proposed structure and function of an ethics of pain medicine. Pain Physician, 11(5), 589-95.
Giordano J, Schatman ME. A Crisis in Chronic Pain Care: an Ethical Analysis. Part Two: Proposed Structure and Function of an Ethics of Pain Medicine. Pain Physician. 2008 Sep-Oct;11(5):589-95. PubMed PMID: 18850024.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A crisis in chronic pain care: an ethical analysis. Part two: proposed structure and function of an ethics of pain medicine. AU - Giordano,James, AU - Schatman,Michael E, PY - 2008/10/14/pubmed PY - 2009/4/10/medline PY - 2008/10/14/entrez SP - 589 EP - 95 JF - Pain physician JO - Pain Physician VL - 11 IS - 5 N2 - In this paper, we propose a constructive approach to an ethics of pain medicine that is animated by a core philosophy of medicine as specific and focal to the uniqueness of pain, the pain patient, and the pain clinician. This philosophy of pain medicine 1) defines the nature of pain, 2) recognizes the variability and subjectivity of its expression in the pain patient, 3) acknowledges and explicates the vulnerabilities rendered by pain, 4) describes the inherent characteristics and asymmetries of the patient-clinician relationship, and 5) defines the ends of pain care. That these ends entail the provision of "good" care links the epistemic domains of pain medicine to its anthropologic focus and ethically sound conduct. We posit that an ethics of pain medicine should define the profession and sustain the practice. Facts establish (the need for) certain duties and rules of pain medicine. These emphasize the duty to self and others, and an appreciation for relational asymmetries, and dictates that those who enter the profession of pain medicine should be generally aligned with this set of core practical and ethical affirmations and duties. To maintain contemporary relevance, rules, duties, and moral reasoning must adjust to changing conditions. Applied ethics shape the practice within the infrastructure of core rules and duties of the profession. An applied ethics of pain medicine must be pragmatic, and therefore, cannot rely upon, or be reduced to, a single principle or ethical system. A number of ethical systems (such as the use of principles, utilitarianism, casuistry, feminist/care orientations) all have relative merit and potential limitations. We argue that the obligation to recognize ethical issues, and utilize knowledge to best reflect appropriate moral values rests upon the clinician as a moral agent, and therefore advocate the relevance and importance of an agent-based virtue ethics, recognizing that virtue ethics cannot stand alone, but must be employed within a larger system of ethical intuition. Yet, if such a structure of normative and applied ethics is to be realized, moral consideration must guide evaluation of the current system of pain care, and provide direction for the development and implementation of therapeutically and ethically integrative pain medicine for the future. SN - 1533-3159 UR - https://www.unboundmedicine.com/medline/citation/18850024/A_crisis_in_chronic_pain_care:_an_ethical_analysis__Part_two:_proposed_structure_and_function_of_an_ethics_of_pain_medicine_ L2 - http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=11&page=589 DB - PRIME DP - Unbound Medicine ER -