Ethics: ethics and pain management in hospitalized patients.

Citation: Bernhofer, E., (October 25, 2011) "Ethics and Pain Management in Hospitalized Patients" OJIN: The Online Journal of Issues in Nursing Vol. 17 No. 1. DOI: 10.3912/OJIN.Voll7No01EthCol01 Optimal pain care for hospitalized patients continues to remain elusive. Results of the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) show that only 63-74% of hospitalized patients nationwide reported that their pain was well controlled (Summary of HCAHPS Survey Results, 2011). Although pain research has resulted in a better understanding of pain modalities and the development of new treatments, patients report little increase in satisfaction with the management of their pain while hospitalized (Department of Health and Human Services, 2011). This column will examine how the deliberate use of ethical principles, when making pain management decisions for hospitalized patients, may provide more optimal outcomes. Assessment and treatment of pain is often complex. The standard definition of pain is "whatever the experiencing person says it is, existing whenever the experiencing person says it does" (McCafferv, 1968, P.95). In practice, however, practitioners' personal biases about the patient's pain may interfere with the realization of this definition when doing a pain assessment. Regrettably, the intrinsic subjectivity of pain is often disregarded. Practitioners who would likely not judge the character of a patient who needs increased amounts of medication to treat hypertension; yet they may believe that a patient whose persistent pain does not respond to standard medications is 'drug-seeking,' a narcotic abuser, or has a current need to 'escape reality.' The unemotional, transparent principles of ethics may be useful in such cases to provide guidelines for better, more effective pain treatment. The ethical principles of autonomy, beneficence, nonmaleficence, and justice should guide all health professionals when they make assessment and treatment decisions. Autonomy Autonomy is the right of individuals to make decisions regarding their own healthcare regardless of what others think of these decisions (Evans, 2000). It is the right of self-determination (American Nurses Association, 2001). The Belmont Report clearly confers this right on all human beings as a 'respect for persons' regardless of age, capacity, or even imprisonment (National Institutes of Health, 1979). Individuals must be treated with respect for their personal healthcare decisions regardless of whether the healthcare provider agrees with these decisions. The principle of autonomy is violated when a practitioner dishonors patients' rights to choose how they want their pain to be treated. Infringement on the right to autonomy or self-determination may also be seen in the withholding of information from patients about how much and how often they can receive pain medication while in the hospital. Patients have the right to know, consider, request, and refuse any treatments that they believe will help manage their pain. They also have the right to have all medications, side effects, and other treatments clearly explained to them in order to make the right decisions. Interestingly, when patients are fully extended their right to autonomy, their pain is often better managed, and they report better satisfaction with their care. When patients perceive that they are understood, and can make their own decisions regarding pain control, they often do better. One example of this is the growing use of Patient Controlled Analgesia (PCA) for the treatment of acute pain in the hospital setting. When analgesics are adequately ordered and the pump is properly programmed for the individual, patients experience personal control over their pain and receive effective analgesia (Hudcova, McNicol, Puah, Lau, &Carr, 2005). Beneficence is defined as doing good for an individual (National Institutes of Health, 1979). …