PEDIATRIC PAIN - ETHICAL ISSUES AND ETHICAL MANAGEMENT

Patients have traditionally received less pain relief than they could, and should. Surprisingly, numerous studies demonstrate that this agon izing gap between need and care is even larger for children. Three ''l icenses'' that have traditionally been used to justify the undertreatm ent of pain are analyzed: (a) the revisionist justification (''The pai n is not that bad''), (b) the comparative justification (''The pain is not the worst''), and (c) the pragmatic justification (''The pain may produce something better''). These justifications are challenged by a review of state-of-the-art scientific knowledge and by the principles of ethical decision making. The conclusion is that both scientific an d ethical standards demand an end to the undertreatment of pain for pe diatric patients.