Ethical dilemmas in pain management

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 belie fs about ethical dilemmas in pain management practice. Respondents rated et hical dilemmas for their importance as well as their own competence in deal ing with these ethical issues. The survey also included an open-ended quest ion that asked respondents to describe clinical situations in which they ha d encountered ethical dilemmas. A total of 1.105 surveys were analyzed, wit h physicians (n = 612), nurses (n = 189). and psychologists (n = 166) repre senting the professions with the greatest response. Management of pain at t he end of life, general undertreatment of pain, and undertreatment of pain in the elderly were the most frequently encountered dilemmas. Qualitative d ata were analyzed to identify ethical issues in the case examples provided by the respondents. Major themes included inappropriate pain management, ba rriers to care, interactions and conflicts with others, regulatory/legal is sues, euthanasia, assisted suicide, and research issues. We conclude that e thical dilemmas are common in pain management practice and that resolution of these dilemmas requires commitment by individual professionals as well a s health systems. (C) 2001 by the American Pain Society.