Opioids for Chronic Nonterminal Pain
Opioids for Chronic Nonterminal Pain
Rapid changes in medical science, technology and funding during the past century have had a profound effect on the role of physicians in society and their relationship with patients. Physicians are provided with tools that can alter life itself, so patients are no longer content to put medical decisions solely in the hands of physicians. The Hippocratic tradition of benevolent paternalism, protecting patients through an ethical code producing good for the patient and protecting that patient from harm, has been replaced by a guidance-cooperation model where the physician steers the patient, but the patient is the primary decision maker. Increasingly, moral and ethical decisions are removed from the confines of individual physician-patient relationships, and move into the realm of public morality. As part of this trend, medical practice is directed more by guidelines, laws and mandates, and less by the dictates of individual physicians. Patients' right to direct their own treatment is expressed in the Patients Bill of Rights, and their right to pain and opioid treatment expressed in intractable pain statutes. Physicians are encouraged to provide pain and opioid treatment by Federal Agencies, State Medical Boards68 and credentialing bodies. But they are also constrained by legal barriers that tend to inhibit prescribing, and that compound the moral and ethical dilemmas that are inherent in the provision of opioids because of their indispensable role in pain management pitched against their tendency to produce addiction. Against a background of conflicting directives, physicians face real patients, all presenting with a cry for relief, all complex, and many whose decision-making capacity is compromised by the pervasive effect of pain or the drugs used to treat pain. The challenge of balancing the needs and rights of patients, and the safety of patients and community is enormous.
Rapid changes in medical science, technology and funding during the past century have had a profound effect on the role of physicians in society and their relationship with patients. Physicians are provided with tools that can alter life itself, so patients are no longer content to put medical decisions solely in the hands of physicians. The Hippocratic tradition of benevolent paternalism, protecting patients through an ethical code producing good for the patient and protecting that patient from harm, has been replaced by a guidance-cooperation model where the physician steers the patient, but the patient is the primary decision maker. Increasingly, moral and ethical decisions are removed from the confines of individual physician-patient relationships, and move into the realm of public morality. As part of this trend, medical practice is directed more by guidelines, laws and mandates, and less by the dictates of individual physicians. Patients' right to direct their own treatment is expressed in the Patients Bill of Rights, and their right to pain and opioid treatment expressed in intractable pain statutes. Physicians are encouraged to provide pain and opioid treatment by Federal Agencies, State Medical Boards68 and credentialing bodies. But they are also constrained by legal barriers that tend to inhibit prescribing, and that compound the moral and ethical dilemmas that are inherent in the provision of opioids because of their indispensable role in pain management pitched against their tendency to produce addiction. Against a background of conflicting directives, physicians face real patients, all presenting with a cry for relief, all complex, and many whose decision-making capacity is compromised by the pervasive effect of pain or the drugs used to treat pain. The challenge of balancing the needs and rights of patients, and the safety of patients and community is enormous.
