How would you handle these cases?
In the December 2017 issue of ENTtoday, the article “The Opioid Crisis: Five Truths Otolaryngologists Need to Know” discussed the threats of opioid overuse and misuse in the United States for patients, physicians, and society. The article identified five elements to consider when otolaryngologists prescribe opioids:
- Your patients may already be on opioids;
- The number of pills you prescribe matters;
- You can probably decrease the amount of opioids you prescribe;
- Patient education regarding proper use (and disposal) of opioids is necessary; and
- Patients who want refills should be referred to pain management specialists.
These points can help guide the otolaryngologist in managing pain requirements by patients in the clinical setting. But the concerns of the opioid crisis and the responsible management of pain in patients require the otolaryngologist to make the best decisions for patients within the context of clinical and professional ethics.
The ethical foundations for patient care rest fundamentally in the four principles of autonomy, beneficence, nonmaleficence, and social justice. It is not always easy to achieve a balance of these principles in medicine, especially when taken in the context of compassion, understanding, honesty, and duty. Often, hard choices must be made, and few clinical situations are more difficult in this regard than pain management.