While it might seem that autonomy (what the patient desires), or even beneficence (doing good), would be the primary ethical principles to follow, in fact, the responsibility for nonmaleficence (do no harm) may well be the best guide. Pain medications in general, but opioids in particular, can lead to misuse, overuse, tolerance, and addiction—hence, the crisis now seen in the U.S. Since it is the physician who can “legally” provide the prescriptions, it is up to us, individually and collectively, to ethically prescribe pain medications for our patients. The key is to appropriately balance the dyad of beneficence and nonmaleficence for each patient, while bearing in mind that patient self-determination and desires (autonomy) will not necessarily be the primary guiding ethical principle in most cases of pain management.
The key is to appropriately balance the dyad of beneficence and nonmaleficence for each patient, while bearing in mind that patient self-determination and desires will not necessarily be the primary guiding ethical principle in most cases of pain management.
Explain Expectations and Limitations
Ideally, in the clinical setting where the level of pain for patients is expected to be high and long-lasting, early discussion of the role of pain medication management in their care is very important. The fear or concern for mitigation of postoperative pain is quite common, and explaining pain management modalities, with their limitations, can be very reassuring for the patient. Educating the patient in the risks, benefits, and goals of pain management is salutary, especially when done with honesty and understanding. Setting boundaries for pain medications initially is much better than trying to work with an unprepared patient in the postoperative setting.