painlaw.org : Patients' Right to Palliative Care : What If Pain Is Not Treated?

Technical expertise is available to treat 90 percent of all pain in terminal illness. Guidance is available to medical facilities and doctors on how to treat pain and where to get help if they're stumped. The new JCAHO standards will require accredited facilities to routinely assess and have in place systems to manage pain. Nonetheless, untreated pain is still common.

Some recent examples brought to the Palliative Care Project:

• An Indiana hospital patient was admitted to the hospital for pain management but the on-call doctor refused to prescribe medications for over 48 hours.
• A woman dying in a hospital spent agonizing hours with only over-the-counter acetaminophen (Tylenol) to relieve her pain despite the pleas of family and nursing staff for a better medication.
• A 74-year-old man was discharged from the ICU to die only 48 hours after his left leg was amputated. He was provided no pain medication at all and family pleas were ignored. Only the family's decision to replace the attending physician summarily with a more compassionate doctor allowed him to die in peace.
• A doctor confronted with the obvious suffering of a woman dying of cancer refused to administer pain medications. When asked why he responded: "I have my reasons."

Physicians have an ethical, moral and legal obligation to manage pain or to assure that the patient is referred to another doctor who is competent and willing to do so. The American Medical Association's Ethical Standard E-2.20 (1991) states that "[p]hysicians have an obligation to relieve pain and suffering and to promote the dignity and autonomy of dying patients in their care."

Still, the patient or the patient's agent or advocate will have to play an active and assertive role in making sure that the ethical obligation translates into comfort for the patient. Doctors are authority figures upon whom patients depend for their very survival. Taking an assertive stand may be very difficult for the patient or the immediate family. Yet if "please" fails, they should be prepared to be advocates.

<<< Previous Next >>> [ Go Up ]