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- Nance Cunningham Butler (1989). Infants, Pain and What Health Care Professionals Should Want to Know Now – an Issue of Epistemology and Ethics. Bioethics 3 (3):181–199.
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The assessment and management of pain is a significant public health problem in the United States. Long-term care facilities face unique barriers and challenges to pain management due to the large population of cognitively impaired residents, little physician contact and poor pain education for nurses and nurse assistants. In addition, common misconceptions about pain and pain treatment in the elderly along with health professional and resident fears of addiction and drug toxicity, add to the problem of pain management. The basic principles of pain treatment in long-term care are identical to all other health care settings – utilizing a combination of drug and non-drug treatments. Recent efforts to institutionalize improved pain management practices, through assessment procedures and defined pain management policies, standards and education programming, is a promising venue for systemically improving pain treatment in long-term care settings.
In this article, it is argued that an appropriate starting point for an analysis of ethical issues in health care is the consideration of the role obligation of health care professionals. These obligations have customary, legal, and moral elements. By appreciating the different kinds of health care roles and their purposes, one can begin to understand some of the role conflicts which arise in the health care community. Moreover, one can see that some criticisms of health care professionals are mistaken. Nonetheless, there are internal conflicts with the roles of persons engaged in health care and historically some role obligations have violated fundamental universal norms. Whereas the latter inadequacy of health care role obligations can be eliminated, the former will, to at least some extent, always be with us. In short, it may be argued that some of the so-called "moral dilemmas" in health care can be resolved by taking the perspective of role morality. As will be shown, this does not suggest that there are no limitations of role morality. CiteULike Connotea Del.icio.us What's this?
This paper introduces a series of papers dealing with the topic of euthanasia as an introduction to a variety of attitudes by health-care professionals and philosophers interested in this issue. The lead in paperâand really the lead in ideaâstresses the fact that what we are discussing concerns only a minority of people lucky enough to live in conditions of acceptable sanitation and who have access to medical care. The topic of euthanasia and PAS really has three questions: (1) is killing another ever ethically acceptable; (2) is the participation of health professionals ethically different and (3) is it wiser to permit and set criteria (being fully aware of some dangers that lurk in such a move) or to forbid (knowing that it will occur clandestinely and uncontrolled). This paper takes no definite stand although it is very troubled by useless suffering (not only pain) by many who would wish their life and with it their suffering ended.
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This essay provides an explanation and interpretation of the undertreatment of pain by discussing some of the scientific, clinical, cultural, and philosophical aspects of this problem. One reason why pain continues to be a problem for medicine is that pain does not conform to the scientific approach to health and disease, a philosophy adopted by most health care professionals. Pain does not fit this philosophical perspective because (1) pain is subjective, not objective; (2) the causal basis of pain is often poorly understood; (3) pain is often regarded as a mere symptom, not as a disease; (4) there often are no magic bullets for pain; (5) pain does not fit the expert knowledge model. In order for health care professionals to do a better job of treating pain, some changes need to occur in medical philosophy, education, and practice.
Discussion of Nance Cunningham Butler, Infants, pain and what health care professionals should want to know now – an issue of epistemology and ethics
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