Jansen L A
New York Medical College, John J. Conley Department of Ethics, St. Vincent's Hospital/Medical Center, New York, New York, USA.
J Palliat Med. 2001 Spring;4(1):23-30. doi: 10.1089/109662101300051924.
In recent years, increased emphasis has been placed on the ethical duty of physicians to relieve pain and suffering. According to a 1992 report from The Agency for Health Care Policy Research (AHCPR), the "ethical obligation to manage pain and relieve the patient's suffering is at the core of a health care professional's commitment." However, despite the increased emphasis on the ethical duty to relieve pain, the undertreatment of pain continues to be a serious problem. This problem has been widely discussed, but so far efforts to respond to it have focused almost exclusively on institutional and educational solutions. Yet surprisingly in this discussion very little attention has been paid to articulating a constructive role for the patient in combating this problem. In this article I argue that adequate pain treatment will often require the active participation of the patient in the decision making process. Given the special nature of pain and the special problems that arise in the treatment of pain, adequate pain treatment requires that physicians and patients realize a particular model of shared decision making--one that I refer to as deliberative decision making. As will become clear, my defense of this model is limited to the context of pain management and may not apply in other clinical contexts.
近年来，人们越来越强调医生缓解疼痛和减轻痛苦的道德责任。根据医疗保健政策研究机构（AHCPR）1992年的一份报告，“管理疼痛和减轻患者痛苦的道德义务是医疗保健专业人员承诺的核心”。然而，尽管越来越强调缓解疼痛的道德责任，但疼痛治疗不足仍然是一个严重的问题。这个问题已经得到广泛讨论，但到目前为止，应对这一问题的努力几乎完全集中在机构和教育解决方案上。然而，令人惊讶的是，在这场讨论中，很少有人关注阐明患者在解决这一问题中的建设性作用。在本文中，我认为充分的疼痛治疗通常需要患者积极参与决策过程。鉴于疼痛的特殊性质以及疼痛治疗中出现的特殊问题，充分的疼痛治疗要求医生和患者实现一种特定的共同决策模式——一种我称之为审议性决策的模式。正如将变得清晰的那样，我对这种模式的辩护仅限于疼痛管理的背景，可能不适用于其他临床背景。
