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疼痛管理的法律与伦理问题

Legal and Ethical Aspects of Pain Management.

作者信息

Jukić Marko, Puljak Livia

机构信息

Department of Anesthesiology and Intensive Care Medicine, University Hospital Split, Split, Croatia.

Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia; Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia.

出版信息

Acta Med Acad. 2018 May;47(1):18-26. doi: 10.5644/ama2006-124.211.

Abstract

UNLABELLED

In this manuscript we presented legal and ethical aspects of pain management. Pain is a global public health problem because the burden of acute and chronic pain is considerable and is continuously increasing. It has been postulated that pain management is a fundamental human right, and that health systems are obliged to ensure universal access to pain management services. The suggestion that pain management is a right was fuelled by ample evidence about inadequate treatment of pain. Undertreatment and underprescribing in the context of pain can potentially have serious legal consequences, including charges about negligence, elder abuse, manslaughter and euthanasia. Multiple international declarations by professional societies have outlined pain management as a core ethical duty in medicine. Therefore, healthcare professionals need to be aware of multiple facets of pain-related ethics, including appraisal of patient's decision-making capacity. The worldwide opioid crisis also calls for careful consideration of specific ethical issues. Finally, healthcare workers need to be aware of the the risks associated with promoting pain management as a human right because patients and their caretakers can mistakenly perceive that they have right to total analgesia.

CONCLUSION

Patients do have the right to pain management, but patient rights have limits, which may interfere with other competing rights, and also rights of their physicians. Treatment of pain must be medically, ethically and economically justified. Healthcare workers have an obligation to continuously improve their knowledge about pain management, including medical, legal and ethical aspects of pain.

摘要

未标注

在本手稿中,我们阐述了疼痛管理的法律和伦理方面。疼痛是一个全球性的公共卫生问题,因为急性和慢性疼痛的负担相当大且持续增加。有人认为疼痛管理是一项基本人权,卫生系统有义务确保普遍获得疼痛管理服务。关于疼痛治疗不足的充分证据推动了疼痛管理是一项权利的观点。在疼痛背景下治疗不足和处方不足可能会产生严重的法律后果,包括过失、虐待老人、过失杀人及安乐死等指控。专业协会的多项国际宣言已将疼痛管理概述为医学中的一项核心伦理责任。因此,医疗保健专业人员需要了解与疼痛相关伦理的多个方面,包括对患者决策能力的评估。全球阿片类药物危机也需要仔细考虑特定的伦理问题。最后,医护人员需要意识到将疼痛管理作为一项人权进行推广所带来的风险,因为患者及其护理人员可能会错误地认为他们有权获得完全镇痛。

结论

患者确实有权获得疼痛管理,但患者权利是有限的,这可能会干扰其他相互竞争的权利以及他们医生的权利。疼痛治疗必须在医学、伦理和经济上具有合理性。医护人员有义务不断提高他们关于疼痛管理的知识,包括疼痛的医学、法律和伦理方面。

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