Retired physician.
Pediatric Hematology-Oncology, University of California, San Diego, California, USA.
J Med Ethics. 2019 Apr;45(4):219-224. doi: 10.1136/medethics-2018-105099. Epub 2019 Feb 22.
In this article, we discuss the ethical dimensions for the prescribing behaviours of opioids for a chronic pain patient, a scenario commonly witnessed by many physicians. The opioid epidemic in the USA and Canada is well known, existing since the late 1990s, and individuals are suffering and dying as a result of the easy availability of prescription opioids. More recently, this problem has been seen outside of North America affecting individuals at similar rates in Australia and Europe. We argue that physicians are also confronted with an ethical crisis where a capitalist-consumerist society is contributing to this opioid crisis in which societal, legal and business interests push physicians to overprescribe opioids. Individual physicians often find themselves unequipped and unsupported in attempts to curb the prescribing of opioid medications and balance competing goals of alleviating pain against the judicious use of pain medications. Physicians, individually and as a community, must reclaim the ethical mantle of our profession, through a more nuanced understanding of autonomy and beneficence. Furthermore, physicians and the medical community at large have a fiduciary duty to patients and society to play a more active role in curbing the widespread distribution of opioids in our communities.
本文讨论了为慢性疼痛患者开阿片类药物处方的行为所涉及的伦理维度，这种情况许多医生都经常遇到。阿片类药物在美国和加拿大的流行是众所周知的，从 20 世纪 90 年代末就开始存在，由于处方类阿片类药物的轻易获得，许多人因此而痛苦和死亡。最近，这一问题已经在北美以外的地区出现，澳大利亚和欧洲也有类似比例的人受到影响。我们认为，医生也面临着一场伦理危机，资本主义消费社会导致了阿片类药物危机，社会、法律和商业利益促使医生过度开阿片类药物处方。个别医生常常发现自己在试图抑制阿片类药物处方和平衡缓解疼痛与合理使用疼痛药物的目标方面缺乏能力和支持。医生个人和整个医学界必须通过更细致地理解自主性和行善原则来恢复我们职业的道德准则。此外，医生和整个医学界都有信托责任，要在遏制我们社区中阿片类药物的广泛分发方面发挥更积极的作用。
