Ethical issues in pain management at home.

This review of several studies from the authors' program of research supports the notion that the experience of pain, particularly in the home, has a profound effect not only on the patient, but on family and health care providers as well. Family caregivers revealed their private grief and burden when describing the physical suffering they witnessed. They faced the daily responsibility of making decisions regarding a loved one's pain, and the decisions often resulted in ethical conflicts. Caregivers generally felt ill-prepared for the administration of pain medication. They struggled to balance the need for medications to relieve pain against the perceived unwanted side effects and fear of addiction. These studies also demonstrate that a concerted effort must be made by health care providers to support the pain management role of family caregivers. By listening, being available, making pain management a priority, and reinforcing appropriate pain management principles, health care professionals help sustain family caregivers in carrying out their anguishing and unrelenting task.