"Suffering due to lack of pain relief is an affront to human dignity"
Many people believe, and I agree, that easy access to reliable pain relief is a matter of human rights. In the paper Pain Management: A Fundamental Human Right, published in the journal Anesthesia and Analgesia, Brennan and colleagues review the ethics of pain relief:The importance of pain relief as the core of the medical ethic is clear. The relief of pain is a classic example of the bioethical principle of beneficence. Central to the good actions of doctors is the relief of pain and suffering. As Post et al. state, "the ethical duty of beneficence is sufficient justification for providers to relieve the pain of those in their care ..." The principle of nonmaleficence prohibits the infliction of harm. Clearly, failing to reasonably treat a patient in pain causes harm; persistent inadequately treated pain has both physical and psychologic effects on the patient. Failing to act is a form of abandonment... [F]or a patient's doctor to ignore the patient's complaint of pain or to refuse to accede to a reasonable request for pain relief arguably contravenes the autonomy of patients and self-determination of their medical care ..."As the authors explain, cultural attitudes have had an large impact on the treatment of pain:
Societal attitudes toward pain relief during surgery and childbirth illustrate the complex interactions between cultural concepts of pain, pain relief, and social behavior...The authors ask:
...In the case of analgesia for childbirth, there was bitter resistance on religious grounds. Fundamentalists cited the Bible as ordaining that childbirth was a necessarily painful process. Opposing both the church and powerful obstetricians, Queen Victoria requested that James Simpson administer chloroform analgesia for the delivery of her son, thus overcoming powerful negative attitudes that discouraged relief of the pain associated with childbirth...
Despite the growing number of initiatives ... to improve pain management, powerful myths (and their proponents) are well entrenched and continue to spread with the ease of an epidemic, independent of any need for logic or rationale. The belief that pain is an inevitable part of the human condition is widespread. The word "patient" itself is derived from the Latin patiens, meaning "one who suffers." Examples of pain
myths shared by health professionals and patients alike include the notions that pain is necessary, natural and hence beneficial ...
Why has it taken so long to recognize the ethical and legal importance of pain relief? There are complex and overlapping reasons for this delay. For centuries, medical and surgical treatment has emphasized saving the life of the patient rather than ameliorating the patient's pain, particularly when there were few options for the latter... At the same time, entrenched attitudes to pain and its rationalization persist, such as that pain in childbirth is biblically preordained. Redemptive qualities continue to be ascribed to pain ...The question for midwives, and health care managers who discourage the use of pain relief in labor, or set up barriers to easy access to pain relief in labor, is this: If easy access to effective pain relief is a fundamental human right, how can you possibly justify your opposition to the use of pain relief in labor?
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