Pain at the End of Life: Optimal Relief
Pain at the end of life evokes questions that are at least as much moral as medical. Relevant medical issues, that is, are entangled with significant ethical issues, as various studies contend (Kinlay 2005; Dubois 2005; Demme et al. 2006; Wheatley and Finlay 2011). In practice, while neglect of relevant medical issues constitutes de facto incompetence, healthcare professionals apparently can ignore such entangled ethical issues without reproach, including the implications of widespread end-of-life pain. Researchers, for example, found that in the last year of life, 51% of subjects—in a broad study of US health and retirement—were troubled by moderate to severe pain (Singer et al. 2015). Even within controlled medical environments, a prestigious earlier study (a 4-year investigation including 9105 adults hospitalized with life-threatening diagnoses) illuminates the vast extent of end-stage pain. It found that 50% of dying hospitalized patients spend at least half their time, according to family members, in moderate to severe pain (The SUPPORT Principle Investigators 1995). Such institutionalized end-of-life pain is not only widespread but also—equally troubling—deeply resistant to efforts at amelioration. A follow-up study designed to improve medical treatment, involving 2 years of targeted educational instruction among physicians and hospital staff, showed no improvement whatever.
- Anquinet, L., Rietjens, J. A. C., Seale, C., Seymour, J., Deliens, L., & van der Heide, A. (2012). The practice of continuous deep sedation until death in Flanders (Belgium), The Netherlands, and the UK: A comparative study. Journal of Pain and Symptom Management, 44(1), 33–43.CrossRefGoogle Scholar
- Byock, I. (1997). Dying well: The prospect for growth at the end of life. New York: Riverhead Books.Google Scholar
- DeMarco, P. (2016, October 16). A letter to the doctors and nurses who cared for my wife. NY Times. https://www.nytimes.com/2016/10/06/well/live/a-letter-to-the-doctors-and-nurses-who-cared-for-my-wife.html?_r=0.
- Fuentes, J., Armijo-Olivo, S., Funabashi, M., Miciak, M., Dick, B., Warren, S., Rashiq, S., Magee, D. J., & Gross, D. P. (2014). Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: An experimental controlled study. Physical Therapy, 94, 447–489.CrossRefGoogle Scholar
- Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296–4301.CrossRefGoogle Scholar
- Institute of medicine. (2015). Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.Google Scholar
- Mooallem, J. (2017, January 8). One man’s quest to change the way we die. NY Times Mag. https://www.nytimes.com/2017/01/03/magazine/one-mans-quest-to-change-the-way-we-die.html?_r=0.
- Morris, D. B. (2010). Sociocultural dimensions of pain management. In J. C. Ballantyne, J. P. Rathmell, & S. M. Fishman (Eds.), Bonica’s management of pain (4th ed., pp. 133–145). New York: Lippincott Williams & Wilkins.Google Scholar
- Ruiz, R. R. (2017, July 13). U.S. charges 412, including doctors, in $1.3 billion health fraud. NY Times. https://www.nytimes.com/2017/07/13/us/politics/health-care-fraud.html?smprod=nytcore.
- Wheatley, V. J., & Finlay, I. G. (2011). Ethical issues in palliative care. Medicine (Abingdon), 39, 680–682.Google Scholar