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Pain at the End of Life: Optimal Relief

  • David B. Morris
Chapter

Abstract

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.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • David B. Morris
    • 1
  1. 1.University of VirginiaRichmondUSA

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