PAIN MANAGEMENT

  Typically, hospice patients are classified as those individuals who have less than six  months left to live. As a patient nears the end-of-life, symptoms, including pain tend to  intensify. A major part of the symptom relief is the use of opioids to relieve pain and  benzodiazipines to reduce anxiety and encourage rest magnified by the intractable  pain. Many of the ethical dilemmas surrounding hospice care stem from the use of  pain medications in terminally ill patients.

  Morphine and morphine derivatives are the most widely used narcotics for treating  pain and other symptoms experienced by hospice patients. It is good at relieving the  two most common symptoms in dying patients – pain and shortness of breath. In the  dosages required for the terminally ill, two major fears of nurses is overdosing the  patient and respiratory depression. In my nursing practice, I have witnessed many  nurses under medicate terminally ill patients who are suffering intense pain.

  According to Sykes and Thorns (2003), nurses fears of overdosing and hastening the death in terminal patients may be unfounded as research has not found narcotics to shorten life or depress respirations in dying patients even when higher than normal doses of narcotics are given. The American Society for Pain Management Nursing (2010) believes that it is an ethical obligation for nurses to advocate and provide effective pain relief and symptom management to alleviate suffering for the patient receiving end-of-life care.

In the context of the caring relationship, the American Nurses Association (2003) states that nurses play a primary role in the assessment and management of pain and other symptoms in dying patients. As such, nurses have a moral obligation to advocate on behalf of the patient when prescribed medications are inadequately managing pain. Furthermore, the increased titration of pain medication to achieve symptom control in dying patients is ethically justified.

Patients need and deserve assurances that their physical pain and emotional suffering will be effectively addressed by the nursing staff. The hospice nurse who provides adequate and effective pain management for terminally ill patients uses personal and professional ethics to demonstrate a respect for human dignity as well as exemplifies the ethical principle of beneficence.