When patients lack capacity, physicians look to family and
friends to step in and provide consent for treatment on behalf of the
patient. These surrogates, whether they
were appointed by the patient as their health care agent or become health care
surrogates by default under state law based on their relationship to the
patient, have the right to receive information related to the care and
treatment of the patient and have the corresponding responsibility to make
health care decisions for the patient based on either the patient’s previously
expressed wishes or her best interests.
What they don’t have, however, is the right to control and direct every minute
aspect of the patient’s care in the hospital.
It would take several blog posts to discuss the conflicts that occur
between surrogates and health care providers because of this (such as DNR
orders, barriers to discharge, and demands for certain medications, to name a
few), but perhaps the most concerning example of surrogate over-reach is the
issue of inadequate pain management.
The use of pain medication can be difficult for both
patients and providers, especially with the rate of opioid abuse
in this country. Patients and their
families are often afraid of the possibility of addiction, while physicians are
reticent to prescribe narcotics for fear of misuse. Whether or not a patient is a “drug-seeker”
is a common question that arises when physicians are deciding what to
prescribe. However, in the context of
terminal illnesses – particularly at the very end of the illness – the shift in
focus from curative to palliative care highlights the need for sufficient pain
control in the face of nearly intractable pain.
It is in this context that denial of pain medication, or poor pain
management, is most clearly an ethical issue.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.