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Ethical dilemmas in the administration of analgesia in patients with progressive benign and malignat disease (Master thesis)

Κοντελα, Ευθυμία/ Kontela, Efthymia/ Βιοηθική

Τhe paper discusses ethical, clinical and structural dilemmas in the provision of analgesia to patients with progressive benign and malignant disease. It evaluates the relationship between varying disease courses, prognostic periods and sociocultural structures in influencing pain management procedures and ethical arguments through a thorough review of the literature. Malignant disease is generally linked to fast-growing symptoms and reduced life expectancy, which generates a clinical atmosphere characterized by the focus on timely relieving the patient of the symptoms. Conversely, benign progressive conditions necessitate long-term plans of analgesic efficacy balanced with the maintenance of function, autonomy, and long-term quality of life. Such divergent contexts require different ethical standards that inform therapeutic decisions, communicating with the patient, and planning treatment. The review reveals that there exist severe differences in the accessibility to analgesics and, in particular, to opioid drugs, both on the global and national levels. Malignant disease patients often have existing care patterns that encourage vigorous analgesia and patients with benign progressive pain face limited prescribing options, due to the fear of chronic opioid treatment and regulatory skepticism. Such inequalities are also contributing to factors of structure inequities or disparities which include socioeconomic status, healthcare infrastructure, limitation of supplies globally and cultural interpretations of suffering. As it is pointed out in the analysis, the ethically sound analgesia must be assessed on a multidimensional scale, make decisions based on proportions, and consider the values individual patients have. The interdisciplinary practice develops to be crucial in controlling the physical, emotional and functional aspects of pain. The paper gives significance to the communication strategies that help in shared decision-making and fostering advance care planning so that analgesia can be consistent with the personal preferences, cultural setting, and changing objectives throughout the disease progression. Legal and policy frameworks are exhibited to influence analgesia delivery in terms of controlled substances regulation, prescription monitoring systems, guidance implementation, and identification of patient rights. These frameworks affect clinical discretion and establish a different level of flexibility to deal with the complex ethical issues. Recent discussion topics are the extent 68 of palliative care in non-malignant illness, the future of opioid stewardship, and the ethical aspect of digital health technologies to monitor and treat pain. The end of the review indicates that there should be a moderate way in which both urgency of malignant pain and the long term needs of benign progressive conditions should be considered. The results indicate that the future developments will be related to perfection of policy frameworks, extension of the interdisciplinary models, enhancement of global access to needed medicines, medical education on chronic pain, and creation of researches that will answer the remaining questions about ethical and clinical issues related to the provision of analgesia.