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Thread: Ethical question

  1. #1 Ethical question 
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    Suppose a man has a herniated disk and is living with a pain level of a constant 8 on scale from one to ten. The doctor refuses to prescribe pain medication claiming that he might abuse it. The man can't take the pain and kills himself.

    In your opinion is the doctor responsible in any way?
    What if the doctor knows that 99.9% pf all patients on pain killers don't abuse their meds. Is he responsible now?
    The most important thing to keep in mind is that you don't know everything and nobody else does either.
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  2. #2  
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    Quote Originally Posted by PhyMan View Post
    Suppose a man has a herniated disk and is living with a pain level of a constant 8 on scale from one to ten. The doctor refuses to prescribe pain medication claiming that he might abuse it. The man can't take the pain and kills himself.

    In your opinion is the doctor responsible in any way?
    I would say the doctor might have some responsibility here. It all depends on whether the man protested that he didn't think he could go on without the meds, and how the doctor assessed his mental state.

    Quote Originally Posted by PhyMan View Post
    What if the doctor knows that 99.9% pf all patients on pain killers don't abuse their meds. Is he responsible now?
    Don't abuse them? Then I would say the doctor is definitely responsible. Why would the doctor think the man would abuse the meds if 99.9% of the population don't?

    If, on the other hand, the doc knew that 99.9% of people DO abuse their meds, then I would say he was acting responsibly in being worried that the man might also abuse them.

    The question is, did the doctor offer any alternatives to the patient other than meds (a chiropractor perhaps)? Or did he just tell the patient to learn to live with the pain?
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  3. #3  
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    Quote Originally Posted by SpeedFreek
    I would say the doctor might have some responsibility here. It all depends on whether the man protested that he didn't think he could go on without the meds, and how the doctor assessed his mental state.
    Why does that matter? Suppose it was you. Could you go on with moderate to severe pain which never ended?
    Quote Originally Posted by SpeedFreek
    Don't abuse them?
    Yes. They have things called a morphine pump which is surgically implanted and gives morphine automatically. There’s no way to abuse it within reason.
    Quote Originally Posted by SpeedFreek
    Then I would say the doctor is definitely responsible. Why would the doctor think the man would abuse the meds if 99.9% of the population don't?
    Perhaps it was ignorance or because he had a previous drug problem. But even then people with previous drug problems can use pain meds with no problems. One simply orders a visiting nurse to give him his medication every day and watches him take it. There is no excuse to not give pain meds for people who’d rather die than live with chronic pain that’s above the moderate level.

    I’ve been reading about all these things. I was told this by a top doctor at Brigham and Women’s Hospital in Boston. He’s a friend of a friend. Consider the following. From Prescription Drug Addiction by Rod Colvin, page 106
    Studies confirm that the incidence of addiction is low among patients who are treated for legitimate pain, who use pain medication as directed, and who are evaluated regularly. According to the National Institute for Drug Abuse, in a study of 12,000 patients who are given opioids for acute pain, only 4 became addicted. And, even long-term use of pain medication shows a limited risk of addiction. In another study of 38 chronic pain patients, who received opioids for four to seven years, only 4 became truly addicted.
    If, on the other hand, the doc knew that 99.9% of people DO abuse their meds, then I would say he was acting responsibly in being worried that the man might also abuse them.
    Nah. There are always ways to prevent that from happening.

    The question is, did the doctor offer any alternatives to the patient other than meds (a chiropractor perhaps)? Or did he just tell the patient to learn to live with the pain?
    The patient was merely supposed to “suck it up” i.e. learn to live with it.

    We’re talking about me, of course. The good news is that I found a new doctor who made it clear that I can count on him not to let me suffer, at least until the pain meds stop working and the amount taken at that point becomes too dangerous to increase. But that'd be many years from now. I can go back to grad school, get my graduate work and get a lot done during that time. Who knows. Maybe Medicare will pay for Laser Spine Surgery by then!

    I did some searching on suicide rates for patients with chronic pain and found this
    http://www.ncbi.nlm.nih.gov/pubmed/1809412
    The most important thing to keep in mind is that you don't know everything and nobody else does either.
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  4. #4  
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    Quote Originally Posted by PhyMan View Post
    Why does that matter? Suppose it was you. Could you go on with moderate to severe pain which never ended?
    Well I suppose it matters because some people can deal with pain better than others. If the patient really protested and tried to impress upon the doctor how desolate he felt, and how he might contemplate suicide if there was no relief from the pain, but the doctor still refused to prescribe the meds or offer any other alternative therapy that might actually help the pain, then I think the doctor could be held responsible for the suicide.

    Could I live with severe unending pain? I very much doubt it. If the doctor wouldn't help me I would seek a second opinion from another doctor. If no doctor would help me, I would probably try to find another way to get pain relief, probably illegally, and so end up abusing the meds anyway - diamorphine is easy to come by if you know where to get it.

    Quote Originally Posted by PhyMan View Post
    Perhaps it was ignorance or because he had a previous drug problem. But even then people with previous drug problems can use pain meds with no problems. One simply orders a visiting nurse to give him his medication every day and watches him take it. There is no excuse to not give pain meds for people who’d rather die than live with chronic pain that’s above the moderate level.
    I agree.

    Quote Originally Posted by PhyMan View Post
    We’re talking about me, of course.
    I hadn't actually realised this.

    Quote Originally Posted by PhyMan View Post
    The good news is that I found a new doctor who made it clear that I can count on him not to let me suffer, at least until the pain meds stop working and the amount taken at that point becomes too dangerous to increase. But that'd be many years from now. I can go back to grad school, get my graduate work and get a lot done during that time. Who knows. Maybe Medicare will pay for Laser Spine Surgery by then!
    Well that is good news! It seems the "second opinion" option worked for you, luckily.

    What I don't understand is whether the first doctor thought you were faking the pain in order to get hold of and abuse meds, or whether he thought you were really in pain but should live with it, just in case you abuse the meds. Did he really think people should do without pain relief for chronic pain? If so, I can understand your frustration with him.

    Here in the UK with the NHS we can change doctors or get a second opinion easily, and I am not so sure the same situation would arise as often over here as it does where you live, although I am sure it happens sometimes. Some doctors can be a real pain, eh?
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  5. #5  
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    Quote Originally Posted by SpeedFreek View Post
    Well I suppose it matters because some people can deal with pain better than others.
    I did some reading on this subject in a psychology text that I have. It states that it’s a complicated issue and depends on perception. I also learned the difference between two different people to tolerate pain does not mean that the two people experience pain differently but they respond/complain differently. Pain tends to destroy concentration. Therefore the person whose ability to enjoy his life requires a greater level of concentration might want less pain so that he can concentrate better. Therefore complaining, the factor that determines tolerance, is not necessarily related to a person’s ability to deal with the pain but more related to how it affects their life. In my case the pain ruins my concentration and ability to concentrate deeply on the math and physics that I’m studying right now.

    Quote Originally Posted by SpeedFreek View Post
    If the patient really protested and tried to impress upon the doctor how desolate he felt, and how he might contemplate suicide if there was no relief from the pain, but the doctor still refused to prescribe the meds or offer any other alternative therapy that might actually help the pain, then I think the doctor could be held responsible for the suicide.
    I agree. Unfortunately doctors think differently. Once you tell them you can’t stand living because of the pain they automatically believe its no longer their problem but the problem of a shrink and you’ll be forced into a psyche unit until you deny such feelings. Been there, done that.
    Quote Originally Posted by SpeedFreek View Post
    Could I live with severe unending pain? I very much doubt it. If the doctor wouldn't help me I would seek a second opinion from another doctor. If no doctor would help me, I would probably try to find another way to get pain relief, probably illegally, and so end up abusing the meds anyway - diamorphine is easy to come by if you know where to get it.
    Thank you very much for the honesty. It is greatly appreciated.
    Quote Originally Posted by SpeedFreek View Post
    What I don't understand is whether the first doctor thought you were faking the pain in order to get hold of and abuse meds, or whether he thought you were really in pain but should live with it, just in case you abuse the meds. Did he really think people should do without pain relief for chronic pain? If so, I can understand your frustration with him.
    He claimed that he wouldn’t prescribe meds because I have a substance disorder, i.e. I used to have a small drug problem. It no longer exists and I never had a problem with pain medication even though I was prescribed it in the past. He wasn’t a very bright doctor. In fact I’m very disappointed with high bright these doctors are.

    Yep. They sure can be a real pain!
    The most important thing to keep in mind is that you don't know everything and nobody else does either.
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