Pain Management in the ED
Mrs. H was a middle aged woman suffering from chronic migraines. She was being treated by a psychiatric neurologist for the condition. The physician was treating her with various medications, and had contracted with her that she would only take narcotic medications that he prescribed for her, and she would not visit the emergency department seeking pain medications. Mrs. H broke the contract time after time, as she visited emergency departments continually asking for narcotic medications. She was addicted to narcotic pain medications, and even bought them illegally (Reinisch, 2007).
At times the ED provided Mrs. H with narcotic pain medications because of her request. At other times, the ED refused to grant her request. The staff at Courtney Reinisch’s ED consulted with Mrs. H’s physician each time she visited for narcotic medications. At first it was decided between the ED and Mrs. H’s physician that she would be given a placebo for pain relief.
As her condition worsened with an increase in mental problems and other symptoms, however, the ED was led into a thorough discussion of how to truly help Mrs. Ethical Pain Management Eventually, Reinisch’s ED decided to give non-narcotic medications to Mrs. H. These medications were the same as the non-narcotic medications given by Mrs. H’s physician. There were various reasons why the ED decided to give medications to Mrs. H instead of trying to help her out with a placebo.
According to Reinisch, it is bad medical practice to avoid giving pain medications to patients who may or may not be showing symptoms of drug addictions or drug-seeking behavior. Regardless of whether Mrs. H was addicted to narcotics, the fact remained that it was the responsibility of the ED to help her. Moreover, it was the responsibility of the ED to reduce the harm in the process of pain management. Such harm was possible if Mrs. H were to be given narcotics time after time by the ED.
By deciding that Mrs. H would be helped through non-narcotic medications to control her pain, the ED had made a decision to truly help her while eliminating the possibility of harm through narcotics. Secondly, the ED determined that although most patients have a right to decide on the kind of treatment they would use or refuse in their condition, patients such as Mrs. H who may be addicted to drugs may not be in a position to be autonomous in this regard. Such patients cannot even be expected to give their informed consent on the right decisions with regards to treatment. Therefore, the conditions of informed consent and autonomy must be ruled out in such cases (Reinisch).
Conclusion Reinisch’s ED further decided that all care providers and nurses should be sufficiently educated in pain management to be able to handle a variety of complicated cases, such as the case of chronic migraines suffered by Mrs. H. What is more, there are ethical issues involved in such cases, and these issues call for lengthy in-depth discussions at the management level of the ED. Fortunately, the ED was able to come up with a solution to truly help Mrs. H. This solution called for the administration of non-narcotic pain medications. The ED refused to grant Mrs. H’s request to administer narcotics, however, given that the harm of narcotic medications was known to be greater than the benefit in her case.
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