Pain: highlighting the law and ethics of pain relief in end-of-life patients

The world of palliative medicine is rapidly becoming a fixture in the paramedic field of practice, and with its proposed inclusion into the UK Ambulance Services Clinical Practice Guidelines (Association of Ambulance Chief Executives (AACE), 2013), it is time for paramedics to inform themselves about the ethics and laws surrounding pain relief for end-of-life patients.

Many healthcare professionals and clinicians working in palliative care believe that failing to address the pain and suffering of terminally ill patients violates two main ethical principles of care. Firstly, the ethical principle of beneficence, whereby failing to relieve a person's pain does not constitute helping the dying patient, and secondly, the ethical principle of non-maleficence, where through the non-treatment of pain, actual harm can be caused to the patient as well as to the loved ones that care for them.

As these patients are, by definition, dying, the principle role to be played here is to reduce any pain and suffering and offer the patient the concept of a ‘good death’. This does, at times, cause conflict between ‘the ethical’ and ‘the legal’, where the fear of litigation forever looms in the shadows should a course of action they choose to undertake shorten the life of the patient. This is a common concern in palliative medicine where research has shown that between 65% and 70% of dying patients experience substantial pain and so need more analgesia, which can ultimately shorten their life (Colvin, 2006).