Post on 15-Feb-2016
description
Prescribing for pain: Ethical considerations that should guide clinical practice
Associate Professor Mark Boughey, St Vincent’s Melbourne
Approaching a patient & their problem: what guides your practice?
Today’s aim• Demonstrate how you can frame practice and decision making within a
clinical ethical basis• Think about the elements that come into play – make you conscious of
what you may already be doing• Use pain prescribing as an exemplar
Why pain:• Complex medical problem• Complex interplay between peripheral & central NS• Complex interplay between nociceptive, neuropathic and
psychological/existential• Dealing with a variety of distinct pain entities-acute, chronic,
progressive/palliative• Treatment modalities are multiple and come with risk/benefits that vary
depending on what you are treating
Gut feeling
Approaching a patient & their problem: what guides your practice?
Theory
Tools & algorithms
Knowledge
Practice
Action reflection
?
Gut feeling
Theory
Tools & algorithms
Knowledge
Practice
Action reflection
Ethical guidance?
Approaching a patient & their problem: what guides your practice?
What does the patient want?
What is going to help?
What might hinder or harm?
Who gets what?
Autonomy
Beneficence
Non Maleficence
Justice
Patient viewsHistoryExpectationsIssues
My general approach to ethical considerations……
EvidenceGuidance docsConsensus of opinionExperienceKnowledge
Legal/illegalScope of practiceSystem supportsAvailability
What does the patient want?
What is going to help?
What might hinder or harm?
Who gets what?
Autonomy
Beneficence
Non Maleficence
Justice
My approach to ethical considerations when prescribing for pain ……
What does the patient want?
What is going to help?
What might hinder or harm?
Who gets what?
Autonomy
Beneficence
Non Maleficence
Justice
Patient viewsHistoryExpectationsIssues
My approach to ethical considerations when prescribing for pain ……
What does the patient want?
What is going to help?
What might hinder or harm?
Who gets what?
Autonomy
Beneficence
Non Maleficence
Justice
My approach to ethical considerations when prescribing for pain ……
EvidenceGuidance docsConsensus of opinionExperienceKnowledge
What does the patient want?
What is going to help?
What might hinder or harm?
Who gets what?
Autonomy
Beneficence
Non Maleficence
Justice
My approach to ethical considerations when prescribing for pain ……Legal/illegalScope of practiceSystem supportsAvailability
What does it all mean?
Gut feeling
Theory
Tools & algorithms
Knowledge
Practice
Patient wants /needsWhat helpsWhat harmsWho gets what
OpioidsNon opioidsPhysicalPsycho/spiritual
Context
Competence
Creativity
Flexibility
Basic skills
Knowing when to do what
How to cope when things go wrong
New ways to solve new problems
Prescribing for pain: Ethical considerations that should guide clinical practice
Associate Professor Mark Boughey, St Vincent’s Melbourne