Dr Paulina Taboada
Profesor Centro de Bioetica
Pontificia Universidad Catolica de Chile
Alameda 340 Correo Central 1
The Journal of Clinical Ethics, 2001; 12, (3) is devoted to a special issue: Neonatal Ethics. Among the many interesting articles contained in the volume, there is one by Franck & Lefrack devoted to “The Ethical Treatment of Infant’s Pain" (pages 275-281).
Among the historical reasons why neonatal pain management has been neglected for decades, the authors mention facts like the special difficulties for an accurate pain evaluation in newborns; particular attitudinal barriers both on the side of care givers and parents; the conception of infants as not yet “full” human persons; etc.
Two clinical cases are presented to illustrate the influence of ethical considerations on the clinical treatment of pain in infants. One is a case of pain release for circumcision and the other post-operative pain management after major cardiac surgery. The authors show how inadequate decisions about pain-management frequently rest on attitudinal, ethical and/or moral barriers that scientific evidence alone cannot change.
Referring to the ‘Ethical Obligations’ pointed out in the ‘Core Curriculum for Professional Education in Pain’ by the International Association for the Study of Pain (IASP Press, Seattle, 1995), the authors discuss some ethical principles that are central to pain management, such as non-malfeasance, beneficence, autonomy, justice, fidelity and veracity. Hence, the beneficial effects of pain-release (principle of beneficence) have to be weighed against the harms of unrelieved neonatal pain as well as against the potential harms of the treatment (principle of non-malfeasance). The principle of justice demands that newborns get the same right to pain-management as adults.
In my opinion, the main contribution of the article is that it shows in an concrete way that in order “to promote a greater cohesion between the practice of pain management and ethics of neonatal care, we need to understand and appreciate the ethical principles that underpin the clinical management of neonatal pain” (p. 276). I see no reasons why this reflection would not apply to other fields of medical care especially to Palliative Care.
Dr. Paulina Taboada, MD, PhD
Palliative Care and Bioethics