PAIN MANAGEMENT
BIOETHICAL CONSIDERATIONS AND EXPECTATIONS
IN ANIMAL PAIN MANAGEMENT
continued from page 1
management ahead of surgery or other
procedure, sedation prior to potentially
painful manipulation, and preventing FAS
are all ways we express beneficence.
The four cornerstones of clinical
bioethics are:
– – Respect for the patient’s autonomy
Justice
– – Nonmaleficence
– – Beneficence
– – Justice
Let us consider each of these in turn as
they apply to painful animal patients.
Respect for Autonomy
Our patients can and do express
preferences, and one of our obligations
as veterinarians is to pay attention
to those preferences. While animals
cannot and do not anticipate or fear their
own death, they certainly can and do
anticipate and fear pain. Understanding
and acknowledging their moral standing
creates an imperative to respect their
autonomy by presuming that one
preference of theirs is to avoid pain and
to have it relieved when it occurs. This
obligates us to take preventing and
relieving animal pain seriously, and to
pursue solutions urgently. drugs, and any appropriate physical
medicine techniques. It also means
not manipulating a painful patient in
order to perform a procedure (e.g.
positioning a dog for radiographs)
without first relieving their pain. Finally,
nonmaleficence applies as we recognize
the intimate relationship between pain
and fear, anxiety, and stress (FAS).
We must view what we do through
the animal patient’s eyes in order to
appreciate how best to avoid harm and
provide best care.
Nonmaleficence Beneficence
Nonmaleficence translates to “do no
harm” or “avoid harm”. For veterinarians,
that means recognizing pain as a
serious harm, and preventing pain
whenever we can by leveraging all the
tools at our disposal including local
anesthesia, gentle surgical and tissue
handling techniques, opioids and other Beneficence means actively pursuing
what is in the best interest of our animal
patients. For painful patients, this
means doing our best actively to prevent
subjecting an animal to any additional
pain, and to relieve existing pain as
aggressively and promptly as possible
when we encounter it. Pre-emptive pain
Justice in the human bioethical world
is typically applied when discussing
allocation of finite healthcare resources
(e.g. solid organ transplantation). In
veterinary medicine, the bioethical
principle of justice is best appreciated
to mean “fairness”. In the context of the
painful animal patient, bioethical fairness
means bringing our best to each and
every case, regardless of our impressions
about what a particular pet owner or
animal producer might want for that
animal. Our focus must remain on the
animal and its immediate need to either
have pain prevented or relieved.
In all of veterinary medicine, but
particularly in the arena of pain
prevention and management, our moral
imperative is to advocate on behalf
of beings who cannot advocate for
themselves. The principles of clinical
bioethics provide us with an even richer
language with which to advocate.
Medicine should be practiced as a form
of friendship - - Leon Bernard (French
physician, 1872 – 1934)
Position Statement: Pain Management
in Veterinary Medicine
www.cvo.org/painmanagement
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College Connection Winter 2019 cvo.org