Insight and Responsibility
Rollin M. Gallagher
Abstract
Abstract Millennia-old philosophical considerations of morality and values in the practice of medicine have led to the development of the field of bioethics encompassing the domains of clinical care, education and training, clinical and basic research, health administration, and public policy. As “keyholders” to solutions to the universal human problem of pain, the pain field must not only provide good care to patients but also steward needed progress in education, science, and health system policy that will improve pain care across populations. This challenge requires both insight and responsibility. Practitioners must understand human nature—humans’ vulnerabilities and strengths—and how these attributes interact with management of the complexity of pain throughout the continuum of care. Core ethical principles (beneficence, nonmaleficence, respect for autonomy, justice, and double effect) help guide daily clinical work, but practice conditions dictated by a commercialized health care system challenge these principles. Data science algorithms based on medical variables help standardize care in clinical practice guidelines, but they must include psychosocial variables to remediate care disparities in providing effective biopsychosocial stepped care. Sociocultural factors, such as mental illness, racism, and poverty, interact with institutionalized barriers such as inadequate training, interspecialty economic disparities, and specialty tribalism to perpetuate poor care. Stewardship teamwork, involving all sectors of the health system and policymakers, is needed to improve pain care for vulnerable populations.