Assignment task:
Ethics case:
Drug Seeking or Pain Crisis? Responsible Prescribing of Opioids in the Emergency Department
Dr. Jones is an emergency room physician in Baltimore. Late one afternoon, he sees a young woman named Marie who has come to the ER because of extreme abdominal and knee pain over the past 12 hours. Marie says that she is in great distress and rates her pain at a 10 out of 10. She says that the pain resembles that of her previous sickle cell crises and that only Dilaudid helped. She points to her abdomen and both of her knees as the sites of pain and refuses to allow Dr. Jones to touch them. Dr. Jones observes no overt swelling or redness.
Looking at her chart, Dr. Jones sees a long list of emergency department visits and admissions over the past 2 years. Marie, 25, has a diagnosis of sickle cell disease. On most ER visits, the peripheral blood smear reports were inconclusive for vaso-occlusive crisis.
Notes from her hematologist comment that she is habitually noncompliant and that they have considered consulting psychiatry to help address her persistent chronic pain.
As he is leafing through the file, Dr. Jones is interrupted by his colleague, Dr. Kapoor, who recognizes the patient's name and quips, "Good luck with her-she's a pro at getting drugs."
When Dr. Jones reenters the room, Marie is tearfully pleading for pain relief.
Video:
Crisis: Experiences of People with Sickle Cell Disease Seeking Health Care for Pain
Questions:
1. Briefly discuss some ethical dilemmas each health-care professional (i.e., ER physician (Dr. Jones), nurse, pharmacist, social worker, etc.) may face as they treat Marie?
2. Did the video change your views, beliefs, or perceptions about treatment of pain in patients with Sickle Cell Disease? Explain your answer.
3. It has been suggested that "high levels of uncontrolled pain were felt to be a public health problem, with significant physiological, psychological, and financial adverse consequences to the patient and society".
a. Discuss why this is a public health problem.
b. What are the adverse consequences and ethical issues to the patient?
c. What are the adverse consequences and ethical issues to society?