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Chapter 7: Pain Management: When Barriers Exist

Terry Altilio and Russell K. Portenoy affirm that effective palliation is itself an ethical responsibility in end-of-life care. Mostly, that responsibility is discharged in ways that cause little conflict. However, as their case illustrates, this does not always occur. The case of Ms. H demonstrates how a variety of factors—surrogacy, cultural issues and mistrust, family conflict, pain management, communication, and differing goals of treatment—can conspire to create profound ethical dilemmas. Altilio and Portenoy also raise other sensitive issues. How can clinicians navigate between ethical mandates to be culturally sensitive and to provide effective pain relief when there is conflict?

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