Pain Care for a Global Community: Part 1
The recently published Ethical Charter for the German Society for the Study of Pain (DGSS) seeks to establish a practical orientation to pain, and the requirements necessary for the treatment of pain patients worldwide1. The Charter claims that “…competent and adequate relief of pain is a basic characteristic of a humane medicine oriented to the quality and meaning of life for all people. A central duty…is treatment of …chronic pain.” To do so, the Charter maintains that all forms of medicine must be aware and responsive to pain-induced “…alterations, disabilities, and limitations of physical, psychic, and social levels…for these patients.”
If we are to consider the possibility of an internationally relevant pain medicine, we must ask whether and how medicine as a profession and practice can be engaged within a pluralistic world culture. Incontrovertibly, socio-cultural norms, values and mores play vital roles in the construct of pain, its expression, meaning, and the life worlds of patients, clinicians and, by extension, the practicalities of pain medicine.2 Therefore, in this essay, we pose that if pain medicine is to be internationalized, it must be grounded to a conceptual and moral base that both affords clarity of its goals and ends, and provides sufficient latitude to appreciate socio-cultural variability in the values and contexts of both patients and clinicians.
We argue that the physician-patient relationship is the point at which the philosophical dimensions of medicine are brought together to achieve the practical purpose of treating and healing pain.3 These dimensions (of knowledge, humanitarian application, and moral concern) must be focused on the primacy of the patient’s best interest, but this requires an understanding of 1) pain, 2) its effects upon the patient as a person, and 3) the moral responsibilities that are specific to medicine.4 We claim that for an internationally relevant pain medicine to be possible, it will be necessary to secure pain medicine to an essential philosophy and to apply this philosophy (and ethics) within the realities of clinical practice.