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Pain and Symptom Management at the End of Life 

Pain and Symptom Management at the End of Life
Chapter:
Pain and Symptom Management at the End of Life
Author(s):

Robert C. Macauley

DOI:
10.1093/med/9780199313945.003.0007
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date: 10 April 2020

The pendulum of pain treatment has swung from stoic acceptance before the widespread availability of opioids, to embrace of opioids as pain became the “fifth vital sign,” to significant concern in light of the current opioid epidemic. The use of opioids for chronic pain should be differentiated from their use in palliative care, where there still exists significant concern for hastened death when high doses are used (i.e., opiophobia). While clinicians should be familiar with the Rule of Double Effect to justify such use, the rule is not truly needed because of the rarity of respiratory depression when opioids are used appropriately. Appropriate pain treatment is a human right, and as such surrogates should not be able to refuse it based on their own views, and global inequities prompt significant justice concerns.

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