Ethik-Charta der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS)

Abstract

The German Society for the Study of Pain has formed an interdisciplinary committee to answer urgent ethical questions on the diagnosis and treatment of pain and to give an ethical orientation on the care of pain and palliative patients. The treatment of pain is a fundamental objective of medicine. Competent and adequate relief of pain in all stages of life is a basic characteristic of a humane medicine oriented to the quality and meaning of life for people. However, there are substantial deficits in all areas, especially in the knowledge of physicians and patients, in training and further education, diagnosis and therapy. Freedom from pain is a substantial element of quality of life. A central duty of all physicians is an adequate diagnosis and treatment of acute pain and thereby the prophylaxis of chronic pain. If pain persists over a longer period of time, it loses the warning function and becomes taken for granted. Alterations, disabilities and limitations of the physical, psychic and social levels are the consequences. For these patients an interdisciplinary approach is necessary by which various medical disciplines, psychologists and physiotherapists are involved and all collaborate on the diagnosis and therapy of pain. All patients have the right to sufficient and individually tailored treatment of pain. Special attention must be paid to vulnerable patient groups, such as newborns, children and adolescents, as well as aged and mentally retarded patients. For cancer patients pain relief of their tumor pain is totally in the forefront. Indications of "unbearable pain" must not lead to resignation or even be seen as an argument for legalization of "death on request". The nursing of terminally ill patients necessitates a special measure not only of clinical, but also ethical competence, communication and multiprofessional collaboration. The modern options for palliative care are real alternatives to demands for legalization of "death on request". Physician-assisted suicide does not belong to the scope of functions of palliative medicine. The basic constitutional law makes an appropriate treatment of pain obligatory. Neglect of pain treatment fulfils the elements of criminal bodily harm. As a consequence, there is a legal right to a comprehensive pain diagnosis and a pain treatment corresponding to the appropriate standard. The state is obliged to provide the legal, social and financial prerequisites for an adequate treatment of pain. Continuous efforts in research are necessary to fill the existing gaps in our knowledge. The transfer between basic research and clinical application of pain therapy must be urgently improved. Of central importance for the German Pain Society are therefore: Improvement of training and further education in pain therapy. Chronic pain must be accepted and coded as an autonomous sickness. Graded structures for care of pain patients must be realized. Interdisciplinary structures of care must be made available to patients with chronic pain. Palliative medical care is a basic right of all...

Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents

“…Pain has a significant negative impact on quality of life, causing physical, mental and social disabilities, and limitations in those affected . The risk of disability increases with the intensity of pain and the number of pain sites .…”

Postoperative pain assessment in special patient groups

“…Im Jahr 2007 wurde von der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS) eine Ethik-Charta erstellt [28]. Es liegt damit ein Dokument vor, das eine ethische Orientierung in Grundsatzfragen und speziellen Herausforderungen im Umgang mit Schmerz bietet.…”

Langzeitanwendung von Opioiden bei nicht tumorbedingten Schmerzen (LONTS)

“…Patienten mit Tumorschmerzen den Zu gang zu einer hinreichenden Opioidthe rapie zu ermöglichen ist seit vielen Jah ren ein politisches Ziel der Weltgesund heitsorganisation ebenso wie der nationa len wissenschaftlichen Gesellschaften, so auch der DGSS. Das wohlbekannte und von niemandem negierte Abhängig keitspotenzial fällt bei Therapieentschei dungen für Tumorpatienten aus ethischen Erwägungen selten ins Gewicht [12].…”