Ethical Considerations Concerning The Pain Therapy In Oncology Patients

The pain of the oncological patient, described by Cicely Saunders as a "total pain," especially in the terminal stage of the disease, is aggravated/exacerbated/heightened by the co-existence of other symptoms, psychological problems, relational and social aspects and spiritual worries/concerns.The approach to non-physical components of pain is likely to lead to therapeutic success, whereas untreated pain in the aspect of all its components -physical and non-physical - renders it refractory and overwhelming.The ethical principles underlying the care of the patient in a terminal stage are focused on ensuring the best quality of life and respect for the dignity of the human being until the last moment.The principle of double effect is a reference in addressing the problems faced by the patient treated with palliative care and in the control of pain and suffering especially. This principle admits and accepts that, following an action deemed necessary and desirable, undesirable side-effects may occur.A proposed solution for refractory pain from terminal oncological diseases is palliative sedation by administering non-opioid drugs together with opioid analgesics in doses necessary to dim or abolish the state of consciousness. When palliative sedation is done correctly, it exceptionally determines the shortening of life, and on the other hand it gives the patient the chance to find resources to deal effectively with the illness they suffer from. In conclusion, the therapeutic approach to terminal oncology pain should be holistic, taking into account both physical and non-physical aspects. The physician consulting the patient and the family in a climate of respect and trust, as well as compliance with ethical principles governing palliative medicine are essential in this therapeutic approach, which must be customized for each palliative caregiver.