Top Ten Tips Palliative Care Clinicians Should Know About Their Work's Intersection with Clinical Ethics.

Palliative care (PC) subspecialists and clinical ethics consultants often engage in parallel work, as both function primarily as interprofessional consultancy services called upon in complex clinical scenarios and challenging circumstances. Both practices utilize active listening, goals-based communication, conflict mediation or mitigation, and values explorations as care modalities. In this set of tips created by an interprofessional team of ethicists, intensivists, a surgeon, an attorney, and pediatric and adult PC nurses and physicians, we aim to describe some paradigmatic clinical challenges for which partnership may improve collaborative, comprehensive care.

Defining chronic pain ethics.

OBJECTIVE: To identify current issues in the diagnosis and treatment of chronic pain. DESIGN: Focus groups were convened to discuss the current issues in chronic pain care. Commentary was analyzed across focus groups using an interpretivist method of qualitative data analysis. Setting. Focus groups were held in five major US cities throughout the United States. PARTICIPANTS: Key stakeholders working and thinking about the issues surrounding chronic pain, including people with pain, providers, insurance and pharmaceutical industry representatives, law enforcement agents, and advocacy groups. OUTCOME MEASURES: Qualitative data was analyzed to determine if consensus regarding the current issues in the diagnosis and treatment of chronic pain exist. RESULTS: Six major themes emerged regarding chronic pain, all of which contained an ethical component: 1) reducing disparities in access to pain care among the young, elderly, and lower socioeconomic groups, 2) defining quality of care in pain management, 3) the need to train qualified providers and training programs in pain medicine, 4) the need for evidence-based public policy regarding opioid use and diversion, 5) the need to raise awareness about chronic pain as a disease to prevent stigmatization and discrimination, and 6) promotion of multimodal therapies for pain care as a way of diverting attention from opioid abuse problem. CONCLUSIONS: There is nationwide consensus among those holding a stake in the diagnosis and treatment of chronic pain regarding the ethical issues that must be addressed. Raising awareness about chronic pain, improving access and outcomes to quality pain care, and resolving public policy debates about the use of opioids in chronic pain populations are the first steps to ensuring a morally justifiable approach to chronic pain management in the 21st century.

"Show me" bioethics and politics.

Missouri, the "Show Me State," has become the epicenter of several important national public policy debates, including abortion rights, the right to choose and refuse medical treatment, and, most recently, early stem cell research. In this environment, the Center for Practical Bioethics (formerly, Midwest Bioethics Center) emerged and grew. The Center's role in these "cultural wars" is not to advocate for a particular position but to provide well researched and objective information, perspective, and advocacy for the ethical justification of policy positions; and to serve as a neutral convener and provider of a public forum for discussion. In this article, the Center's work on early stem cell research is a case study through which to argue that not only the Center, but also the field of bioethics has a critical role in the politics of public health policy.