VIII. Ethical and Legal Issues

This section includes materials related to ethical issues and end of life care in pain management, decision making and suffering.

       City of Hope Publications

  1. Laneader, A., Angelos, P., Ferrell, B. R., Kolker, A., Miner, T., Padilla, G., Swaney, J., Krouse, R., & Casarett, D. (2007). Ethical issues in research to improve the management of malignant bowel obstruction: Challenges and recommendations. Journal of Pain and Symptom Management, 34(Supl 1), S20-S27. 
    DOI: 10.1016/j.jpainsymman.2007.04.007
  2. Ferrell, B. R. (2007). Beyond politics - the patient in painCenter for Practical Bioethics, 3(3), 10-15.
  3. Ferrell, B. R. (2006). Understanding the moral distress of nurses witnessing medically futile care. Oncology Nursing Forum, 33(5), 922-930.  
    DOI: 10.1188/06.ONF.922-930.
  4. Ferrell, B. (2005). Ethical perspectives on pain and suffering. Pain Management Nursing. 6(3), 83-90.
    DOI: 10.1016/j.pmn.2005.06.001. 
  5. Sullivan, M., & Ferrell, B. R. (2005). Ethical challenges in the management of chronic nonmalignant pain: Negotiating through the cloud of doubt. The Journal of Pain, 6(1), 2-9. 
    OI: 10.1016/j.jpain.2004.10.006.


       Recommended Publications

  1. Health Care Ethics: Critical Issues for the 21st Century, 2nd Edition
    - Morrison, E. E. & Furlong, B. (2013).  NM: Jones and
       Bartlett Publishers. ISBN #: 978-1449665357.
  2. The American Nurse. (2011). The practice of ethics, RNs learn and discuss issues.  MD: The American Nurse Association.
  3. Bernhofer, E. (2011). Ethics and pain management in hospitalized patients. Online Journal of Issues in Nursing, 17(1).              DOI: 10.3912/OJIN.Vol17No01EthCol01.
  4. Guide to Code of Ethics for Nurses: Interpretation and Application 
     Fowler, D. M. (2010) MD: American Nursing
       ISBN: 978-1558102583.      
  5. Clinical Ethics: A practical Approach to Ethical Decisions in Clinical Medicine, 7th Edition
     Jonsen, A., Siegler, M. & Winslade, W. (2010).  NY:
      McGraw-Hill.  ISBN: 13: 978-0071634144.
  6. Ethical Issues in Chronic Pain Management
    - Schatman, M. E. (2007). NY: Informa Healthcare.
       ISBN #: 0849392683.

  7. Moral Dilemmas in Community Health Care: Cases and Commentaries 
    - White, B. & Zimbelman, J. (2005).  NY: Pearson
       Longman.  ISBN: 0321133552.
  8. Code of Ethics for Nurses with Interpretive Statements
    - American Nurses Association. (2001). 
       ISBN-13: 978-1558101760.
  9. Palliative Care Ethics: A Companion for All Specialties, 2nd Edition
    Randall, F., & Downie, R. S. (1999).  UK: Oxford
       University Press.  ISBN: 0192630687.   

  10. Suffering 
    - Ferrell, B. R. (1996).  NM: Jones and Bartlett
       Publishers. ISBN #: 086720723.

       Educational Materials/Curriculum

  1. In the Face of Pain
    - Ethics and Pain Fact Sheet 

       Guidelines/Clinical Pathways

  1. Achieving Balance in State Pain Policy: A Guide to Evaluation – Pain & Policy Studies Group, University of WI  
    Achieving Balance in State & Federal Pain Policy: A Guide to Evaluation – Pain & Policy Studies Group, University of WI
  2. Achieving Balance in National Opioids Control Policy: Guidelines for Assessment - World Health Organization
     This 42 page document provides guidelines that can
       be used by governments and health professionals to
       assess the national opioids control policies and their
       administration of any country to determine if they
        contain the provisions, procedures and cooperation
       that are necessary to ensure the availability of
       opioid analgesics
      Available in 22 languages.

  3. Addressing State Policy Issues in End of Life Care - Robert Wood Johnson Foundation
    - Downloadable publications that advance balanced
       approaches to pain management policy, consumer
       protection and    professional development.
  4. Guide to Legal Issues in Life-Limiting Conditions - American Health Lawyers Association, Washington, DC
  5. Model Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain - Federation of  State Medical Boards of the United States, TX

      Other Organizational Links

         American Society for Bioethics and Humanities  

         American Society of Law, Medicine and Ethics (ASLME)

         American Society of Pain Management Nurses 

         American Society on Aging: Legal and Ethical Issues  
         BWH Office of Clinical Ethics   

         Caring Community ~ Wellness Through Life's End

         Center for Bioethics  
         Center for Ethics in Health Care       
         Center for Practical Bioethics  
         Clinical Ethics in Action  
         Code of Ethics for Nurses  

         Emerging Solutions in Pain  

         Ethical and Legal Issues: Aging in the Know  
         Pain & Policy Studies Group    
         The Center for Ethics and Human Rights ~ American
        Nurses Association
         The Hastings Center  
         The Legal Side of Pain  

Key References

  1. American Society of Law, Medicine & Ethics
    A community of colleagues across three disciplines
      exploring the major health issues to protect public
       health; reduce racial, ethnic, and economic health
       disparities; promote patient safely and quality of
       care; and facilitate dialogue on emerging 
         biomedical science and research. 

      Position Statements/Standards 

       (see Position Statements/Standards in 
       Palliative Care)

  1. Ethics and Human Rights – American Nurses Association        
  2. Promoting Pain Relief and Preventing Abuse of Pain Medications: A Critical Balancing Act  
    - Joint statement from 21 health organizations and
       the Drug Enforcement Administration.  The roles of
       both health professionals and law enforcement
      personnel in maintaining the balances between
    care and diversion prevention are 

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