Front Cover

Developments in Neuroethics and Bioethics

SERIAL EDITOR

Pain Neuroethics and Bioethics

Copyright

Contents

CONTRIBUTORS

EDITORS’ BIOGRAPHY

FOREWORD

ACKNOWLEDGEMENTS

REFERENCES

One - Introduction to Pain Neuroethics and Bioethics

ACKNOWLEDGEMENTS AND CONFLICTS OF INTEREST

REFERENCES

Two - Is There a Duty to Relieve Pain?

1. INTRODUCTION

1.1 Necessity

1.2 Expediency

2. WHAT DO WE OWE PATIENTS WITH CHRONIC PAIN?

2.1 A Diagnosis, a Cure

2.2 Pain Relief: No Pain, less Pain?

2.3 Pain Management: What Tools, What Goals?

2.4 Improved Function: What Kind, What Goals?

2.5 Improved Quality of Life: As Defined by Whom, and According to What Standard?

2.6 Pain as Innocent Suffering

2.7 Opioids as Pain-Specific Relief

3. CONCLUSION: WHAT WE OWE TO PATIENTS WITH CHRONIC PAIN

ACKNOWLEDGEMENTS

REFERENCES

Three - Ethical Considerations in Paediatric Pain Research and Clinical Practice

1. INTRODUCTION

1.1 Clinical Case Example

1.2 Research Case Example

2. CONTEMPORARY ETHICAL ISSUES

2.1 Beneficence and Nonmaleficence

2.1.1 Issues in Practice

2.1.2 Issues in Research

2.2 Consent

2.2.1 Issues in Practice

2.2.2 Issues in Research

2.3 Protection of Vulnerable Persons

2.3.1 Issues in Practice

2.3.2 Issues in Research

3. ETHICAL ISSUES REQUIRING FURTHER CONSIDERATION

3.1 Pain in Nonverbal Children

3.2 Personality and Pain Outcomes

3.3 Experimental Pain Procedures

3.4 Late- and Long-Term Effects of Pain Management

3.5 The Role of E-Health and Social Media in Paediatric Pain Research

3.6 Pain Management in Children Around the World

4. MANAGEMENT OF ETHICAL DILEMMAS

5. CASES REVISITED

5.1 Clinical Case Example

5.2 Research Case Example

6. CONCLUSION

ACKNOWLEDGEMENT OF FUNDING

REFERENCES

Four - Status and Surveillance in the Use of Brain-Based Pain Imaging in the Law

1. INTRODUCTION

2. WHY PAIN? PAIN AS A PROBLEM AND PARADIGM IN LAW

3. MONITORING IS A MATTER OF CONTROL, NOT RISK

3.1 Law Is Form and Belief Is Content

4. FEAR, NOT RISK, THE DRIVER OF MONITORING AND SURVEILLANCE IN LAW

4.1 Surveillance

4.2 Evidence

4.3 Technology Use

5. BRAIN IMAGING OF PAIN IN LEGAL AND ETHICAL CONTEXTS

5.1 A History of Suspicion and Surveillance, a Likelihood of Abuse in Measuring Pain

5.2 Brain Scans to the Rescue?

5.3 Legal and Ethical Issues in Non-legal Uses of Brain-Based Pain Assessment

5.3.1 Brain-Based Pain Detection in Medical Practice

5.3.2 Brain-Based Pain Detection and Drug Enforcement Law

5.3.3 Brain-Based Pain Detection in Insurance and Employment

5.4 Ethical Issues in Medical, Legal, and Employment Uses of Pain Detection or Measurement Technologies

5.4.1 Marginalization of Subjective Experience

5.4.2 Implicit and Explicit Use Requirements

5.4.3 Resource Allocation

5.4.4 Neurological Privacy and Data Security

6. CONCLUSION

ACKNOWLEDGEMENTS

REFERENCES

Five - Pain, Stigma, & Neuroimaging: History, Ethics & Policy

1. INTRODUCTION

2. IMAGING, OBJECTIVITY, & TRUTH IN THE WEST

2.1 Historical Concepts of Representation and Objectivity in Science

2.2 Mechanical Objectivity

2.3 Mechanical Objectivity, the Anatamo-Clinical Method, and the Brain

3. OBJECTIVITY, NEUROIMAGING, & TRUTH

3.1 Lombrosian Criminology & Neuro-Anatomy

3.2 Pain & “the Neuromolecular Gaze”

3.3 The Brain, Personhood, & Pain Stigma

3.3.1 Stigma, Pain and Health

4. CONCLUSION

REFERENCES

Six - Towards a Socially-Just Neuroethics of Inequalities in Pain Treatment

1. INTRODUCTION

2. PAIN AND THE PROBLEM OF TRUST

3. PAIN AND BIOLOGICAL CITIZENSHIP

4. TOWARDS A SOCIALLY-JUST NEUROETHICS OF PAIN

Glossary

4.1 Tackling Neurorealism

4.2 The Neurofication of the Subject

4.3 Conceptualizing Difference

5. FINAL THOUGHTS

ACKNOWLEDGEMENTS

REFERENCES

Seven - Ethics at the Intersection of Chronic Pain and Substance Use

1. INTRODUCTION

2. TWO CONTEMPORARY PUBLIC HEALTH PROBLEMS

3. CLINICAL CONSIDERATIONS

3.1 Opioids and Opioid Use Disorder

3.2 Cannabis

3.3 The Need for an Integrative Approach

4. CHRONIC PAIN AND SUBSTANCE USE: ETHICAL INTERSECTIONS

4.1 The Making of an Epidemic

4.1.1 Persuasion by Moral Argumentation

4.1.2 Pain Patient Advocacy Organizations

4.1.3 Assumptions About Legitimate and Illegitimate Pain, Brain Diseases, and Pseudoaddiction

4.2 Stigma, Distrust, and Epistemic Injustice

4.3 Clinical and Health Policy Tools to Minimize Opioid-Related Harms

4.3.1 Opioid Treatment Agreements

4.3.2 Prescription Drug Monitoring Programs

5. CONCLUSION

ACKNOWLEDGEMENTS

REFERENCES

Eight - End-of-Life Care, Pain, and the Problem of Intolerable Suffering

1. INTRODUCTION

2. PAIN, SUFFERING, AND PAIN-RELATED SUFFERING AT THE END OF LIFE

2.1 Pain

2.2 Suffering

2.3 Pain and Suffering at the End of Life

2.3.1 Suffering and Medical Assistance in Dying

2.4 The Problem of Intolerable or Unbearable Suffering

2.4.1 Definition of Intolerable Suffering

2.4.2 Recognizing Intolerable Suffering

2.4.3 Responding to Intolerable Suffering

3. ILLNESS AND THE ENIGMA OF HEALTH

3.1 Gadamer's Definition of Illness

3.2 The Role of the Physician

3.3 Therapeutic Dialogue and the Problem of Intolerable Suffering

4. CONCLUSION

ACKNOWLEDGEMENTS

REFERENCES

FURTHER READING

Nine - Global Chronic Pain: Public and Population Health Responses

1. INTRODUCTION

2. THE GLOBAL BURDEN OF CHRONIC PAIN

2.1 Prevalence of Chronic Pain

2.2 Global Under-treatment of Chronic Pain

2.3 Cultural Barriers to Pain Control

2.4 Socio-Relational Impact of Undertreated Pain

2.5 Economic Impact of Unmanaged Pain

3. INTERSECTING CONTEXTS OF UNMANAGED PAIN

3.1 Recommendations for National and International Responses

4. CONCLUSION

ACKNOWLEDGEMENTS

REFERENCES

FURTHER READING

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