The Moral Experience of the Patient with Chronic Pain: Bridging the Gap Between First and Third Person Ethics

TY - JOUR

T1 - The Moral Experience of the Patient with Chronic Pain

T2 - Bridging the Gap Between First and Third Person Ethics

AU - Edwards, Ian

AU - Jones, Mark

AU - Thacker, Michael

AU - Swisher, Laura Lee

PY - 2014/3

Y1 - 2014/3

N2 - Background There has been a widespread call for an ethics in the management of patients with chronic pain which is patient centered and takes into account the lived experience of the patient. It has been argued in literature that current duty or principlist-based models of ethics (so-called 3rd person ethics) have not adequately addressed the needs of either patients or practitioners in this area. Method Two strands of literature within phenomenology were reviewed: the literature of interpretative phenomenological analysis and the study of the lived experience of the person with chronic pain; and the contribution of phenomenology in neo-Aristotelian virtue ethics (1st person ethics). Findings Patients experience chronic pain in existential and moral terms in addition to their biomedical issues, facing dilemmas in understanding their own self-identity and in attempting to recover a sense of moral worth and agency. Discussion We outline a patient-centered ethics to underpin contemporary collaborative, multimodal approaches in the management of chronic pain. We firstly describe an agency-oriented, neo-Aristotelian 1st person ethics and then outline a hermeneutic relationship with extant duty-based, 3rd person bioethics. The utility of the ethics model we propose (the ethical reasoning bridge) lies in its capacity for developing a sense of moral agency for both practitioner and patient, resonating with the current emphasis of seeking active engagement of patients in management.

AB - Background There has been a widespread call for an ethics in the management of patients with chronic pain which is patient centered and takes into account the lived experience of the patient. It has been argued in literature that current duty or principlist-based models of ethics (so-called 3rd person ethics) have not adequately addressed the needs of either patients or practitioners in this area. Method Two strands of literature within phenomenology were reviewed: the literature of interpretative phenomenological analysis and the study of the lived experience of the person with chronic pain; and the contribution of phenomenology in neo-Aristotelian virtue ethics (1st person ethics). Findings Patients experience chronic pain in existential and moral terms in addition to their biomedical issues, facing dilemmas in understanding their own self-identity and in attempting to recover a sense of moral worth and agency. Discussion We outline a patient-centered ethics to underpin contemporary collaborative, multimodal approaches in the management of chronic pain. We firstly describe an agency-oriented, neo-Aristotelian 1st person ethics and then outline a hermeneutic relationship with extant duty-based, 3rd person bioethics. The utility of the ethics model we propose (the ethical reasoning bridge) lies in its capacity for developing a sense of moral agency for both practitioner and patient, resonating with the current emphasis of seeking active engagement of patients in management.

KW - Chronic Pain

KW - Phenomenology

KW - 1st Person-3rd Person Ethics

KW - Ethical Decision Making

KW - Moral Agency

KW - INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS

KW - LOW-BACK-PAIN

KW - DISTORTED BODY-IMAGE

KW - MUSCULOSKELETAL PAIN

KW - PHYSICAL-THERAPY

KW - MEDICINE

KW - MANAGEMENT

KW - STIGMATIZATION

KW - DISPARITIES

KW - DIRECTIONS

U2 - 10.1111/pme.12306

DO - 10.1111/pme.12306

M3 - Literature review

SN - 1526-2375

VL - 15

SP - 364

EP - 378

JO - Pain Medicine

JF - Pain Medicine

IS - 3

ER -