Ethics and Religion Discussion: The Ethics of Pain Management

Linda Knieriemen, senior pastor of First Presbyterian Church in Holland, responds:

“There are no restrictions in the use of painkillers in the Presbyterian Church (USA). In fact, I and most of my clergy colleagues will tell you that the creative force of God lies in the development of pharmaceutical products.

Fred Stella, the Pracharak (minister of outreach) of the West Michigan Hindu Temple, responds:

“There is none. Some yogis who have practiced deep spiritual exercises are able to endure everything from physical discomfort to extreme temperatures. But for most Hindus, there is a consensus that if the pain can be removed, we should allow that to happen.

“Once I was the spiritual guide of a dying woman. She refused painkillers due to her misunderstanding of Hindu teachings. This decision made her quite a cantankerous person who didn’t look like the sweet person she was. Fortunately, she was persuaded to give up her absurd beliefs and receive much-needed medicine. The brief rest of his life and the lives of his carers were immeasurably improved.

Reverend Colleen Squires, pastor at All Souls Community Church of West Michigan, a Unitarian Universalist congregation, responds:

“Unitarian Universalists place no restrictions on pain management. We believe that all medical decisions are best made by the patient in consultation with their healthcare provider.

Reverend Sandra Nikkel, senior pastor of the Conklin Reformed Church, responds:

“No! And although we believe that God can heal supernaturally and without the use of drugs, we also believe that God has dispersed great talents and ideas to doctors to heal and restore our health. Therefore, this does not It is not for lack of faith that many Christians use drugs. It is because we believe that God rules over all creation and all creatures. God has dispersed his gifts and talents and given great ideas to those who serve him in the medical field. He did this to help us live a blessed and fruitful life. Therefore, we take the medicines prescribed for us by the doctors, thanking God for their knowledge and devotion to their profession. We do this without fear, putting our trust not so much in medicines and their healing power, but in the God who heals and restores in different ways.” For God has not given us a spirit of fear and timidity, but of power, love and self-discipline.” (2 Timothy 1:7)”

Father Kevin Niehoff, OP, a Dominican priest who serves as Judicial Vicar, Diocese of Grand Rapids, responds:

“In 1995, the National Conference of Catholic Bishops, now the United States Conference of Catholic Bishops, addressed this issue in a document entitled Ethical and Religious Guidelines for Catholic Health Services. The bishops wrote then, and it is still the practice today:

“Patients should be kept as free from pain as possible so they can die comfortably and with dignity and where they wish to die. Since a person has the right to prepare for their death by being fully conscious, they should not be deprived of consciousness without a compelling reason. Drugs capable of alleviating or suppressing pain can be given to a dying person, although this therapy may indirectly shorten the person’s life as long as the intention is not to hasten death. Patients who experience suffering that cannot be relieved should be helped to appreciate the Christian understanding of redemptive suffering (n. 61).

My answer:

The only restriction on the use of analgesics is the potential “double effect” of the analgesic which hastens death, for example by decreasing respiration. Generally, if the intent of the drug is to relieve pain and the risk of hastening death is less than 50%, then there are no restrictions on its use. However, if the painkiller is more likely than not to hasten death (more than a 50% chance), its use would be limited. And especially since if the painkiller is used to intentionally hasten death, this would not be permitted in Jewish ethics.

The issue of pain management occupies an important place in the planning of end-of-life care. In the later stages of life, there is often a trade-off between mindful alertness and complete pain relief. My tradition and most others also believe that a person has the autonomy to choose the amount of pain they are willing to accept. Some people will choose not to tolerate any pain; others will choose to tolerate some pain in exchange for the ability to be mentally present and aware as death approaches. Palliative care physicians and palliative care nurses are comfortable having this discussion with their patients ahead of time so that when the time of death approaches, they and their families know what their options are.

This column answers questions of ethics and religion by putting them to a multi-faith panel of spiritual leaders from the Grand Rapids area. We would love to hear about common ethical questions that arise in your day as well as religious questions you have. Tell us how you solved an ethical dilemma and see how members of the Ethics and Religion Talk panel would have handled the same situation. Please send your questions to [email protected].