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Old 04-15-2010
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Medicolegal and Ethics pain in patient of multipla myeloma!!!

A mentally competent 76-year-old man is in the terminal stage of multiple myeloma. He is unable to move and requires 24-hour nursing care. Increasing doses of narcotics are needed to control severe pain. As a result, when he is pain-free, respiratory function is impaired and consciousness is clouded. The patient says he cannot live with this degree of pain and asks to be given a lethal injection of pain medication. Which of the following is the most appropriate step regarding the pain medication?

A) Reduce the dosage so as not to impair respiration
B) Administer the dosage necessary to control pain despite respiratory impairment
C) Administer the dosage necessary to control pain and add a centrally acting stimulant
D) Appeal to the family to convince the patient to tolerate a bit more pain
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Old 04-15-2010
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Another classic one. A terminally ill patient should not suffer in any way. Thus, potent analgesics (i.e. narcotics) should be prescribed at any dose that seems to be controlling pain, despite the potential side effects (i.e. respiratory suppression). There is no use in adding a central stimulant -- this would result in prolongation of the torture without any obvious benefit & our patients' interest is what matters the most in our profession. So, the correct answer is B.
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Old 04-16-2010
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yeah i would go with B too. read this somewhere in kaplan. that if its a terminal disease and the patient is in tremendous pain, then do whatever u can to nullify the pain and let the patient go (pass-on) with ease.
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