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LETTER TO THE EDITOR

Fitness of Patients in Pain to Make Optimal Decisions

Department of Anesthesiology; Kingdom Hospital; Saudi Arabia, Riyadh; Zafer{at}cyberia.net.lb

To the Editor:

The effect of pain, untreated or inadequately managed, on psychology and attention of patients was recently stressed by Brennan et al.1 and Dick and Rashiq.2 The testimonies mentioned in the editorial of Johnson,3 show the social, physical, and psychological suffering of patients in pain. This, in addition to the increased risk for poorer mental health4 in those patients, allows us to question the fitness of patients in pain for making vital decisions for themselves, including consenting advance directives, and for others, during performance of their daily duties. In our opinion, patients in pain may not be as fit as healthy people for making optimal decisions. This issue needs to be discussed and clarified by law and health professionals, in the same manner as was done with the issue of recognizing pain management as a fundamental right of patients.1

REFERENCES

1. Brennan F, Carr D, Cousins M. Pain management: a fundamental human right. Anesth Analg 2007;105:205–21[Abstract/Free Full Text]
2. Dick BD, Rashiq S. Disruption of attention and working traces in individuals with chronic pain. Anesth Analg 2007;104:1223–9[Abstract/Free Full Text]
3. Johnson S. Legal and ethical perspectives on pain management. Anesth Analg 2007;105:5–7[Free Full Text]
4. Shifren K, Park DC, Bennett JM, Morrell RW. Do cognitive processes predict mental health in individuals with rheumatoid arthritis? J Behav Med 1999;22:529–47[Web of Science][Medline]

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