title: The shifting architectonics of pain medicine: toward ethical realignment of scientific, medical and market values for the emerging global community--groundwork for policy.
abstract: Following the Second Industrial Revolution, Western medicine has become an interwoven enterprise of humanitarian and technologic values. In this essay, we posited that rather than being seen as a means toward achieving the ends of providing technically right and morally sound pain care, the resources and goods of pain medicine have been subordinated to a market-based values system that regards these tools as ends unto themselves. We argued that this approach is 1) pragmatically inapt, in that it fails to acknowledge and provide those tools as rightly necessary for the "good" of pain medicine to be enacted; and is therefore 2) morally unsound, in that the good, while recognized, is not afforded, thereby disserving the fiduciary of science/technology, medicine, and economics. We framed these issues within 1) the context(s) and effects of postmodernism and 2) the increasing call for a globally relevant and applicable system of pain care. Toward this latter end, we addressed how policies can be created that accommodate differing social values, and still enable the execution of care in ways that are morally sound, yet economically viable. We posited that such policies need to be finely grained so as to 1) sustain research in pain diagnosis, assessment, treatment, and management; 2) translate research efforts into clinically relevant resources; 3) enable availability and just distribution of both low- and high-tech resources; and 4) prompt fiscal programs that support, allow, and reinforce responsible choice (of such resources) as socioculturally required, valued, and valid.
authors.affiliation: Center for Neurotechnology Studies, Potomac Institute for Policy Studies, Arlington, Virginia 22203, USA. jgiordano@potomacinstitute.org
authors.forename: James
authors.initials: J
authors.lastname: Giordano
authors.forename: Roland
authors.initials: R
authors.lastname: Benedikter
mesh_terms: D003469:Culture; D004992:Ethics, Medical; D014943:Global Health; D006297:Health Services Accessibility; D006801:Humans; D008511:Medicine; D010146:Pain / Q000191:economics* / Q000523:psychology; D059408:Pain Management; D057766:Policy; D033302:Postmodernism; D012111:Residence Characteristics; D012945:Social Values