Perspectives on Drug Addiction in Islamic History and Theology, Research Paper Example

Introduction

As a healthcare provider, it is essential to oversee every aspect of the patient’s well-being including pain management. Pain management is a complex process that involves identifying the appropriate course of treatment to effectively address and achieve a tolerable level of comfort according to the patient’s perception of pain. Though pain management centers towards maximizing the overall health and wellness of the patient; it can pose as an ethical dilemma due to the potential causative factor for inadequate pain relief or relapse in patients recovering from substance abuse. According to Cooper (2016), individuals living with substance abuse problems experience a stigmatism that reflects in the care provided to them. These patients are less likely to receive treatment conforming to an accepted standard of care by experiencing bias from healthcare providers as drug-seeking, affecting pain assessment and disregarding the subjectivity of the perceived pain (Cooper, 2016).

Given the steadily rising population of patients with substance abuse problems seeking pain management, healthcare providers are confronted with an ethical dilemma involving both beneficence and nonmaleficence within the code of ethics. The drive of this paper is to gain an insight into ethical decision making within the concept of providing pain management in patients with substance abuse problems aided by the ethical principles of beneficence and nonmaleficence.

Ethical Issue

Substance or drug abuse is one of the prominent issues that patients present within different hospitals today. Studies in the medical sector indicate an increase in the number of patients that abuse toxic and strong substances like opioids. There are several ways and substances that people use such as alcohol, illicit drugs and prescription medicines that affect the health of those practicing the habit. Findings from Parsons (2015) indicate that patients abusing opioids have higher risks of experiencing pain incidences as well as high hospitalization rates. It means that drug abuse is a significant health influence in the US and world over and has a relationship with pain management. Therefore, substance abuse is one of the most significant social and medical issues that affect the health of people which is tasking for medical personnel to find the best ways of helping them.

The drug also called substance abuse involves the patterned use of illegal drugs which may lead to dependence or addiction and other health and psychological damages. In the provision of healthcare, people with drug addictions tend to give challenges to nurses and medical professionals due to their behavior. Some patients with active dependence require clinical attention such that they are supervised on use or practice abstinence (Center for Substance Abuse Treatment, 2014). However, healthcare providers and the public have a number of misconceptions about the dangers of dealing with addictive persons which affect the care and treatment they receive. That is why many of the addicted patients receive under treatment for pain, which results in a withdrawal or inadequate pain management. Thus, drug abuse always results in an addiction which is surrounded by misconceptions that affect the way medical workers deal with their pain and how they react to therapy.

Dimensions of the Ethical Issue

Handling pain and other health issues related to drug addicts require an assessment to identify suitable pain management methods that are in line with the code of ethics. Following the Substance Abuse and Mental Health Services Administration view, there are six dimensions of drug abuse that aid the wellness of the patient (Uusitalo, Salmela & Nikkinen, 2013). The first three dimensions include acute intoxication/withdrawal potential, biomedical complications and conditions and emotional, cognitive and behavioral complications and conditions (Mee-Lee, 2013). Meanwhile, the other three entails readiness to change, relapse, continuous use or continued potential of the problem, and the recovery environment. These are the six dimensions of substance abuse that contribute significantly to patient wellness during assessment and finding a treatment plan for an addicted person. Some more detail is given below on what these six dimensions in relation to medical ethics and pain management strategies in this generation.

In the first dimension ‘acute intoxication and withdrawal potential’ the medical personnel and the patient explore both past and present experiences concerning the use of substances. They as well explore the withdrawal efforts that the patient has gone through to understand their pain and how to manage it. Essentially, dealing with addicted persons has become a challenge for managing pain because of lack of background information on them. Cheatle, Comer, Wunsch, Skoufalos, and Reddy (2014) mention that this dimension helps to know if the individual presents risks of withdrawal from drugs by history. Meaning, addicts need to be understood entirely before assigning a successful treatment pain.

The dimension of biomedical complications and conditions explore a person’s health history as well as their present physical condition. Assessing the current illness and chronic health conditions like pain creates a basis for finding pain management. Likewise, the emotional, cognitive and behavioral complications and conditions dimension assists in analyzing the patient’s emotions, thoughts and mental health problems (Mee-Lee, 2013). For instance, if a person with an addiction reports with severe pain, the doctor will use these measurements to understand the issue and find out what strategies will work. Therefore, these dimensions help in exploring the patient’s physical as well as psychiatric wellness to help them effectively.

Readiness to change is one of the most critical substance abuse dimensions that looks into a patient’s willingness to reform. It is at this point that most medical personnel struggle with ethical issues in handling unwilling patients. At this point, the ethical dilemma that involves beneficence and nonmaleficence ethics come up because the patient is not willing to cooperate with the available options (Cooper, 2016). Take an illustration of the old woman who would sell medication to buy illicit drugs; the nurses were challenged on how to help her (Lemme et al. 2017). Therefore, it is through this dimension that helps understand how willing and ready the addict is to change.

Finally, there are the dimensions of relapse, continuous use or continued potential of the problem, and the recovery environment. Basically, these measurements help explore an individual’s relationship with the continued use of drugs or relapse and the recovery situation plus the things people or places surrounding them. In philosophy, it is said that the environment in which a patient lives affects their behavior which affects their perception of leaving the drug abuse habits (O’Connor, 2012). Meaning, the ethical issues on administering pain management can be influenced by whether the patient will not continue with drugs or their peers and environment. For that matter, it is upon these dimensions that the healthcare provider makes considerations for assessment and treatment and attain successful pain management.

Ethical Argument

Whereas pain management is an essential part of medicine, several structural barriers limit healthcare providers. One of the structural barriers mentioned are the nursing policies as well as a code of ethics that sometimes limit pain management due to the requirements on patient handling (Cheatle et al. 2014). Indeed, some addictive patients require forceful and unwilful administration of pain management medication and therapy to have the relief required. However, due to the nonmaleficence section that doctors sign in the code of ethics, they encounter an ethical dilemma, for they must not harm the patient in any way (Center for Substance Abuse Treatment, 2014). Meaning, despite the inability to make a decision to take on medication, the professional must conform to the ethical code of conduct, yet it affects efficient pain management.

There is an issue of stigma among patients with substance abuse problems that affect pain management efforts by nurses. Practically, this stigmatic experience reveals in the type of care they receive as the substance abusers kind of distance from most of the options thinking they are labeled as addicts (Cooper, 2016). As Ali (2014) puts it, drug addicts are criminals and sinful in the Islam faith. However, the ethical principle of beneficence outlines the responsibility of enhancing the welfare of patients. It means that the nurse has to do good to the patient, but this is subjective because what the caregiver calls ‘good’ may conflict with the client’s perspective. Therefore, it is suitable that the healthcare giver understands the substance abuse dimensions to avoid stigmatizing the patient and not acting against the ethical principles.

Relapse inpatient recovery due to abuse of substances creates some ethical dilemma in pain management. Clinical practitioners face ethical and legal issues while dealing with the treatment of addicted patients because they have to work in line with the beneficence and nonmaleficence principles (O’Connor, 2012). The truth is that addicts most of the time face relapse while on medication which affects their behavior and action towards the therapy. For instance, a patient admitted can comply with medication, but due to a relapse, he goes back to drugs and forgets about the medication. Cheatle et al. 2014 reveal that pain management in addicts is challenging, since measuring the likelihood of drug-seeking tendencies are uncertain. In summary, the ethical issues of not causing harm and doing good to addicts meet challenges of relapses among patients under a pain management scheme.

The fact that there are biases and misconceptions about the addictive dangers by nurses and healthcare practitioners creates gaps in proper pain management. Studies reveal an increase in the number of patients, especially young adults and adolescents, reporting in hospitals and are into drug abuse. Due to the statistics, it is possible that nurses treat pain in patients that are using illicit substances like opioids (Parsons, 2015). The issue here is that some clinicians end up undertreating their pain due to the misconceptions and biases on the dangers of the drugs (Center for Substance Abuse Treatment, 2014). For instance, a nurse will undertreat pain of a heroin user, because he thinks the pain accrues from taking the substance. In the end, violation of the beneficence principle occurs as the patient’s pain is poorly managed, leading to frequent readmissions and emergency outpatient visits.

Theological/Cultural Dynamics

Theologians postulate that misuse of drugs among the Muslims is referred to as a crime. In other words, use of drugs in the Muslim community is immoral and unacceptable. Firm believers of this belief do not use drugs to meet several interests such as painkilling and recreational use. Most notably, the belief they hold that substance use is unethical helps them receive excellent medical services from healthcare providers. It is remarked that religion as well as spirituality are protective factors against substance use and can unquestionably act as devices against relapse. Ali (2014), stipulates that there exists a significant relationship between spirituality and drug dependence with the latter being a spiritual concern since it affects beliefs as well as values. Therefore, patients who are strongly attached to their religious beliefs would never think of substance use as an option to pain management.

As Lemme et al. 2017 assert that pain management among drug abusers is complicated and comes with diverse issues. A professional health care provider might do their best to meet the needs of their patients but simply because they are substance users they hinder the process. For example, a person seeking treatment for pain management most especially as an outpatient may decide to receive the medicine but fails to take it as prescribed. More to that, others go ahead and sell their prescriptions to get money and buy drugs as they believe that taking them can help solve the pain problem (Lemme et al. 2017). The decision made by the patient brings about an ethical dilemma for the health care provider as they will wonder what exactly they have to do. Given the above, the beliefs held by substance users on pain management hinders the excellent provision of healthcare services.

Several theories have been developed to explain the primary cause of substance use among people from diverse disciplines, for example, sociology, biology, and psychology. Among these models is the disease model and this is remarked to be debatable among scientists (Ali, 2014). The theory asserts that drug use is a biological phenomenon that is genetically passed from one generation to another, for example, from grandparents to grandchildren and parents to children. Advocates of this theory do not believe in other causes of addiction such as group influence. It is revealed that this model also assists to eliminate social stigma as well as blame from drug users and boosts the opinion that addicts are victims in need of help rather than condemnation. For this matter, strong advocates of the disease model are most likely to bring about issues of substance use during the pain management treatment.

According to Rotchford (2017), pain and substance use have the same social, physical, emotional as well as economic effects on the health and well-being of a person.  Most notably, a person with these conditions is likely to report cases of insomnia, impaired functioning, depression, and other health concerns. It should be remarked that effective pain management among patients having a history of substance use ought to address both concerns concurrently. Besides, some medical attention extended to the patient may not react immediately but instead increase or lessen a little on the pain, thus, causing depression and anxiety. As such, a patient with a history of substance use will undeniably think of drugs such as opium to help kill the pain as well as do away with depression and anxiety. Therefore, the delayed results brought about by pain management approaches in the healthcare centers influence substance use among patients.

Alternate Ethical Perspectives

One of the alternative ethical perspectives of the issue discussed in the paper is utilitarianism. The outlook is remarked to have been founded by Jeremy Bentham, and with the help of Mill and other people, it was promoted to be regarded as something good (Venkat, Fromm, Isaacs & Ibarra, 2013). The perspective stipulates that what matters are the results of some action but not rules as most people hold. Something is considered to be right in case it yields good results to the parties involved. For example, if a health care provider asks a drug user not to take drugs during the time they are receiving medical assistance. They are looking at the results that come with the approach but not the rules. They know that when this patient stops taking drugs, the treatment process will be absolutely affected, thus, meeting the diverse needs.

Further, Venkat, Fromm, Isaacs & Ibarra (2013), postulate that the most promising manner to obtain agreement with a patient and physician is to identify the good, and the bad. The right decision to make considering ethics is choosing the approach that is attached to the highest amount of utility. The authors also assert that the utilitarianism perspective holds that an act is good if only the extent of usefulness evident in it is more significant than that from any other possible action. For example, looking at the options, the health care provider has, and deciding which one is more useful. The one that not only helps them to meet their interests but also those of their patients holds greater utility than that that meets the needs of only one party. Therefore, the best alternative ethical perspective on the issue is embracing the utilitarianism outlook.

Nursing Profession/Policy

There are several policies put across to ensure that patients receive effective health care services related to pain management. Principlism is one of the significant policies, and it covers principles of beneficence and nonmaleficence to assist articulate the ethical tensions pain management among patients that use drugs.

Nonmaleficence

The principle asserts that health care providers ought not to inflict harm on patients carelessly or intentionally. All physicians are urged not to cause harm to their patient during pain management process. According to Substance Abuse Treatment (U.S) (2014), the step of avoiding to cause harm is stricter than the responsibility of doing good. Harm entails any injury to the patient, reputation, and property although in health care it is limited to physical such as disability, pain as well as death. As such, the primary assertion of nonmaleficence is that failure to ensure harmless treatment to the patients with those who use drugs being no exception is violating the professional guidelines. Extending ineffective and inappropriate pain management treatment that involves harm violates the nonmaleficence ethical principle. For this matter, all health care providers ought to extend pain management services that do not harm patients to avoid them from using other methods such as drugs.

Beneficence 

The principle asserts that physicians ought to do what is good for their patients as well as other healthcare providers. When a nurse or any other health care provider extends services to a patient with a painful illness, they are helping them get pain relief and comfort, thus, doing good. According to center for Substance Abuse Treatment (U.S) (2014), active concern, as well as the promotion of patient welfare, would undeniably put pain relief together with management among the most significant objectives in extending care to patients with painful illnesses. Involving the patient and knowing their concerns about the pain they experience and what exactly they hope for is encouraging to many people in the health care center. Ultimately, some health care professions fail to do good to their patients experiencing pain for several reasons or if done the relief is not experienced there and then, thus, violating the principle of beneficence.

The fact that there are several theories aimed at explaining the causes of drug abuse affects pain management treatment. For example, advocates of the disease theory that asserts that drug abuse is connected to genetics believe they cannot live without using drugs. With this said, even when receiving treatment aimed at reducing the pain they will still opt for drugs as a painkiller. It is evident that these people chose to do this because they believe it is the truth but with sensitization about the primary causes of drug abuse they can consider using one type of medication and forego the other. As such, the health care providers should move an extra mile and educate their patients who decide to seek for pain management therapy and are under drug use about the causes and effects of using substances.

Conclusion

To sum up, substance abuse is a prominent issue in the several hospitals that has raised several ethical concerns, although with effective as well as appropriate steps they can be overcome. It is evident that the dimensions of the moral issue contribute to the wellness of the patient. It should be noted that meeting the needs of the patient is the most significant goal of extending medical services to the patients. Besides, a patient who uses substances seeks for pain management because they want to get comfort as well as relief. It is revealed that the health care provider has to focus on doing only what is good (beneficence) and not causing harm (nonmaleficence) to meet the needs of their patients. Therefore, the health care providers have to consider the ethical principles when performing their profession, hence delivering excellent services.

References

Ali, M. (2014). Perspectives on Drug Addiction in Islamic History and Theology.  Religions, 5(3), 912-928. doi:10.3390/rel5030912

Center for Substance Abuse Treatment (U.S.). (2014). Ethical issues in Substance abuse treatment for persons with HIV/AIDS. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.
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Cheatle, M., Comer, D., Wunsch, M., Skoufalos, A., & Reddy, Y. (2014). Treating Pain in Addicted Patients: Recommendations from an Expert Panel. Population Health Management, 17(2), 79-89. doi:10.1089/pop.2013.0041
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Lemme, N., Leyva, B., Seol, Y., Badger, J., & Mannix, M. (2017). To Continue or to Withhold Opioid Analgesics? An Ethical Dilemma Involving a 63-year-old Cancer Patient Who ‘Broke the Pain Contract’. Rhode Island Medical Journal. Retrieved from http://www.rimed.org/rimedicaljournal/2017/10/2017-10-26-ethics-lemme.pdf

Mee-Lee, D. (2013). The ASAM Criteria; Treatment criteria for addictive, substance-related, and co-occurring conditions (3rd Ed.). American Society of Addiction Medicine

O’Connor, P. (2012). In the Cave: Philosophy and Addiction. The New York Times [New York].

Parsons, G. (2015). Pain management in patients with a substance use disorder. Clinical Pharmacist. doi:10.1211/cp.2015.20069490
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Rotchford, J. K. (2017). Cultural Factors within the United States Promote Substance Use Disorders- A Helpful Perspective for Responding To the Opioid Misuse Epidemic. Global Journal of Addiction & Rehabilitation Medicine, 4(2). doi:10.19080/gjarm.2017.04.555631

Uusitalo, S., Salmela, M., & Nikkinen, J. (2013). Addiction, Agency and Affects – Philosophical Perspectives. Nordic Studies on Alcohol and Drugs, 30(1-2), 33-50. doi:10.2478/nsad-2013-0004
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Venkat, A., Fromm, C., Isaacs, E., & Ibarra, J. (2013). An Ethical Framework for the Management of Pain in the Emergency Department. Official journal of the society for Academic Emergency Medicine, 716–723. doi: 10.1111/acem.12158