The ethics of pain control in infants and children

In this chapter we will offer a way of framing the ethical balance of competing considerations in pain treatment in infants and children, distinguishing between analyses of harms and benefits, from other more pragmatic, contextual, and cultural considerations. We begin with the ethical foundations behind good pain management for any patient, and especially children: the ethical duty to prevent harm by alleviating pain or suffering, and the importance of assuring equal access to pain treatment. Historically, the driving ethical concern in paediatric pain has been the pervasive undertreatment of pain in children. In the second and main section of the chapter, we offer a detailed analysis of the practical ethical challenges involved in weighing the harms and benefits of pain relief against untreated or undertreated pain. In the third section, we will discuss the more specific concerns of socioeconomic and cultural determinants to paediatric pain treatment. Finally, in the last section, we will address concerns in conducting research on pain interventions in infants and children, as clearly many of the modal methodologies traditionally used for clinical trials in adults (e.g. placebo control designs) pose unjustifiable risk to younger individuals. We will also discuss the importance of considering local context as it impacts standards of care to guide ethical paediatric pain research.