The principle of nonmaleficence is defined as refraining from doing harm (National Institutes of Health, 1979). Herein may lie the greatest obstacle to ethical adherence in deciding the appropriate treatment for pain in the acute care setting.
Nonmaleficence is often the principle of ethics invoked by nurses and practitioners when having difficulty deciding on pain treatments: they withhold medication citing ‘safety’. There certainly can be a reasonable fear on the part of the practitioner of causing harm while treating pain since so many treatments for pain have potentially dangerous side effects. It is imperative to understand, however, that pain itself may be more harmful to the patient than the side effects of the drugs used to control it. As stated previously, untreated pain can have detrimental physical and emotional effects on a patient. For example, an opioid may be the only effective treatment for an acute pain situation in a hospitalized person, yet a nurse or physician’s general fear of opioids (usually a fear of respiratory depression) can result in inadequate pain treatment. This fear is often unsubstantiated in the hospital setting since the administration of opioids and their effects are carefully monitored. Nurses must remember that expecting a patient to remain in unacceptable pain can cause harm in many ways ranging from mild (anxiety) to severe (suicide).