In this book, public health ethicist Daniel S. Goldberg sets out to characterize the subjective experience of pain and its undertreatment within the US medical establishment, and puts forward public policy recommendations for ameliorating the undertreatment of pain. The book begins from the position that the overwhelming focus on opioid analgesics as a means for improving the undertreatment of pain is flawed, and argues instead that dominant Western models of biomedicine and objectivity delegitimize subjective knowledge of the body and pain in the US. This general intolerance for the subjectivity of pain is part of a specific American culture of pain in which a variety of actors take part, including not only physicians and health care providers, but also pain sufferers, caregivers, and policymakers. Concentrating primarily on bioethics, history, and public policy, the book brings a truly interdisciplinary approach to an urgent practical ethical problem. Taking up the practical challenge, the book culminates in a series of policy recommendations that provide pathways for moral agents to move beyond contests over drug policy to policy arenas that, based on the evidence, hold more promise in their capacity to address the devastating and inequitable undertreatment of pain in the US.
Introduction: The Power of the Visible & the Undertreatment of Pain in the U.S. Section I: The Lived Experience of Pain 1. The Current State of Pain in the United States 2. The Lived Experience of Pain Section II: History, the Power of the Visible, and Pain 3. The History of Pain without Lesion in Mid-to-Late Nineteenth Century America 4. Objectivity, Subjectivity, and Why the History of Pain is Relevant to its Contemporary Undertreatment Section III: Ethics, Subjectivity, and Pain 5. Mind-Body Dualism, Subjectivity, and Consciousness 6. Pain, Objectivity, and Bioethics Section IV: Towards Ethical, Evidence-Based Pain Policy 7. Opioids & Pain Policy 8. Evidence-Based Pain Policy Recommendations Conclusion