Pain Management in a Terminally Ill Patient with a Surrogate Decision-maker: A Challenge

When health care proxies are in charge of pain management, it may become very difficult to address the patient’s pain if the health care proxy has misconceptions about analgesics. We report a case of an 87-year-old lady who was found to be pulseless, and after successful cardiopulmonary resuscitation (CPR), was intubated and remained so for over a month in the intensive care unit (ICU). The medical team could not provide the patient with pain medication, as the daughter who was the surrogate decision-maker did not allow the administration of any pain medication in the false belief that it would kill the patient. This case helps us to shed light on the surrogate decision-maker and pain management and how medical professionals can solve similar issues in the future. Early consultation with palliative care may be beneficial. For continued disagreement, the ethics committee should be consulted.