[Pain therapy--legal reference points and stumbling blocks]

Pain therapy and palliative medicine have gained new importance in medical treatment in recent years. Pain is no longer considered an acceptable evil; in fact, awareness has increased that even in tumor patients and those with chronic pain the available options for special pain therapy can provide long-term pain relief. Pain therapy is not limited to these fields but applies to all areas of medicine. Unfortunately though, pain therapy has become the focus of forensic considerations, illustrated by the current case of an internist in Hannover who has to answer for eight counts of manslaughter this year. She is charged with ordering inappropriately high doses of morphine and in part excessive administration of diazepam. Legal practice shows however that the predominant number of preliminary criminal proceedings and civil liability lawsuits do not involve pain specialists and palliative physicians, but rather other specialties such as the surgical disciplines and patient care. This is not surprising since good pain therapy is at present expected in all branches of medicine but obviously those fields not specialized in this subject lag further behind in these expectations than those already dedicated to pain therapy or palliative medicine.