The Ethical Responsibility to Advocate for Change in End-of-Life Pain Management.

BACKGROUND: Despite the moral and ethical imperative to provide effective pain relief, many people around the world continue to die in pain. This paper examines the historical and current forces that shape these challenges across practice, policy, ethics, and research, with the goal of offering actionable recommendations to transform the current landscape of pain management. METHODS / APPROACH: The issue was analyzed by synthesizing historical and current forces across clinical practice, health policy, ethical frameworks, and research. The strategic framework builds upon raising awareness of decades-long stagnation in overcoming known barriers and explicitly framing ongoing failures as breaches of ethical care. The literature was synthesized to develop evidence-based recommendations for overcoming these challenges. RESULTS / KEY FINDINGS: The persistent failure to provide adequate pain relief stems from critical gaps in healthcare professionals' knowledge and attitudes, socio-political and economic barriers, cultural and spiritual beliefs surrounding pain, and limited access to appropriate care and resources. CONCLUSION & RECOMMENDATIONS: Addressing these ethical breaches requires immediate action by health care professionals, advocacy, and systemic policy reform. Actionable recommendations are provided across practice and governance to transform pain management care so that no person, anywhere, ever should have to die in pain.