Unrelieved pain: an ethical and epistemological analysis of distrust in patients.

Unrelieved pain is a serious clinical problem that has received little attention in bioethics. This paper contends that unrelieved pain is the result of distrust in patients that reveals both an ethical and epistemological failure on behalf of nurses and physicians. The analysis is conceptually framed in previous work on the articulation of trust in nursing. Specifically, an argument is made that clinicians do not trust patients' subjective experiences, distrust patients from marginalized and relatively less powerful groups, and resist entrusting themselves or becoming vulnerable to patients' pain and suffering. The authors discuss the need for awareness and critical examination of deeply entrenched societal beliefs and values that influence everyday decision-making in pain management.