Exploring Medicine's Moral and Ethical Questions on Pain Management

Travis Rieder, a professor of bioethics at Johns Hopkins University, is fascinated by the world’s ethical dilemmas.

His work sits at the intersection of medicine and philosophy, but also draws from his own life experiences like in his book, In Pain: A Bioethicist's Personal Struggle with Opioids. His latest book, Catastrophe Ethics: How to Choose Well in a World of Tough Choices, delves into moral decision-making in the context of climate change and other pressing ethical challenges.

Travis chats with host Greg LeBlanc about his harrowing experience with opioid withdrawal following a motorcycle accident, historic societal shifts in opioid perception, and how much one’s individual decision-making truly impacts structural problems like climate change or the healthcare system.

*unSILOed Podcast is produced by University FM.*

Episode Quotes:

How did we get to the place where we have conflicting attitudes about opioids?

09:53: How did we get to the place where we have conflicting attitudes about opioids? Because some people seem to think that they are, worth giving out like candy, and some people seem to think that they're like the devil's magic or whatever. And that story is old. That story is 200 years old plus, and it involves basically North America's attitudes just swinging back and forth from one extreme to the other. Every once in a while, we're like, "Oh, we really need to take pain seriously. Let's take opiates all the time." And then it predictably leads to a drug overdose crisis, an addiction crisis. And so the politicians freak out, and they slam on all the brakes, and they introduce new legislation. And then the country gets scared, and medicine gets scared. And we talk about how terrible these drugs are. And then we withhold them for 50 years. And then everyone's like, "Hey, maybe we should take care of cancer patients who are dying." And we start using the drugs again, and so on. And so we've done that move since the 1800s.

Risky handoffs in medication management

16:03: When it comes to pain medicine, when it comes to addiction management, when it comes to managing all sorts of difficult-to-manage medications, those handoffs are some of the riskiest places because they require care, and our system is not set up for that care to be there. 

Basic moral structure is everywhere

41:00: The main contribution that I wanted my book to make was to make clear that same basic moral structure, that we are contributing in very small ways to all sorts of goods and bads, good moral projects and bad moral projects, all the time. That basic puzzle is everywhere.

If someone argues that individual behavior doesn't matter, why would anyone bother trying?

33:44: Our actions have been decoupled from the consequences that make us worry. And so climate change is bad because it harms people. And so my classic moral brain says, okay, harm, that means don't do it. So, everything that I do that contributes to climate change, I'm like, okay, I shouldn't do that because climate change harms. But the thing is that the principle was don't cause harm, and your individual action doesn't cause harm. Your individual action does this other thing, which is it infinitesimally contributes to this massive, complex system that is so big and so complex, we can't really comprehend it. A trillion metric tons of greenhouse gasses accumulating in an atmosphere and cycling through a carbon cycle that is just unimaginably complex. And so there is no hurricane that is even a little bit worse because of what I did. That's just not how any of this works.

Show Links:
Recommended Resources:

• Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe 
• Michael E. Mann
• David Wallace-Wells
• Mary Annaïse Heglar
• Siddharth Kara
• Arthur Schopenhauer

Guest Profile:

• Faculty Profile at Johns Hopkins University
• Professional Website
• Professional Profile on X

His Work:

• Catastrophe Ethics: How to Choose Well in a World of Tough Choices
• In Pain: A Bioethicist's Personal Struggle with Opioids