Quote from CrohnieToo
As a person w/Crohn's disease I've read of so many Crohn's disease and/or UC patients who have encountered a colonoscopy where for whatever reason they were not adequately sedated. Many not only endured a lot of pain but asked, pleaded and begged the doctor to stop and the doctors did not. I'm always aghast as that. I know reimbursement for an incomplete scope can be a real PITA but nonetheless is it really ethical for a doctor to continue when the patient has asked that he/she stop? I know the doctor and I would part company in a hurry plus I would file a complaint w/the hospital, the state licensing board and his state professional organization if I were to encounter such a situation.
I would analyze this ethics problem by asking the following questions:
Is the patient warned about the potential pain? Since the patient is required to sign an informed consent, he should have been provided with an explanation of benefits, risks, and reasonable alternatives. Clearly, pain control should have been covered under the risks section.
Is there any harm to the patient in stopping the procedure? No, there is not.
Are there alternatives to pain control? Yes, propofol and MAC are two options. These require advanced training, such as CRNA.
I conclude that failing to stop upon patient request is unethical. There used to be a website hosted by a doctor in favor of colonoscopy without sedation. He claimed that only about 2% of doctors would stop a colonoscopy under sedation, even with repeated patient requests. Although I had a paid membership to this site, I was unable to find the source of his claim. However, in addition to reports on the web, I know of a relative who remembers repeatedly saying "This hurts", so lack of effective pain control can be a problem.