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Background and Importance Effective pain management in trauma and burn settings depends not only on pharmacological efficacy but also on ethical soundness. Ethical principles–autonomy, beneficence, non-maleficence, and justice–should guide therapeutic decisions, yet their consistent application remains uncertain in high-pressure clinical environments. The concept of ethical potency refers to the strength of ethical principle implementation in daily practice. Assessing its alignment with pharmacological decisions is essential to ensuring ethically balanced, patient-centred pain care.Aim and Objectives This study aimed to evaluate the degree of alignment between ethical principles and pharmacological practices in pain management within trauma and burn units. Secondary objectives included identifying barriers and facilitators influencing ethical decision-making among physicians and paramedics.Material and Methods A cross-sectional audit was conducted between September and December 2024. Sixty-four healthcare professionals (32 physicians, 32 paramedics) completed a validated questionnaire assessing knowledge and implementation of ethical principles in pain-related clinical scenarios. The survey explored perceptions of autonomy, informed consent, and treatment refusal, as well as workload, organisational support, and access to ethics training. Statistical analysis was performed using chi-square tests (p < 0.05). Pharmacological categories were mapped using the WHO Anatomical Therapeutic Chemical (ATC) classification.Results While 78% of respondents were aware of core ethical principles, only 45% reported consistent application (p = 0.045). Physicians showed higher alignment (90% knowledge/60% practice) compared with paramedics (70%/ 35%, p = 0.03). In end-of-life contexts, 57% of physicians respected treatment refusal, versus 85% of paramedics who attempted persuasion (p = 0.044). Key barriers included lack of ethics training (54% paramedics vs 29% physicians) and work overload (76% vs 11%). Access to ethics resources was the most cited facilitator (p < 0.05).Conclusion and Relevance Ethical potency in pain management mirrors pharmacological potency: both require structured systems, continuous education, and institutional commitment. Disparities between professionals underscore the necessity of integrating ethics into pain management protocols. Strengthening ethical competencies through inter-professional training and clinical ethics support can improve quality of care, patient safety, and professional accountability.References and/or Acknowledgements 1. Loeser JD. Pain and ethics: balancing relief and responsibility. Pain Med. 2021;22(2):285–9.Conflict of Interest No conflict of interest