BENEFICENCE NON MALEFICENCE

Group 6 Med 1 C

INTRODUCTION

INTRODUCTION• BENEFICENCE – do good• NON MALEFICENCE – avoid

evil• However, we cannot do all

good and avoid all evil • Limitations – time, space,

talents

The impossibility of doing all good

• TIME – there isn’t enough time to do all we want and plan to do, no matter how efficient we try to be

• SPACE – we cannot do good to those who are far away and beyond our reach

• LIMITED TALENT AND INTELLIGENCE • LACK OF TOOLS

ALSO…

• Our obligation to do good is limited by our obligation to avoid evil – THE PRINCIPLE OF NON MALEFICENCE LIMITS THE PRINCIPLE OF BENEFICENCE

The sight of a child drowning in a raging stream filled with floating ice urges one to attempt a rescue. But one stops after realizing that attempting such rescue would threaten one’s own life and would still not save the child anyway.

The impossibility of avoiding all evil

• Nearly everything we do has some undesirable side effect or at least the risk of some evil.– Crossing the street – can get hit by a car– taking a pill – side effects of the drug– undergoing a major surgery - complications

The impossibility of avoiding all evil

• Because we are social beings, we are involved, in a greater or lesser extent, on some evils.– Some people work on factories that destroy

the environment– Some work in hospitals who tolerate

incompetent health care workers.

Therefore…• Doing good and avoiding evil is not

simply a question of principles but of practical wisdom weighing the relevant aspects of the factual social situation as well as the concrete meaning of human dignity in a particular time and place.

BENEFICENCE

BENEFICENCE

• from Latin bene , well or good + facio , to do• to promote the good or interest of somebody else• Health providers: going beyond doing no harm and

actively contributing to the health and well-being of their patients

Ex. quality-of-life issues

Middle principle

• partially dependent for its content on how one defines the concepts of the good and goodness

• not a specific moral rule and cannot by itself tell us what concrete actions constitute doing good and avoiding evil

Some of the specific norms that arise from the principle of beneficence in the Catholic tradition are:

• Never deliberately kill innocent human life• Never deliberately (directly intend) harm• Seek the patient’s good• Act out of charity and justice• Respect the patient’s religious beliefs and value system in

accord with the principle of religious freedom• Always seek the higher good• Never knowingly commit or approve an

objectively evil action• Do not treat others paternalistically but help them to pursue

their goals• Use wisdom and prudence in all things

BENEFICENCE IN BIOMEDICAL

ETHICSOBLIGATO

RYIDEAL

OBLIGATORY BENEFICENCE

• Physicians have an obligation to:

1) Prevent and remove harms

2) Weigh and balance possible benefits against possible risks of an action.

NON MALEFICENCE

NON-MALEFICENCE “Do no harm” provides that evil or harm should not be inflicted

either on oneself or on others binds and urges everyone to avoid inflicting

harm as a moral obligation mandates the right not to be killed, right not to

have bodily injury, or pain inflicted on oneself and right not to have one’s confidence revealed to others

NON-MALEFICENCE• requires of us that we do not create a

needless harm or injury to the patient, either through acts of commission or omission

• Anything that harms the person and his human dignity in all aspects of his existence is a lucid transgression of the principle of non-maleficience

NON-MALEFICENCE• Health care practice

– remind us that medical practice involves risk and potential harm, and we should never expose our patients to such harm unnecessarily through carelessness or a cavalier attitude. But we know that 100% non-maleficence is not possible. There is some necessary maleficence in our work due to the limitations of investigative and therapeutic options before us.

NON-MALEFICENCE

• Some violations:– Physically harming a person as in suicide,

abortion, infanticide, mutilation, torture and violence

– Exposing a person to physical harm as in subjecting a person to unnecessary treatment or to dangerous procedure without a commensurate important goal

NON-MALEFICENCE

• Some violations:– Harming a person’s reputation, honor,

property or interests as by revealing confidential information

– Degrading working conditions that can seriously threaten quality of human life

NON-MALEFICENCE• A man driving his motorcycle slides but manages

to go to the hospital for treatment. He suffers minor abrasions and contusions. The attending nurse applies Hydrogen peroxide and 10% solution of betadine to the injured bodily areas along with other medications. The application of the antisepsis is painful. Now, the patient experiences pain out of the said health care intervention. Does it not contradict the principle of non-maleficience? Why?

NON-MALEFICENCE• It is impossible to avoid all evil• Most helpful when it is balance against principle

of beneficience• Principle of double effect• Principles of proportionality

– provided that action does not go directly against the dignity of the individual person (the intrinsic good), there must be a proportionate good to justify permitting or risking an evil consequence

PRINCIPLE OF PROPORTIONALITY

Principle of Proportionality assesses an act in view of the consequences it has on an individual’s dignity.

( Note: this principle prioritizes the

dignity of a person.)  

Proportionality involves a careful balancing between the good intended and the evil risked.

Wedge / Camel’s Nose Principle

Logical Form

• Logical consistency• Not necessarily with actual

effects.• Exceptions are seen as the

logical wedge that will undermine the principle.

Empirical Form

• Does not worry about logical consistency

• More on the actual consequences of the act or the exception to the rule

Improved principle of beneficence and nonmaleficence

stated as : doing good unless the effects of the action produce a disproportionate evil; and, avoiding evil/evil effects unless the reason is proportionate for allowing/risking them.

CASE ANALYSIS

CASE #1

Joseph and Edmund Campion were born as Siamese twins, joined below the waist and sharing the lower part of their digestive tract and three legs. Internal abnormalities existed as well. At birth, the twins had such respiratory problems and were in such critical condition that they were not expected to live for more than a few days.

The father, a professional, and their mother requested that there be no treatment and no feeding. A nurse wrote on the chart, "Do not feed in accordance with parents' wishes." This was countersigned by the physician in charge. Some of the nurses disregarded this order and fed the babies. The twins did not die in a few days, as expected. After intervention by the Children and Family Service. Which received court-ordered custody of the twins, they were fed. Four months in the neonatal intensive care unit was reported to have cost $166,000.

Tests indicated that the twins would not survive a surgical removal. When returned to the family, they needed constant care.

• Are the parents ethically justified on the basis of the surrogate principle they have chosen?

• Is there a quality of life judgment hidden here?

• If there is one, what are its logical consequences for health care ethics?

CASE #2