DE LA SALLE HEALTH SCIENCES CAMPUS – COLLEGE OF MEDICINE

Detoxicol
SDLS 2008
Medicine for the intoxicated
Subject: Bioethics Lecture Date: July 29, 2005
Topic: Beneficence Transcriber(s): Jaime Aherrera
Lecturer: Dr. Melchor Frias IV No. of pages: 2

BENEFICENCE
• One has the obligation to help the patient for his/her benefit (one has the obligation to help others)
• Practice Proportionality in Recommending Treatment (doing good to the patient for the interest of the patient)

I. IMPLICATIONS OF BENEFICENCE
• There is an Obligation to confer Benefits that is, doing or promoting good, and actively to prevent and remove harm
/ evil (think of the consequences of the treatment for the patient, not for yourself)

• There is an implication to weigh and balance the possible good against harm of an action (Proportionality)

II. THE IMPOSSIBILITY OF DOING ALL GOOD (Arises from Limitations of. . .)

A. The Nature of Time and Space

o We can only be in one place at one time
o We cannot help everyone all the time; we can only do one operation at a time

B. One’s Own Limitations

o As general practitioners, physicians are limited by skills and knowledge
o As a surgeon, physicians are limited only to the field of surgery (not pediatrics, not a lawyer, etc)

C. The State of the Art in the Given Area, as well as the Availability of the State of the Art Tools
o Limited by equipment and facilities

D. One’s Obligation to Avoid Evil

o Sometimes, we are exposed to wrong doings and we cannot avoid this
o Ex) We see a drowning child, but we don’t know how to swim – we want to do good to save the child but
we might kill ourselves – in the end, we don’t save the child

III. SOME GENERALIZATIONS:

• Doing good & avoiding evil is NOT simply a set of principles, but of Practical Wisdom based on Knowledge, Skills
and Common Sense
• You have to weight certain aspects, such as the patients social situations, how the treatment affects the relatives,
the patient per se and the meaning of his dignity in a particular time and place
• Take into consideration the Time and Place you are situated in
• As physicians, the things necessary for the person to remain human and to maintain dignity are on top of the list
• For us, it would be important among the good that we are obligated to maintain the dignity of the patient
• Always weight between good and evil that would occur in any situation (in your decision making)
• Always treat patient as a Human Being

III. SPECIFICATIONS OF BENEFICENCE (DO GOOD!)

➢ The things necessary for the person to remain Human and Maintain Dignity are at the top of the list of Goods to be
Done (maintain the patient’s dignity)
o Ex) When a person refuses treatment for a Terminal Cancer, we should not insist or force the patient!

➢ There are Two Limits or Specifications:

A. Talent
o It is a matter of situations in which the effort to do good / better or to preserve the good (in ourselves /
patients) may conflict with the good of other Human Beings
 In these cases, one’s betterment is often Subordiante to the Survival of others (Ex. when treatment
is expensive & would bankrupt the patient’s family – patient forgoes treatment)
  Betterment of Patient < Betterment of the Family
 At times, the obligation to respect others may limit the Obligations to attain every basic necessary
goods (Autonomy = respect for freedom of choice)
 Principle of Autonomy = limits physician to do good (if patient does not give his consent for
treatment, physician cannot treat him)

o There is tension between respecting Freedom and Securing what a health care professional may consider
the best interest of the patient
 Related to the Principle of Beneficence and Autonomy
 There is tension between Beneficence and Autonomy
 Patients may choose not to be treated (Autonomy) – Physicians are limited by the freedom of the
patients to choose

B. Agreement
o Social Agreement = Laws + Customs
o Most of the goods we have to do are specified by:
1. Laws
 certain laws in the state (Do’s
and Don’t’s)
 ex) Doctors are required to
report child abuse cases

2. Customs
 we cannot do good to some patients who practice certain traditions
 ex) when patients put urine in Conjunctivitis

3. Relationships and Roles

 these limits physicians
 ex) Doctor-Patient relationship – both have certain obligations
 ex2) in a married couple – there is an established relationship – if man has a mistress, he
is breaking the said “relationship”

4. Agreements
 “Implied Promises”
 doctors are limited to what has been agreed upon

IV. PATIENT’S GOOD:

A. The Ultimate Good

 the meaning and destiny of Human Existence
 this is the position taken with reference to relationships with other human beings, the world and
God
 the “Ultimate Concern” – the one to which we turn for Final Justification of our acts if all Secondary
or Intermediated Reasons fail (“Bahala na ang Diyos!”)
 this value supersedes the Biomedical good and the patient’s view of his own good
 ex) When physician recommends cancer patient to take chemotherapy – patient says “I’d rather be
with my family – bahala na ang Diyos.”  patient deals with the Ultimate Good

B. The Biomedical Good

 the good that can be achieved by Medical Intervention into a particular disease state
 the statement of what can be achieved based on strictly scientific and technical assessments
 as physicians, we are concerned about the Biomedical Good (also some patients
 ex) “Bahala na kayo Doc, do whatever is best for me”

C. Patients Concept of his Own Good

 the patient’s subjective assessment of the Quality of life the Intervention might produce
 whether or not this quality of life is consistent with his life plan, goals and aims
 his life plan is highly personal
 the choices that are to be made according to his life plan may seem counter to Biomedical Good or
what the MD thinks is a good life for the patient
 ex) If Treatment will leave a patient crippled, being crippled is as good as being dead for the
patient (because this is the quality of life the patient has)

D. The Good of the Patient as a Human Person

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  this good that is grounded in his capacity as a Human Person to reason, to choose, and to express
those choices in speech with other Humans (principle of Autonomy)
 Freedom to Choose
 this value supersedes the biomedical good and the patient’s view of his own good
 take into consideration that your patient is a Human Being Capable to reason and choose

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