Beneficence and Non-Malefience

As the principles of beneficence and non-maleficence are closely related, they are discussed together
in this section.

# Beneficence involves balancing the benefits of treatment against the risks

and costs involved, whereas non-maleficence means avoiding the causation
of harm. As many treatments involve some degree of harm, the principle of non-maleficence
would imply that the harm should not be disproportionate to the benefit of the treatment. Respecting
the principles of beneficence and non-maleficence may in certain circumstances mean failing to
respect a person’s autonomy i.e. respecting their views about a particular
treatment. For example, it may be necessary to provide treatment that is not desired in order to
prevent the development of a future, more serious health problem. The treatment might be
unpleasant, uncomfortable or even painful but this might involve less harm to the patient than would
occur, were they not to have it.
In cases where the patient lacks legal competence to make a decision, medical staff are expected to
act in the best interests of the patient. In doing so, they may take into account the principles of
beneficence and non-maleficence. However, it would be helpful for medical staff in such cases, if the
patient lacking capacity had made an advance directive. Nevertheless, as will be seen in the following
section on “the position of advance directives alongside current wishes”, problems may arise when
there is a conflict between what a person requested in an advance directive and what in the doctor’s
view is in their best interests, particularly in cases where it is no longer clear that the person in
question would still agree with the decision previously made.

In Western medicine, the principles of beneficence and non-maleficence derive

historically from the doctor-patient relationship, which for centuries was based on
paternalism. In the last few decades, there has been a change in the doctor-patient
relationship involving a move towards greater respect for patients’ autonomy, in that
patients play a more active role in making decisions about their own treatment (Mallia,
2003). According to Kao (2002), this is not the same in non-Western medicine. She explains that in
Islamic medical ethics, a greater emphasis is placed on beneficence than on autonomy especially at
the time of death. Aksoy and Tenik (2002), who investigated the existence of these principles in the
Islamic tradition by examining the works of Mawlana, a prominent Sufi theologian and philosopher,
support this claim. They found evidence of all four principles in one form or another, with a clear
emphasis on the principle of beneficence. In China where medical ethics were greatly
influenced by Confucianism, there is also a great emphasis on beneficence in that
Chinese medicine is considered “a humane art, and a physician must be loving in
order to treat the sick and heal the injured” (Kao, 2002).

NEW AS ON 4.01.2018
Beneficence: The concepts of beneficence and nonmaleficence are two closely related
ethical concepts which are mostly used in the fields of healthcare and medicine.

Beneficence refers to the act of helping others. It refers to actions that promote the well-
being of others.

Definition: Beneficence is action that is done for the benefit of others. Beneficent
actions can be taken to help prevent or remove harms or to simply improve the situation
of others. Beneficence prompts you to help others

Beneficent actions can help prevent or remove harm or to simply improve the situation
of others. In other words, beneficent actions include rescuing a person from harm or
danger or helping a person to improve his situation. Specific examples of beneficence
include rescuing a person from drowning, encouraging a person to quit smoking,
building a home for a homeless person, educating people about general sanitation.
These two terms are mostly related to medical ethics. In this context, beneficence refers
to taking actions that serve the best interests of patients. It involves the obligation to
help those who are in trouble, and protecting patients’ rights, providing treatment for
those who need it, preventing further complications, etc. Beneficence is considered as
the core value of healthcare ethics.

Non-Malefience:

Definition: Non-Malefience means to “do no harm.” Physicians must refrain from

providing ineffective treatments or acting with malice toward patients. This principle,
however, offers little useful guidance to physicians since many beneficial therapies also
have serious risks. The pertinent ethical issue is whether the benefits outweigh the
burdens.

Nonmaleficence is doing no harm. Nonmaleficence prompts you not to harm others.

These two concepts taken together state that you must act in a manner that benefits the
others and at the same time, you must not cause them any harm. Nonmaleficence
comes from the Latin maxim primum non nocere meaning “first, do no harm”. Thus,
nonmaleficence basically means do no harm. Examples of non maleficence include not
saying hurtful things to another person and not giving harmful drugs. In the practice of
medicine, examples of nonmaleficence include stopping a medication that is shown to
be harmful or refusing to provide a treatment that has not been shown to be effective.

Many people consider that non maleficence is the primary consideration of ethics since
it is more important not to harm the patients than to do them good. Since many
treatment methods involve some degree of harm, the concept non maleficence would
imply that the harm shouldn’t be disproportionate to the benefit of the treatment.

Balancing Beneficence and Non-maleficence:

One of the most common ethical dilemmas arises in the balancing of beneficence and
non-maleficence. This balance is the one between the benefits and risks of treatment
and plays a role in nearly every medical decision such as whether to order a particular
test, medication, procedure, operation or treatment. By providing informed consent,
physicians give patients the information necessary to understand the scope and nature
of the potential risks and benefits in order to make a decision. Ultimately it is the patient
who assigns weight to the risks and benefits. Nonetheless, the potential benefits of any
intervention must outweigh the risks in order for the action to be ethical.