BENEFICENCE NON MALEFICENCE

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INTRODUCTION

INTRODUCTION

BENEFICENCE do good NON MALEFICENCE avoid evil However, we cannot do all good and avoid all evil Limitations time, space, talents

TIME there isnt 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

The impossibility of doing all good

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 ones own life and would still not save the child anyway.

Nearly everything we do has some undesirable side effect or at least the risk of some evil.

The impossibility of avoiding all 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.

BENEFI CENCE
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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 patients good Act out of charity and justice Respect the patients 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 ETHICS

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 MALEFI CENCE

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NON-MALEFICENCE
n n n

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 ones 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% nonmaleficence 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 persons 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
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Principle of Proportionality assesses an act in view of the consequences it has on an individuals dignity.
( Note: this principle prioritizes the
dignity of a person.)

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

Wedge / Camels 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

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

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CASE ANALYSIS

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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?

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CASE #2