Beneficence

Beneficence

1. Put simply, beneficence is doing good for others

1. In medical ethics, the idea of the ‘patients interests coming first’ is an undesirable moral imperative because there are many competing interests in a person’s life, including his own, those of his loved ones, those who he has special obligations towards and the interests of the community

1. Some argue that beneficence is not a moral obligation but it is, undoubtedly, a virtue, and is morally commendable

1. Medical professionals usually place the interests of their patients before their own and is a feeling of benevolence, good will or sympathy towards the sick

1. There are three constraints to beneficence:

• The need to respect the autonomy of those whom one intends to help, especially to find out what it is they want in terms of help (beneficence needs to be tempered by the duty of respect for autonomy)

• The need to ensure that the help one renders is not bought at too high a price (the duty of beneficence needs to tempered by the duty of non-maleficence)

• The need to consider the wants, needs and rights of others (the duty of beneficence must be tempered by the duty of justice)

1. Respect for autonomy: if one wants to do good for a patient or client, one generally needs to find out what he or she actually wants one to do, which often doesn’t require much inquiry e.g. a patient with a broken arm wants it set and the pain relieved.

1. However, doctors are often too ready to assume that they can tell what the patient wants; the doctor who ‘knows’ what the patient wants without asking them is quite likely to get it wrong e.g. for a sore throat, one patient might want antibiotics, another wants a sick note for his employer and would like for it to heal naturally, etc.

1. Sometimes, the patients wants and needs might be in conflict, such as wanting something that will not benefit them e.g. antibiotics for a viral infection.

1. A doctor is not obliged by the prima facie duty of beneficence always to do what the patient wants after discussion, because sometimes the request might go against the doctor’s moral principles e.g. asking for assisted suicide/euthanasia. They will want to respect the law or the professional code of ethics. Another example is if the patient wants a prescription for expensive drugs when the doctor believes that cheaper versions will be just as effective. It will place unnecessary burdens on taxpayers etc.
2. The duty to do no harm: Medical professionals often have to weigh the costs against the benefits

1. An important need is to be good at ones job, so a medical education with continued postgraduate study can be effective because it constantly updates ones knowledge and ability to conduct a cost-benefit analysis.

1. Respect for the patient’s autonomy is once again needed because it needs to be discussed what the patient feels will benefit them, and what costs they are prepared to accept e.g. one patient might accept a survival rate of 3 years, whereas another wouldn’t.

1. Effective, sympathetic and adequate communication is also required especially in such delicate matters, in which poor communication skills are likely to harm patients.

1. Friendliness, warmth, concern, politeness and good time-keeping are further requirements of the principle of beneficence.

1. It could be argued that a guaranteed income leads to a decrease in concern within the profession and towards patients. After all, doctors are getting paid well despite how they might treat their patients.

1. The duty of justice: if all available medical resources were used to provide care for a favoured section of the sick population, say, the rich, it would be said to be unjust and unfairly provided.

1. When medical resources are scarce, which is the inevitable case, some form of just distribution of those resources must be achieved. A cost-benefit analysis can be used again.

1. In this context, doctors may face a major dilemma because they may insist that it is only their duty to care for patients; it is not their business to share out inadequate resources.

1. This might lead some doctors to see their position as similar to that of a barrister

1. Essentially, doctors have the duty of obeying the Hippocratic Oath.

1. Some doctors might accept as part of their moral purpose not just the health of “my patients” but the health of all sick people, including future sick people.

1. This means they commit themselves and medical ethics to require justice in the distribution of medical resources; justice not only for their patients, not only for their country’s patients, but for all the world’s sick, present and future, even the world’s potentially sick.

1. Such a commitment, if taken seriously, would have quite staggeringly radical results in terms of taking away medical care from the well-provided and redistributing it to the medically destitute.

1. Those concerned with fairness for all have sought and continue to seek to reduce medical control over the distribution of medical resources. It is a dilemma that the medical profession has on the whole evaded.

1. If, however, we do not resolve it ourselves, it is likely to be resolved for us.