Beneficence[edit]

Main article: Beneficence (ethics)

The term beneficence refers to actions that promote the well being of others. In the medical context,
this means taking actions that serve the best interests of patients and their families. [1] However,
uncertainty surrounds the precise definition of which practices do in fact help patients.
James Childress and Tom Beauchamp in Principle of Biomedical Ethics (1978) identify beneficence
as one of the core values of healthcare ethics. Some scholars, such as Edmund Pellegrino, argue
that beneficence is the only fundamental principle of medical ethics. They argue that healing should
be the sole purpose of medicine, and that endeavors like cosmetic surgery and euthanasia are
severely unethical and against the Hippocratic Oath.

Non-maleficence[edit]
Main article: Primum non nocere
The concept of non-maleficence is embodied by the phrase, "first, do no harm," or the Latin, primum
non nocere. Many consider that should be the main or primary consideration (hence primum): that it
is more important not to harm your patient, than to do them good, which is part of the Hippocratic
oath that doctors take.[28] This is partly because enthusiastic practitioners are prone to using
treatments that they believe will do good, without first having evaluated them adequately to ensure
they do no harm to the patient. Much harm has been done to patients as a result, as in the saying,
"The treatment was a success, but the patient died." It is not only more important to do no harm than
to do good; it is also important to know how likely it is that your treatment will harm a patient. So a
physician should go further than not prescribing medications they know to be harmful—he or she
should not prescribe medications (or otherwise treat the patient) unless s/he knows that the
treatment is unlikely to be harmful; or at the very least, that patient understands the risks and
benefits, and that the likely benefits outweigh the likely risks.
In practice, however, many treatments carry some risk of harm. In some circumstances, e.g. in
desperate situations where the outcome without treatment will be grave, risky treatments that stand
a high chance of harming the patient will be justified, as the risk of not treating is also very likely to
do harm. So the principle of non-maleficence is not absolute, and balances against the principle
of beneficence (doing good), as the effects of the two principles together often give rise to a double
effect (further described in next section). Even basic actions like taking a blood sample or an
injection of a drug cause harm to the patient's body. Euthanasia also goes against the principle of
beneficence because the patient dies as a result of the medical treatment by the doctor.
Double effect[edit]
Main article: Principle of double effect
Double effect refers to two types of consequences that may be produced by a single action, [29] and in
medical ethics it is usually regarded as the combined effect of beneficence and non-maleficence. [30]
A commonly cited example of this phenomenon is the use of morphine or other analgesic in the
dying patient. Such use of morphine can have the beneficial effect of easing the pain and suffering of
the patient while simultaneously having the maleficent effect of shortening the life of the patient
through the deactivation of the respiratory system. [31]

Respect for human rights[edit]

The human rights era started with the formation of the United Nations in 1945, which was charged
with the promotion of human rights. The Universal Declaration of Human Rights (1948) was the first
major document to define human rights. Medical doctors have an ethical duty to protect the human
rights and human dignity of the patient so the advent of a document that defines human rights has
had its effect on medical ethics.[32] Most codes of medical ethics now require respect for the human
rights of the patient.
The Council of Europe promotes the rule of law and observance of human rights in Europe. The
Council of Europe adopted the European Convention on Human Rights and Biomedicine (1997) to
create a uniform code of medical ethics for its 47 member-states. The Convention
applies international human rights law to medical ethics. It provides special protection of physical
integrity for those who are unable to consent, which includes children.
No organ or tissue removal may be carried out on a person who does not have the capacity to
consent under Article 5.[33]
As of December 2013, the Convention had been ratified or acceded to by twenty-nine member-
states of the Council of Europe. [34]
The United Nations Educational, Scientific and Cultural Organization (UNESCO) also promotes the
protection of human rights and human dignity. According to UNESCO, "Declarations are another
means of defining norms, which are not subject to ratification. Like recommendations, they set forth
universal principles to which the community of States wished to attribute the greatest possible
authority and to afford the broadest possible support." UNESCO adopted the Universal Declaration
on Human Rights and Biomedicine to advance the application of international human rights law in
medical ethics. The Declaration provides special protection of human rights for incompetent persons.
In applying and advancing scientific knowledge, medical practice and associated technologies,
human vulnerability should be taken into account. Individuals and groups of special vulnerability
should be protected and the personal integrity of such individuals respected. [35]

Solidarity[edit]
Individualistic standards of autonomy and personal human rights as they relate to social justice seen
in the Anglo-Saxon community, clash with and can also supplement the concept of solidarity, which
stands closer to a European healthcare perspective focused on community, universal welfare, and
the unselfish wish to provide healthcare equally for all. [36] In the United States individualistic and self-
interested healthcare norms are upheld, whereas in other countries, including European countries, a
sense of respect for the community and personal support is more greatly upheld in relation to free
healthcare.[36]

Acceptance of Ambiguity in Medicine[edit]

The concept of normality, that there is a human physiological standard contrasting with conditions of
illness, abnormality and pain, leads to assumptions and bias that negatively affects health care
practice.[37] It is important to realize that normality is ambiguous and that ambiguity in healthcare and
the acceptance of such ambiguity is necessary in order to practice humbler medicine and
understand complex, sometimes unusual usual medical cases.[37] Thus, society's views on central
concepts in philosophy and clinical beneficence must be questioned and revisited, adopting
ambiguity as a central player in medical practice.[37]

Conflicts[edit]
Between autonomy and beneficence/non-maleficence[edit]
Autonomy can come into conflict with beneficence when patients disagree with recommendations
that healthcare professionals believe are in the patient's best interest. When the patient's interests
conflict with the patient's welfare, different societies settle the conflict in a wide range of manners. In
general, Western medicine defers to the wishes of a mentally competent patient to make their own
decisions, even in cases where the medical team believes that they are not acting in their own best
interests. However, many other societies prioritize beneficence over autonomy.
Examples include when a patient does not want a treatment because of, for example, religious or
cultural views. In the case of euthanasia, the patient, or relatives of a patient, may want to end the
life of the patient. Also, the patient may want an unnecessary treatment, as can be the case
in hypochondria or with cosmetic surgery; here, the practitioner may be required to balance the
desires of the patient for medically unnecessary potential risks against the patient's informed
autonomy in the issue. A doctor may want to prefer autonomy because refusal to please the patient's
self-determination would harm the doctor-patient relationship.
Organ donations can sometimes pose interesting scenarios, in which a patient is classified as a non-
heart beating donor (NHBD), where life support fails to restore the heartbeat and is now considered
futile but brain death has not occurred. [22] Classifying a patient as a NHBD can qualify someone to be
subject to non-therapeutic intensive care, in which treatment is only given to preserve the organs
that will be donated and not to preserve the life of the donor. [22] This can bring up ethical issues as
some may see respect for the donors wishes to donate their healthy organs as respect for
autonomy, while others may view the sustaining of futile treatment during vegetative state
maleficence for the patient and the patient's family.[22] Some are worried making this process a
worldwide customary measure may dehumanize and take away from the natural process of dying
and what it brings along with it.[22]
Individuals' capacity for informed decision-making may come into question during resolution of
conflicts between autonomy and beneficence. The role of surrogate medical decision-makers is an
extension of the principle of autonomy.
On the other hand, autonomy and beneficence/non-maleficence may also overlap. For example, a
breach of patients' autonomy may cause decreased confidence for medical services in the
population and subsequently less willingness to seek help, which in turn may cause inability to
perform beneficence.
The principles of autonomy and beneficence/non-maleficence may also be expanded to include
effects on the relatives of patients or even the medical practitioners, the overall population and
economic issues when making medical decisions.

Euthanasia[edit]
Main article: Euthanasia
There is disagreement among American physicians as to whether the non-maleficence principle
excludes the practice of euthanasia. Euthanasia is currently legal in the states of Washington DC,
California, Colorado, Oregon, Vermont, and Washington. Around the world, there are different
organizations that campaign to change legislation about the issue of physician-assisted death, or
PAD. Examples of such organizations are the Hemlock Society of the United States and the Dignity
in Dying campaign in the United Kingdom. These groups believe that doctors should be given the
right to end a patient's life only if the patient is conscious enough to decide for themselves, is
knowledgeable about the possibility of alternative care, and has willingly asked to end their life or
requested access to the means to do so.
This argument is disputed in other parts of the world. For example, in the state of Louisiana, giving
advice or supplying the means to end a person's life is considered a criminal act and can be charged
as a felony. In state courts, this crime is comparable to manslaughter. The same laws apply in the
states of Mississippi and Nebraska.