Beneficence

BENEFICENCEBENEFICENCE

ObjectivesObjectives

At the end of the session, the student is able to: explain the meaning and implications of

Beneficence, differentiate the various types of Good, explain the meaning of Paternalism differentiate strong from weak paternalism, apply the principle in given situations, judge what is ethically/unethically acceptable

as the principle is applied in given situations

BeneficenceBeneficence

One has the obligation to help others further their important and legitimate interests.


ImplicationsImplications

1. There is an obligation to confer benefits that is, doing or promoting good, and actively to prevent and remove harm or evil.


ImplicationsImplications

2. There is an obligation to weigh and balance the possible good against the possible harm.


The impossibility of doing all good - this The impossibility of doing all good - this arises from limitations of:arises from limitations of:

1. The nature of time and space

2. One’s own limitations.

3. The state of the art in a given area as

well as the availability of state of the art

tools.

4. One’s obligation to avoid evil


Doing good and avoiding evil is no simply Doing good and avoiding evil is no simply

a question of principles but of practical a question of principles but of practical

wisdom weighing the relevant aspects of wisdom weighing the relevant aspects of

the factual and social situation as well as the factual and social situation as well as

the concrete meaning of human dignity in the concrete meaning of human dignity in

a particular time and spacea particular time and space


SpecificationSpecification

The things necessary for the person to

remain human and maintain dignity are the

top of the list of goods to be done.


LimitsLimits

1. Talent

It is a matter of situations in which the

effort to do good/better or to preserve the

good may conflict with the good of other

human beings


LimitsLimits

1. Talent

There is tension between respecting

freedom and securing what a health

care professional may consider the

best interests of the patient.


LimitsLimits

2. Most goods we have to do are specified by:

Law

Custom

Relationship and roles

Agreements


Patient’s Good:Patient’s Good:

The ultimate good

The biomedical good

The patient’s concept of his own good: his

best interest

The good of the patient as a human person

capable of reasoned choices


The Ultimate GoodThe Ultimate Good

The meaning and destiny of human existence;

The positions 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

intermediate reasons fail;

This value supersedes the biomedical good and the

patient’s view of his own good


The Biomedical GoodThe 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

assessment


The Patient’s View of his Own GoodThe Patient’s View of his Own Good

The patient’s subjective assessment of the quality of

life the intervention might produce;

Whether of not this quality of life is consistent with the

patient’s life plan and goals;

The patient’s life plan is highly personal

The choices that are to be made according to his life

plan may run counter to biomedical good or what the

physician thinks is a good life for the patient.


The Good of the Patient as a Human PersonThe Good of the Patient as a Human Person

The 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;

Freedom to choose

This value supersedes the biomedical good and the

patient’s view of his own good


PaternalismPaternalism

Involves acting without consent. Or even

over-riding the patient’s wishes, wants or

actions, in order to benefit the patient or at

least to prevent harm to the patient


Two (2) Elements of PaternalismTwo (2) Elements of Paternalism

The absence of consent or the over-riding

of consent

The beneficent motive

(the welfare of the patient)


Strong PaternalismStrong Paternalism

Also called extended paternalism

The health care provider attempts to

override the wishes of a competent person


Weak PaternalismWeak Paternalism

Also called limited or restricted paternalism

Consent is missing or the health care

provider overrules or overrides the wishes

of an incompetent or a doubtfully

competent patient.


Weak PaternalismWeak Paternalism

Sometimes called cooperative paternalism

when one of its purposes is to restore the

person’s competence so that the patient

may give informed consent.


Strong paternalism is ethically rejectedStrong paternalism is ethically rejected

The competence of an individual to make

decisions for another competent individual

would require both a knowledge of the other

person’s values and of all the factors

influencing their lives.



Health care professionals do not have the

right to enforce value judgments on the

patient on the grounds that “doctor knows

best.”



It would be a rare health care professional

who knew all the factors influencing the life

of the patient.


It is NOT paternalism:It is NOT paternalism:

When the health care provider acts to

prevent the patient from causing serious

injury to others.



If the health care professional overrules the

patient for the convenience or profit of the

provider.



If the health care professional refuses to go

along with the patient’s wishes because

these wishes are against the conscience or

professional standard of the provider, and

vice versa.


Paternalism is justified:Paternalism is justified:

If the harms prevented from occurring or the

benefits provided to the patient outweigh the

loss of independence and the sense of

invasion caused by the interference.


Paternalism is justified:Paternalism is justified:

If the person’s condition seriously limits

his/her ability to choose autonomously.

If the interference is universally justified

under relevantly similar circumstances.


Rule of thumb involving Paternalism:Rule of thumb involving Paternalism:

Decisions about health, life and death are

not merely medical decisions but involve the

good of the society and the good of third

parties, as well as the values of the patient.

Thank You!

Beneficence

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Transcript of Beneficence