The Principle of Beneficence

What is Beneficence?
- In ordinary English the term beneficence can suggest acts of mercy, kindness, and
charity. However, the concept of beneficent action should not be limited to mercy,
kindness, or charity because it includes any form of action to benefit another. In its
most general form, the principle of beneficence asserts an obligation to help others
further their important and legitimate interest.

The Two Principles of Beneficence

The first principle requires the provision (including the prevention and removal of
harm as well as the promotion of welfare).
The second principle requires a balancing a benefits and harms.

The Assumption of Beneficence in Health Care

The belief that there is an obligation to provide benefits is an unchallenged assumption
in biomedicine: Promoting the welfare of patients – not merely avoiding harm is the goal of
health care and also of therapeutic research.

Obligatory Beneficence
William Frankena have argued that, “even if one holds that beneficence is not a
requirement of morality but something supererogatory and morally good, one is still regarding
beneficence as an important part of morality – as desirable if not required.
Frankena’s observation can, however, be reconstructed for our purposes. To say we
ought to do something in general may mean that (1) we ought to do it because it is a moral
obligation, (2) we ought to do it because of a weak moral obligation, or (3) we ought to do it
because of a self-imposed requirement, such as a rule of charity.

The Obligation to Rescue

The obligation of beneficence is not enough, in our view, to require that the passerby
who is a very poor swimmer try to swim a hundred yards to rescue someone who is drowning in
deep water. But if the passerby does nothing – for example, fails to run several yards to alert a
lifeguard – the omission is morally culpable.

Grounds of General Obligation of Beneficence

Kant – said that the grounds of general beneficence is required by the categorical
imperative.
 Ross – said that beneficence is a part of common morality.
Hume – said that all our obligation to do good to society seem to imply something
reciprocal.

Grounds of Specific Obligation of Beneficence

Specific obligations of beneficence often derive from special moral relationships with
persons, frequently through institutional roles and contractual arrangements such as those that
bring the patient and the physician into a relationship. These obligations are not general and
stem particularly from implicit and explicit commitments.
Positive beneficence and the donation of cadaver organs
The current debate about policies to increase the supply of cadaver organs for
transplantation can be used to eliminate many subtleties that surround the obligation of
beneficence when applied both to public policy and to individual responsibility
We conclude that obligation of positive beneficence – for society, hospitals, health-care
professionals, individuals, and families – can best be discharged, at least for the time being, by a
policy of required request, which appears to be effective and efficient without threatening or
violating other ethical principles.

Nature of Paternalism
The term paternalism from the 1880’s, giving the root meaning as “the principle and
practice of paternal administration; government as by a father; the claim or attempt to supply
the needs or to regulate the life of a nation or community in the same way a father does those of
his children.”
Cases of paternalism, then, involve overriding a person’s wishes or intentional actions in
order to benefit or to avoid or prevent harm to that person. Paternalistic actions generally
involve force or coercion on the one hand or deception, lying, or non-disclosure of information
on the other

Justification of Paternalism by consent

The Paternalistic principle will specify precisely which goods, needs and interests
warrant paternalistic protection. In recent formulations, it has been maintained that an
individual or the state is justified in interfering with a person’s action if that interference
protects against his or her extremely and unreasonably risky actions.
Paternalism can be justified only;
 The harms prevented from occurring or the benefits provided to the person outweigh the
loss of independence and the sense of invasion caused by the interference
 The person’s condition seriously limits his or her ability to choose autonomously
  The interference is universally justified under relevantly similar circumstances

Antipaternalistic Individualism
Some believe that paternalistic intervention cannot be justified because it violates
individual rights and unduly restricts free choice. The serious adverse consequences of giving
such power to the state, or to any class of individuals, such as physicians, also motivate
antipaternalists to reject the view that the completely rational person would accept paternalism
under some circumstances.

Strong and Weak paternalism

Joel Feinberg’s distinction between strong and weak paternalism illuminates
disagreement. In weak paternalism, one “has the right to prevent self-regarding conduct only
when it is substantially non-voluntary or when temporal intervention is necessary to establish
whether it is voluntary or not.”
Strong paternalism, by contrast, holds that it is sometimes proper to intervene in
order to benefit a person even if that person’s risky choices are informed and voluntary. Strong
paternalism overrides autonomy: it restricts the information available to a person or overrides
the person’s informed and voluntary choices.

Nature of costs, risks and benefits

Cost are the resources required to bring about the benefit, as well as the negative effects
of pursuing and realizing that benefit. These resources may be financial, or, if they involve time
and energy, they may be statable in monetary terms.
The term risk, by contrast, refers to a possible future harm, where harm is defined as a
setback to interests such as those in life, health and welfare
The term benefit is sometimes used to refer to cost avoidance and risk reduction, but
more commonly in bio-medicine it refers to something of positive value such as life or health

Cost effectiveness and cost-benefit analysis

Cost-effectiveness analysis (CEA) and benefit-cost or cost benefit analysis
(CBA) are two controversial tools of formal analysis. The both CEA and CBA aim to identify,
measure, compare and evaluate all relevant costs and consequences of policies, programs and
technologies in quantitative terms.
CBA – MONETARY TERMS
CEA – QUALITY OF LIFE
Valuing life
In the simplest terms, the value of a life is equivalent to the sum of money that would
have to be invested at the present time in order to pay dividends equal to the sum the person
would earn over the course of an expected lifetime.

Decision – making process; Who decides?

Whether the focus is on decisions in medical practice or on public policies, there are
important questions who rightly decides. The main tension is between those who emphasize
decision making by experts engaged in objective analyses and those who put a premium on
public participation.
1. THE PATIENT
2. THE PHYSICIAN
3. THE GOVERNMENT
4. FAMILY OR RELATIVE

THEY DECIDE ONLY IF CERTAIN CIRCUMSTANCES ARE MET OR THE

PATIENT IS INCAPABLE OF DECIDING FOR HIMSELF.