BENEFICENCE

Objectives
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

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

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

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

Beneficence
The impossibility of doing all good - this arises from limitations of: 1. The nature of time and space 2. Ones own limitations. 3. The state of the art in a given area as well as the availability of state of the art tools.

Beneficence
Doing good and avoiding evil is no simply a question of principles but of practical wisdom weighing the relevant aspects of the factual and social situation as well as the concrete meaning of human dignity in a particular time and space

Beneficence
Specification The things necessary for the person to remain human and maintain dignity are the top of the list of goods to be done.

Beneficence
Limits 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

Beneficence
Limits 1. Talent There is tension between respecting freedom and securing what a health care professional may consider the best interests of the patient.

Beneficence
Limits 2. Most goods we have to do are specified by: Law Custom Relationship and roles Agreements

Beneficence
Patients Good: The ultimate good The biomedical good The patients concept of his own good: his

best interest
The good of the patient as a human person

capable of reasoned choices

Beneficence
The 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 patients view of his own good

Beneficence
The 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

Beneficence
The Patients View of his Own Good
The patients subjective assessment of the quality of life the intervention might produce; Whether of not this quality of life is consistent with the patients life plan and goals; The patients 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.

Beneficence
The 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 patients view of his own good

Beneficence
Paternalism

Involves acting without consent. Or even

over-riding the patients wishes, wants or actions, in order to benefit the patient or at least to prevent harm to the patient

Beneficence
Two (2) Elements of Paternalism

The absence of consent or the over-riding

of consent
The beneficent motive

(the welfare of the patient)

Beneficence
Strong Paternalism

Also called extended paternalism The health care provider attempts to

override the wishes of a competent person

Beneficence
Weak 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

Beneficence
Weak Paternalism

Sometimes called cooperative paternalism

when one of its purposes is to restore the persons competence so that the patient may give informed consent.

Beneficence
Strong paternalism is ethically rejected

The competence of an individual to make

decisions for another competent individual would require both a knowledge of the other persons values and of all the factors

Beneficence
Strong paternalism is ethically rejected

Health care professionals do not have the

right to enforce value judgments on the patient on the grounds that doctor knows best.

Beneficence
Strong paternalism is ethically rejected

It would be a rare health care professional

who knew all the factors influencing the life of the patient.

Beneficence
It is NOT paternalism:

When the health care provider acts to

prevent the patient from causing serious injury to others.

Beneficence
It is NOT paternalism:

If the health care professional overrules the

patient for the convenience or profit of the provider.

Beneficence
It is NOT paternalism:

If the health care professional refuses to go

along with the patients wishes because these wishes are against the conscience or professional standard of the provider,

Beneficence
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.

Beneficence
Paternalism is justified:

If the persons condition seriously limits

his/her ability to choose autonomously.

If the interference is universally justified

under relevantly similar

Beneficence
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

Thank You!