Beneficence and non-maleficence
The four common bioethical principles
As the principles of beneficence and non-maleficence are closely related, they are discussed together in this section. Beneficence involves balancing the benefits of treatment against the risks and costs involved, whereas non-maleficence means avoiding the causation of harm. As many treatments involve some degree of harm, the principle of non-maleficence would imply that the harm should not be disproportionate to the benefit of the treatment. Respecting the principles of beneficence and non-maleficence may in certain circumstances mean failing to respect a person’s autonomy i.e. respecting their views about a particular treatment. For example, it may be necessary to provide treatment that is not desired in order to prevent the development of a future, more serious health problem. The treatment might be unpleasant, uncomfortable or even painful but this might involve less harm to the patient than would occur, were they not to have it.
In cases where the patient lacks legal competence to make a decision, medical staff are expected to act in the best interests of the patient. In doing so, they may take into account the principles of beneficence and non-maleficence. However, it would be helpful for medical staff in such cases, if the patient lacking capacity had made an advance directive. Nevertheless, as will be seen in the following section on “the position of advance directives alongside current wishes”, problems may arise when there is a conflict between what a person requested in an advance directive and what in the doctor’s view is in their best interests, particularly in cases where it is no longer clear that the person in question would still agree with the decision previously made.
In Western medicine, the principles of beneficence and non-maleficence derive historically from the doctor-patient relationship, which for centuries was based on paternalism. In the last few decades, there has been a change in the doctor-patient relationship involving a move towards greater respect for patients’ autonomy, in that patients play a more active role in making decisions about their own treatment (Mallia, 2003). According to Kao (2002), this is not the same in non-Western medicine. She explains that in Islamic medical ethics, a greater emphasis is placed on beneficence than on autonomy especially at the time of death. Aksoy and Tenik (2002), who investigated the existence of the four principles in the Islamic tradition by examining the works of Mawlana, a prominent Sufi theologian and philosopher, support this claim. They found evidence of all four principles in one form or another, with a clear emphasis on the principle of beneficence. In China where medical ethics were greatly influenced by Confucianism, there is also a great emphasis on beneficence in that Chinese medicine is considered “a humane art, and a physician must be loving in order to treat the sick and heal the injured” (Kao, 2002).
Last Updated: Friday 09 October 2009