Principle of Beneficence

by Mark Hughes, MD, MA

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    00:01 The 3rd principle is beneficence.

    00:04 So as we said this is acting in the best interest of an individual.

    00:09 And that is both for the individual acts that we perform for a patient, but also for the practice of medicine, the practice of nursing, the practice of healthcare.

    00:19 Is it aimed towards the best interest of the patient? And so this is like the flipside of non-maleficence.

    00:27 So, there is the idea of performing positive actions, doing things that will be beneficial but the other aspect of beneficence is refraining from negative actions.

    00:38 So it's the same as non-maleficence in effect of you don't want to cause harm but you want to do good.

    00:46 And as I said, another way to think about benefit is terming it as utility, net benefit.

    00:52 So, weighing the net benefit against non-maleficence.

    00:57 It also means that you want to remove conditions that would cause harm to others.

    01:02 So, if you know that persons in a situation that could be harmful to them, you want to try to prevent that, prevent that harm from occurring to them.

    01:13 And if they are in actual danger, you know, they are taking a course of action that you know is dangerous to them based on your medical expertise, you want to rescue that person in danger.

    01:28 Why should you be beneficent? Why is it important to act in the best interest of the individual? Well, you know, in philosophy we think about various reasons.

    01:39 In general, there is this idea of reciprocity.

    01:42 If you do good for other people, you'd except the same in return.

    01:45 So this idea of reciprocal action if you're acting for the benefit of the other person, they're going to act towards the benefit of you.

    01:55 There's also this idea of altruism or philanthropy, love of the other person, love of humanity, the idea of you want to be charitable to the other person may be moved out of benevolence, out of love for the other person.

    02:10 So you're just doing it as other regarding actions just because, you know, you think it's important to be altruistic.

    02:19 But there also may be particular circumstances where based on the moral relationship that has been developed, there's a need to be beneficence.

    02:28 So, are you fulfilling an institutional role and therefore, you know, the relationship that is developed requires, obliges you to act towards the other person's benefit.

    02:39 We call this sort of fiduciary or a promise.

    02:43 So, this idea of patient comes to me, I say how can I help you.

    02:48 They tell me, you know, their symptoms, what's going on with them.

    02:52 I make a diagnosis, I want to perform, you know, treatment for them.

    02:57 My institutional role, the role that's been developed as a result of they're a patient, I'm a doctor, I said I'm going to help them.

    03:06 That creates this need to be beneficent.

    03:10 And then also there is this idea of contractual agreements.

    03:13 So, it's not, you know, just the idea of in the practice of medicine has this own internal morality and the nature of the relationship means that we are obliged to help the other person.

    03:24 But maybe there is actual contract where we signed on the dotted line of we need to fulfill our contractual agreement to be beneficent toward the other person.

    03:36 The way I generally think about beneficence is 4 levels of the patient's good and all of this is done for the patient's good.

    03:44 So the 1st level is the medical good.

    03:46 So, again, they have come to us with symptoms, we've made a diagnosis, we recommended a treatment.

    03:52 That treatment is for their medical good.

    03:55 We think it's going to help them with their physical, psychological, you know problem and that's going to be the medical good.

    04:05 The 2nd level of the patient's good is going to be the individually defined good.

    04:10 So, that person that comes from their own cultural background, their own, you know, sense of who they are in the world has their own individually defined good.

    04:19 That may or may not match the medical good.

    04:22 You know hopefully they do line up, but there may be times where a patient says, you know, what's more important to me is my other defined goods in my life, not so much the medical good that you are proposing as the clinician.

    04:35 The 3rd level of good is the idea of just the fact of we want to respect people's autonomy and being able to make their own decisions even if it might, you know, disagree with what we think is medically good for them.

    04:48 Just that virtue, that nature of being autonomous, we want to try to achieve that good.

    04:56 And then lastly, this 4th level is the ultimate good.

    05:00 So, again, how does that person define what is ultimately good for them? Some people might rely on religious tradition to define that, a sense of a higher being.

    05:11 Some people might think about secular humanism and the idea of humanity.

    05:17 What is ultimately meaningful for them in their life? That's how they would define their good.

    05:23 Now the hope with all 4 levels of the good is that they will line up, that they all will match up and you can achieve all of those 4 levels for an individual patient.

    05:34 But sometimes there may be disagreements of what you want to try to achieve medically with what the person defines as good for them or make a different decision based on their own wishes or their own ultimate good.

    About the Lecture

    The lecture Principle of Beneficence by Mark Hughes, MD, MA is from the course Introduction to Clinical Ethics.

    Included Quiz Questions

    1. Acting in the best interests of an individual
    2. Acting in the best interests of yourself
    3. Sacrificing the interests of one person to benefit many others
    4. Serving others for your financial benefit
    5. Serving yourself without recognizing its effect on others
    1. Reciprocity
    2. Nepotism
    3. Narcissism
    4. Greed
    5. Espionage
    1. Medical good, individually defined good, good as an autonomous person, ultimate good
    2. Poor, fair, good, excellent
    3. Medical good, individually defined good, my good, physician's good
    4. Medical good, individually defined good, my good, absence of good
    5. Political good, individually defined good, autonomous good, absence of good

    Author of lecture Principle of Beneficence

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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