The 3rd principle
So as we said this is acting in the
best interest of an individual.
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.
Is it aimed towards the best
interest of the patient?
And so this is like the
flipside of non-maleficence.
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.
So it's the same as non-maleficence in effect of you
don't want to cause harm but you want to do good.
And as I said, another way to think about
benefit is terming it as utility, net benefit.
So, weighing the net benefit
It also means that you want to remove
conditions that would cause harm to others.
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.
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.
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.
In general, there is this
idea of reciprocity.
If you do good for other people,
you'd except the same in return.
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.
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.
So you're just doing it as other
regarding actions just because,
you know, you think it's
important to be altruistic.
But there also may be particular circumstances
where based on the moral relationship
that has been developed, there's
a need to be beneficence.
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.
We call this sort of
fiduciary or a promise.
So, this idea of patient comes
to me, I say how can I help you.
They tell me, you know, their
symptoms, what's going on with them.
I make a diagnosis, I want to perform,
you know, treatment for them.
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.
That creates this need
to be beneficent.
And then also there is this
idea of contractual agreements.
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.
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.
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.
So the 1st level is
the medical good.
So, again, they have come
to us with symptoms,
we've made a diagnosis, we
recommended a treatment.
That treatment is for
their medical good.
We think it's going to help them
with their physical, psychological,
you know problem and that's
going to be the medical good.
The 2nd level of the patient's good is
going to be the individually defined good.
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.
That may or may not
match the medical good.
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.
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.
Just that virtue, that nature of being
autonomous, we want to try to achieve that good.
And then lastly, this 4th
level is the ultimate good.
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.
Some people might think about secular
humanism and the idea of humanity.
What is ultimately meaningful
for them in their life?
That's how they would
define their good.
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.
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.