BIOETHICS: REPORT

Beneficence
The term beneficence refers to actions that promote the wellbeing of others. In the medical context, this means taking actions that serve the best interests of patients. However, uncertainty surrounds the precise definition of which practices do in fact help patients. James Childress and Tom Beauchamp in Principle of Biomedical Ethics (1978) identify beneficence as one of the core values of health care ethics. Some scholars, such as Edmund Pellegrino, argue that beneficence is the only fundamental principle of medical ethics. They argue that healing should be the sole purpose of medicine, and that endeavors like cosmetic surgery, contraception and euthanasia fall beyond its purview.

Beneficence and Best Interests The principle of beneficence highlights the moral importance of doing good to others. When a patient is unable to make an autonomous choice the health professional has a duty of beneficence. Beneficence is usually considered to rely on an objective view of what would be best for the patient whereas respect for autonomy identifies what the patient subjectively considers to be in his/her best interests. The concept of 'best interests' is linked to well-being / beneficience but includes considerations wider than purely medical risks and benefits such as the religious and cultural interests of the patient. This implies a duty to discover if possible what the patient would have wanted or what is likely to be appropriate in the context of this patients particular life. Thus respecting the patient as an individual person (or respecting his/her autonomy) is an intrinsic part of the process of determining best interests. There is generally no conflict between beneficence and the principle of respect for autonomy - most patients would choose the course of treatment that is objectively considered to be in his/her best interests. However difficulties arise where the view of a competent adult patient as to what is in his/her best interests conflicts with medical opinion - for example where a Jehovah's Witness patient refuses treatment using blood products. The principle of respect for patient autonomy overrides the principle of beneficence in a competent patient. If the patient is unconscious, then knowledge of what he/she would have wanted in the circumstances is part of the assessment of what is in his/her best interests. If the patient is able to communicate but is not competent

to make the particular decision, the health professional should still seek to ascertain any wishes, preferences and values of the patient that may be relevant to the decision. It may be helpful to consider how judges in legal cases have used the concept of best interests.

Beneficence and nonmaleficence

Beneficence means to do good, not harm, to other people. Nonmaleficence is the concept of preventing intentional harm. Both of these ethical concepts relate directly to patient care. In the American Nurses Association Code for Nurses, there is a specific charge to protect patients by specifying that nurses should report unsafe, illegal, or unethical practices by any person. Nurses are often faced with making decisions about extending life with technology, which might not be in the best interest of the patient. Often the concept of weighing potential benefit to the patient against potential harm is used in making these difficult decisions, along with the patient's own stated wishes.
Beneficence The second principle, beneficence, is at the heart of everyday nursing practice.Beauchamp and Childress (1994) state that "Each of ...[the following] three forms of beneficence requires taking action by helping--preventing harm, removing harm and promoting good...." (p. 192). The principle of beneficence may give rise to ethical issues when there is conflict between what is good between nurse and patient, between patient and organizations, between patients themselves, or between states engaged in interstate practice. Differences that may have ethical implications include: financial reimbursement, approved services, different laws on reporting sexually transmitted diseases or abuse, and protocols from whom nurses can accept orders. While most agree in principle that a patient's good comes before the organization's or nurse's good, nurses often confuse what is good for the patient with what the nurse believes is good for the patient. At debate is what constitutes good for a patient without infringing on the patient's autonomy or letting the patient come to serious harm. Is it ethical to overrule your patients' preferences? Beauchamp and Childress (1994, pp. 277-278) argue that paternalism can be examined as "weak" or "strong." Weak paternalism infers that the health care provider is protecting the patient when the patient is unable to make decisions due to problems such as depression or the influence of medications. On the other hand, "Strong paternalism...involves interactions intended to benefit a person despite the fact that the person's risky choices and actions are informed, voluntary, and autonomous" (Beauchamp & Childress, 1994, p. 277). Relevant to this discussion is whether possible state differences about when a patient is impaired may bring up ethical issues for nurses who are in positions where they provide care to patients with impaired decision-making capabilities.