Lecture notes, lecture Beneficence & Non-maleficence PDF

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NON-MALEFICENCE:  

ABOVE ALL DO NO HARM

The cornerstone of health care on which practices and legislation relating to duty of care, negligence and malpractice are based. A person who is treated by a health practitioner should not be worse off as a result of their treatment than when they initially presented.

PRINCIPLES OF NON-MALEFICENCE     

Focuses on actions which either permit or cause or intend to permit or cause, harm or risk of harm. Includes failure to act in situations that permit, cause or risk harm. Obligation not to injure versus the obligation to help In most cases non-maleficence is more stringent than beneficence Research – not to injure but when injured then a duty of beneficence to rescue – ergo beneficence is more stringent

RULES OF NON-MALEFICENCE     

Do Do Do Do Do

not not not not not

kill cause pain incapacitate cause offense deprive others of the goods of life

HARM    

Harm may include injury, injustice, violation of rights... Harm to one person may not mean harm to another. Harm may be physical, psychological or financial (or a combination of these). Harm may be intentional or unintentional

NON-MALEFICENCE DUTY OF CARE  

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Obligation not to harm Legal duty of care in negligence o Breach of duty of care o Violates the principle of non-maleficence Treat or not to treat – professional codes, the law, institutional and religious traditions

WITHHOLDING VERSUS WITHDRAWING OF TREATMENT

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Moral dilemma – when should treatment be withheld or withdrawn? Criteria? Burden versus benefit (outcomes) Excessively burdensome treatment? Who decides?

ORDINARY VERSUS EXTRAORDINARY TREATMENT  

Ordinary – offers hope of benefit without excessive pain, expense and inconvenience. Extraordinary – no reasonable hope, expensive and painful.

INTENDED EFFECTS VERSUS FORSEEN EFFECTS  

The doctrine (rule) of double effect Intention of the act must be to do good.

DOCTRINE OF DOUBLE EFFECT     

The action must be good in itself Intention - only the good The bad effect can be foreseen, tolerated and permitted but must not be intended. The bad effect must not be a means to a good effect, the good and evil must follow from the same action. There must be a favourable balance of good over evil effects of the action.

OPTIONAL VERSUS OBLIGATORY TREATMENT     

Need to analyse the quality of life. Obligatory to treat (wrong not to treat) Obligatory Not to treat (wrong to treat) Optional to treat Life sustaining treatment can violate a patient’s interest.

FUTILITY 

Must consider futility of treatment – futile treatment is not obligatory.

BURDENS VERSUS BENEFITS     

The riskiness of the treatment The excessive pain, discomfort or distress of the treatment The severely negative impact that the treatment will have on the patient’s life Treatments judged morally or psychologically repugnant and Treatments which would be too costly in terms of the patient or family.

QUANTITY VERSUS QUALITY OF LIFE 

Quality of life shifts the focus on whether the treatment is beneficial to whether the patient’s life is beneficial – allows for active involuntary euthanasia.

KILLING VERSUS LETTING DIE    

Euthanasia – “eu” happy or good – “thanatos” death. Active – assisting a person in their death Passive – withdrawing or withholding life sustaining treatment Voluntary – proceed with the informed consent of the person Involuntary – proceed without consent

LETTING SOMEONE DIE VS KILLING 

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(letting someone die) Justified when o Treatment is futile o Refusal of treatment by patient or surrogate. o If conditions are not met = negligence  Breach of duty to the patient Killing is a prima facie wrong, but letting someone die can be justified in some circumstances.

SCOPE OF PATIENTS RIGHTS 

Patients can refuse treatment and die but not allowed to receive assistance to die.

SLIPPERY SLOPE ARGUMENT 

Conceptual argument where concepts and distinctions used in moral and legal rules are vague and may lead to unanticipated outcomes.

PSYCHOLOGICAL CONSIDERATION   

Anyone in severe pain may make a wrong decision May lead to involuntary euthanasia Minority groups may be disadvantaged e.g. mental health patients.

BENEFICENCE       

Comes from the Latin word ‘beneficus’ ‘Bene’ meaning “well” or “good” ‘facere’ meaning “to do” Above all, do good Prima facie principle Establishes an obligation to help others Allows for autonomy

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Central to utilitarianism – principle of utility – the greatest good… Kant – an imperfect duty Ross – prima facie duty

CONCEPTS    

Action to benefit others Acts of beneficence include mercy, altruism, empathy, charity, kindness to others. Balance probable outcomes of the action with risk, costs and possible harms. Positive beneficence does support specific moral rules of obligation.

RULES OF BENEFICENCE       

Protect and defend the rights of others Prevent harm occurring to others Remove conditions which will cause harm to others Help people with disabilities Rescue a person in danger Specific beneficence: Directed to specific parties such as children, friends and patients. General beneficence: Goes beyond these relationships. This obligation is more controversial and can be demanding or generate philosophical debate....