Beneficence and non-maleficence. 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 (Xxxxxx, 2003). According to Xxx (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. Xxxxx and Xxxxx (2002), who investigated the existence of the four principles in the Islamic tradition by examining the works of Xxxxxxx, a promin...
Beneficence and non-maleficence. The term beneficence has been used in literature on biomedical ethics since about 1975 to refer to the principle of balancing the risk of harm to a patient with the possible benefits which might occur as a result of a particular treatment or course of action (Stanford University, 2008). As such, it is not limited to non-maleficence which simply involves not causing harm. This is important as sometimes a certain degree of pain, discomfort or risk is necessary in order to prevent a more serious (and perhaps more painful) condition. When deciding on end-of-life treatment for people with dementia, the risk of developing more serious conditions is perhaps less relevant due to the extremely limited life expectancy of patients. The risks and potential burden involved in any particular treatment are also subject to individual as well as medical interpretation and may be linked in some cases to judgements about the value and quality of life. In the case of palliative care of people with dementia, there is a danger that blanket judgments will be made about the value or quality of life of people with advanced stages of dementia, that insufficient information will be sought about patients’ wishes and that opinions about the value or quality of life may be projections of decision makers’ own feelings about such issues. Justice/equity The principle of “justice/equity” could be described as the moral obligation to act on the basis of fair adjudication between competing claims. As such, it is linked to fairness, entitlement and equality. In health care ethics, this can be subdivided into three categories: fair distribution of scarce resources (distributive justice), respect for people’s rights (rights based justice) and respect for morally acceptable laws (legal justice) (Xxxxxx, 1994). Palliative care services are not particularly well-developed throughout Europe and access to existing services is often restricted to people with cancer. Yet people who are dying with/from dementia are every much as entitled to palliative care as people with cancer.
