Medical Ethics: Non-Maleficence

What Is Non-Maleficence?

Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics.

Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence.

How Is Non-Maleficence Different to Beneficence?

Non-maleficence differs from beneficence in two major ways.

First of all, it acts as a threshold for treatment. If a treatment causes more harm than good, then it should not be considered. This is in contrast to beneficence, where we consider all valid treatment options and then rank them in order of preference.

Second, we tend to use beneficence in response to a specific situation – such as determining the best treatment for a patient. In contrast, non-maleficence is a constant in clinical practice. For example, if you see a patient collapse in a corridor you have a duty to provide (or seek) medical attention to prevent injury.

 Non-Maleficence Example

One of the best ways to understand the difference between non-maleficence and beneficence is by looking at an ethical example:

A 52-year-old man collapses in the street complaining of severe acute pain in his right abdomen. A surgeon happens to be passing and examines the man, suspecting that he is on the brink of rupturing his appendix. The surgeon decides the best course of action is to remove the appendix in situ, using his trusty pen-knife.

From a beneficence perspective, successful removal of the appendix in situ would certainly improve the patient’s life.

But from a non-maleficence perspective, let’s examine the potential harms to the patient:

• The environment and the pen-knife are unlikely to be sterile, so the risk of infection is high.
• The surgeon has no other clinical staff available or surgical equipment, meaning that the chances of a successful operation are already lower than in normal circumstances.
• Assuming that the surgeon has performed an appendectomy before, they have almost certainly never done it at the roadside – and so their experience is decontextualised and therefore not wholly appropriate.
• Unless there isn’t a hospital around for miles, this is an incredibly disproportionate intervention..

Again this is a rather silly example but it is important to remember that before leaping to action, we need to consider the implications and risks of intervening at all.

Discussing Non-Maleficence At Interview

Ethics will come up in your interview, and you need to think about non-maleficence. You should consider:

• What are the associated risks with intervention or non-intervention?
• Do I possess the required skills and knowledge to perform this action?
• Is the patient being treated with dignity and respect?
• Is the patient being put at risk through other factors (e.g. staffing, resources, etc)?

Non-Maleficence Questions

Some questions you could be asked at an interview include:

• Does euthanasia have a place in modern Medicine?
• What are the ethical issues associated with abortion?
• What are the ethical issues if a 14-year-old patient asks her GP for the oral contraceptive pill?

You can find the answer to these questions – and more – in our ethics questions and answer guide.

Hot Topics

Some hot topics that would apply to non-maleficence include:

• Inequalities suffered by the BAME community
• Public health interventions
• Mental health services
• Medicinal cannabis prescriptions