To continue on from my last blog on Autonomy, today’s piece will walk you through beneficence and how to approach medical ethics questions.
What is Beneficence?
All medical practitioners have a moral duty to promote the course of action that they believe is in the best interests of the patient. This is beneficence.
Often, however, beneficence is simplified to mean that practitioners must do good for their patients – although thinking of it in such a simplistic way can land you in trouble.
For instance, if there are a number of treatments that a patient can have and all of them will provide some benefit which do you choose?
How to approach a question with respect to beneficence
It is better to think of beneficence as the process of ranking the available options for the patient from best to worst – taking into consideration the following aspects:
Will this option resolve this patient’s medical problem?
Is it proportionate to the scale of the medical problem?
Is this option compatible with this patient’s individual circumstances?
Is this option and its outcomes in line with the patient’s expectations of treatment?
You will notice that several considerations are concerned with the patient’s expectations or circumstances. This is also known as holistic or patient-centric care.
It is important to bear the patient’s expectations in mind when ranking treatments because when we refer to doing “good” we are not simply referring to what is medically good for the patient, but also what is acceptable to the human being we are treating.
Let’s look at an example
An 8 year-old child has been admitted to hospital with a significant open fracture to their left leg. The limb is deformed with significant bleeding and the patient is extremely distressed. The parents are demanding immediate action be taken.
There are a number of options for treatment here, but let’s take an extreme one – amputation. If the bleeding is life threatening, the limb injured sufficiently and the risk of infection extremely high then amputation could be a treatment option. It would be “good” for the patient in as much as the injury would be resolved and the threat to life from bleeding or infection somewhat reduced.
But let’s consider the implications of amputation. The treatment would result in a life-changing injury and the risks of infection or massive bleeding aren’t proportionate. The limitations to their physical movement also carry other future risks that could inadvertently result in further physical and mental health issues.
Most important of all, there are other interventions available to us that have better outcomes attached. Using blood products to manage the bleeding, reducing the fracture if possible and orthopaedic surgery if necessary will have better outcomes for this patient. That course of action is “more good” than amputation.
It’s a rather silly example, but I use it to demonstrate an important point. Beneficence asks us to promote a course of action, but in practice we also need to de-promote certain courses of action if there are better options available.
Next up, non-maleficence
Watch out for my next blog on non-maleficence. All you have to do to look out for it is filter the blogs section of The Medic Portal website by ‘Medical Ethics’.