So, you’ve got autonomy and beneficence down. What about the other pillars of medical ethics? Today’s post goes over…
Non-maleficence is the sister to beneficence and is often considered as inseparable. It 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.
Tackling a medical ethics scenario with respect to non-maleficence
In order to prevent harm to patients, we therefore need to consider the following aspects:
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 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.
Let’s look at a classic 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, a 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.
First of all, the environment is unlikely to be sterile (as is that manky pen-knife) and so the risk of infection is extremely high.
Second, 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.
Third, assuming that the surgeon has performed an appendectomy before, they have almost certainly never done it at the roadside – and so their experience is decontextualized and therefore not wholly appropriate.
Fourth, 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. As we will see in future articles, in many cases the most harm is often caused with the absolute best of intentions.
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