Ethical Decisions


BeneficenceVs Nonmaleficence


Teammate1 adopts a more liberal definition of beneficence noting,“Beneficence is the compassion and taking positive action to helpothers, a desire to do good, and a core principle of our patientadvocacy.” This definition conforms to the ethical definitionprovided byDe Roubaix (2011)observing that Beneficence is an ethical principle in clinicalpractice in which physicians have it upon themselves to “do well”to their patients. This is a key principle in medicine with roots inthe Hippocrates. This definition is similar to that provided byTeammate 1 since they both emphasize the “doing of good” topatients and that it is a professional and moral duty of thehealthcare practitioners to observe this principle in the interest oftheir patients. Moreover Teammate 1 notes that “the failure totreat pain or under treatment of pain in older patients can belegally considered as elder abuse (Denny &amp Guido, 2012).” Thisobservation appeals to the legal and professional ethics dimension ofthe beneficence principle.

Aswith nonmalaficence, he observes, “it refers to the avoidance ofharm or hurt to patients.” The definition of nonmalaficence isethically correct since nonmalaficence is an ethical principle thatgoverns the professional conduct of health practitioners such thatthey don’t do harm to their patients while treating them. Moreaptly, “Nonmamaleficence is an ethical principle which requiresphysicians to undertake their duties professionally in such a mannerthat they “do no harm” to patients (Clark&amp Weaver, 2015).” Essentially, the distinction between the two principles for Teammate1 is that in beneficence, the physician is called upon to act in theinterest of the patient while in nonmalaficence, the physician iscompelled to observe safety while dealing with the patient such thatno harm results.


Accordingto Teammate 2, ““Beneficence is action that is done for thebenefit of others. Beneficent actions can be taken to help prevent orremove harms or to simply improve the situation of others.” (StevePantilat, 2008).&nbsp” In this view, beneficence denotes theactions undertaken purely for the benefit of others. This isethically accurate since the majority of ethical definitions of theprinciple emphasizes the aspect of “doing good at the patients’interests.” Essentially, in performing medical procedures, theoperational interest should be the patient’s good. Ethicalliteratures on this principle, however, posit, obligatory beneficenceinvolves acting for the benefit of others subject to certainoperating elements (Cummings&amp Mercurio, 2010).Here, the definition provided by Teammate 2 is ethically correct,only that it fails to observe that there are exceptional cases andcontexts within which this principle operates. This is especiallytrue in medical practice since physicians are exempted frompracticing ideal beneficence (DeRoubaix, 2011).

Teammate2 defines nonmalaficence briefly and concisely i.e. “Nonmalaficencemeans to “do no harm.” This definition is apt since ethically,Nonmamaleficence, on the other hand, is an ethical principle whichrequires physicians to undertake their duties professionally in sucha manner that they “do no harm” to patients (Cummings&amp Mercurio, 2010).Further, Teammate 2 posits, “Physicians must refrain from providingineffective treatments or acting with malice toward patients. Thisprinciple, however, offers little useful guidance to physicians sincemany beneficial therapies also have serious risks. The pertinentethical issue is whether the benefits outweigh the burdens (StevePantilat, 2008).” This is ethically correct since the principle ofnonmalaficence and balancing between it and beneficence involves acost-benefit analysis (Anderson et al, 2010).


Teammate3 begins by providing distinctive definitions to both beneficence andnonmalaficence writing, “nonmaleficence is to do no harm whilebeneficence is to bring about goodness (Purtilo, R., &amp Doherty,R., 2011).” In this definition, beneficence denotes a medicalpractice that calls on the practitioners to act in a manner that doesgood to the patient while nonmalaficence implies a practice thatavoids harm. Both definitions are ethically accurate give the ethicaldefinitions provided by Cummings&amp Mercurio (2010), Andersonet al (2010) and DeRoubaix (2011) which all emphasize “doing good” in observing thebeneficence principle and “avoiding harm” to the patient byphysicians in carrying out their professional duties.

Teammate3 comes across as more effective in identifying the variables thatimpinge on the ideal and real practice of the two principles inhealthcare practice. This is especially in the significance ofproviding the patient with “adequate information” concerning theprocedures involved. This is clear in his experience thus: “Anexample of nonmaleficence in my work setting is to be completelyhonest and keep patient informed on the services they requested asall services are based on medical necessity. For example, a patientmay ask for a hospital bed in their home, if there is not sufficientdocumentation for the patient’s PCP stating medical need, themember may be denied this service. Doing no harm in the case for mewould be to explain this process to the patient and advocate byproviding community resources for the request in exchange orassisting in an appeal process or a fair hearing so that members willhave a say in what their needs are and why they feel they need theservice.”


Adoptinga similar fashion of introducing beneficence and nonmalaficence,Teammate 4 adopts the definition that “beneficence is the duty todo good while nonmaleficence is preventing harm or to do no harm(Purtilo &amp Doherty, 2012).” According to the definitionsadopted by Teammate 4, beneficence denotes a medical practice thatcalls on the practitioners to act in a manner that does good to thepatient while nonmalaficence implies a practice that avoids harm.Both definitions are ethically accurate give the ethical definitionsprovided by Cummings&amp Mercurio (2010), Andersonet al (2010) and DeRoubaix (2011) which all emphasize “doing good” in observing thebeneficence principle and “avoiding harm” to the patient byphysicians in carrying out their professional duties. However,Teammate 4 goes ahead to observe, “in practicing the ethicalprinciples, physicians must take note of the fact that at any onepoint, one principle can supersede the other depending on theprevailing situations.” This implies that there are certainexternal considerations that have to be made in conducting acost-benefit analysis of the two principles, which is ethicallyacceptable.

Moreimportantly, the case scenario provided by Teammate 4 illustrates anethically accurate decision based on the prevailing condition, whichbreached a principle, but acted in the “best interest” of thepatient. He notes, “Forexample, when a patient comes in with a bowel obstruction andrequires an NG tube to be placed in order to alleviate somediscomfort or prevent complications, as well as, seeking to providethe least invasive intervention as possible. Although placing an NGtube is an intervention being considered to prevent further harm dueto the bowel obstruction and will benefit the patient if the patientresponds favorably, there is the potential to cause harm as well.Thus, the treatment was decided upon based on intentions to do good,but if the patient becomes harmed due to the procedure such asaspiration or tissue trauma causing an active bleed. This wouldviolate the ethical principle of preventing harm, but weighing therisks and benefits is always an important step. If the interventionis deemed to provide more benefits than harm, it would be in thepatient`s best interest to procedure.”


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