Beneficence

Dato’ Ahmad Tajudin Jaafar

Allianze College of Medical Sciences
 Principles of Beneficence
Imposes a duty upon doctor to act
always for the good of their
patients
 The very heart of morality
Question: Are we trying to help
or harm?
Answer;
i. Underlying motives
ii. Actual effects or
consequences of action
In Medicine: Uncertainty regarding
outcome of actions

- No advance guarantee
- But motives can be examined by
asking whether or not action is
aimed to benefit the patient
Beneficence is central to most code of
professional ethics e.g. GMC 2001;
“Make The Care Of Your Patient Your
First Concern”
Hippocratic Oath,

“I will prescribe regimen for the good

of my patients according to my ability
and judgment and never do no harm to
anyone”
 What does it mean in practice
“to act for the good of patients”?
Three working approaches to this
question
i. What do we mean by the
“good” of the patient?
ii. Treading the fine line
between beneficence and
paternalism
iii. What is medically good?
 2. Acting in the patient’s best
interests?
In some situation, very straight
forward e.g. patient with chest pain;
meningitis
 Often things are complicated because
of conflict between; health interests
and other important interests that
patient might have e.g. employment
interests, religious interests.
 May be tensions between a person’s
health interests and the other
interests
In secondary and tertiary care, health
problems can be urgent and
overwhelming that patient interests
shrunk to coincide with his health
interests
Doctors have to appreciate and
negotiate these contending interests so
that the patient sees the primary of the
health interest vis a vis others
2. Balance between beneficence and
paternalism
At times, beneficence means taking
charge of patient leading to a morally
justified beneficence to a morally
questionable paternalism
 Differences between beneficence
and paternalism
ii. The way decisions occur
iii. Extent to which patient contributes
to the decisions
v. Attitude of doctor
 3. What is the medical ‘good’?

 Onus on doctor to check which

treatment are effective or not
 Role of EBM (Evidence-Based
Medicine) to clarify issues.
 The Limits of Beneficence
A. Patients driven constraints
 Normally motivated by health
interests
 Conflicts arise when patient’s aim
diverge from doctor
 Patients reject treatment but they
must understand fully, implication
of their decisions
How to tell if a refusal is informed?
i. Patient’s competence
ii. Enough information provided
iii.Voluntary
Even if the patient refuses treatment,
the doctor has demonstrated 3 ethical
roles;
i. Listening - demonstrates a
commitment to care and
trustworthiness
ii. Correct misunderstandings and
misconceptions
iii.Refusal is fully informed
A.Practitioner-driven constraint
and medical responsibility
 Patients request medical services
which doctor consider unnecessary
 Use of EBM guidelines not in the
best interest for patients.
A. External Constraints
 Lack of resources e.g. waiting list
for investigations, referral and
treatments.
 Access to specialists care takes a
long time leading to ethical issues
e.g. patients dying while waiting for
treatment, paying patients
bypassing public patients for
treatment.