Subject: Bioethics 2 Topic: Non-Maleficence Lecturer: Date of Lecture:August 6, 2011 Transcriptionist: 10x-9 Editors: It girl no.

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Non-Maleficence y y y Opposite of beneficence To avoid evil/sin As a physician you ought not to inflict evil or harm either by imposition or by actuality Avoid evil and evil consequences unless you have a proportionate reason for risking or permitting them.

continuously knowledge. c. diligence

updating

your

A physician shall obtain consultation and use the talents of other health professionals when indicated. Accepting your limitation in terms of knowledge and skills (eg. for a
particular illness). A physicians obligation to refer

Two justification of Non-maleficence: 1) Human dignity one of the good that almost all patients want.
In terms of treatment, as long as you maintain the patient's dignity then that would be good for them which is supposedly your primary concern as a physician.

patient to other specialist if knowledge is limited(e.gPediatricians

seek talents of other professionals because knowledge is limited.)

2) Risk- Benefit Assessment the focus is on the risk of harm. drugs have certain risks and side effects, thats why before recommending certain drug a physician should be able to know and weigh the harm/side effects of a drug/specific treatment. choosingdrugs with less or minor side effects. assess the risk of harm in recommending drugs, treatments or even procedures. So that before a procedure is done you already have the anticipation of the possible harm of the treatment and be able to disclose this to your patient. 3) Detriment- Benefit Assessment focus on the harms that occur at the time of the procedure or benefit.
e.g major surgical procedures like open heart surgery; some complicated procedures in the abdomen like colon cancerwhere dissecting a lot part of the large and small intestine may cause/ permit death; in terms of drug one eg.ispropofol? (michealjackson's cause of deathaccdg. to docfor insomnia). Pain in colon cancer (in case of former Pres. Cory Aquino) morphine can cause respiratory

2) Patient's Rights there is the right to treatment and that treatment is something that is good and something that has less complication and side effects. Uses of Principle The moral requirement that medical practitioners strive to serve the well-being of the patients: 1) According to the Standards of due care a. proper training to provide competent and quality medical service.
doctors have to train for a long time. (med-school, boards, specialization, training, sub-specialty, 1-2 years research fellowship)

b. skills to continue to study, apply and advance scientific knowledge.

after training, we have to seek more knowledge for more advance technology, specialization, etc.

SY 2011-2012

depression once you give it in a higher dosage. *Your intention for giving such drug is for pain, and not to cause harm/ death on the patient.

in the example above; the primary goal is to alleviate pain not the harm (death). again, informing and disclosing such assessment to the patient is important! ^^ this figures prominently in determining when can an action that cause or permit death be viewed either as non-violation or as justified infringements of the principle. The Impossibility of Avoiding all Evil 1. There is NO escape from all risk and so NO escape from all evil. 2. Because life is social, we are involved in actual evils to a greater or lesser extent.
e.g practicing in a hospital where in they have certain practices that is unethical. You are not involved in the procedure but because you're an affiliated in that hospital, you are involve in a lesser extent thus the physicians who performed the unethical practice has the greater extent.

of attaining the good with less evil or less risk of evil, common sense dictates that the alternative be chosen The good is to be done with the Smallest Amount of Evil Possible. Patient decides on the Treatment he is dependent on the information we give the patient.
E.g Fever; you have many options in treating fever like paracetamol, mefenamic acid, etc. (you have many choices, and all will now depend on the knowledge of the side effects of these drugs).

E.g Infections; there are many

antibiotics that are given to patients as an option but of course there is one which is recommended. For example in typhoid fever, there is a drug of choice (cloramphenicol) but besides that drug of choice there are other choices such as Azithromysin? Which is commonly used also in cases of salmonella.(prangmejo weird?)

B. Level of good intended and the level of the evil risked or permitted. what threatens basic human rights and dignity, life or physical integrity in a major way is serious the hope of a serious good is needed to justify even risking such evils. books/textbooks giving prognosis or occurrence of side effects which inform you the level of good that you'll provide to your patient. if there is a major side effect make sure the good will still outweighs that side effect.
e.g doing surgical procedure which has its major risk (may cause death of the patient) such as bleeding in taking out the colon cancer. The patient should understand/ comprehendall of that by way of your disclosure.

Specifications y Frameworks of specifications: reasons for such

1. Principle of Proportionality provided the action does not go directly against the dignity of the person, there must be a proportionate good to justify permitting of Risking an Evil consequence. the proportionality contained in the principle is to be judged by considering the following four factors: a. Alternatives b. Level of Good and Evil c. Certitude of Good and Evil d. Causal Influence of Agent A. Alternatives Whether there are alternative ways to Attaining the Intended good w/ NO Evil or Less Evil Consequences If there are alternative ways / means

C. Certitude of probability of the good intended or evil permitted or risked. in practice, proportionality involves a very complicated, if not always, precise balancing of the levels of goods and evils with the probability or certainty of those same goods and evils. physicians greatly rely on Statistics and Prognosis.
e.g When we tell the patient that there is a 30% chance of success of a procedure.

D. Causal influence of the agent

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 most effects are results of many causes such that a particular agent is seldom the sole cause of the consequence. in some, the action of a particular agent may be a very minor contributory to the evil. 2. Principle of Double Effect an action, good in itself, has two effects, (1) an intended and otherwise not reasonably attainable good effect and (2) a foreseen but merely permitted evil effect may licitly be placed, provided there is a due proportion between the intended good and the permitted evil. a certain procedure has two effects: a Good Effect + Evil Effect;Good Effect = desired effect; Evil Effect = it is foreseen, BUT it is merely permitted. Principle of Double Effect A person may perform an act which has no or risks evil effects provided the following conditions areverified: The action in itself be good or at least indifferent. The good effect is the one directly intended; the evil effect is only permitted. The good effect must come first before the evil effect (or at least simultaneously) it is NEVER allowed that the good effect is produced by the Bad Effect. That there must be a grave reason for permitting the foreseen evil effect to occur and the proportion between the good that is intended and the evil that is permitted. .The good effect cannot be obtained in some equally expeditious and effective way without the concomitant evil effect.

APPLICATIONS: y Certain rare cases in abortion E.g In the case of ectopic pregnancy. Saving the life of the mother by way of operating the patient which is already the good effect (the first thing you are going to do) thus the consequence would be killing the fetus. E.g In the case of pregnant patient with uterine cancer, taking out the cancer will save the mother thus the consequence would be aborting the fetus (the one directly intended is saving the life of the mother. And the permitted foreseen evil is killing the fetus). gets? y Administration of pain-killing medication at the end of life. Morphine which is used in alleviating pain but causing death by way of respiratory depression. (as mentioned earlier) y y Self-defense Civilian causalities during war.

*the last two are non-medical application for double effect. Principle of Non-Maleficence y Avoid Evil and Evil Consequences unless you have a proportionate reason for risking or permitting them.

-----------END OF TRANSCRIPTION----------If you rely upon God's strength and live a life that's true, then what you do in Jesus' name will be his work through you -D. De haan

*all pong examples na we ve included here are from doc s lecture..we ve tried our best kahitmejomagulo at nakakalito pa din..sori