Canadian Bioethics Society. Parliament of Canada - Research Publications. Impact Ethics Dalhousie University. ICN Position Statements. End-of-Life Decision Making. Bill C medical assistance in dying. Respecting Choices in End-of-Life Care. Insite Clinic Vancouver. Salome Insite Clinic. Insite Clinic Interview. Summary of Vancouver Insite Clinic Program. Pharmacare Trillium Gift of Life Network. Nurses' Ethical Considerations in a Pandemic.
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The Principle of Beneficence in Applied Ethics
Contact us or visit us on. Applied health ethics books or reference sources. News reports, health ethics websites Canadian. Applied health ethics books Scholarly journals health ethics websites. Current contextual example. Therapeutic termination, Skewed gender ratio in a population. Religion, culture, beliefs. Explain ethical dilemma. State contradicting ethical principles. However, it does not follow that we should give up a principle of beneficence.
It only follows that establishing the moral limits of the demands of beneficence is profoundly difficult. An individual is only required to aid others beneficently at the level that would produce the best consequences if all in society were to give their fair share. One is not required to do more even if others fail to act on their fair-share obligations of beneficence, and it would be an unfair imposition of responsibility to ask more of them.
Unlike act-consequentialism, this theory does not demand more of agents when non-complying agents fail to do their part. Murphy seems right to suggest that large-scale problems requiring beneficence should be conceived as cooperative projects, but his limit on individual obligations seems unlikely to have a practical effect of increasing international aid and the like beyond present commitments and levels. The more demanding a principle is, the less likely are people to comply with its demands.
Singer has defended his arguments about beneficence, with a somewhat sympathetic response to Murphy. Singer seems concerned with which social conditions will motivate people to give, rather than with attempting to determine obligations of beneficence with precision. Unless we draw the line here, we might not be able to motivate people to give at all.
The emphasis on motivation is presumably intended to provide a more subtle and convincing approach to increasing charitable donations even though the nature and limits of beneficence should be set by his utilitarian moral theory, as he has always proposed. Wherever the line of precise limits of obligatory beneficence is drawn, the line is likely to be revisionary of ordinary morality.
A variety of proposals regarding the limits of beneficence have been made by philosophers, but no agreement exists on even a single general principle. Given this situation, some now doubt that ethical theory and practical deliberation are equipped to establish precise conditions and limits of obligations of beneficence, especially when confronting problems of global poverty. Various principles commonly assumed to be moral principles have been advanced to justify the limitation of individual liberties.
Feinberg agreed with Mill that the principle of paternalism , which renders acceptable certain acts intended to benefit another person when the other does not prefer to receive the benefit, is not a morally acceptable liberty-limiting principle. The term paternalism has its roots in the notion of paternal administration—government as by a father to administer in the way a beneficent father raises his children. An act of paternalism, then, overrides moral obligations to respect autonomous choice on grounds of beneficence.
Philosophers divide sharply over whether some restricted form of paternalism can be justified and, if so, on what basis. In this account preventing minor harms or providing minor benefits while deeply disrespecting autonomy lacks plausible justification; but actions that prevent major harms or provide major benefits while only trivially disrespecting autonomy have a plausible paternalistic rationale. Though no consensus exists over the justification of paternalism, virtually no one thinks that benefit paternalism can be justified unless at least the following conditions are satisfied:. Debates about benefit paternalism have also emerged in public policy contexts.
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Often health policies have the goal of avoiding a harm or providing a benefit in a population in which most affected parties are not consulted. Some percentage of the population will not support the policy because they are given no choice in the matter, whereas others will approve the policy. In effect, the policy is intended to benefit all members of a population without consulting the specific preferences of the individuals affected—all the while foreseeing that many individuals will in fact reject the imposed control that the policy exerts over their lives.
So-called libertarian paternalists or neopaternalists , principally the team of Cass Sunstein and Richard Thaler, have argued for government and other institutional policies intended to protect or benefit individuals through shaping, steering, or nudging their choices without altogether disallowing or coercing those choices.
These policies pursue values that an intended beneficiary allegedly already holds, at least implicitly, but does not realize because of limited capacities, limited resources, or limited self-control. Since they already embrace these values, their autonomy is not violated despite the paternalism at work. This conception must confront two major problems: The first is conceptual. It is head-scratching how a libertarian can be a paternalist in the standard senses of these terms. It would be improper to assert that he supports the current platform of the party he has always supported in the past.
Since the late s, principles of beneficence have been a mainstay of the literature of biomedical ethics. Persons engaged in medical practice, research, and public health appreciate that risks of harm presented by interventions must often be weighed against possible benefits for patients, subjects, and the public. Their professional obligations are deeply informed by their commitments to prevent or reduce harm and to produce a positive balance of goods over inflicted harms.
The principle of beneficence plays a foundational role in the framework of research ethics and federal regulations in the United States and beyond. The Belmont Report has provided the basic moral framework for research ethics in the United States. This commission was established in by the U. Congress with a charge to discover and publish the basic principles of human research ethics and also to "consider" the boundaries between biomedical research and accepted medical practice. The commission found that beneficence is one of only three basic principles of research ethics.
This principle soon became and remains today one of three canonical principles in American research ethics governing research funded by the federal government. The three basic principles are 1 respect for persons, 2 beneficence, and 3 justice. In this context, the principle of beneficence is understood as an abstract norm that includes derivative rules such as "Do no harm," "Balance benefits against risks," and "Maximize possible benefits and minimize possible harms.
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As one major demand of beneficence, the National Commission required that during the course of the ethical review of research protocols there be arrayals of data pertaining to benefits and risks and of alternative ways of obtaining the benefits if any sought in the research.
It also demanded that systematic and nonarbitrary presentations of risks and benefits be made to subjects, as part of the informed consent process, and that assessments of risks and safeguards be considered by ethics committees when they evaluate whether research protocols are justified. The moral concern is that some subjects, notably children, would be overburdened and possibly disturbed or terrified. However, the commission recognized that risks must be permitted during the course of many forms of research, including pediatric research, in order for investigators to be positioned to distinguish harmful from beneficial outcomes.
Today, the problem might be expressed in terms of the need for investigators to determine the safety or effectiveness of a therapy or diagnostic tool under investigation in a study. This understanding of beneficence and its role in protecting human subjects is deeply embedded at the core of research ethics in many countries.
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Beneficence has played a major role in a central conceptual issue about the nature and goals of medicine as a social practice. If the end of clinical medicine is healing, which is a goal of beneficence, then arguably medicine is fundamentally a beneficent undertaking, and beneficence grounds and determines the professional obligations and virtues of the physician. Authors such as Edmund Pellegrino write as if beneficence is the sole foundational principle of professional medical ethics.
In this theory, medical beneficence is oriented exclusively to the end of healing and not to any other form of benefit.
The category of medical benefits does not, for Pellegrino, include items such as providing fertility controls unless for the prevention and maintenance of health and bodily integrity , performing purely cosmetic surgery, or actively helping a patient to effect a merciful death by the active hastening of death.
This characterization of the ends of medicine allows Pellegrino to limit severely what counts as a medical benefit for patients: Benefit in medicine is limited to healing and related activities such as caring for and preventing injury or disease. This thesis is controversial.
Even if healing and the like are interpreted broadly, medicine does not seem to many in bioethics to have such precise boundaries. If these are bona fide medical benefits, how far does the range of benefits extend? If a physician runs a company that manufactures powered wheel chairs for the elderly, does this activity supply a medical benefit?
When physicians consult with an insurance company about cost-effective treatments that save their patients money, is this activity a beneficent component of the practice of medicine?
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Controversy over the ends of medicine requires decisions about what is to count as the practice of medicine and, derivatively, what counts as medical beneficence.