Subject: Bioethics Topic: Beneficience Lecturer: Dr.

Melchor Vrias Date of Lecture: 29 July 2011 Transcriptionist: Gluttinoids Pages: 3

BENEFICENCE
One has the obligation to help others further their important and legitimate interests. The term beneficence refers to actions that promote the wellbeing of others. In the medical context, this means taking actions that serve the best interests of patients. One of the obligations of the physician and other health care professionals is TO DO GOOD and to do everything to benefit the patient Not absolutely good, there are some risks in every procedure that are unavoidable Always do good as a physician

You would need other to ask help from other physicians. Referral is also an obligation of the physician 3. The state of the art in a given area as well as the availability of state of the art tools. Limited by equipment and facilities If assigned in a barrio, there are limitations in terms of diagnostic test a physician can request as well as th availability of medications 4. Ones obligation to avoid evil Sometimes we cannot avoid evil in the course of the treatment o Ex: Adverse effects of drugs are inevitable, but the drug is necessary and will do more good than harm The physician must inform the patient or the significant other about the risks (both known and unknown risk) Beneficence Doing good and avoiding evil is NOT simply a question of principles but of practical wisdom of knowledge, skills, and common sense weighing the relevant aspects of the factual and social situation as well as the concrete meaning of human dignity in a particular time and space You have to weight certain aspects, such as the patients social situations, how the treatment affects the relatives, the patient per se and the meaning of his dignity in a particular time and place In doing good, consider the dignity of the patient. Always treat patient as a Human Being o E.g: In a brain dead patient, the relatives may say to continue treatment.. But the doctor must explain that continuing with the treatment can be harmful.

Implications of Beneficence 1. There is an obligation to confer benefits that is, doing or promoting good, and actively to prevent and remove harm or evil. The physician should be able to identify both the benefits and harm that could be brought about by the procedure/treatment The treatment should be more beneficial than harmful to the patient. As a student, we should be mindful for we have all the preparations, to be able to discern in the future what is good and what is harmful. 2. There is an obligation to weigh and balance the possible good against the possible harm. There is always a certain degree of harm in every procedure you perform in your patient. Make sure that the benefits outweighs the harm Recommend something that is better or more beneficent The impossibility of doing all good - this arises from limitations of: 1. The nature of time and space Doctors hold many clinics and manages many patients in different places and hospitals Distance limitation the physician will not be able to attend a patient may be if he is at home or at different place 2. Ones own limitations. Limitations of a physician depends on the physician's expertise or specialization.

SPECIFICATION OF BENEFICIENCE
The things necessary for the person to remain human and maintain dignity are the top of the list of goods to be done. It would be more important for the patient to die with dignity especially in terminal cases. For instance, they would rather die at home than stay in the hospital. 1

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patients, in this case the employees, as indicated by the company Limits of Specification 1. Talent It is a matter of situations in which the effort to do good/better or to preserve the good may conflict with the good of other human beings o As physicians, sometimes you really want to do good, but keep in mind that the patient and his relatives have the right to choose, this includes their choice to refuse the treatment. o So no matter how much you want to do good, the obligation to do good is over ridden when the patient or the relatives doesnt want to continue with the treatment. o Betterment of Patient < Betterment of the Family - Ex. when treatment is expensive & would bankrupt the patients family patient forgoes treatment) There is tension between respecting freedom and securing what a health care professional may consider the best interests of the patient. o Medical benificence can come in conflict with the autonomy of the patient. o You may know what is best for the patient, but the patient's autonomy dictates that he doesn't want to continue with the treatment. o Autonomy of the patient shall prevail, given that the patient is competent. 2. Most goods that we have to do are specified by: a. Law Law: patients right Law of childs abuse Doctors are required to report child abuse. b. Custom Some customs and principles limit your obligation to do good o Custom includes tawas, can't take a bath during menstrual periods. o Religion Cannot do blood transfusion on Jehovas witnesses; one religion forbid medical intervention c. Relationship and Roles doctor-patient relationship, patientrelative relationship, patient-spouse relationship can be limiting d. Agreements Agreements like contracts. Example, company physicians are limited by the fact that they should disclose certain information regarding his PATIENTS GOOD Take the following into consideraration because patients use one or combination of these goods in making a decision: 1. The Ultimate Good The meaning and destiny of human existence; The positions taken with reference to relationships with other human beings, the world and God; The ultimate concern the one to which we turn for final justification of our acts if all secondary or intermediate reasons fail If the other good fail this would be our last resort, to turn to our Creator. This value supersedes the biomedical good and the patients view of his own good 2. The Biomedical Good The good that can be achieved by medical intervention into a particular disease state; The statement of what can be achieved based on strictly scientific and technical assessment Ultimate good supercedes the medical good The good that is usually used by health care professionals o The biomedical good is the basis of the physicians on why a patient should follow the decisions of the physician 3. The Patients View of his Own Good: His Best Interest The patients subjective assessment of the quality of life the intervention might produce; Whether of not this quality of life is consistent with the patients life plan and goals; The patients life plan is highly personal The choices that are to be made according to his life plan may run counter to biomedical good or what the physician thinks is a good life for the patient. The initial good the patient use If an information is disclosed, this good is used when the patient is making a decision. If the probable result of the treatment is in conflict with the patient's life plan and goals, the patient may not adhere with the treatment. 4. The Good of the Patient as a Human Person The good that is grounded in his capacity as a human person to reason, to choose and to express those choices in speech with other humans; Freedom to choose This value supersedes the biomedical good and the patients view of his own good

PATERNALISM Involves acting without consent. Or even overriding the patients wishes, wants or actions, in order to benefit the patient or at least to prevent harm to the patient Physicians used this principle before Physicians can overlook the autonomy and rights of the patient. Two (2) Elements of Paternalis 1. The absence of consent or over-riding of consent 2. The beneficent motive The welfare of the patient Types of Paternalism 1. Strong Paternalism Also called extended paternalism The health care provider attempts to override the wishes of a competent person 2. Weak Paternalism Also called limited or restricted paternalism Consent is missing or the health care provider overrules or overrides the wishes of an incompetent or a doubtfully competent patient. Doubtfully competent patient: alcohol/ drug intoxicated patient, in sedatives, effect of illness ( high-grade fever, depression) Sometimes called cooperative paternalism when one of its purposes is to restore the persons competence so that the patient may give informed consent. Example: Over-ride by giving IV fluid and IV antipyretic to lower the fever making the patient competent again and making them capable to make competent decisions Strong paternalism is ethically rejected if: The competence of an individual to make decisions for another competent individual would require both knowledge of the other persons values and of all the factors influencing their lives. Health care professionals do not have the right to enforce value and judgments to the patients on the grounds that the doctor knows best It would be a rare health care professional who knew all the factors influencing the life of the patient. - Unless the patient tells you bahala ka na Doktor. However, you still need to inform the patient. It is NOT Paternalism 1. When the health care provider acts to prevent the patient from causing serious injury to others. Ex: psych patients, though incompetent (especially waning patients,who are

sometimes competent, sometimes not) you may constrain them by giving sedative to calm them and make them competent 2. If the Health care professional overrules the patient for the convenience or profit of the provider Example: Like nurses in a hurry in shifting and give a drug immediately, some drugs are painful when administered in fast rate, it's not paternalism because the provider has other obligation to do and not to give care and compassion to the patient, this is inhumane at times. If the health care professionals refuses to go along with the patients wishes because these wishes are against the conscience or professional standard of the provider, and vice versa. If the patient has the right to refuse treatment, the physician also has right to refuse a patient. This occurs when the patient is noncompliant because he/she doubts the physician as a competent professional. This doesn't apply in emergency cases though, a physician can't refuse a patient in an emergency case

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Paternalism is justified: 1. If the harm is prevented from occurring or the benefits provided to the patient outweigh the loss of independence and the sense of invasion caused by the interference. 2. If the person's condition seriously limits his/her ability to choose autonomously. 3. If the interference is universally justified under relevantly similar circumstances. Example: sedatives can be given to violent patients, restraining restless patient (tied to railings), this is universally justified and may do without the consent of the patient Rule of thumb involving Paternalism: Decisions about health, life and death are not merely medical decisions but involve the good of the society and the good of third parties, as well as the values of the patient. Consider that it is not only the physician who decides, also consider the value and situation of the patient (socially, emotionally...) End of Transcription

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