BENEFIT AND HARM

DR. AMALIA MUHAIMIN, M.SC.

DEPARTMENT OF BIOETHICS, SCHOOL OF MEDICINE
FACULTY OF MEDICINE AND HEALTH SCIENCES
UNIVERSITAS JENDERAL SOEDIRMAN

Blok Bioethics and Health Law 1 (2 July 2013)

 The Four Basic Moral Principles
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1. Autonomy (respect for autonomy)

  respecting the decision making capacities

2. Justice
  distributing benefits, risks, & costs fairly

3. Beneficence
  providing & balancing benefits against risks & costs
4. Nonmaleficence
  avoiding the causation of harm

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 Learning Objectives
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 Students should be able to identify harms and

benefits in health care settings

 Students should be able to evaluate harms and

benefit in health care settings

 Students should be able to justify decisions taking

harms and benefits into account

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 What is a health benefit?
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 Why do we see a doctor?

 Health
 Care
 Relief of suffering
 Prevention of disease, illness, disability
 Psychological benefit
 Enhancement, etc.

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 Are health benefits only available to “unhealthy”

people??
 health benefits are available to people who do not
presently suffer from any disease
 prophylactic treatments or disease prevention
programs  vaccination
 Restoring proper physical functioning  treating
results of non-disease events such as broken legs and
brain injuries
 the social context of a physical condition
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 What is the concept of health?

 The WHO definition of “health”:

“A state of complete physical, mental, and social well-

being and not merely the absence of disease or
infirmity”
 Too narrow or too wide??

 the WHO definition is often criticized for being too wide; it is

encompassing many situations that are not disease related and
that can expand the area of work of medical doctors

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 What is harm?
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 Example: ovarian cyst surgical procedure,

delivering cancer diagnosis, …
 Interpretations of “harm”?

 physical harm

 psychological harm

 moral harm (harm to interests, harm as

unfairness, harm as disrespect)

 social/economic harm (consequences for social
role, stigmatization)
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 Primum non nocere

 “above all do no harm”
 Surgery, chemotherapy, etc.

 What justifies them is the net balance of benefit over the

harm which the treatments inevitably involve
 Any clinical intervention has to be undertaken only after the
completion of a risk of harm/likelihood of benefit calculation
 Where the risk of harm outweighs possible benefit, then the
treatment is not indicated

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 Will uncertainty ever be eliminated??

 In ancient medical ethics, an important moral principle is
‘above all do no harm’. This notion continues to be used as
an important ethical principle in contemporary health
care.

 Can a physician avoid harm?

 What is the distinction between expected and
unexpected harm?
 What is positive and negative harm?

 Who determines what counts as harm?

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 In health care practice it is important to
evaluate benefits and harms!!
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 Difficulties of measuring harms and benefits in

individual patients, may involve:

 The assessment of degrees of harm and benefit

 The incommensurability of harms and benefits

 The social context of physical and mental suffering

 The subjective nature of suffering

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 CONCLUSION
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 Treatment choices also have to be made among

patients
 Assessment has to be made between risk of harms
and potential benefits for different patients
 Important for resource allocation; when time or

material resources are scarce

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 Reference
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 UNESCO. Bioethics Core Curriculum. UNESCO, 2008. Available at:

http://unesdoc.unesco.org/images/0016/001636/163613e.pdf
 UNESCO Bangkok. A Cross Cultural Introduction to Bioethics.
Eubios Ethics Institute, 2006. Available at:
http://www.eubios.info/ccib.htm
http://www.unescobkk.org/rushsap/resources/shs-
resources/ethics-resources/bioethics-documentation-
centre/bioethics-textbook/

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