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What Is Nonmaleficence In Healthcare?

What Is Nonmaleficence In Healthcare
Percentage of trained teachers by region (2000–2017) Teacher education or teacher training refers to programs, policies, procedures, and provision designed to equip (prospective) teachers with the knowledge, attitudes, behaviors, approaches, methodologies and skills they require to perform their tasks effectively in the classroom, school, and wider community.

  • The professionals who engage in training the prospective teachers are called teacher educators (or, in some contexts, teacher trainers).
  • There is a longstanding and ongoing debate about the most appropriate term to describe these activities.
  • The term ‘teacher training’ (which may give the impression that the activity involves training staff to undertake relatively routine tasks) seems to be losing ground, at least in the U.S., to ‘teacher education’ (with its connotation of preparing staff for a professional role as a reflective practitioner).

The two major components of teacher education are in-service teacher education and pre-service teacher education,

What is an example of Nonmaleficence?

« Back to Glossary Index Non-maleficence means to do no harm. Traditionally, this is at the heart of medical(.) ” href=”https://toolbox.eupati.eu/glossary/non-maleficence/” data-gt-translate-attributes=””>Non-maleficence means to do no harm. Traditionally, this is at the heart of medical ethics and is part of the Hippocratic Oath (an oath that new doctors take in many countries). An example of a Non-maleficence means to do no harm. Traditionally, this is at the heart of medical(.) ” href=”https://toolbox.eupati.eu/glossary/non-maleficence/” data-gt-translate-attributes=””>non-maleficent action would be stopping a medication known to be harmful or refusing to give a medication to a patient if it has not been proven to be effective. However, ethical dilemmas often occur. In many medical situations, Non-maleficence means to do no harm. Traditionally, this is at the heart of medical(.) ” href=”https://toolbox.eupati.eu/glossary/non-maleficence/” data-gt-translate-attributes=””>non-maleficence must be balanced with the principle of Beneficence is a concept in research ethics that states that researchers should have(.) ” href=”https://toolbox.eupati.eu/glossary/beneficence/” data-gt-translate-attributes=””>beneficence (an action done for the Benefit is a positive outcome (such as the relief of symptoms, cure, or prevention)(.) ” href=”https://toolbox.eupati.eu/glossary/benefit/” data-gt-translate-attributes=””>benefit of others). For example, many beneficial medications may also have serious Side effect is the lay-man’s term to describe an adverse event (usually to describe(.) ” href=”https://toolbox.eupati.eu/glossary/side-effect/” data-gt-translate-attributes=””>side effects and so the Risk is the probability of harm or injury occurring as a result of using a treatment(.) ” href=”https://toolbox.eupati.eu/glossary/risk/” data-gt-translate-attributes=””>risks and Benefit is a positive outcome (such as the relief of symptoms, cure, or prevention)(.) ” href=”https://toolbox.eupati.eu/glossary/benefit/” data-gt-translate-attributes=””>benefits must be carefully considered by doctors and patients. Ultimately, the patient must decide whether the Benefit is a positive outcome (such as the relief of symptoms, cure, or prevention)(.) ” href=”https://toolbox.eupati.eu/glossary/benefit/” data-gt-translate-attributes=””>benefits outweigh the Risk is the probability of harm or injury occurring as a result of using a treatment(.) ” href=”https://toolbox.eupati.eu/glossary/risk/” data-gt-translate-attributes=””>risks before consenting to a treatment. « Back to Glossary Index

What does Nonmaleficence mean in health?

Nonmaleficence. The principle of nonmaleficence holds that there is an obligation not to inflict harm on others.

What is non-maleficence in healthcare ethics?

Non-maleficence – This means that nurses must do no harm intentionally. Nurses must provide a standard of care which avoiding risk or minimizing it, as it relates to medical competence. An example of nurses demonstrating this principle includes avoiding negligent care of a patient.

What is an example of nonmaleficence in healthcare?

Nonmaleficence – In nursing, the ethical principle of nonmaleficence is to avoid causing harm. For example, a nurse demonstrating nonmaleficence would perform multiple checks before administering medication to avoid a dangerous medication error. The difference between beneficence and nonmaleficence may seem subtle, but you can remember that beneficence is promoting good and nonmaleficence is avoiding harm by remembering that the prefix mal- means bad (think malnourished, malfunctioning, malpractice, malodorous, Maleficent from Sleeping Beauty) We created our Medical Terminology flashcards to make breaking down words into their parts easy, so you never have to be confused by an unfamiliar word on an exam!

What is nonmaleficence vs beneficence?

Nonmaleficence (do no harm) Obligation not to inflict harm intentionally ; In medical ethics, the physician’s guiding maxim is ‘First, do no harm.’ Beneficence (do good) Provide benefits to persons and contribute to their welfare. Refers to an action done for the benefit of others.

What is the difference between beneficence and Nonmaleficence examples?

Beneficence is the ethical principle of promoting good, while nonmaleficence is to avoid causing harm. Taking a patient outside for fresh air is an example of beneficence, while performing multiple checks to avoid a medication error is an example of nonmaleficence.

Is nonmaleficence the same as negligence?

The principle of nonmaleficence requires of us that we not intentionally create a harm or injury to the patient, either through acts of commission or omission. In common language, we consider it negligent if one imposes a careless or unreasonable risk of harm upon another.

What are examples of nursing Nonmaleficence?

Nonmaleficence: The avoidance or minimization of harm. Nonmaleficence in nursing requires the provision of safe, effective, high-quality care. Examples of nonmaleficence in nursing include holding a medication due to adverse reactions or taking steps to ensure a safe work environment.

Why is it important for Nonmaleficence?

Why is Nonmaleficence important in nursing? Non-maleficence is a very important aspect of nursing because it guides one when making significant decisions. This is particularly true when conflicting points of view, stressful environments, or differences of opinion further complicate these decisions.

Can Nonmaleficence be defined as doing no harm?

The Principle of Nonmaleficence – Nonmaleficence means doing no harm. Providers must ask themselves whether their actions may harm the patient either by omission or commission. The guiding principle of primum non nocere, “First of all, do no harm,” is found in the Hippocratic Oath.

Actions or practices of a healthcare provider are “right” as long as they are in the interest of the patient and avoid negative consequences. Harm by an act of omission means that some action could have been done to avoid harm but wasn’t done. Omission would be failing to raise the side rails on the patient’s hospital bed, upon which the patient fell out and was injured.

An act of Commission is something actually done that resulted in harm. An example of an act of commission would be delivering a medication in the wrong dose or to the wrong patient. Case managers can be accused of maleficence by omission if they failed to coordinate a patient’s care correctly—for example, discharging a patient to an inappropriate level of care or leaving a patient in a dangerous living situation.

  1. First of all, assess your patient.
  2. Not being malicious.
  3. Doing no harm.
  4. Avoiding malpractice.

Answer: C Patients with terminal illnesses are often concerned that technology will maintain their life beyond their wishes; thus, healthcare professionals are challenged to improve care during this end stage of life. Patients may even choose to hasten death if options are available.

  1. The right of the individual to choose to “die with dignity” is the ultimate manifestation of autonomy, but it is difficult for healthcare providers to accept death when there may still be viable options.
  2. Indeed, in most states it is still illegal to hasten death by any active means.
  3. Here we see the principle of nonmaleficence conflicting with the principle of autonomy as the healthcare providers or case managers desire to be beneficent or, at the least, cause no harm.

The active choice to hasten death versus the seemingly passive choice of allowing death to occur requires that we provide patients with all the information necessary to make an informed choice about courses of action available to them. A complicating factor in end-of-life decisions is patients’ concern that, even if they make their wishes clear (such as through an advance directive), their family members or surrogates will not be able to carry out their desires and permit death to occur.

  1. Treating against the wishes of the patient can potentially result in mental anguish and subsequent harm to the patient or family members.
  2. Euthanasia can be either active or passive.
  3. Currently active euthanasia, which is actively giving a medication to bring about death is illegal under federal law in the United States; however, passive euthanasia may be allowed.

Removing ventilation equipment or withholding nutrition, which may cause a natural death, are permissible and currently identified in living wills or advance directives when patients state they desire no extraordinary measures be taken to sustain life.

Is nonmaleficence an ethical issue?

A term that is generally discussed along with beneficence is nonmaleficence. As an ethical principle, nonmaleficence means avoiding harming others.

What is autonomy vs beneficence vs Nonmaleficence?

There are four pillars of medical ethics which are defined as follows: –

  • Autonomy – respect for the patient’s right to self-determination
  • Beneficence – the duty to ‘do good’
  • Non-Maleficence – the duty to ‘not do bad’
  • Justice – to treat all people equally and equitably.

Can beneficence and nonmaleficence conflict?

Function – Brief History of Medical Ethics and Human Rights Writings that specify ethical obligations (both in general and by physicians) predate by millennia writings that specify human rights (both in general and for patients). The earliest writings containing ethical principles date from the Old Kingdom of the Egyptians, e.g., the autobiography of Nefer-seshem-re, circa 2340 BCE.

  • Ethics began to flourish as a scholarly discipline during the golden age of Greece (the time of Socrates, Plato, and Aristotle) in the 5th century BCE.
  • In these respective cultures, discussions of physicians’ ethical duties date to the same times, e.g., an inscription on the tomb of Nenkh-Sekhmet, “chief of the physicians,” circa 2400 BCE, and the writings of the Hippocratic school of Cos in the 5th century BCE.

Deontological or “duty” ethics (which stems largely from the writings of Immanuel Kant in the late 18th century and is a dominant form of ethics within modern law and healthcare) imposes on persons the obligation to preserve the rights and freedoms of others.

Whereas the Cyrus Cylinder (from the 530s BCE) is an exception, human rights writings are a relatively late development in civilization. The Magna Carta (1215 CE) first established political rights for citizens living in Western society. However, human rights did not enter into Western scholarly or philosophical circles until the 1600s and 1700s by Enlightenment thinkers such as John Locke.

Whereas patients had earlier been enabled to establish “rights” through civil suits against their healthcare providers after adverse outcomes (1374 CE), the first policy-making body to establish prospective patient rights was the First Geneva Convention (1864) on behalf of wounded soldiers.

  • The World Health Organization (formed in 1948) created the first bill of health rights intended for application to all persons.
  • Since then, the movement to expand patient rights has become increasingly widespread across all of healthcare.
  • As the rationale for patient rights depends on the ethical principles that predated them, the moral principles will be discussed first, followed by a discussion of how they result in related patient rights.
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Overview of Core Ethical Principles in Modern Western Medicine Beneficence Beneficence is doing what is in the best interest of the patient throughout the process of diagnosis and treatment. The physicians of the Hippocratic school of Cos vowed to “help the sick” in a general sense.

In recent times, such as with the development of osteopathic medicine, Western physicians have begun to renew the call for a more holistic approach to benevolence, which entails addressing the patient’s emotional, social, and spiritual well-being in addition to the care of the body. Of the other principles, a physician’s intent for beneficence conflicts most often with patient autonomy.

This conflict has led to the development of documentation in which the patient must demonstrate their understanding of the predictable consequences of his decision to act against medical advice. When disagreements arise between a healthcare provider and a patient, the health care provider must explain the reasons for their recommendations, allowing the patient to make a more informed decision.

Patient Autonomy Autonomy (literally “self-rule”) refers to the capacity to live according to one’s own reasons and motives. Concerning the autonomy of ordinary citizens, Western society has undergone a radical change in the last 350 years. Before the Enlightenment, most persons lived under the rule of a monarch or similar type of authority.

Early Enlightenment philosophers (e.g., Hobbes, Locke, and Rousseau) advocated what is now called social contract theory. This is the view that persons’ moral and political obligations should depend on an agreement amongst themselves regarding which rules will hold in their particular society.

Later philosophers argued for individual autonomy to an even greater degree than championed by social contract theorists. Autonomy as a fundamental aspect of human existence was advanced largely by two moral and social philosophers, John Stuart Mill (early 19th century; of the school of utilitarian liberalism) and Immanuel Kant, respectively.

Kant proposed that each person of sound mind should first live in moral autonomy, imposing moral decisions regarding himself or herself on himself or herself and secondly allow all other persons to do the same. Mill advocated autonomy with regard to a person’s capacity to govern oneself, and subsequent philosophers and jurists expanded autonomy to include other forms of self-expression.

  • Western post-Enlightenment philosophy and law are no longer concerned with whether autonomy in its various forms is a human right but instead to whom it extends and to what degree.
  • A patient who can defend his or her judgments has the right to make decisions that do not coincide with what the physician believes is beneficial to that patient.

This philosophical concept has become a legal right essentially throughout the Western world. As legal precedents have advanced the requirements for patient autonomy to a greater degree than the requirements for health care provider beneficence, patient autonomy has arguably become the dominant principle affecting patient rights.

For example, a patient may refuse treatment that the physician deems to be an act of beneficence. In such cases, the unwritten social contract between patient and physician requires that medical professionals still attempt to inform the patient of the potential consequences of proceeding against medical advice.

A patient’s autonomy is violated when family members or members of a healthcare team pressure a patient or when they act on the patient’s behalf without the patient’s permission (in a non-emergency situation). Nonmaleficence (“Do no harm”) Complementary to beneficence, nonmaleficence seeks to ensure a patient will be no worse off (physically, emotionally, or otherwise) after treatment than before.

Nonmaleficence dates to the medical writings of the early Egyptians, as cited earlier. The Hippocratic Oath lists specific acts of nonmaleficence, including euthanasia, abortion, an attempt by the professional at procedures outside of his area of expertise, stealing property, making sexual advances, and violating privacy.

The consideration of whether a treatment plan is or is not malevolent extends to all types of treatments, including medications, physical manipulations, and invasive procedures. In relation to other ethical principles, nonmaleficence most commonly conflicts with beneficence.

  1. Despite the potential reason why treatment is beneficial, the therapy may have unintended harm.
  2. Examples include procedures in which a surgeon must cut into a patient’s body or certain drugs (such as chemotherapies).
  3. The body is essentially poisoned so that it may have the opportunity to heal later.
  4. In each case, the odds and degree of harm must be weighed against that of benefit.

Physicians cannot control all responses to treatments. So a physician can still act under the principle of nonmaleficence if the physician takes measures to minimize the chances of harm and informs the patient prior to taking the risk so that the patient has the opportunity to accept or decline the risk.

Patient-Provider Fiduciary Relationship Not unique to the medical profession, but essential to its function, is the trust (Latin: fiducia) that the client places in the professional. Primarily, the belief is that the health care professional will act in such a way as to serve the client’s best interests.

There is inherently unequal power within a patient-physician relationship. As stated by the Illinois Supreme Court, “he physician-patient relationship has its foundation is on the theory that the former is learned, skilled and experienced in those subjects about which the latter ordinarily knows little or nothing, but which are of the most vital importance and interest to him since upon them may depend the health, or even life, of himself or family.

herefore, the patient must necessarily place great reliance, faith, and confidence in the professional word, advice, and acts of the physician.” Patients have different preferences for the degree of passiveness or proactiveness they exert within the fiduciary relationship. Emanuel and Emanuel described four patient-physician relationship models within the history of Western medicine.

In each model, the patient and physician relate to each other with a varied degree of passiveness or proactiveness.

In a paternalistic relationship, the doctor decides on behalf of the patient. This is the most passive type of relationship for the patient. In an interpretive relationship, the doctor first discerns what the patient’s goals and values are and then offers options that help achieve those goals and preserve those values. The patient remains passive in this relationship. In an informative relationship, the doctor provides information to assist with a decision and, without swaying the patient, allows the patient to decide for himself or herself. In a deliberative relationship, the doctor and patient collaborate essentially as equals. They work together. This model is the most likely to achieve a patient’s healthcare goals and preserve his or her values.

Justice In healthcare, justice refers explicitly to the philosophical concept of “distributive justice.” This principle asserts that all persons (patients) will be treated fairly and equitably. It means not only respecting the rights of individuals but also treating all patients in a given situation the same regardless of who they are.

  1. Laws and policies within healthcare use the principle of justice to establish access for all persons to obtain healthcare required to preserve life, such as in emergency situations.
  2. Some governing bodies, such as the Canadian federal government, have extended justice in healthcare far beyond emergency care.

Distributive justice, as defined by John Rawls, can be understood as equal respect for persons – entitlement of persons having a given need to the same rights and services as other persons with the same need and the provision of services of a more significant benefit offered to persons with greater need.

Sanctity and Dignity of Human Life In addition to prescriptions regarding moral behavior, the belief in a creator god or set of gods is a common feature of the earliest literate societies. Before 500 BCE, the Egyptians, Babylonians, Assyrians, Vedic culture of ancient India, Greeks, and Israelites all wrote regarding theology in conjunction with moral behavior.

The ethical codes of all these early civilizations condemned lay citizens from ending the lives of other citizens. For the ancient Egyptians, preparation for one’s afterlife was a major facet of one’s present life. Ancient Greek philosophers, including Plato and Aristotle, taught extensively about the notion of humans having souls.

The Israelites (founders of a nation of people later to be known as Jews) originated the notion of a divinity that placed value on the lives of all members of the society of believers. The Jews also were original in believing that the divinity itself was the author of the societal moral code, that the divinity created humans in Its image, and that human life itself, therefore, is sacred or holy.

The idea that a person is created “in the image of God” is mentioned several times in the book of Genesis alone (Genesis 1:26-27, 5:1-2 9:6). The book of Psalms echoes this concept when the psalmist asserts that God was responsible for his formation, in contrast to the notion that the psalmist may have been formed solely by biological mechanisms (Psalms 139:13).

Christianity retained the holy books of Judaism and much of the Jewish philosophy pertaining to the sanctity of the lives of its adherents. The book of Acts, for example, professes that God gives life and breath to all people (Acts 17:25). Christian culture fused with Greco-Roman culture in the 4th century CE upon the Christianization of the Roman emperor Constantine and his family.

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This fusion eventually resulted in the dissemination of Judeo-Christian beliefs on the value of human life throughout the West geographically and, later, through the development of all three North American countries. Judaism has become the second-largest religion in North America.

Islam, the third-largest religious group in North America, shares much in common with Judeo-Christian belief, not only concerning its traditional stories and notions of God but also concerning notions of the sanctity of human life. Although Mexico, the United States, and Canada’s governments were based on the separation of religion and state, the moral teachings of the Abrahamic religions have nevertheless greatly influenced the health care policies of these three countries both in the laws at the national and state level and in the rules set by medical societies and medical administrative organizations.

Furthermore, the belief that human life is sacred is not limited to the Abrahamic faiths. As just one example, the Hippocratic physicians (living in a polytheist society) vowed not to take measures to end human life either prior to conception or in the setting of gravely ill patients.

  • Despite the division of religion and national government politics that occurred in many Western countries starting after 1700 CE, the fusion of religion and politics that existed for thousands of years had effects that persist in the ethical and legal codes of secularized countries today.
  • Western secularization has resulted in the substitution of religious terms (e.g., sanctity) with secular terms (e.g., inviolability) and arguments.

The right of a person to maintain one’s property, originated by Jean Jacque Rousseau and championed by John Locke, continues to be used in secular defenses that one human cannot legally destroy the life of another. Scientific advancement has allowed the study of human fetal development and options for the care of sick and dying adults to a more advanced degree than what was possible for ethicists of earlier centuries.

The question of modern debate no longer is at what point an embryo is biologically human but at what point it be granted rights as one. Similarly, in many instances, physicians no longer wonder how to prolong the life of a suffering individual but whether it is the morally correct decision to do so. Instances have occurred in which patients have been pronounced clinically dead or in a persistent vegetative state but have later regained consciousness.

It is not possible to determine when a soul departs a body. Drafted shortly after World War II in response to Nazi experimentation on humans and an increased need for international standards, the Declaration of Geneva (Physician’s Pledge) and the International Code of Medical Ethics both included language protecting the rights of the unborn.

However, revisions in subsequent decades gradually made the language vaguer prior to eventually removing it altogether. Under the 1948 Declaration of Geneva, it was the duty of a doctor to respect human life “from the time of conception.” In 1994, the phrase was revised to respect human life “from its beginning” and in 2005 was retracted altogether.

As with all ethical dilemmas, reaching a morally acceptable decision requires examination of how each of the core ethical principles interplay. For example, while abortion proponents emphasize beneficence and patient autonomy for the mother, pro-life supporters place greater emphasis on nonmaleficence and the sanctity of human life for the unborn child.

How do beneficence and nonmaleficence work together?

Evidence-Based Medicine Ethics – EBM ethics incorporate aspects of both deontology and utilitarianism. For example, our population studies approach shares many aspects with utilitarian ethics, and our approach to medical research incorporates many deontology aspects.

  1. For several decades, a popular approach to understanding Western bioethics has involved the 4 principles.
  2. These principles—respect for autonomy, beneficence, nonmaleficence, and justice—initially were described by Beauchamp and Childress in 1979.16 The principles are deontologic and follow the prima facie (conditional) obligations initially described by WD Ross in 1930.17 Ross broke with classical deontologists to assert that there are no absolute duties, only conditional duties.

When a conflict of duties arises, the duty that ultimately is chosen is based on the circumstances of that particular case. The ethical concepts of beneficence and nonmaleficence warrant definition and discussion. Beneficence entails promoting the well-being of others; nonmaleficence is an intention to avoid harming or injuring others.6 Although head-to-head comparisons of EBM and other approaches to patient care 18 – 20 are not readily available, we can argue that it is our moral duty to follow an EBM approach because it allows practitioners to determine the true benefits and harms of a particular intervention.21, 22 The EBM process described earlier led us to reach conclusions and to provide recommendations on the basis of the medical literature.

  • We are less confident about true benefits and harms if we let tradition or expert opinion guide our practice.
  • Using an EBM approach, we should be able to distinguish the range of benefits and harms among possible treatment options.
  • And provided there is little difference between efficacy and effectiveness for a particular intervention, patient, or population, we should be able to quantify both benefits and harms (eg, number needed to treat, number needed to harm, etc).

Among all patient care approaches, EBM should foster confidence that we are providing beneficent and nonmaleficent care. However, issues in the medical research and publication process can affect certainty regarding beneficence and nonmaleficence. For example, we know from the pediatric literature that about one-half of pediatric trials are not completed or do not get published, 23 and industry-sponsored pediatric trials are twice as likely to go unpublished.

We also know that industry may suppress publication of research results if the data have adverse marketing implications.24 Besides publication bias, ethical issues arise regarding published yet underpowered studies. These studies may contain type II errors; there may be a difference in treatments studied, but researchers have not identified the difference and may conclude that treatments are equivalent (a larger trial might demonstrate a new treatment as inferior to an established treatment).25 Selection, reporting, and attrition bias also may exist.

Although EBM possesses tools that allow us to identify and to adjust for biases (eg, funnel plot, power analysis, Cochrane risk of bias tool), to some extent EBM investigators are at the mercy of the research establishment and the way in which it conducts and publishes its research.

  • Other issues may affect certainty regarding beneficence and nonmaleficence.
  • There may be large differences between efficacy and effectiveness.
  • Data frequently originate from optimized, resource-intense care processes that may not translate well into the real world.
  • Also, patients can be harmed when practitioners follow EBM too rigidly and adhere to evidence-based clinical practice guidelines without accounting for unique patient situations.26 These biases and other issues have ethical implications because they make predictions of beneficence and nonmaleficence on the basis of EBM less certain.20 Guideline developers who take these biases and other issues into account likely will produce more ethical guidelines than those who do not.

Searching and adjusting for these biases may be time- and resource-consuming, but the effort and expense likely will provide value in the end.

What is the principle of beneficence?

Part B: Basic Ethical Principles – B. Basic Ethical Principles The expression “basic ethical principles” refers to those general judgments that serve as a basic justification for the many particular ethical prescriptions and evaluations of human actions.

  • Three basic principles, among those generally accepted in our cultural tradition, are particularly relevant to the ethics of research involving human subjects: the principles of respect of persons, beneficence and justice.1.
  • Respect for Persons.
  • Respect for persons incorporates at least two ethical convictions: first, that individuals should be treated as autonomous agents, and second, that persons with diminished autonomy are entitled to protection.

The principle of respect for persons thus divides into two separate moral requirements: the requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy. An autonomous person is an individual capable of deliberation about personal goals and of acting under the direction of such deliberation.

To respect autonomy is to give weight to autonomous persons’ considered opinions and choices while refraining from obstructing their actions unless they are clearly detrimental to others. To show lack of respect for an autonomous agent is to repudiate that person’s considered judgments, to deny an individual the freedom to act on those considered judgments, or to withhold information necessary to make a considered judgment, when there are no compelling reasons to do so.

However, not every human being is capable of self-determination. The capacity for self-determination matures during an individual’s life, and some individuals lose this capacity wholly or in part because of illness, mental disability, or circumstances that severely restrict liberty.

  • Respect for the immature and the incapacitated may require protecting them as they mature or while they are incapacitated.
  • Some persons are in need of extensive protection, even to the point of excluding them from activities which may harm them; other persons require little protection beyond making sure they undertake activities freely and with awareness of possible adverse consequence.

The extent of protection afforded should depend upon the risk of harm and the likelihood of benefit. The judgment that any individual lacks autonomy should be periodically reevaluated and will vary in different situations. In most cases of research involving human subjects, respect for persons demands that subjects enter into the research voluntarily and with adequate information.

In some situations, however, application of the principle is not obvious. The involvement of prisoners as subjects of research provides an instructive example. On the one hand, it would seem that the principle of respect for persons requires that prisoners not be deprived of the opportunity to volunteer for research.

On the other hand, under prison conditions they may be subtly coerced or unduly influenced to engage in research activities for which they would not otherwise volunteer. Respect for persons would then dictate that prisoners be protected. Whether to allow prisoners to “volunteer” or to “protect” them presents a dilemma.

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Respecting persons, in most hard cases, is often a matter of balancing competing claims urged by the principle of respect itself.2. Beneficence. – Persons are treated in an ethical manner not only by respecting their decisions and protecting them from harm, but also by making efforts to secure their well-being.

Such treatment falls under the principle of beneficence. The term “beneficence” is often understood to cover acts of kindness or charity that go beyond strict obligation. In this document, beneficence is understood in a stronger sense, as an obligation.

  • Two general rules have been formulated as complementary expressions of beneficent actions in this sense: (1) do not harm and (2) maximize possible benefits and minimize possible harms.
  • The Hippocratic maxim “do no harm” has long been a fundamental principle of medical ethics.
  • Claude Bernard extended it to the realm of research, saying that one should not injure one person regardless of the benefits that might come to others.

However, even avoiding harm requires learning what is harmful; and, in the process of obtaining this information, persons may be exposed to risk of harm. Further, the Hippocratic Oath requires physicians to benefit their patients “according to their best judgment.” Learning what will in fact benefit may require exposing persons to risk.

  • The problem posed by these imperatives is to decide when it is justifiable to seek certain benefits despite the risks involved, and when the benefits should be foregone because of the risks.
  • The obligations of beneficence affect both individual investigators and society at large, because they extend both to particular research projects and to the entire enterprise of research.

In the case of particular projects, investigators and members of their institutions are obliged to give forethought to the maximization of benefits and the reduction of risk that might occur from the research investigation. In the case of scientific research in general, members of the larger society are obliged to recognize the longer term benefits and risks that may result from the improvement of knowledge and from the development of novel medical, psychotherapeutic, and social procedures.

The principle of beneficence often occupies a well-defined justifying role in many areas of research involving human subjects. An example is found in research involving children. Effective ways of treating childhood diseases and fostering healthy development are benefits that serve to justify research involving children – even when individual research subjects are not direct beneficiaries.

Research also makes it possible to avoid the harm that may result from the application of previously accepted routine practices that on closer investigation turn out to be dangerous. But the role of the principle of beneficence is not always so unambiguous.

A difficult ethical problem remains, for example, about research that presents more than minimal risk without immediate prospect of direct benefit to the children involved. Some have argued that such research is inadmissible, while others have pointed out that this limit would rule out much research promising great benefit to children in the future.

Here again, as with all hard cases, the different claims covered by the principle of beneficence may come into conflict and force difficult choices.3. Justice. – Who ought to receive the benefits of research and bear its burdens? This is a question of justice, in the sense of “fairness in distribution” or “what is deserved.” An injustice occurs when some benefit to which a person is entitled is denied without good reason or when some burden is imposed unduly.

  • Another way of conceiving the principle of justice is that equals ought to be treated equally.
  • However, this statement requires explication.
  • Who is equal and who is unequal? What considerations justify departure from equal distribution? Almost all commentators allow that distinctions based on experience, age, deprivation, competence, merit and position do sometimes constitute criteria justifying differential treatment for certain purposes.

It is necessary, then, to explain in what respects people should be treated equally. There are several widely accepted formulations of just ways to distribute burdens and benefits. Each formulation mentions some relevant property on the basis of which burdens and benefits should be distributed.

These formulations are (1) to each person an equal share, (2) to each person according to individual need, (3) to each person according to individual effort, (4) to each person according to societal contribution, and (5) to each person according to merit. Questions of justice have long been associated with social practices such as punishment, taxation and political representation.

Until recently these questions have not generally been associated with scientific research. However, they are foreshadowed even in the earliest reflections on the ethics of research involving human subjects. For example, during the 19th and early 20th centuries the burdens of serving as research subjects fell largely upon poor ward patients, while the benefits of improved medical care flowed primarily to private patients.

  • Subsequently, the exploitation of unwilling prisoners as research subjects in Nazi concentration camps was condemned as a particularly flagrant injustice.
  • In this country, in the 1940’s, the Tuskegee syphilis study used disadvantaged, rural black men to study the untreated course of a disease that is by no means confined to that population.

These subjects were deprived of demonstrably effective treatment in order not to interrupt the project, long after such treatment became generally available. Against this historical background, it can be seen how conceptions of justice are relevant to research involving human subjects.

For example, the selection of research subjects needs to be scrutinized in order to determine whether some classes (e.g., welfare patients, particular racial and ethnic minorities, or persons confined to institutions) are being systematically selected simply because of their easy availability, their compromised position, or their manipulability, rather than for reasons directly related to the problem being studied.

Finally, whenever research supported by public funds leads to the development of therapeutic devices and procedures, justice demands both that these not provide advantages only to those who can afford them and that such research should not unduly involve persons from groups unlikely to be among the beneficiaries of subsequent applications of the research.

What are examples of Nonmaleficence in research?

Nonmaleficence has two basic principles. The principles are not to cause harm either intentionally or through omission. Firstly, research shouldn’t be undertaken with the purpose of causing harm. For example, the level of torture a human can withstand is not an ethical research topic.

Can Nonmaleficence be defined as doing no harm?

The Principle of Nonmaleficence – Nonmaleficence means doing no harm. Providers must ask themselves whether their actions may harm the patient either by omission or commission. The guiding principle of primum non nocere, “First of all, do no harm,” is found in the Hippocratic Oath.

  1. Actions or practices of a healthcare provider are “right” as long as they are in the interest of the patient and avoid negative consequences.
  2. Harm by an act of omission means that some action could have been done to avoid harm but wasn’t done.
  3. Omission would be failing to raise the side rails on the patient’s hospital bed, upon which the patient fell out and was injured.

An act of Commission is something actually done that resulted in harm. An example of an act of commission would be delivering a medication in the wrong dose or to the wrong patient. Case managers can be accused of maleficence by omission if they failed to coordinate a patient’s care correctly—for example, discharging a patient to an inappropriate level of care or leaving a patient in a dangerous living situation.

  1. First of all, assess your patient.
  2. Not being malicious.
  3. Doing no harm.
  4. Avoiding malpractice.

Answer: C Patients with terminal illnesses are often concerned that technology will maintain their life beyond their wishes; thus, healthcare professionals are challenged to improve care during this end stage of life. Patients may even choose to hasten death if options are available.

  1. The right of the individual to choose to “die with dignity” is the ultimate manifestation of autonomy, but it is difficult for healthcare providers to accept death when there may still be viable options.
  2. Indeed, in most states it is still illegal to hasten death by any active means.
  3. Here we see the principle of nonmaleficence conflicting with the principle of autonomy as the healthcare providers or case managers desire to be beneficent or, at the least, cause no harm.

The active choice to hasten death versus the seemingly passive choice of allowing death to occur requires that we provide patients with all the information necessary to make an informed choice about courses of action available to them. A complicating factor in end-of-life decisions is patients’ concern that, even if they make their wishes clear (such as through an advance directive), their family members or surrogates will not be able to carry out their desires and permit death to occur.

  • Treating against the wishes of the patient can potentially result in mental anguish and subsequent harm to the patient or family members.
  • Euthanasia can be either active or passive.
  • Currently active euthanasia, which is actively giving a medication to bring about death is illegal under federal law in the United States; however, passive euthanasia may be allowed.

Removing ventilation equipment or withholding nutrition, which may cause a natural death, are permissible and currently identified in living wills or advance directives when patients state they desire no extraordinary measures be taken to sustain life.

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