Which of the following is an example of how the principle of beneficence?
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The Belmont Report states that “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.”
Securing a research subject’s well-being falls under the principle of beneficence. Beneficence, as described in the Belmont Report, obligates the investigator to follow two general rules. The first is to “do no harm,” and the second is to “maximize possible benefits and minimize possible harms.” With respect to the first general rule of beneficence, the authors of the Belmont Report did not intend for investigators to reach the standard of “above all do no harm” (primum non nocere), which is
commonly said to be the first principle of medical ethics. Rather, the Commission intended to forbid the deliberate injury of a human subject for the purpose of developing generalizable new knowledge, no matter how important that knowledge might be. They endorsed the acceptability of exposing an individual subject to a possibility (or statistical probability) of injury as long as an IRB determined that this was justified in light of the probability and magnitude of the sought-for benefits.
Benefits may accrue to individual subjects or, through the development of generalized knowledge, to society, perhaps in the form of better health care. Risks, however, are borne by individual subjects. The risks and benefits of research are not always known, and investigators, along with the IRBs that approve their protocols, must decide with imperfect knowledge when it is justifiable to seek certain benefits despite the risks involved, and when the benefits should be foregone because of the
risks. The second general rule of beneficence obligates investigators to design their protocols so as to maximize the probability and magnitude of benefits to individual research subjects as well as to society. It further requires investigators to minimize the probability and magnitude of injury to individual research subjects. It is during the process of informed consent that the risks of participation in research are disclosed and that a promise to pursue the individual or collective
benefits is made with each potential subject. Some authors have argued that the two general rules described above are actually two fundamental ethical principles, beneficence (do good) and nonmaleficence (do no harm). However, others feel beneficence should be viewed as a single principle, because in a research context, it is necessary to consider harms and benefits in relation to each other. The authors of the Belmont Report drew upon
medical tradition when considering the ethical principle of beneficence. It is commonly said that the first principle of medical ethics is “do no harm.” This principle can trace its origin back over 2,500 years to Hippocrates. However, the National Commission recognized that “even avoiding harm requires learning what is harmful; and, in the process of obtaining this information, persons may be exposed to the 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.” Determining when the pursuit of certain benefits is justified despite the risks is the difficult question faced daily by investigators and IRBs. Although beneficence is generally viewed as acts of kindness and charity which individuals are not obligated to pursue or bestow upon others, the National Commission viewed beneficence (to do or promote good) as a strict
obligation or duty in the research context, because investigators consent or pledge to be bound by it. Investigators pledge to promote good, by creating new knowledge or providing some benefit to subjects, when they accept public support for their work. In addition, during the process of informed consent, investigators pledge to pursue the benefits with potential subjects. It would be unethical to put human beings at risk without the prospect of creating beneficial new knowledge or promoting the
social good. In each case, the foundation of the obligation is like the obligation to keep promises. An investigator’s ethical obligation to treat subjects with beneficence is primarily carried out during the process of assessing and balancing the risks and benefits faced by subjects (See Module 3). However, ethical norms derived from this principle are discussed in each of the modules. Author: Thomas R. McCormick, D.Min., Senior Lecturer Emeritus, Dept. Bioethics and Humanities, School of Medicine, University of Washington The place of principles in bioethics Ethical choices, both minor and major, confront us everyday in the provision of health care for persons with diverse values living in a pluralistic and multicultural society. In the face of such diversity, where can we find moral action guides when there is confusion or conflict about what ought to be done? Such guidelines would need to be broadly acceptable among the religious and the nonreligious and for persons across many different cultures. Due to the many variables that exist in the context of clinical cases as well as the fact that in health care there are several ethical principles that seem to be applicable in many situations these principles are not considered absolutes, but serve as powerful action guides in clinical medicine. Some of the principles of medical ethics have been in use for centuries. For example, in the 4th century BCE, Hippocrates, a physician-philosopher, directed physicians “to help and do no harm” (Epidemics, 1780). Similarly, considerations of respect for persons and for justice have been present in the development of societies from the earliest times. However, specifically in regard to ethical decisions in medicine, in 1979 Tom Beauchamp and James Childress published the first edition of Principles of Biomedical Ethics, now in its seventh edition (2013), popularizing the use of principlism in efforts to resolve ethical issues in clinical medicine. In that same year, three principles of respect for persons, beneficence, and justice were identified as guidelines for responsible research using human subjects in the Belmont Report (1979). Thus, in both clinical medicine and in scientific research it is generally held that these principles can be applied, even in unique circumstances, to provide guidance in discovering our moral duties within that situation. How do principles "apply" to a certain case? Intuitively, principles in current usage in health care ethics seem to be of self-evident value and of clear application. For example, the notion that the physician "ought not to harm" any patient is on its face convincing to most people. Or, the idea that the physician should develop a care plan designed to provide the most "benefit" to the patient in terms of other competing alternatives, seems both rational and self-evident. Further, before implementing the medical care plan, it is now commonly accepted that the patient must be given an opportunity to make an informed choice about his or her care. Finally, medical benefits should be dispensed fairly, so that people with similar needs and in similar circumstances will be treated with fairness, an important concept in the light of scarce resources such as solid organs, bone marrow, expensive diagnostics, procedures and medications. The four principles referred to here are non-hierarchical, meaning no one principle routinely “trumps” another. One might argue that we are required to take all of the above principles into account when they are applicable to the clinical case under consideration. Yet, when two or more principles apply, we may find that they are in conflict. For example, consider a patient diagnosed with an acutely infected appendix. Our medical goal should be to provide the greatest benefit to the patient, an indication for immediate surgery. On the other hand, surgery and general anesthesia carry some small degree of risk to an otherwise healthy patient, and we are under an obligation "not to harm" the patient. Our rational calculus holds that the patient is in far greater danger from harm from a ruptured appendix if we do not act, than from the surgical procedure and anesthesia if we proceed quickly to surgery. Further, we are willing to put this working hypothesis to the test of rational discourse, believing that other persons acting on a rational basis will agree. Thus, the weighing and balancing of potential risks and benefits becomes an essential component of the reasoning process in applying the principles. In other words, in the face of no other competing claims, we have a duty to uphold each of these principles (a prima facie duty). However, in the actual situation, we must balance the demands of these principles by determining which carries more weight in the particular case. Moral philosopher, W.D. Ross, claims that prima facie duties are always binding unless they are in conflict with stronger or more stringent duties. A moral person's actual dutyis determined by weighing and balancing all competing prima facie duties in any particular case (Frankena, 1973). Since principles are empty of content the application of the principle comes into focus through understanding the unique features and facts that provide the context for the case. Therefore, obtaining the relevant and accurate facts is an essential component of this approach to decision making. What are the major principles of medical ethics? Four commonly accepted principles of health care ethics, excerpted from Beauchamp and Childress (2008), include the:
1. Respect for Autonomy Case 1 Discussion 2. The Principle of Nonmaleficence Case 2 Discussion
(Beauchamp & Childress, 1994, p. 207) The reader may apply these four criteria to the case above, and find that the principle of double effect applies and the four conditions are not violated by the prescribed treatment plan. 3. The Principle of Beneficence It is sometimes held that nonmaleficence is a constant duty, that is, one ought never to harm another individual, whereas beneficence is a limited duty. A physician has a duty to seek the benefit of any or all of her patients, however, a physician may also choose whom to admit into his or her practice, and does not have a strict duty to benefit patients not acknowledged in the panel. This duty becomes complex if two patients appeal for treatment at the same moment. Some criteria of urgency of need might be used, or some principle of first come first served, to decide who should be helped at the moment. Case 3 Discussion 4. The Principle of Justice It is generally held that persons who are equals should qualify for equal treatment. This is borne out in the application of Medicare, which is available to all persons over the age of 65 years. This category of persons is equal with respect to this one factor, their age, but the criteria chosen says nothing about need or other noteworthy factors about the persons in this category. In fact, our society uses a variety of factors as criteria for distributive justice, including the following:
(Beauchamp & Childress, 1994, p. 330) John Rawls (1999) and others claim that many of the inequalities we experience are a result of a "natural lottery" or a "social lottery" for which the affected individual is not to blame, therefore, society ought to help even the playing field by providing resources to help overcome the disadvantaged situation. One of the most controversial issues in modern health care is the question pertaining to "who has the right to health care?" Or, stated another way, perhaps as a society we want to be beneficent and fair and provide some decent minimum level of health care for all citizens, regardless of ability to pay. Medicaid is also a program that is designed to help fund health care for those at the poverty level. Yet, in times of recession, thousands of families below the poverty level have been purged from the Medicaid rolls as a cost saving maneuver. The principle of justice is a strong motivation toward the reform of our health care system so that the needs of the entire population are taken into account. The demands of the principle of justice must apply at the bedside of individual patients but also systemically in the laws and policies of society that govern the access of a population to health care. Much work remains to be done in this arena. Summary and critique The four principles currently operant in health care ethics had a long history in the common morality of our society even before becoming widely popular as moral action guides in medical ethics over the past forty-plus years through the work of ethicists such as Beauchamp and Childress. In the face of morally ambiguous situations in health care the nuances of their usage have been refined through countless applications. Some bioethicists, such as Bernard Gert and colleagues (1997), argue that with the exception of nonmaleficence, the principles are flawed as moral action guides as they are so nonspecific, appearing to simply remind the decision maker of considerations that should be taken into account. Indeed, Beauchamp and Childress do not claim that principlism provides a general moral theory, but rather, they affirm the usefulness of these principles in reflecting on moral problems and in moving to an ethical resolution. Gert also charges that principlism fails to distinguish between moral rules and moral ideals and, as mentioned earlier, that there is no agreed upon method for resolving conflicts when two different principles conflict about what ought to be done. He asserts that his own approach, common morality, appealing to rational reflection and open to transparency and publicity is a more useful approach (Gert, Culver & Clouser, 1997). Further, bioethicst Albert Jonsen and colleagues (2010) claim in their work that in order to rigorously apply these principles in clinical situations their applicability must start with the context of a given case. (See Bioethics Tools).. This article is intended to be a brief introduction to the use of ethical principles in health care ethics. Students of clinical ethics will find additional information and deeper analysis in the suggested readings below. References Beauchamp T, Childress J. Principles of Biomedical Ethics, 7th Edition. New York: Oxford University Press, 2013. Frankena, WK. Ethics, 2nd Edition. Englewood Cliffs, NJ: Prentice-Hall, 1973. Hippocrates. The history of epidemics. Samuel Farr (trans.) London: T. Cadell, 1780. Jonsen A, Siegler M, Winslade W. Ethics, 7th Edition.New York: McGraw-Hill Medical, 2010. McCormick, TR. Ethical issues inherent to Jehovah’s Witnesses. Perioperative Nursing Clinics 2008;3(3): 253-259. Rawls J. A Theory of Justice. Cambridge, MA: Harvard University Press, 1999. Related Discussion Topics/Links Informed Consent, Parental Decision Making, Withholding or Withdrawing Life-Sustaining Treatment, Bioethics Tools Thomas R. McCormick, D Min What does the Belmont principle of beneficence require?Beneficence thus requires that we protect against risk of harm to subjects and also that we be concerned about the loss of the substantial benefits that might be gained from research. The Systematic Assessment of Risks and Benefits.
What is beneficence in research quizlet?Beneficence. "Ethical principle to minimize possible harms and maximize benefits" Engel & Shutt (2013)
Which of the following statements most clearly illustrates the principle of beneficence?Which of the following statements most clearly illustrates the principle of beneficence? Determining whether the benefits of a study outweigh the risks.
Which of the following are the 3 principles discussed in the Belmont Report?Though approximately 40 years have passed since the 1979 publication of the Belmont Report, the 3 basic ethical principles identified and set forth as guidelines for the conduct of biomedical and behavioral research involving human subjects — respect for persons, beneficence, and justice — remain particularly relevant ...
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