Beneficence - principles of biomedical ethics

Beneficence

Morality requires not only that we treat persons autonomously and refrain from harming them, but also that we contribute to their welfare. These beneficial actions fall under the heading of “benefice.n^)'’ .-Principles of beneficence potentially demand much more than the principled nonmaleficence, because agents must take positive steps to help others, not merely refrain fromharmful acts.

This chapter presents two principles of beneficence: positive beneficence and utility. Positive beneficence requires agents to provide benefits to others. Utility requires that agents balance benefits, risks, and costs to produce the best overall results. We also treat the virtue of benevolence, various forms of care, and non- obligatory ideals of beneficence. Building on thesedistinctions, we discuss the conflicts between beneficence and respect for autonomy that occur in paternalistic refusals to accept a patient’s wishes or in public policies designed to protect or improve individuals’ health. The remainder of the chapter focuses on balancing benefits, risks, and costs through analytical methods designed to implement the principle of utility in health policy and clinicalcare. We conclude that these analytical methods have a useful, although limited, role as aids in decision making.

THE CONCEPT OF BENEFICENCE

In ordinary English, the term beneficence connotes acts of mercy, kindness, and charity. Forms of beneficence also typically include altruism, love, and humanity. We use beneficence to cover beneficent action more broadly, so that it includes all forms ofaction intended to benefit other persons. Benevolence refers to the character trait or virtue of being disposed to act for the benefit of others. Principle of beneficence refers to a statement of moral obligation to act for the benefit of others. Many acts of beneficence are not obligatory, but some forms of beneficence, in our analysis, are obligatory.

Beneficence and benevolence have playedcentral roles in certain ethical theories. Utilitarianism, for example, is systematically arranged on a principle of

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beneficence (the principle of utility). During the Scottish Enlightenment, major figures such as Francis Hutcheson and David Hume made benevolence the centerpiece of their common-morality theories. These theories all closely associate beneficence with the goal of moralityitself. We agree that obligations to confer benefits, to prevent and remove harms, and to weigh an action’s possible goods against its costs and possible harms are central to the moral life. However, principles of beneficence are not broad enough, in our account, to determine or justify all other principles.

The principle of utility is thus not identical, in our analysis, to the classicutilitarian principle of utility. Our principle should be viewed neither as the sole principle of ethics nor as one that justifies or overrides all other principles. It is one among a number of prima facie principles, and it does not determine the overall balance of moral obligations. Although utilitarians allow society’s interests to override individual interests and rights, the principle of utilitythat we defend can be legitimately constrained by the various other principles in our framework.

OBLIGATORY BENEFICENCE AND IDEAL BENEFICENCE

Some deny that morality includes any form of positive obligations. They hold that beneficence is purely a virtuous ideal or an act of charity, and thus that persons are not morally deficient if they fail to act beneficently. These views rightly point to aneed to clarify and specify beneficence, stating the points at which beneficence is optional rather than obligatory. An instructive and classic example of this problem is found in the New Testament parable of the Good Samaritan, which illustrates several problems in interpreting beneficence. In this parable, robbers beat and abandon a “half-dead” man traveling from Jerusalem to Jericho. After...