Ethical Principles in Healthcare: Nonmaleficence, Beneficence, and Justice
The Principle of Nonmaleficence
The principle of nonmaleficence requires that we do not intentionally create harm or injury to the patient, either through acts of commission or omission. In common language, we consider it negligence if one imposes a careless or unreasonable risk of harm upon another. Providing a proper standard of care that avoids or minimizes the risk of harm is supported not only by our commonly held moral convictions but by the laws of society as well. In a professional model of care, one may be morally and legally blameworthy if one fails to meet the standards of due care. The legal criteria for determining negligence are as follows:
- The professional must have a duty to the affected party.
- The professional must breach that duty.
- The affected party must experience harm.
- The harm must be caused by the breach of duty.
This principle affirms the need for medical competence. It is clear that medical mistakes occur; however, this principle articulates a fundamental commitment on the part of healthcare professionals to protect their patients from harm.
The Principle of Beneficence
The ordinary meaning of this principle is that healthcare providers have a duty to benefit the patient, as well as to take positive steps to prevent and remove harm from the patient. These duties are viewed as rational and self-evident and are widely accepted as the proper goals of medicine. This principle is at the very heart of healthcare, implying that a suffering supplicant (the patient) can enter into a relationship with one whom society has licensed as competent to provide medical care, trusting that the physician’s chief objective is to help. The goal of providing benefit can be applied both to individual patients and to the good of society as a whole. For example, the good health of a particular patient is an appropriate goal of medicine, and the prevention of disease through research and the employment of vaccines is the same goal expanded to the population at large.
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.
The Principle of Justice
Justice in healthcare is usually defined as a form of fairness, or as Aristotle once said, “giving to each that which is his due.” This implies the fair distribution of goods in society and requires that we look at the role of entitlement. The question of distributive justice also seems to hinge on the fact that some goods and services are in short supply; there is not enough to go around, thus some fair means of allocating scarce resources must be determined.