The Principles of Biomedical Ethics (8th edition)
annotations are not derived from the book
Chapter 6: Beneficence
Besides the principles of respect for autonomy and nonmaleficence, morality also requires that we
contribute to the welfare of others.; not solely refrain from harmful acts, but actively trying to help
others. There are (in this book) two principles to beneficence: positive beneficence & utility.
The concept of beneficence and principles of beneficence
Beneficence: “all norms, dispositions, and actions with the goal of benefiting or promoting the well-
being of other persons”
Benevolence: “the character trait, or virtue, of being disposed to act for the benefit of others”
Principle of beneficence: “a statement of a general moral obligation to act for the benefit of others”
- Positive beneficence: “requires agents to balance benefits, risks, and costs to produce the
best overall results”
o The common morality does not hold a principle of beneficence obligating
beneficence in every single instance (in cases of “severe sacrifice/extreme altruism”).
Thus we don’t always have to help, even though we are able to.
Prima facie rules of obligation following the principle of positive beneficence 1
1. Protect and defend the rights of others
2. Prevent harm from occurring to others
3. Remove conditions that will cause harm to others
4. Help persons with disabilities
5. Rescue persons in danger
- Utility: “requires agents to balance benefits, risks, and costs to produce the best overall
results”
o in this chapter “utility” should not be looked at from the point of view of
utilitarianism; they view utility as “a fundamental, absolute principle of ethics”,
whereas we see it as one of multiple principles. Not sufficient on it’s own, but in
interaction with the others (autonomy, nonmaleficence, justice).
Distinguishing rules of beneficence from rules of nonmaleficence
beneficence Nonmaleficence
How to act in order to help How not to act, in order to prevent harm
Who you’re obligated to help depends on You are obligated to act in an nonmaleficent
personal relations. You’re less obligated if you way to all.
don’t have a (special) relation to someone –
unless the risks aren’t great.
Does not constitute legal prohibitions through Does constitute legal prohibitions through
moral reasons – no legal consequences when moral reasons – legal consequences when
someone does not abide to it someone does not abide to it
General and specific beneficence
1
Note that they seem somewhat similar to the ones named in chapter 5 “distinction between nonmaleficence
and beneficence”
, specific is directed at the relations you have with people, whereas general beneficence is directed
beyond those special relations.
- Obligations to others than the people you have special relations with seem impractical,
whereas it becomes a lot and it will be less likely we will meet our primary responsibilities.
Peter Singer – “the obligation to assist”; if you, without having to sacrifice something of
comparable value, are able to do something. You are morally obliged to do it. – through this
criteria of comparable goods a limit has been set on sacrifice (however how do you
determine comparable?)
1. Singer acknowledges the overdemanding of his principle – the “Fair share” , he sees
it as a obligation, everyone should chip in in order to tackle problems.
The duty of rescue as obligatory beneficence
In this chapter the writers introduce conditions for if someone (X) has a prima facie obligation of
beneficence, from the perspective of a duty of rescue
1. “Y is at risk of significant loss of or damage to life, health, or some other basic interest”
2. “X’s action is necessary (singly or in concert with others) to precent this loss or damage”
3. “X’s action (singly or in concert with others) will probably prevent this loss or damage”
4. “X’s action would not present significant risks, costs or burdens to X”
5. “the benefit that Y can be expected to gain outweighs any harms, costs, or burdens that X is
likely to occur”
A reciprocity-based justification of obligations of beneficence
Reciprocity: “the act or practice of making an appropriate, often proportional, return”
Following David Hume, an obligation to benefit others is the product of social interaction. I interact
with people, and receive the benefits of that interaction (of society). Thus I ought to promote the
interests of those interaction/that interaction.
Paternalism: conflicts between beneficence and respect for autonomy
In health care doctors used to act out of their own beliefs about what a patient needed
(information/treatment). Over the years however claims arose on the rights of patients (autonomy
rights).
The writers of this book define paternalism as: “the intentional overriding of one person’s
preferences or action by another person, where the person who overrides justifies the action by
appeal to the goal of benefiting or of preventing or mitigating harm to the person whose preferences
or actions are overridden” – note that this doesn’t exclude autonomous people, meaning someone
justifies overriding an autonomous decision and justifies it by the principles of beneficence and
nonmaleficence.2
“discussions of medical paternalism focus on how to specify or balance these principles,
which principle to follow under which conditions, and how to intervene in the decisions and
affairs of such patients when intervention is warranted”
Soft and hard paternalism
2
The principles nicely come together in the case of paternalism; through the argument of beneficence and
nonmaleficence, the principle of autonomy is overridden.
