Nonmaleficence
Nonmaleficence is a fundamental ethical principle in medicine that emphasizes the obligation of healthcare providers to avoid causing harm to patients. This principle underlines the expectation that medical professionals will refrain from actions that have the intent to harm and will not administer ineffective treatments, regardless of their potential harm. The concept is often discussed alongside beneficence, which focuses on actions taken for the benefit of patients, such as providing necessary medical care or health education.
Healthcare decisions can be complex, as some interventions may involve a degree of discomfort or risk to the patient, yet are justified by the greater benefits they may provide. For instance, routine procedures like blood draws or surgeries may cause temporary pain but are essential for accurate health assessments or treatments. Nonmaleficence also encompasses avoiding unnecessary procedures that do not contribute positively to a patient’s health, as well as addressing the ethical challenges posed by the principle of double effect, where a good action may lead to both beneficial and harmful outcomes.
Ultimately, nonmaleficence calls for a careful balance between minimizing harm and maximizing patient well-being, with an emphasis on informed consent and patient involvement in decision-making processes. This principle reflects a commitment to ethical medical practice that respects patient autonomy while prioritizing their safety and health.
On this Page
Subject Terms
Nonmaleficence
Nonmaleficence is a principle in medicine that states that health care providers should avoid doing any harm to those in their care. Under this principle, physicians and other health care providers are required to avoid acting with any intent to harm a patient and avoid providing treatments that are known to be ineffective, even if they are not necessarily harmful. The concept does allow physicians to do things that might cause some harm if the action will result in a greater benefit. Medical professionals must frequently strive to find a balance between helping the patient and causing some level of discomfort or harm.
Overview
The word maleficence refers to the act of being evil or committing bad actions. It is derived from the Latin maleficus, meaning "wicked," and came into use in the sixteenth century. Nonmaleficence refers to avoiding maleficent behavior, or behaviors that are bad, evil, or intentionally harmful.
Nonmaleficence is frequently discussed in conjunction with another concept, beneficence. Beneficent behavior is something that is done solely for the benefit of someone else. In medical situations, it usually refers to something that shields patients from harm, prevents them from being harmed, or improves their situation to some degree. For instance, a nutritionist who provides a class to young mothers on how to feed their children or a physician who restarts a patient's heart is performing a beneficent act.
Beneficent actions are generally easy to identify. However, determining what to do in instances where some harm might result from actions that are for the overall good of a patient is more complicated. Medical procedures often carry some risk, and prescription medications usually have side effects. Medical professionals frequently have to examine possible actions and treatments to determine which will bring the greatest good with the least harm.
For instance, some patients suffer anxiety and physical pain from having blood drawn. However, drawing blood is necessary to determine many aspects of a person's health, so the harm is considered justified in this case. The same is generally true of most surgeries and other procedures that a physician might order.
Another aspect of nonmaleficence is not ordering or performing treatments that are useless and will be of no help. Performing surgery when it is unlikely to help the patient's problem would fall into this category, as can prescribing some drugs that have long lists of potential side effects and little hope of helping the patient. Physicians can also struggle with the principle of double effect, a situation in which the good action will automatically result in both a good and bad result. For example, giving chemotherapy to a pregnant woman may save her life but may result in birth defects or loss of life for her unborn child.
Physicians address these concerns by bringing the patient into the decision. Since the patient is the one who will bear the risk of harm, providing a thorough explanation of risks and benefits will allow the patient to participate in reaching a balanced decision. However, nonmaleficence still requires that the physician not act in a deliberately harmful way, even if it is the patient's preference.
Bibliography
"Beneficence vs. Nonmaleficence." University of California at San Francisco School of Medicine, missinglink.ucsf.edu/lm/ethics/content%20pages/fast‗fact‗bene‗nonmal.htm. Accessed 11 Nov. 2017.
"Ethics at a Glance: Nonmaleficence." Regis University, rhchp.regis.edu/HCE/EthicsAtAGlance/Nonmaleficence/Nonmaleficence.pdf. Accessed 11 Nov. 2017.
Kinsinger, Frank Stuart. "Beneficence and the Professional's Moral Imperative." Journal of Chiropractic Humanities, vol. 16, no. 1, Dec. 2009, pp. 44–6.
Koch, Peter. "Harm and Medical Ethics." Baylor College of Medicine, 3 Mar. 2017, blogs.bcm.edu/2017/03/03/harm-medical-ethics/. Accessed 11 Nov. 2017.
Macklin, R. "Applying the Four Principles." Journal of Medical Ethics, 2003, jme.bmj.com/content/29/5/275. Accessed 11 Nov. 2017.
McCormick, Thomas R. "Principles of Bioethics." University of Washington School of Medicine, depts.washington.edu/bioethx/tools/princpl.html. Accessed 11 Nov. 2017.
"The Principle of Nonmaleficence: Illustrative Cases." University of Washington School of Medicine, depts.washington.edu/bioethx/tools/prin2cs.html. Accessed 11 Nov. 2017.
"What Are the Basic Principles of Medical Ethics?" Stanford University, web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm. Accessed 11 Nov. 2017.