Medical practice includes some issues that concern professional and other responsibilities, for instance, adherence to medical ethics. Those duties that the healthcare sector employees are to perform imply following the standards of assistance to the population while taking into account certain norms and principles, one of which is the concept of nonmaleficence.
Since both senior and junior medical providers are responsible for patients’ well-being and care outcomes, this term is fundamental in the context of different approaches to treatment and medicine in general. This work is aimed at describing the concept of nonmaleficence as Beauchamp and Childress address it. As topics for discussion, such nuances will be covered as the obligations of personnel, the essential components included in this notion, and its possible implications and relevance to the healthcare sector.
Nonmaleficence is the idea that is supported not only in medical practice but also in some other areas. However, in healthcare and, in particular, its ethical component, this term is used frequently. According to Beauchamp and Childress, nonmaleficence may be interpreted as follows: “one ought not to inflict evil or harm” (152). This principle explains the fundamental essence of activities aimed at addressing the needs and requirements of those who need help. The concept of harm, in this case, is considered comprehensively. The direct violations of duties are taken into consideration and attendant errors – unwillingness to assist, the denial of access, and other issues.
Therefore, nonmaleficence cannot be viewed as a concept that affects only one omission. This term describes “moral ideals” that distinguish the field of biomedical ethics from other disciplines (Beauchamp and Childress 152). Evaluating all factors determining the efforts to create appropriate conditions for interaction is based on assessing the outcomes of the work done. As a result, the notion of nonmaleficence plays a crucial role in biomedical ethics and largely determines the quality of services provided.
The discussion on nonmaleficence and the nuances of working to maintain the appropriate professional activity conditions is held on various examples. Beauchamp and Childress consider cases where the concept under consideration is involved and matters as a critical component determining “the nature and stringency of the obligations” (152). The authors mention the case of refusal to donate organs after a donor has passed all potential surveys and argue that this situation proves the difficulty of identifying obligations (Beauchamp and Childress 153).
Also, the notion of harm itself cannot be considered of an exclusively violative nature. As practice shows, even following the framework of legal rights may be regarded as the factor that has entailed negative consequences for a particular person’s well-being. Beauchamp and Childress note that, for example, limb amputation, as a rule, is a necessary measure that, nevertheless, bears significant harm to health (153). Therefore, the very essence of harm is broader than the standard arguments in favor of intentional and planned violations.
Based on nonmaleficence features as a phenomenon that requires compliance with specific regulations, some principles define this concept. Beauchamp and Childress cite five rules defining the prohibitions in the area in question, all of which relate to ensuring the safety of those who need help (154). Negligence concerning these principles is fraught with both moral and legal violations, and interested persons may be legally liable for failure to comply with those working norms that they are to follow. Since the field of biomedical ethics is the key topic that the authors discuss, they define negligence as “the absence of due care” (Beauchamp and Childress 155).
The incompetent performance of immediate duties has the same implications as deliberate failure to provide necessary assistance. In the medical sphere, employees take responsibility for communication with patients, and any manifestations of the lack of professionalism may be regarded as harmful. As Beauchamp and Childress state, “the line between due care and inadequate care is often difficult to draw” (156). Nevertheless, any adverse patient outcomes are the reason to doubt the quality of care.
To describe the significance of the nonmaleficence concept, some historical references are given, which address the issues of both under- and overprotection. According to Beauchamp and Childress, state laws may be misinterpreted, and non-compliance with specific standards of care can be the result of unwise regulations. For instance, the authors cite examples of cases when patient consent becomes the critical factor determining the actions of medical staff (157).
However, following such legal procedures does not mean exemption from liability for the results of specific interventions. Therefore, the rules for the work of senior and junior medical personnel should be supervised by adequate authorities, which is typical for both standard and extraordinary cases of treatment. Regardless of religious, social, or other beliefs, patients are entitled to rely on proper care with the necessary equipment (Beauchamp and Childress 163). Despite “the rule of double effect (RDE),” the nature of all medical professionals’ actions is to be based on help (Beauchamp and Childress 164). Therefore, optional and mandatory treatment guidelines should rely on ethical standards but not just legislation.
Another controversial issue that is raised when discussing the concept under consideration is the validity of judgments regarding the quality of life. Beauchamp and Childress mention some cases of chemotherapy as examples of how ambiguous the assessment of treatment adequacy and its outcomes may be (172). Letting patients die is one of the topics that are particularly acutely discussed, and the aforementioned features of legislation and moral obligations are used as primary rationales (Beauchamp and Childress 176).
The task of physicians is to understand how objective each case is so that any decisions made could be not only consistent with medical ethics but could also satisfy patients and their families. It is essential to protect those who are incompetent in matters of personal protection and help people understand the consequences of specific decisions. In conclusion, the authors point out that, despite the obligatory observance of the nonmaleficence rule, there is no direct evidence that healthcare services should be provided necessarily (Beauchamp and Childress 192). Therefore, the ambiguity of this practice indicates a large number of conventions that are to be taken into account.
When evaluating the arguments presented as substantiation of specific hypotheses concerning the concept of nonmaleficence, one can note that all the justifications are reasonable and objective. Beauchamp and Childress provide sufficient evidence to prove the importance of this phenomenon in the field of medical ethics by using documented cases (164). While assessing the significance of the work done in detail, one can assume that the use of real-life examples increases the credibility of the study. As a result, applying such background makes it possible to consider specific cases of nonmaleficence in healthcare practice. In addition, current issues are discussed that are relevant to the problems of voluntary and compulsory treatment, and the existing legal norms and regulations are cited.
The number of justifications is a valuable factor confirming the high quality of the work conducted. In all cases, a sufficient number of references to the stated statistical results contribute to avoiding bias and substantiating specific hypotheses. Also, there is no manifestation of personal preferences since any arguments in support of certain assumptions have reasoned evidence accompanied by references.
When interpreting the position of the authors, one can note that they are not ready to take responsibility for too bold assumptions and intend to consider only the scope taken. For instance, Beauchamp and Childress argue that “obligations to provide positive benefits are the territory of beneficence and justice” (193). This statement indicates the independent and unbiased assessment of the selected phenomenon.
Assumptions about the relevance of the issues related to nonmaleficence in medical practice are relevant and may be used as a basis for studying the concept of beneficence. Regarding harm to patients, the aforementioned principles for assessing the objectivity and need for treatment can be applied in most healthcare institutions. The manifestations of medical ethics and its nuances in practice have a direct impact on the reputation of clinics.
Accordingly, when using the arguments presented in this chapter, one can create a comprehensive picture of what norms the staff of this sphere should be guided by when faced with the concept of nonmaleficence and its features.
The concept of nonmaleficence is relevant to the field of healthcare and, in particular, medical ethics and reflects the principles and norms that employees are to follow in order to provide appropriate assistance. In this chapter, the quality of care is assessed as the component that determines the degree of staff involvement and compliance with professional working standards. Optional and obligatory forms of treatment are considered, and the responsibility of medical staff is evaluated on the basis of individual cases and existing legislation. A sufficient number of justifications allow describing all the nuances of work on maintaining the practice of nonmaleficence in the care environment and creating conditions for effective patient care.
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed., Oxford University Press, 2013.