Africa Focus Debates on Contemporary Contentious Biomedical Issues

Chapter Seven

131 Chapter Seven Beneficence and Life Saving in Biomedicine Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine and as a scholarly discipline, it encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, anthropology and sociology1 . As such there are a number of values in medical ethics such as autonomy, nonmaleficence , confidentiality, dignity, honesty, justice and beneficence, among others. These values act as guidelines for professionals in the medical fraternity and are therefore used to judge different cases in medicine. For purposes of this chapter, I will only focus on the principle of beneficence in biomedicine. The Nature of the Principle of Beneficence The concept of beneficence though widely used in medicine is difficult to define with precision. As such, a number of interpretations have been conjured. However broadly used in English, the word beneficence is considered to mean “the doing of good, the active promotion of good, kindness and charity”2 or any action that is done for the benefit of others.3 Though traditionally, acts of beneficence are often done from obligation, the principle is suggestive of altruism, humanity, unconditional love and nonobligatory optional moral ideals. More commonly in medical ethics, beneficence is understood as a principle requiring that physicians provide, and to the best of their ability, positive benefits such as good health, prevent and remove harmful 132 conditions from patients. This is to say that beneficence as a principle of medical ethics asserts an obligation (on the part of the physician) to help others (patients) further their important and legitimate interests and abstain from injuring them in any way, that is, psychologically, morally or physically. From the foregoing, it can be noted that the central question for beneficence within the patient-physician relationship is: “What does it mean for the physician to seek the greater balance of good over harm in the care of patients?”4 The beneficence model answers this question at least in terms of the perspective that medicine takes on the patient’s best interests rather than the physician’s. The model clearly explicates that the central theme for beneficence is the physician’s obligation to benefit patients. This has its earliest expression or its primary historical sources in ancient Greece and the Hippocratic Oath which characterizes physicians as a group of committed men (as women were excluded from medicine in the Greek society) set apart from and above others in the society. The central values of the classical Hippocratic ethics were nonmaleficence (doing no harm), beneficence and confidentiality. As such, the physician, according to the Hippocratic writings has always had the obligation to “apply dietetic measures to the benefit of the sick according to his ability and judgment, and he ought to keep patients from harms and injustice.”5 In the modern era, the Hippocratic Oath is traceable to the 18th century with John Gregory and after World War II, medical ethics started to advocate patient autonomy in the guise of informed consent. However, over the last 20 years, there has been growing dissatisfaction with the individual rights-cantered ethical framework.6 Yet like its old version, 133 the Oath stresses on the virtues that keep the physician’s attention fixed on his obligations to patients and the latter’s best interests, rather than the physician’s personal interests. Thus the Hippocratic Oath, by itself, is a “mere” skeleton of the principle of beneficence in so far as it sheds light on concepts that define what it means to be a physician and to ‘benefit the sick’ while avoiding ‘harm and injustice’-the moral responsibility of physicians to do away with the sufferings of the sick, and to lessen the violence of their diseases. The Complexities of Beneficence in Biomedicine As has been seen on the nature of the principle of beneficence explicated above, the obligation to confer benefits and actively prevent and remove harms from patients is important in biomedical ethics. However, equally important is the obligation to assess or “weigh and balance the possible goods against the possible harms of an action.”7 This makes it important to distinguish two principles under the general principle of beneficence-the principle of positive beneficence and the principle of utility.8 The first principle is known as the principle of positive beneficence. This principle requires the provision of benefits including the prevention and removal of...