Wednesday, November 09, 2011

Beneficence in Nursing

Questions of morality and ethical analysis pervade the biomedical field, and one of the major theoretical issues is that of beneficence.  Labeled as a combination of altruism, humanity, and the promotion of the good for others, beneficence acts done for the benefit of others.  The ethical issues surrounding beneficence are one of the cornerstones of the nursing profession.  But serious and legitimate questions remain how far beneficence should go, especially in the field of nursing.  This paper will explore the foundations of beneficence in ethical theory, the role of beneficence in the medical field, and issues regarding nurses.  
Beneficence Roots in Ethical Theory
Beneficence is the action of helping or doing good for others.  When discussing beneficence as a morality trait, being disposed to act for the benefit of others, it is referred to as benevolence.  Thus discussions of beneficent acts in ethical discussions can broadly be organized under the term benevolence.  Beneficence can be found in a variety of ethical theories of human nature, but are most evident in the writings of David Hume and make up a central component of his theory of morality.  Hume saw benevolence as a principle component of human nature.  In juxtaposition to those philosophers supporting notions of psychological egoism, Hume (1751) argued that benevolence is in fact “the origin of morality” (p. 36).  In other words, Hume argued in contrast to those theorists like Hobbes (1924) who held that ego and private interest was the ruling force of human nature (p. 89).
Strong disagreements have also developed in moral theory over the level of beneficence that morality requires.  Some philosophers have argued for obligatory beneficence to the point of devoting much of one’s income and time to the benefit of other’s in need and greater societal obligations.  Yet others have called for less drastic forms of altruism in human nature.  For example a sharp division has arisen in ethical theory over the line between obligatory non-malfeasance (not causing harm), and beneficence.  A handful of theorists argue that while there may be a moral obligation to do no harm to others, this does not translate into an affirmative obligation to help (Hurley, 2003, p. 82).     
Issue in Biomedical Ethics & Nursing
The above theoretical debate plays out in very real life ways in the healthcare field everyday.  A healthcare professionals understanding and opinion of harm to and benefit for a patient can lie in sharp contract from that of the patient.  Further, differing patients may have varying opinions about what makes up harms and benefits.  Finally, many argue that separating notions of benefits and harms from that of the patient’s judgment is next to impossible (Arneson, 2004, p. 58). 
Within these ethical questions of beneficence the field of nursing deals with its own dynamics.  Beauchamp and Childress (1994) argue that "Each of ...[the following] three forms of beneficence requires taking action by helping--preventing harm, removing harm and promoting good...." (p. 192).  Ethical dilemmas abound in the area of beneficence when it comes to nursing.  Such as what is good between patients and nurses, patients and organizations, and among patients themselves (Nussbaum, M. and Amartya S., 1993, p. 56).  Questions arise regarding whether nurses should act for the benefit of what the patient wants, or needs.  Should a nurse’s judgment about what is best for the patient supersede that of the patient’s if the patient is ill- informed, heavily medicated, or has their decision-making abilities impaired (Pellegrino, and Thomasma, 1988, p. 112).
Many examples of beneficence in nursing can also be cited to.  For instance beneficence can be seen as working above and beyond for the patients, making sure they have everything they need including discharge instructions without making them feel helpless.  It could also come in a psychiatric setting, perhaps by helping a combative client relax by letting him talk out his feelings.  When a nurse practices therapeutic communication such as this, and helps the patient work through their concerns, it is an act of beneficence.  Finally, when a nurse understands and recognizes the cultural practices of a patient and includes nontraditional remedies with western medical practices, this is also an act of beneficence.
To concluded, issues of beneficence should be taken on a case by case basis and analyzed within the context of the situation.  While patient needs are important, sometimes it is up to the nurse and the attending physician to do what is necessary to give the greatest good to the patient while still respecting individual cultural and societal norms. 


Arneson, Richard J., 2004, “Moral Limits on the Demands of
Beneficence?” in The Ethics of Assistance. Cambridge: Cambridge University Press.
Beauchamp, T. L., & Childress, J. F. (1994). Principles of
biomedical ethics (4th ed.). New York: Oxford University Press
Hobbes, T. (1924). Leviathan. London: J.M. Dent
Hume, D. 1751, An Enquiry concerning the Principles of Morals.
Oxford: Oxford University Press.
Hurley, P. 2003. “Fairness and Beneficence,” Ethics, 113: 841–
Nussbaum, M. and Amartya S. 1993. The Quality of Life.
Oxford: Clarendon Press.
Pellegrino, E. and Thomasma, D. 1988. For the Patient's Good: The
Restoration of Beneficence in Health Care. New York: Oxford
University Press.

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