Topic: Nonmaleficence
February 12, 2016 | Posted By Claire Horner, JD, MA

When patients lack capacity, physicians look to family and friends to step in and provide consent for treatment on behalf of the patient. These surrogates, whether they were appointed by the patient as their health care agent or become health care surrogates by default under state law based on their relationship to the patient, have the right to receive information related to the care and treatment of the patient and have the corresponding responsibility to make health care decisions for the patient based on either the patient’s previously expressed wishes or her best interests.  What they don’t have, however, is the right to control and direct every minute aspect of the patient’s care in the hospital.  It would take several blog posts to discuss the conflicts that occur between surrogates and health care providers because of this (such as DNR orders, barriers to discharge, and demands for certain medications, to name a few), but perhaps the most concerning example of surrogate over-reach is the issue of inadequate pain management.

The use of pain medication can be difficult for both patients and providers, especially with the rate of opioid abuse in this country. Patients and their families are often afraid of the possibility of addiction, while physicians are reticent to prescribe narcotics for fear of misuse.  Whether or not a patient is a “drug-seeker” is a common question that arises when physicians are deciding what to prescribe. However, in the context of terminal illnesses – particularly at the very end of the illness – the shift in focus from curative to palliative care highlights the need for sufficient pain control in the face of nearly intractable pain.  It is in this context that denial of pain medication, or poor pain management, is most clearly an ethical issue.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

July 31, 2013 | Posted By Marleen Eijkholt, PhD

You are mid 50ties, you have several university degrees from top universities, you have a PhD in Chemistry and are happily married. You seem to have a great life, but for one thing: while your legs are fully functioning, you do not want them. And it is not even that you just do not want them; you feel that they do not belong to you. They give you great suffering.

Earlier this week, the Huffington Post reports on Cloe Jennings who suffers from her healthy legs. Reportedly, she suffered from her legs since she was 4 years old and has held the desire to have them amputated or to be paralysed from that time. Jennings is raising money to travel to a surgeon who has offered to help her.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

July 18, 2013 | Posted By Paul Burcher, MD, PhD

Most practicing physicians learn the four principles of biomedical ethics at some point during medical school or residency training.  Despite the original intent of Tom Beauchamp and James Childress when they first described the four principles as co-equal in importance, we physicians tend to think first about patient autonomy and view it as the most critical of the four principles.  The least understood and appreciated of the four principles is nonmaleficence. (Even my word processor wants to change it to malfeasance, and so do many medical students I teach). 

The reason nonmaleficence is misunderstood, and therefore often ignored, is that the duty to “do no harm” seems impossible to follow.   Beauchamp and Childress are clear that harm is anything that counts as a setback to a patient—any pain or injury is therefore a harm—and practically everything we do to our patients is in some sense a harm.  The duty to nonmaleficence must be more complicated that simply doing no harm or it would be a duty to stop practicing medicine.\

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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