M1.2: Non-Maleficence - Justice

• Non-Maleficence

  ● Opposite of beneficence

  ● To “DO NO HARM”

  ● As a future healthcare provider, you ought not to inflict evil or harm either by imposition or by actuality

  ● Avoiding evil and evil consequences unless you have a proportionate reason for risking or permitting them
• Non-maleficence


  Stopping a medication that is shown to be harmful
• Non-maleficence


  Refusing to provide a treatment that has not been shown to be effective
• Non-maleficence


  Nurse grip the client’s arm gently during a fall
• 2 Justifications of Non-Maleficence

  • Human Dignity
  • Patient's Rights
• Human Dignity


  One of the “good” that almost all patients want
• Patient's Rights


  There is the right for the provision of healthcare and that is something that is good and something that has less complication and side effects
• THE IMPOSSIBILITY OF AVOIDING ALL EVIL

  [1] There is NO escape from all risk and so NO escape from all evil

  [2] Because life is social, we are involved in actual evils to a greater or lesser extent

  Example: Practicing in a clinic or a barangay health unit wherein they have

  certain practices that are unethical
• PRINCIPLE OF DOUBLE EFFECT

  ● An action, good in itself has two effects:

  ○ An intended and otherwise not reasonably attainable good effect

  ○ A foreseen but merely permitted evil effect may be placed, provided that there is a due proportion between the intended good and the permitted evil.
• PRINCIPLE OF DOUBLE EFFECT

  A certain procedure has two effects:

  Good Effect: Desired effect

  Evil Effect: Foreseen, but merely permitted
• Non-maleficence


  Avoiding evil and evil consequences unless you have a proportionate reason for risking or permitting them
• A PERSON MAY PERFORM AN ACT WHICH HAS NO RISK OR EVIL EFFECTS PROVIDED THE FOLLOWING CONDITIONS ARE VERIFIED:

  ● The action in itself be good or at least indifferent

  ● The good effect is the one directly intended; the evil effect is only permitted

  ● There must be a grave reason for permitting the foreseen evil effect to occur and the proportion between the good that is intended and the evil
• A PERSON MAY PERFORM AN ACT WHICH HAS NO RISK OR EVIL EFFECTS PROVIDED THE FOLLOWING CONDITIONS ARE VERIFIED:

  ● The good effect must come first before the evil effect (or at least simultaneously)

  ● It is NEVER allowed that the good effect is produced by the evil effect

  ● Always outweigh the good effect

  ● The good effect cannot be obtained in Justice
• Beneficence


  Doing good
• Non-maleficence


  Do not cause harm
• Beneficence


  Act in a way that benefits patients
• Non-maleficence


  Going beyond to do good to the patient, to prevent harm
• Beneficence


  Promotes well-being
• Non-maleficence


  Avoids harm and injury
• Justice

  ● Moral rightness based on ethics, rationality, law, national law, religion, or equity

  ● Act of being just or fair

  ● Formal principle (Aristotle): Equals must be treated equally, and unequal must be treated unequally
• Justice


  Medical practitioners giving treatment fairly to all the clients regardless of their economic status, ethnicity, sexual orientation, etc.
• 3 Principles of Justice

  Allocation of Resources, Triage, and Distributive Justice
• Allocation of Resources


  Choose what to prioritize first
• Triage

  • The provider will decide who will decide or who will or will not be treated
  • Greatest good for the greatest number
  • May sometimes refer to one’s contribution to society or “social worth”
  • Triage of Care [ABC]
  • Airway
  • Breathing
  • Circulation
• Distributive Justice

  • Rules and principles that govern the distribution of social benefits and burdens
  • Condition of scarcity and competition
  • Principles of Justice
• Principles of Justice

  To each person an equal share

  To each person according to need

  To each person according to effort

  To each person according to contribution

  To each person according to free market exchanges
• 4 ETHICAL RULES COVERS FOLLOWING

  • Veracity
  • Privacy
  • Confidentiality
  • Fidelity
• Veracity


  Telling truth, respecting autonomy and informed consent.
• Privacy


  It is the right of a person to remain private and not to disclose information.
• Confidentiality


  This is sharing private information on a ‘need to know basis’ only.
• Fidelity


  Is maintaining the duty to care for all no matter who they are or what they may have done.