What is beneficence?

Beneficence relates to acts or personal qualities of mercy, kindness, generosity and charity: in other words, aiming to do good for others, including maximising the benefit that others might receive from such acts.

In medical ethics, beneficence is understood as a principle requiring physicians to provide to their patients, and to the best of their ability, positive benefits, such as good health, including the treatment and prevention of harmful conditions.

In medicine and other health-related professions, beneficence is far more than an abstract concept, as to incorporate beneficence into medical practice requires it to form the basis of every patient interaction.

Many human interactions carry a certain level of beneficence, without which society would break down and humanity would be hostile. Such beneficence is found in most workplaces. Whereas in certain areas of work, however, the act of putting others first might only be an occasional requirement, in medicine there is a much greater emphasis – and expectation. In medicine and related areas of healthcare, professionals work hard to offer a service with no expectation of return.

What are the characteristics of beneficence?

There are several professions where beneficence is an important and expected working characteristic – where beneficence forms a morally integral component of their work.

Some of the roles most obviously associated with beneficence include those that protect the rights of other people, or jobs that provide tangible benefits to others. Working to better the plight of refugees and raising funds for relief operations, as a result of wars or natural disasters, are two examples about which we have heard much in recent years. Rescuing people in danger and providing aid to homeless people are two further, if quite different, examples of what might be termed ‘professional beneficence’. In acts of what might be called ‘personal beneficence’, most of us probably know a family member who donates blood, or others who have signed up to donate their organs, if they die unexpectedly, to strangers in need of transplants. These are all acts of beneficence.

Beneficence in medicine

In medicine, beneficence can be seen at play in many ways. The underlying principle in all areas of medicine is that, in order to practise as a doctor, you have to put your patients’ best interests at the heart of all you do. But the best interests of one patient might be very different to the best interests of another, and many factors come into play in reaching the beneficent judgement that is most appropriate for each individual patient – in modern-day medicine, there is no room for a ‘one-size-fits-all’ approach. In all professional interactions, doctors must consider patients’ expectations alongside their personal/social circumstances. This is what is often referred to as ‘holistic care’.

Medical beneficence is also closely linked to ‘autonomy’ and ‘nonmaleficence’ (see other medical ethics blogs on our website if you are interested in these topics). While the doctor may feel that their proposed treatment plan is in the best medical interests of their patient, all doctors must, except in certain circumstances, respect the autonomy of their patients. It is important to remember that for the patient and their particular personal circumstances, the proposed treatment plan might not in fact be as beneficial as the doctor believes it will be. Medical professionals, therefore, must ensure that they never act against the will of their patients.

A very good and current ‘hot topic’ example of this is in the provision of terminal care. At its most basic level, while a physician may believe that preserving life is what they have been trained to do, it would be wrong, in the case of a terminally ill patient seeking to end their life, not to take into account the nature of the disease being treated, with its associated prognosis, and the social circumstances and personal wishes of the patient concerned.

In this case of the terminally ill patient seeking to end their life, the practice of beneficence might require the doctor to respect the autonomy of the patient, perhaps agreeing to withdraw active treatment, allowing the patient to die what is in their minds is a dignified death, spending their last few days in their own home, even when active treatment may well have prolonged their lives.

Of course, this is a very different matter to assisted suicide, which remains illegal in UK law.

To practise medicine with beneficence, therefore, professionals must actively and continually consider all treatment options available, based on the individual circumstances of each individual patient, while at the same time respecting patients’ autonomy to decide what is in their own best interests.

Hot Topic cases to consider

How are the considerations of medical beneficence in the following cases?

• Abortion
• Whether the COVID vaccination – or other vaccinations – should be mandatory
• The Charlie Gard case (see one of or other blogs for further details)
• Terminal care
• Amputation versus limb salvage