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At least 19 recordsLinked to original sources
PubMed2005

Beneficence, justice, and lifelong learning expressed in medical oaths.

INTRODUCTION: The principles of justice, beneficence, and nonmaleficence are prescriptions of the Hippocratic Oath. To fulfill them, physicians are obligated morally to lifelong learning; yet, there is little evidence that the relationship of beneficence to lifelong learning or to continuing medical education (CME) is expressed in medical oaths. METHODS: We analyzed 48 medical oaths written from the first century Ce through the present day, searching for a commitment to lifelong learning and for specification of a relationship to the principle of beneficence. Thirteen ancient and medieval and 35 modern and contemporary oaths were inventoried for source, such as corresponding to a medical school. They were sorted by those that mention the commitment toward lifelong learning and to determine their relationship with the principle of beneficence. RESULTS: Of the 48 medical oaths analyzed, only 20 manifest the commitment to lifelong learning. However, most of the oaths that contain this commitment do not pertain to medical schools, with the exception of the Declaration of Geneva. Of this group, 16 also indicate the principle of beneficence. Of these 16, only 3 establish a link between both. One medical oath indicated this commitment, and none of them analyzed the relation with the principle of beneficence. DISCUSSION: The commitment toward CME should not be absent in the present medical oaths. It is a duty and right of all physicians, and in turn, society should recognize this obligation in order to offer opportunities for the achievement of the principle of beneficence that will result in better health care.

Beneficence↗
PubMed2003

[Papal provisions for lesser benefices in the diocese of Breslau 1447-1471].

During the fifteenth century the popes were severely criticized for problems allegedly created by their provisions for benefices: prolonged law-suits, immense costs, and absenteeism of priests. Papal provisions for higher benefices, bishoprics and monasteries, were usually a political compromise. For lesser benefices, i.e. canonries or vicaries in cathedral or collegiate churches, parishes or altars in towns or villages, the background is seldom clear. Sometimes influential people at the papal curia strove to secure their livings, sometimes local princes, lords or towns provided their servants with incomes, sometimes ambitious clerics sought papal protection against local rivals. The extent to which the papacy was involved in appointments to lesser benefices varied throughout Europe and can only be studied in the regional archives. For the diocese of Breslau this has not been done so far, but the Repertorium Germanicum published by the German Historical Institute in Rome provides the data extant in the papal registers and account-books. The present study sums up these sources from the accession of Nicholas V in 1447 to the death of Paul II in 1471, a period, during which Silesia and especially its capital Breslau held close contact with Rome in order to fight the heretic Bohemian king George of Podiebrad. Nevertheless, the proportions of papal involvement in appointments for lesser benefices in the dioceses were apparently small. The cathedral of St John at Breslau had to admit papal exspectanices and provisions. But only half of the collegiate churches in Silesia were affected to some degree, especially Holy Cross at Breslau and St Mary at Grob-Glogau. Very few important town parishes were concerned, for example St Mary Magdalene at Breslau, the parishes at Neisse and at Neumarkt. It is not possible to say how many papal provisions were successful; those that were usually favoured men with influential friends in Silesia. If Rome introduced foreigners at all, they came from neighbouring courts (Habsburg, Poland, Brandenburg). Many clerics who sought papal provisions had studied at universities (including three doctors of medicine). ALthough provisions by papal legates in Breslau, whose registers are lost, may slightly alter the picture, it is clear that in general the papacy was not an important factor for the appointment to lesser benefices in late medieval Silesia, despite an impressive number of papal documents concerning Silesia and despite some spectacular cases (e.g. Paul Stange von Legendorf, later bishop of Ermland, and his nephew Adam Stange von Pfeildorf). The local authorities themselves were responsible for obvious deficiencies of the pre-Reformation church owing to bad training of clerics or the accumulation of benefices which led to the installation of badly paid vicars.

Catholicism↗
PubMed1999

The beneficent nature of chronic wound care.

The principle of beneficence is one of four bioethical principles, which also include non-maleficence, autonomy, and justice. Beneficence is a moral term; it is the obligation to act for the benefit of others. Social policy is developed from informed choices with regard to a balance between costs, risks, and beneficence. Wound care clinicians conduct clinical and economic outcome studies to guide those responsible for making reimbursement decisions for patients with costly complications of chronic illness. This column discusses the balance of benefits, costs, and risks in the face of the principle of beneficence. Prevention, as an alternative to costly treatment of recurrent wounds, is presented as a strategy to balance cost, risk, and beneficence.

Chronic Disease↗
PubMedDate not supplied

[Analysis of the ethical principles of beneficence and no harm in medical oaths in relation with the Hippocratic one].

The principles of beneficence and no-maleficence, already set forth in the Hippocratic Oath, have been the foundation of medical ethics for the last twenty-five centuries. The principle of beneficence is currently maintained in most wordings of the pledges of medical schools of the United States, Canada and Argentina; it is not the same with the principle of non-maleficence. The aim of this paper is to determine whether these principles are described in medical oaths at different times. These principles did not remain in an oaths. Of twenty-nine analyzed texts, nine describe both principles simultaneously, eleven only mention beneficence; three only express non-maleficence, and six indicate neither of them. Most wordings that describe these principles are modifications of the Hippocratic Oath. Two contemporary wordings describe the achievement of the greatest benefit with minimum harm. Two current wording also subordinate the principle of beneficence to the principle of respect for the patient's autonomy, and eight wordings indicate not only patients' benefit in particular but that of society in general. It is not possible to ignore that it is no enough to fulfill only these two principles. Physicians should encourage the development of patients' responsibility in managing their own health and respect their autonomy.

Ethics, Medical↗
PubMed1989

Just health care (I): Is beneficence enough?

Few in our society believe that access to health care should be determined primarily by ability to pay. We believe instead that society has an obligation to assure access to adequate health care for all. This is the view explicitly endorsed in the President's Commission Report Securing Access to Health Care. But there is an important moral ambiguity here, for this obligation may be construed as being either beneficence-based or justice-based. A beneficence-based construal would yield a much weaker obligation with respect to the distribution of health care. In the first section of this paper I argue that the President's Commission is committed only to this weaker construal of this obligation. In the second section I argue that such a beneficence-based obligation is really rooted in a libertarian conception of justice, similar to that recently articulated by Engelhardt, and that this conception is seriously flawed when it comes to effecting a just distribution of health care.

Advisory Committees↗
PubMed2006

Procreative beneficence and the prospective parent.

Julian Savulescu has given clear expression to a principle-that of "procreative beneficence"-which underlies the thought of many contemporary writers on bioethics. The principle of procreative beneficence (PPB) holds that parents or single reproducers are at least prima facie obliged to select the child, out of a range of possible children they might have, who will be likely to lead the best life. My aim in this paper is to argue that prospective parents, just by dint of their being prospective parents, are in fact not obliged to act on PPB. That is, there is something about their filling the role of prospective parents that exempts them from selecting the child with the best life. I urge that it is more realistic to view prospective parents as bound by a principle of acceptable outlook, which holds that they ought not to select children whose lives will contain an unacceptable amount of suffering.

Attitude to Health↗
PubMed1999

Beneficence in general practice: an empirical investigation.

OBJECTIVES: To study and report the attitudes of patients and general practitioners (GPs) concerning the obligation of doctors to act for the good of their patients, and to provide a practical account of beneficence in general practice. DESIGN: Semi-structured interviews administered to GPs and patients. SETTING AND SAMPLE: Participants randomly recruited from an age and gender stratified list of GPs in a geographically defined region of South Australia. The sample comprised twenty-one general practitioners and seventeen patients recruited by participating GPs. RESULTS: In practice, acting for the good of the patient not only accommodates the views of patients and GPs on expertise and knowing best, but also responds to the particular details of the clinical situation. Patients had a complex understanding of the expertise necessary for medical practice, describing a contextual domain in which they were expert, and which complemented the scientific expertise of their GPs. General practitioners identified multiple sources for their expertise, of which experience was the most significant. The role of the GP included responding to individual patients and particular clinical problems and ranged from the assumption of responsibility through to the proffering of medical advice. CONCLUSION: This study found that GPs acting for the good of their patients covered a variety of GP actions and patient preferences. Beneficence was not justified by presumed patient vulnerability or the inability of patients to understand medical problems, but furthered through a recognition of the different areas of expertise contributed by both parties to the consultation.

Adult↗
PubMed1995

Aggressive intrapartum management of lethal fetal anomalies: beyond fetal beneficence.

OBJECTIVE: To evaluate management recommendations from the current literature for patients whose fetuses are certain to have lethal anomalies or absent (or virtually absent) cognitive function. These recommendations include termination of pregnancy or, for cases in the third trimester, nonaggressive intrapartum management, avoiding cesarean delivery for fetal indications. METHODS: We report our experience with several patients who voiced opposition to nonaggressive intrapartum care and present a rationale for selectively aggressive, intrapartum management for some of these cases. RESULTS: Four women whose fetuses had lethal anomalies requested aggressive intrapartum management. For three of the four, standard aggressive management of labor resulted in vaginal delivery of live-born infants who died shortly thereafter. The patients found comfort in the live births. The fourth patient accepted a recommendation to avoid fetal monitoring during labor, and the fetus was stillborn. This patient found the intrapartum experience to be very stressful. CONCLUSION: When a patient's desire to avoid an intrapartum stillbirth is strong enough that substantial psychological harm might result from one, the physician's beneficence-based obligation to her and respect for maternal autonomy justify selectively aggressive intrapartum therapy, even if no beneficence-based obligation to the fetus exists.

Adult↗
PubMed1989

The role of beneficence in clinical genetics: non-directive counseling reconsidered.

The popular view of non-directive genetic counseling limits the counselor's role to providing information to clients and assisting families in making decisions in a morally neutral fashion. This view of non-directive genetic counseling is shown to be incomplete. A fuller understanding of what it means to respect autonomy shows that merely respecting client choices does not exhaust the duty. Moreover, the genetic counselor/client relationship should also be governed by the counselor's commitment to the principle of beneficence. When non-directive counseling is reexamined in light of both these principles, it becomes clear that there are cases in which counselors should attempt to persuade clients to reconsider their decisions. Such attempts are consistent with non-directive counseling because, while respecting the clients' decision-making authority, they insure that clients act with full knowledge of the moral consequences of their decisions.

Beneficence↗
PubMed1983

Justice, beneficence, or common sense?: The President's Commission's Report on access to health care.

The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research published in March of 1983 its Report, Securing Access to Health Care: The Ethical Implications of Differences in the Availability of Health Services. Concluding that there are "ethical obligations" on behalf of society which are balanced by individual obligations, the Report provides an ethical framework for ensuring "ultimate responsibility" of the Federal government to arrange for equitable access to health and to a fair share of cost. In doing so the Report neither makes justice nor beneficence the prime moral principle in public health care, it rather calls for a common sense approach in "approximating adequacy". But how to define equality without creating uniformity in a society rich in its diversity, including attitudes towards health?

Advisory Committees↗
PubMed2001

Procreative beneficence: why we should select the best children.

Eugenic selection of embryos is now possible by employing in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD). While PGD is currently being employed for the purposes of detecting chromosomal abnormalities or inherited genetic abnormalities, it could in principle be used to test any genetic trait such as hair colour or eye colour. Genetic research is rapidly progressing into the genetic basis of complex traits like intelligence and a gene has been identified for criminal behaviour in one family. Once the decision to have IVF is made, PGD has few 'costs' to couples, and people would be more inclined to use it to select less serious medical traits, such as a lower risk of developing Alzheimer Disease, or even for non-medical traits. PGD has already been used to select embryos of a desired gender in the absence of any history of sex-linked genetic disease. I will argue that: (1) some non-disease genes affect the likelihood of us leading the best life; (2) we have a reason to use information which is available about such genes in our reproductive decision-making; (3) couples should select embryos or fetuses which are most likely to have the best life, based on available genetic information, including information about non-disease genes. I will also argue that we should allow selection for non-disease genes even if this maintains or increases social inequality. I will focus on genes for intelligence and sex selection. I will defend a principle which I call Procreative Beneficence: couples (or single reproducers) should select the child, of the possible children they could have, who is expected to have the best life, or at least as good a life as the others, based on the relevant, available information.

Beneficence↗
PubMed2005

Beneficence, determinism and justice: an engagement with the argument for the genetic selection of intelligence.

In 2001, Julian Savulescu wrote an article entitled 'Procreative Beneficence: Why We Should Select the Best Children', in which he argued for the genetic selection of intelligence in children. That article contributes to a debate on whether genetic research on intelligence should be undertaken at all and, if so, should intelligence selection be available to potential parents. As such, the question of intelligence selection relates to wider issues concerning the genetic determinism of behavioural traits, i.e. alcoholism. This article is designed as an engagement in the intelligence selection debate using an analysis of Savulescu's arguments to raise a series of problematic issues in relation to the ethics of parental selection of intelligence. These problematic issues relate to wider assumptions that are made in order to put forward intelligence selection as a viable ethical option. Such assumptions are more generic in character, but still relate to Savulescu's article, concerning issues of genetic determinism, private allocation and inequality, and, finally, individual versus aggregate justice. The conclusion focuses on what the implications are for the question of agency, especially if intelligence selection is allowed.

Beneficence↗
PubMed2000

Beneficence versus respect for autonomy: an ethical dilemma in social work practice.

Ethical dilemmas are an integral part of the practitioner's reality and impact upon the quality of care provided to the resident. The establishment of ethical principles aims to guide the worker through difficult scenarios involving morals, values and beliefs. Often, these precepts contradict one another and are strongly bound to the practitioner's and the resident's standpoints. The ethical principles of beneficence and respect for autonomy pose a conflict in judgment regarding an elderly woman's care in an 816-bed long term care facility. The contributing parties to the conflict are the medical staff, social worker and the resident. The ethical dilemma will be analyzed according to the utilitarian and deontological theories. Resolution to the conflict is offered at the conclusion.

Aged↗
PubMed2006

Justified paternalism: the nature of beneficence in the care of dementia patients.

The issue of patient autonomy in cases of permanent dementia has recently received a great deal of philosophical attention. Specifically, many have worried about ethical issues surrounding advance directives in which people specify how they shall be treated when they are no longer competent to make their own medical decisions. Ronald Dworkin has been a staunch defender of what he calls precedent autonomy in these cases, believing persons have a right to control, to some degree, how their lives will end, despite the common intuition that the principle of beneficence requires us to improve the experiential quality of patients' lives. Objections have been brought against Dworkin on a number of fronts, including worries about personal identity theory and informed consent. Here, I offer an objection to Dworkin's assessment of the nature of paternalism as it relates to cases of permanent dementia.

Advance Directive Adherence↗
PubMed1998

Capacity to choose place of residence: autonomy vs beneficence?

Health care workers often perceive a conflict between autonomy and beneficence when dealing with clients living at risk in the community. Respect for personal freedom and the desire to help and protect vulnerable people frequently appear to demand opposite interventions. The assessment of decision-making capacity is a vital part of any process that deals with these complicated situations and can resolve some of the apparent conflict. Standardized assessment tools which are flexible enough to deal with the complexities of capacity assessment are needed. Health care workers aim to maximize the safety of people incapable of making decisions while protecting the freedom and autonomy of the capable. Some limits to autonomy must be accepted, especially where others' interests are threatened.

Aged↗
PubMed2002

New perspectives on taste and primate evolution: the dichotomy in gustatory coding for perception of beneficent versus noxious substances as supported by correlations among human thresholds.

In various environments where primates are presently observed, as well as in forests and savannas which have been inhabited by australopithecines and early hominids, there are (or there have been presumably) categories of substances eliciting taste signals associated with stereotyped responses. Such is the case for various soluble sugars of fruits and nectars, attracting consumers, and for several plant compounds in which bitter or strongly astringent properties have a repulsive effect. The occurrence of such classes of tasty substances among natural products appears to be related to the evolutionary trends that shaped primate sensory perception (for detecting either beneficent or potentially noxious substances) in the context of a long history of coevolution between animals and plants. Here, we present original psychophysical data on humans (412 individuals aged 17-59 years) as an analogy with which to test recent evidence from electrophysiology in nonhuman primates (Hellekant et al. [1997] J. Neurophysiol. 77:978-993; Danilova et al. [1998] Ann. N.Y. Acad. Sci. 855:160-164) that taste fibers can be grouped into clusters of "best-responding fibers" with two more specific clusters, one for sugars and one for quinine and tannins. The collinearity found between human taste responses (recognition thresholds) for fructose and sucrose, as well as for quinine and tannins, is presented and discussed as another evidence of the two-direction evolutionary trend determining taste sensitivity. Salt perception appears to be totally independent of these trends. Accordingly, the appreciation of a salty taste seems to be a recent culturally learned response, and not a primary taste perception. The very existence of primary tastes is discussed in the context of evolutionary trends, past and present.

Adolescent↗
PubMed1984

Beneficence and the aged.

The present paper reexamines the modernization hypothesis, focusing principally on the issues of whether and why the relative status and prestige of old people is lower in late 20th century industrial societies than it was during the preceding century. It is argued that the status of most old people, whether considered in absolute or relative terms, is indeed higher now than earlier. No longer bound by the usual norms of reciprocity governing social interaction, old people benefit by a renascence of the norm of beneficence. The very old, in other words, receive more than they are owed under the norm of reciprocity. For the young-old, however, the norm of reciprocity continues in effect. Because of this, and the tightening in eligibility criteria for programs of social support, the position of the young-old is less a function of age than it is of social class.

Aged↗
PubMed1996

Beneficence re-examined: protective intervention in mental health.

Social workers have long reacted negatively to the idea of limiting client freedoms, seeing such activity as directly contrary to such central social work values as autonomy and self-determination. Nevertheless, practitioners often find themselves required to actively intervene in a protective manner when clients are unable to fend for themselves. Such interventions are increasingly a part of everyday practice as social workers respond to new mandates to provide services to disabled and vulnerable individuals. Because of these changing circumstances, the concept of beneficence and the process of protective treatment are currently being re-examined, especially in mental health. This article develops a conceptual model of protective intervention that can be used by clinical decision makers in a variety of situations. Case examples drawn from work with chronically mentally ill patients are used to illustrate the discussion.

Aged↗