Discussions of beneficence have historically been sparse in the medical literature, though one might expect otherwise. Shifting societal attitudes that apply to the practice of medicine, however, have brought about important basic changes, including emphasis on patients’ education and legal rights, patient autonomy, and self-advocacy, and despite a continued deficiency in the relevant literature, the concept of beneficence seems to have become essential to contemporary medical dialogue and thinking.
Explore this issue:February 2017
The word beneficence, which comes from Latin roots, basically connotes the doing of good and, in the genre of medical care, refers to doing what is in the best interest of the patient. Pursuance of other definitions involves generalities that all circle around this basic concept—that which improves patients’ circumstances and, ideally, leads to improvement and wellness.
Simple enough, right? It’s important, however, to realize that it is more about the intent, and, as such, is not limited to specific pathways of improvement; obviously such goals are not always achieved in medicine, especially in dealing with patients with cancer. This word play reveals a subjective distinction: the manifestation of the doctor’s intent to do a good thing, no matter the outcome.
Put another way, from an ethics standpoint, the judgment or the decisions of a physician may not always be correct, but if the planning and the intent that leads to them are based on beneficence, the action or series of actions are morally correct. Although this argument may not always provide legal immunity, the ultimate unintended outcome is at least more defendable.
The Importance of Trust
Above, I alluded to the evolution in our changing society of both the concept and the usage of the word beneficence. This is especially reflected in the attitude of contemporary physicians when compared with that of our predecessors, who tended to treat patients in a paternalistic way, often leaving them in the dark about the reality of their conditions and circumstances.
I’m convinced that past generations of physicians cared as much as we do today, and they did in fact want to do good for their patients but, in their naïveté, sometimes hedged on the truth, withheld information about potential unpleasantness or poor outcomes, and in general presumed that they knew best what the patient and the family were capable of dealing with.
Thankfully, these practices are no longer the standard, and I would venture to say that the new climate of tailored realism and forthrightness is better for both doctors and patients. In looking back in time, and judging by today’s standards, no matter how well intended, what was meant to be an act or acts of beneficence actually constituted a type of unintentional betrayal. In fairness to those doctors, this was the attitude of an era, and was not limited to the medical profession, but permeated the typical family and other social units. Obviously, patient mental competence has to be considered in making these decisions, and I have factored this into my thoughts here. It should also be noted that some doctors are poor communicators, and what they say often belies reality. Finally, it is unfortunately but true that some physicians are simply indifferent! Lest we become desensitized to the essence of ideal medicine practice, we must remember that indifferent is the antithesis of what a physician ought to be.