Study Material for Medical Ethics for Block 1.1 Medical Students of College of Medicine, King Faisal University

1. Chapter 1.1.3: Doing Well/Doing No Harm
Intended Learning Outcomes:
 To discuss the concept of Doing Well/Doing No Harm [Beneficence/Non-
Maleficence].
 To recognise medical scenarios with respect to Beneficence/Non-Maleficence
 To express the essence of the Oath of a Muslim Physician
 To discuss ethics relation to commitments to the patient, personal excellence,
and medicine as a profession.
Learning Questions:
1. What do you understand about the basic ethics principle “Doing well/Doing no
Harm”?
2. What is the concept of doing well and not doing harm to patient
[Beneficence/Non-Maleficence]?
3. What do you know about the oath of a muslim physician?
4. What is the importance of Doing Well/Doing No Harm [Beneficence/Non-
Maleficence] in medical practice?

2. Doing Well: Beneficence
 Benefitting others
 Prevent harm
 Create a safe and supportive
environment
 Help people in crises
 Desire to do good.
 Acting in the patient's 'best
interests
Doing No Harm
 do not to inflict harm on
people
 do not cause pain or
suffering
 do not incapacitate
 do not cause offence
 do not deprive people
 do not kill
Beneficence vs. Non-maleficence
Beneficence:
Definition: Beneficence is action that is done for the benefit of others. Beneficent
actions can be taken to help prevent or remove harms or to simply improve the
situation of others.
This principle is linked in part to both of the earlier principles, as well as others. Harm
is usually measured in comparison to benefits and not in absolute terms. Thus, many
interventions include a “justifiable” degree of harm because they bring much greater
benefit. For example, almost all drugs have side effects, ranging from mild (e.g.,
nausea or abdominal upset) to severe (e.g., atrial fibrillation or bleeding). However,
this doesn‟t usually stop people from taking drugs because they compare the risk of
these side effects with the ultimate benefit they get from the drug, which is hopefully
a cure for their condition. That being said, without the “truth,” such informed decisions
about the benefit of the intervention can never be reached. This means that the state
of being “uninformed” (or misinformed) might lead people to miss a true benefit, or to
have illusions about a false one.
Clinical Applications: Physicians are expected to refrain from causing harm, but they
also have an obligation to help their patients. Ethicists often distinguish between
obligatory and ideal beneficence. Ideal beneficence comprises extreme acts of
generosity or attempts to benefit others on all possible occasions. Physicians are not
necessarily expected to live up to this broad definition of beneficence. However, the
goal of medicine is to promote the welfare of patients, and physicians possess skills
and knowledge that enable them to assist others. Due to the nature of the
relationship between physicians and patients, doctors do have an obligation to 1)

3. prevent and remove harms, and 2) weigh and balance possible benefits against
possible risks of an action. Beneficence can also include protecting and defending
the rights of others, rescuing persons who are in danger, and helping individuals with
disabilities.
Examples of beneficent actions: Resuscitating a drowning victim, providing
vaccinations for the general population, encouraging a patient to quit smoking and
start an exercise program, talking to the community about STD prevention.
Non-maleficence:
Definition: Non-maleficence means to “do no harm.” Physicians must refrain from
providing ineffective treatments or acting with malice toward patients. This principle,
however, offers little useful guidance to physicians since many beneficial therapies
also have serious risks. The pertinent ethical issue is whether the benefits outweigh
the burdens.
One of the most crucial duties of a health care provider is not to harm the patient, i.e.,
if the provider cannot be part of the solution, then at least he/she should not be part
of the problem. The concept of harm is a wide and contested one. Many
commentators have different views on it, but what matters is what the patient (the
person concerned) believes to be harmful. There are many risks/harms that we, as
providers, may not be aware of or even consider at all, but they mean a lot to the
affected person-our patient. Again, people need to know about their conditions in
order to make an adequate assessment of harm. How can patients tell what the
potential harm of this investigation or that treatment is, if they do not know the
“truth”? Hiding, manipulating, or falsifying information given (or not) to the patient
could affect their ability to make a decision, which in turn may cause them direct
harm if they make a misguided decision, or cause harm that could have been
avoided if they knew the “truth.”
Clinical Applications: Physicians should not provide ineffective treatments to patients
as these offer risk with no possibility of benefit and thus have a chance of harming
patients. In addition, physicians must not do anything that would purposely harm
patients without the action being balanced by proportional benefit. Because many
medications, procedures, and interventions cause harm in addition to benefit, the
principle of non-maleficence provides little concrete guidance in the care of
patients. Where this principle is most helpful is when it is balanced against
beneficence. In this context non-maleficence posits that the risks of treatment (harm)

4. must be understood in light of the potential benefits. Ultimately, the patient must
decide whether the potential benefits outweigh the potential harms.
Examples of non-maleficent actions: Stopping a medication that is shown to be
harmful, refusing to provide a treatment that has not been shown to be effective.
Balancing Beneficence and Non-maleficence:
One of the most common ethical dilemmas arises in the balancing of beneficence
and non-maleficence. This balance is the one between the benefits and risks of
treatment and plays a role in nearly every medical decision such as whether to order
a particular test, medication, procedure, operation or treatment. By providing
informed consent, physicians give patients the information necessary to understand
the scope and nature of the potential risks and benefits in order to make a
decision. Ultimately it is the patient who assigns weight to the risks and
benefits. Nonetheless, the potential benefits of any intervention must outweigh the
risks in order for the action to be ethical.
Note: For related topic on oath please refer to Chapter 1.1.5 this Handbook
References and Further Reading Resources.
1. http://missinglink.ucsf.edu/lm/ethics/index.htm , University of California San
Francisco website last accessed on May 22, 2015.
2. Module 4. Truthtelling and Breaking Bad News; Professionalism and Ethics
Handbook for Residents. Saudi Commission for Health Specialties, Riyadh -
2015. ISBN: 978-603-90608-2-6.