Week 14 Non Maleficence

NONMALEFICENCE
NONMALEFICENCE
• One’s own obligation to do good in the practice of medicine is also limited by
one’s own obligation to avoid evil/harm. One’s avoidance of harm on others is
embedded into what we call, the principle of nonmaleficence. In medical
ethics it has been closely associated with the maxim, primum non nocere,
which means, above all (or first) do no harm (Beauchamp and Childress,
2001). This maxim expresses an obligation of nonmaleficence in the
Hippocratic tradition, ‘I will use treatment to help the sick according to my
ability and judgment, but I will never use it to injure or wrong them’. This
principle helps in decision-making about issues that may alter one’s own life,
such as on killing and letting go, withholding and withdrawing treatment, use
of extraordinary and ordinary means/procedures and other issues.
•
THE MEANING OF
NONMALEFICENCE
• Nonmaleficence comes from a Latin words: ‘non’ to mean ‘not’; ‘malos’
from which ‘male’ is taken to mean ‘bad/evil’ and ‘faceo’ from which ‘fic’
comes which means ‘do/make’. Thus the term nonmaleficence means not
to make or to do bad or to make evil things intentionally.
• In medicine, nonmaleficence means not to inflict harm which is not
different from ‘not doing evil or bad things’. This principle requires a health
care provider to prevent or refrain from any sort of actions that
eventually causes harm to patient and more importantly when the action
is never been justified.
DISTINCTION BETWEEN
NONMALEFICENCE AND BENEFICENCE
• Generally an obligation of nonmaleficence is

more stringent than obligations of beneficence
and in some cases, nonmaleficence perhaps may
override beneficence. Beauchamp and Childress
suggested the following schema to distinguish the
principle of nonmaleficence and beneficence. But
the said authors do not propose a hierarchical
order.
INSTRUCTIVE PRINCIPLE BIOETHICAL PRINCIPLE
One ought not to inflict evil Nonmaleficence

or harm
One ought to prevent evil or Beneficence
harm
One ought to remove evil or Beneficence
harm
One ought to do or promote Beneficence
good
EXAMPLES OF NONMALEFICENCE:
• 1. Do not kill
• 2. Do not cause pain or suffering to others
• 3. Do not cause offense to others
• 4. Do not incapacitate others
• 5. Do not deprive others of the goods of life
CRITERIA ON DETERMINING
NEGLIGENCE:
• 1. The professional must have the duty to the

affected party
• 2. The professional must breach that duty
• 3. The affected party must experience a harm
• 4. The harm must be caused by the breach of
duty
PRINCIPLE OF NONMALEFICENCE
• affirms the need for medical competence

• a part of Filipino character through
avoidance of confrontational dialogue that
will eventually cause harm to others
PRACTICAL
APPLICATION/IMPLICATION OF THE
PRINCIPLE OF NON-MALEFICENCE
Withholding Treatment and Withdrawing Treatment
- are bioethical issues which can be acted upon or
justified by the following conditions:
1. When the case is irreversible any form of
treatment will not benefit the patient
2. When death is immanent or when patient is
already dead
Ordinary and Extra-ordinary Treatments
Ordinary treatment comprises of the provision of
necessities of life that usually pertain to food, normal
respiration and elimination process. Hence like
intravenous fluids, nasogastric tube feedings, indwelling
catheters, are some among the many considered ordinary
and necessary measure of treatment and may be sustained
even if the case is irreversible.
Extra ordinary treatment comprises of
the use of aggressive modalities vis-à-vis the
capacities of the family or maybe some
family who can very well afford it, continue
to give extra ordinary measure. But this
means do not necessarily offer any benefit
to the patient.
KILLING AND LETTING DIE
• In ordinary language ‘killing’ is a causal action that

deliberately brings about another’s death
• ‘Letting die’ is ‘prima facie’ acceptable in medicine under
two conditions:
• 1) a medical technology is useless (medically futile) and
• 2) patients (or valid surrogate/proxy) have validly refused
a medical technology,
•THANK YOU!!!

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NONMALEFICENCE

• Generally an obligation of nonmaleficence is

One ought not to inflict evil Nonmaleficence

• 1. The professional must have the duty to the

• affirms the need for medical competence

• In ordinary language ‘killing’ is a causal action that

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