What ethical principle is related to acting in the best interest of the patient?

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Beneficence is one of the four pillars of ethics. You need to know what this term means and how you can apply beneficence to ethical situations because it’s highly likely to come up in your Medical School interview.

Beneficence means that all medical practitioners have a moral duty to promote the course of action that they believe is in the best interests of the patient. Often, it’s simplified to mean that practitioners must do good for their patients – but thinking of it in such a simplistic way can be problematic.

It’s better to think of beneficence as the process of ranking the available options for the patient from best to worst, taking into consideration the following aspects:

Will this option resolve this patient’s medical problem?
Is it proportionate to the scale of the medical problem?
Is this option compatible with this patient’s individual circumstances?
Is this option and its outcomes in-line with the patient’s expectations of treatment?

You will notice that several considerations are concerned with the patient’s expectations or circumstances. This is also known as holistic or patient-centric care.

It is important to bear the patient’s expectations in mind when ranking treatments because when we refer to doing “good” we are not simply referring to what is medically good for the patient, but also what is acceptable to the human being we are treating.

Beneficence is important because it ensures that healthcare professionals consider individual circumstances and remember that what is good for one patient may not necessarily be great for another.

You may be given an ethical scenario to consider during your interview. For example:

An eight-year-old child has been admitted to hospital with a significant open fracture to their left leg. The limb is deformed with significant bleeding and the patient is extremely distressed. The parents are demanding immediate action be taken.

There are a number of options for treatment here, but let’s take an extreme one – amputation.

If the bleeding is life-threatening, the limb sufficiently injured and the risk of infection extremely high, then amputation could be a treatment option. It would be “good” for the patient in as much as the injury would be resolved and the threat to life from bleeding or infection somewhat reduced.

But let’s consider the implications of amputation. The treatment would result in a life-changing injury and the risks of infection or massive bleeding aren’t proportionate. The limitations to their physical movement also carry other future risks that could inadvertently result in further physical and mental health issues.

Most important of all, there are other interventions available to us that have better outcomes attached. Using blood products to manage the bleeding, reducing the fracture if possible and orthopaedic surgery if necessary will have better outcomes for this patient. That course of action is “more good” than amputation.

It’s a rather severe example but also helps demonstrate an important point. Beneficence asks us to promote a course of action, but in practice, we also need to de-promote certain courses of action if there are better options available.

When you’re talking about ethical issues, you need to consider beneficence. You should think about the following things:

Have you thoroughly considered every option and weighed up what the best course of action is for the specific patient in the scenario?
Does the best course of action align with patient expectation?

Beneficence Questions

Some questions you could be asked at an interview include:

Why is it important to consider the best interests of a mother in cases involving abortions?
What should be done if a patient refuses treatment for a life-threatening condition?

You can find the answer to these questions – and more – in our ethics questions and answer guide.

Hot Topics

Keep on top of the hot topics that you can apply the principle of beneficence, for example:

Charlie Gard – how did Doctors consider beneficence?
Vaccinations – can HPV vaccinations be justified as mandatory on the grounds of beneficence?
Abortion – how does beneficence factor here?

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From: The theorisation of ‘best interests’ in bioethical accounts of decision-making

Factor	Sources and notes
Conscious experience	Conscious experience is defined as sentience [55] which manifests (at minimum) in short-term recall [63]. It is suggested as a factor by a number of sources [50, 57, 61, 63, 92]
Dignity	Identified without definition by [49, 60, 62, 86, 92]. Defined as inalienable rights to equal treatment and respect [61, 87] and a recognition of common humanity linked to human rights [55, 77]
Medical interests	Clinical needs/medical interests are identified as factors in best interest [75, 76]. Identified as a potential narrative of best interests offered by the courts [75]. No specific definition of what counts as a medical interest
Benefits and burdens	Many sources identify benefits and burdens [44, 46,47,48,49,50,51,52,53,54,55, 58,59,60,61,62], with a variety of examples given
Pleasure and pain	Pleasure exclusively identified as an interest of children [34, 56]. Pain Identified as pain [83] or harm [86]. Some [57] argue pain is only against interests to the extent a person is aware of it
Quality of life	Frequently identified [49, 50, 52, 54, 55, 57, 60, 62, 85, 88, 98]. Defined as either subjective or objective value of life [49, 54, 73, 75] Authors argue that quality of life is an implicit factor guiding legal [49, 62, 98] and clinical [44, 50] best interests decisions or used as explicit cover for arbitrary and prejudiced decisions [44, 52,53,54]
Futility	Identified by [49, 53, 61, 76, 88, 98, 99]. Sometimes [44, 62, 75] identified with a medical judgment
Effective treatment possibilities and prognosis	Identified by [44, 86]
Developmental potential	Identified by [34, 50]
Medical progress	Identified by [51] in context of research
Sanctity of life	Noted in the context of law [44, 54, 55, 59, 95]. Defined as the inviolability of life [44]