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SDLS 2008
Medicine for the intoxicated
Subject: Bioethics Lecture Date: August 19, 2005
Topic: Non-maleficence Transcriber(s): Jaime Aherrera
Lecturer: Dr. Melchor Frias IV No. of pages: 3

 “To Avoid Evil / Sin”
 in health care settings: One ought not to inflict evil or harm either by opposition of actuality
 Avoid Evil and Evil consequences unless you have a Proportionate Reason for risking or permitting them
 Non-Malificence is the OPPOSITEE of Beneficence

**Justification of Non-Maleficence:
o Human Dignity
o Patient’s Rights


A. Moral Requirement
 Medical Practitioners should strive to serve the well-being of their patients
 First Goal: Don’t do Harm to the Patient

B. According to the Standards of due Care

 before saying that we will not harm the patient, we need the following

1. Proper Training
• to provide competent and quality medical service
• doctors have to train for a long time (med-school, specialization)

2. Skills
• to continue to
study, apply and advance scientific knowledge
• after training, we
have to seek more knowledge for more technology, specialize, etc

3. Diligence
• to obtain consultation and use talents of other health professionals when indicated
• it is physician’s obligation to refer patient to other specialist if knowledge is limited
• ex) Pediatricians seek talents of other professionals because knowledge is limited

C. Making Risk-Benefit Assessments

 the Focus here is on the Risks of Harm
 before giving a treatment, we weigh the harms of a specific treatment
 ex) In Pharmacology, we study the side effects of the different drugs

D. Making Detriment-Benefit Assessments

 the Focus here is on the Harms that occur at the time of the procedure or benefit
 this figures prominently in determining when actions that cause or permit death can be viewed
either as non-violations or as justified infringements of the principle

 In giving Vaccines, we advice the patient that he will have Fever; so he should take Paracetamol
before the onset of fever
 When we give Morphine to Cancer Patients, our Primary Goal is to relieve the PAIN, however,
Morphine can cause DEATH (Take NOTE: Our Primary Goal is to relieve Pain, not the harm)


• There is no escape from all Risk and so No Escape from all Evil
• Because life is social, we are involved in Actual Evils to a greater or lesser extent
• Ex) Being part of a Organization that charges P10,000 for a Circumcision (if we do not do the operation directly, we
are involved in a LESSER Extent; but the Physician performing the operation to a Greater Extent)


• Frameworks of Reasons for such Specifications:
o Principle of Proportionality
o Principle of Double Effect

**NOTE: When there is Benefit and Harm; how do we weigh the two in a Particular Action or Procedure?


• Provided the action does not go directly against the dignity of the person, there must be a Proportionate good to
justify permitting of Risking an Evil Consequence

• The proportionality contained in the Principle is to be judged by considering the following four factors:
o Alternatives
o Level of Good and Evil
o Certitude of Good and Evil
o Causal Influence of Agent

A. Alternatives
o Whether there are alternative ways to Attaining the Intended good w/ NO Evil or Less Evil Consequences
o If there are alternative ways / means of attaining the good with less evil or less risk of evil, common sense
dictates that the Alternative be chosen
o The good is to be done with the Smallest Amount of Evil Possible (we recommend the treatment with the
LEAST Side Effects)
o Patient decides on the Treatment – he is dependent on the information we give the patient

B. Level of Good Intended

o The Level of Good Intended and the Level of the Evil Risk or Permitted
o We recognize that some things are merely useful for the life of a Human Being, while other are necessary
for Human Life and Dignity
o Certain things are seriously evil and others are very minor
o What threatens basic human rights and dignity, life or physical integrity in a major way is serious
o The hope of a serious good is needed to justify even risking such Evils

 In an Adolescent who will undergo operation, she will fear that her appearance will be ruined –
therefore, this is an EVIL for Her
 When we recommend a procedure which would threaten the Life of a Patient (High Probability of
Death), leave the patient crippled / physically disabled – there should be a SERIOUS GOOD to
justify such a procedure / treatment (ex. It would prolong patient’s life – patient should decide)

C. Certitude of Good and Evil

o The certitude or Probability of the Good Intended or Evil Permitted or Risk
o In practice, proportionality involves a very complicated, if not always, precise balancing of the levels of
goods and evils with the probability or certainty of those same goods and evils
o Physicians greatly rely on Statistics and Prognosis

 When we tell the patient that there is a 30% Chance of success of a procedure

D. Causal Influence of the Agent

o Most effects are results of many causes such that a particular agent is seldom the sole cause of the
o In some, the action of a particular agent may be a very minor contributory to the evil
o In many cases, there is no causal influence and no possibility for a given person to change the situation
o In these cases, there may be no obligation to avoid the evil simply because it is impossible to do so

SDLS 2008
 In chemotherapy, patient looses Hair–we cant remove this Evil because it is impossible to do so


• An Action, Good in itself, which has two effects = an intended and otherwise not reasonably attainable good effect
and a foreseen but merely permitted evil effect may licitly be placed, provided there is a due proportion between the
intended good and the permitted evil

• A Certain Procedure has two Effect: a Good Effect + Evil Effect

o Good Effect = desired effect
o Evil Effect = it is foreseen, BUT it is merely permitted

A. Requirements of the Principle of Double Effect

• a person may perform an act which has no or risks evil effects provided the following conditions are
 The action in itself be good or at least indifferent
 The good effect cannot be obtained in some equally expeditious and effective way without
the concomitant evil effect
 The good effect is the one directly intended; the evil effect is only permitted
 The good effect must come first before the evil effect (or at least simultaneously) – it is
NEVER allowed that the good effect is produced by the Bad Effect
 That there be a grave reason for permitting the foreseen evil effect to occur and proportion
between the good that is intended and the evil that is permitted

B. Examples for Application

o Pregnant Woman with Uterine Cancer – we recommend Chemotherapy or a C-Section to remove the
Uterus, but in doing so, the Fetus is there (Surgical Procedure is needed to save the life of mother)
 The good effect cannot be obtained by other means = we have to do the operation
 The good effect is the one directly intended = to save the life
 The good effect comes first = we save the life of the mother first, before killing the fetus


• Avoid Evil and Evil Consequences unless you have a proportionate reason for risking or permitting them

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SDLS 2008