Medical School Interviews – Medical Ethics Non-Maleficence
The term non-maleficence is derived from the Latin phrase primum non nocere meaning first do no harm. The Hippocratic oath also describes how doctors have an obligation to ensure their action d not cause pain or suffering to their patients. Non- maleficence is closely related to beneficence meaning to do good. Often when acting in a patient’s best interest and in doing good we are preventing harm.
Harm can be defined as physical, psychological and emotional. Harm is caused due to adverse events and decisions in healthcare this may be due to human factors such as poor communication, stress and burn out. Harm to patients may occur due to structural factors such as reporting systems, workforce loads, environments and infrastructure.
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Direct vs Indirect Harm
Non maleficence can be both direct and indirect. Patients are directly harmed when the delivery of care is unsafe and ineffective. The good medical practice document created by the governing body of doctors, the General Medical council, provides practical advice to doctors of how they can practise medicine in a manner that minimises harm. This involves keeping professional knowledge and skills up to date and taking prompt action if they think that the safety of a patient is being compromised. An example of indirect harm is when a necessary treatment is avoided or withheld from a patient. Doctors need to monitor patients to ensure that they can stop a medication if it is deemed physiologically harmful.
The extent of harm
Doctors must avoid harm on an individual level and more widely. It is easy to consider how doctors could physically harm their patients. Having an understanding of the broader capacity of doctors to harm therapeutic relationships shows maturity in your answers. Harm may be caused to the doctor-patient relationship where physicians fail to treat their patients with compassion, dignity and respect. Harming the doctor-patient relationship is detrimental to the health of the patient as patients loose trust in their doctor and become less engaged in their healthcare. More broadly, doctors must ensure they do not harm relatives or dependants of the patient. Doctors should consider how their decisions will have implications of the family or other patients. Moreover, doctors are occasionally victim to public scrutiny. Doctors’ actions are considered harmful if they undermine the public trust in the medical profession.
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How to apply non-maleficence
It can be difficult to 100% fulfil the principle of non-maleficence as all medical investigations and treatments carry some risk of harm. Therefore, doctors must consider the harm-benefit balance. In order to identify potential benefits and harms of treatments doctors must use guidelines from the National Institute for Health and Care Excellence. These quality standards are based upon evidence-based medicine which access’ the predicted risks of treatments and investigations. It is the role of the doctor to provide patients with adequate information about the potential harms and risks a treatment may cause. Using this adequate information patients can provide valid consent to procedures.
It is crucial that medical professionals admit to their mistakes and report any actions that have or could have caused patient harm. When harm is done to patients’ doctors must not only take action to reduce the negative effects occurring due to this incident but must mitigate against future harms to patients. Doctors are human and it is natural at some point in their practice they will make mistakes. By reporting incidents that cause harm we can improve patient safety by understanding and learning from what has gone wrong.
Using Non-maleficence in MMI station answers
Consider the ethical topic of euthanasia. Euthanasia goes against the pillar of nonmaleficence as we are killing our patients. However, we may need to consider whether more harm is caused by prologued suffering where patients experience distressing symptoms, pain and have a very poor quality of life. In order to apply non-maleficence, it is important to not only consider the harm that your patient will experience but the potential for wider harms. For example, how will the relatives and dependants of this person be harmed or effected by the decision being made.
By considering the ethical topic of abortion we can appreciate the importance of non-maleficence and consider how to use it when debating ethical topics. The abortion debate argues rather it is morally right to terminate a pregnancy before normal childbirth. Ideas supported by applying non-maleficence may both be in favour and against abortion. Considering the pro-choice argument, you could argue that abortions avoid harm both for the mother and foetus. Doctors must assess the potential detriment of pregnancy and child birth to the mothers mental and physical health. Moreover, there is potential that the future child will experience harm where an abortion is withheld. Criminalising abortions may promote child birth where babies have congenital defects or are placed in the care system. Alternatively, the prolife argument argues that life begins at conception therefore an abortion is doing harm by killing the potential life.
Breaking confidentiality may be necessary in order to avoid harm. A patient’s conditions may put them or other parties at risk. In these scenarios relevant information may be discussed between the relevant parties.