What is non-maleficence and why is it a fundamental pillar of ethics? Find out what it means and how to approach any ethical scenarios you are given in your Medical School interview.
What Is Non-Maleficence?
Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics.
Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence.
How Is Non-Maleficence Different to Beneficence?
Non-maleficence differs from beneficence in two major ways.
First of all, it acts as a threshold for treatment. If a treatment causes more harm than good, then it should not be considered. This is in contrast to beneficence, where we consider all valid treatment options and then rank them in order of preference.
Second, we tend to use beneficence in response to a specific situation – such as determining the best treatment for a patient. In contrast, non-maleficence is a constant in clinical practice. For example, if you see a patient collapse in a corridor you have a duty to provide (or seek) medical attention to prevent injury.
Non-Maleficence Example
One of the best ways to understand the difference between non-maleficence and beneficence is by looking at an ethical example:
A 52-year-old man collapses in the street complaining of severe acute pain in his right abdomen. A surgeon happens to be passing and examines the man, suspecting that he is on the brink of rupturing his appendix. The surgeon decides the best course of action is to remove the appendix in situ, using his trusty pen-knife.
From a beneficence perspective, successful removal of the appendix in situ would certainly improve the patient’s life.
But from a non-maleficence perspective, let’s examine the potential harms to the patient:
- The environment is unlikely to be sterile (as is that manky pen-knife) and so the risk of infection is extremely high
- The surgeon has no other clinical staff available or surgical equipment meaning that the chances of a successful operation are already lower than in normal circumstances
- Assuming that the surgeon has performed an appendectomy before, they have almost certainly never done it at the roadside – and so their experience is decontextualized and therefore not wholly appropriate
- Unless there isn’t a hospital around for miles, this is an incredibly disproportionate intervention.
Again this is a rather silly example but it is important to remember that before leaping to action, we need to consider the implications and risks of intervening at all.
Discussing Non-Maleficence At Interview
Ethics will come up in your interview, and you need to think about non-maleficence. You should consider:
- What are the associated risks with intervention or non-intervention?
- Do I possess the required skills and knowledge to perform this action?
- Is the patient being treated with dignity and respect?
- Is the patient being put at risk through other factors (e.g. staffing, resources, etc.)?
Non-Maleficence Questions
Some questions you could be asked at an interview include:
- Does euthanasia have a place in modern medicine?
- What are the ethical issues with abortion?
- What are the ethical issues if a 14-year-old patient asks her GP for the oral contraceptive pill?
You can find the answer to these questions – and more – in our ethics questions and answer guide.
Hot Topics
Some hot topics that would apply to non-maleficence include:
- The inequalities suffered by the BAME community
- Public health interventions
- Mental health services
- Medicinal cannabis prescriptions
Negligence and Malpractice
The terms negligence and malpractice are frequently used interchangeably. However, there is a difference in the two terms.
Negligence is:
- A general term that denotes conduct lacking in due care;
- Carelessness; and
- A deviation from the standard of care that a reasonable person would use in a particular set of circumstances.
Anyone, including non-medical persons, can be liable for negligence.
Malpractice a more specific term that looks at a standard of care as well as the professional status of the caregiver. To be liable for malpractice, the person committing the wrong must be a professional.
The courts define malpractice as the failure of a professional person to act in accordance with the prevailing professional standards, or failure to foresee consequences that a professional person, having the necessary skills and education, should foresee.
The same types of acts may form the basis for negligence or malpractice.
- If performed by a non-professional person the result is negligence;
- If performed by a professional person the acts could be the basis for a malpractice lawsuit.
In order to prove negligence or malpractice, the following elements must be established:
- Duty owed the patient;
- Breach of duty owed the patient;
- Foreseeability;
- Causation;
- Injury; and
- Damages.
There are different levels of responsibility or liability for malpractice.
- An individual is accountable for acts of negligence personally committed;
- The manager or supervisor may be held liable for the acts of the nurse if there has not been appropriate delegation of duties or adequate supervision;
- An employer may be liable for the acts of its employees for failing to do the following:
- hire staff who has the qualifications and skills to perform the necessary functions;
- provide opportunities for the professional growth of the staff such as workshops and seminars;
- provide adequate library services;
- provide opportunities for exchange of ideas;
- provide adequate and sufficient equipment and supplies and maintaining them; and
- ensure that managers and supervisors carry out their duties competently.
References
Brent, Nancy J. (1997). Nurses and the
Law. W.B. Saunders.
Feutz-Harter, Sheryl. (1993). Nursing and the Law. Professional Education Systems, Inc.
Wacker Guido, Ginny. (1988). Legal Issues in Nursing. Appleton and Lange.
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