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Principle of Beneficence. is to produce benefit, to do good, to always act in the best interests of the patient whatever is done or said must be for the patient's good includes being honest with patients, which in nearly all circumstances will be of benefit to the patients
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Principle of Beneficence • is to produce benefit, to do good, to always act in the best interests of the patient • whatever is done or said must be for the patient's good • includes being honest with patients, which in nearly all circumstances will be of benefit to the patients • patients should not be subjected to unnecessary investigations
Principle of Beneficence • patients should not be subjected to unnecessary or futile therapies • applies not only to physical good but also to psychological, social and existential well-being • must be distinguished from paternalism ('doctor knows best')
Principle of Nonmaleficence • is to minimize or do no harm • whatever is done or said must not harm the patient, physically or psychologically • includes being honest with patients; lying to patients or telling only part of the truth will very probably cause harm • for every intervention, the potential benefits must be weighed against possible adverse effects • treatments should not be prescribed unless there is a strong chance they will help the patient and only a small chance of unpleasant • adverse effects
Withholding or Withdrawing Treatments • The goal of palliative care is to maintain the quality of life while neither hastening nor postponing death • death is the natural end of life • there is no ethic, in any culture or religion, which say that a terminally ill patient must be kept alive by any means • what matters is the quality of life left to the patient, not the time which is left to them • palliative care must never become an exercise in prolonging life
Whether it is appropriate to offer or to withhold or withdraw a particular therapy depends on the balance between the possible benefits and the potential risks of the treatment, i.e. what is in the patient's best interests • it will depend on individual clinical circumstances • it is often difficult and complex • futile therapy, with no chance of benefit (“You have to do something!”), can never be justified
depends on many factors, including • the patients' nearness to death • the wishes of the patients and their families • the expected benefits from the patients' point of view