Beneficence Vs Nonmaleficence

Beneficence and nonmaleficence are arguably two of the most well-known and relevant topics in ethics. These terms are a central aspect of the nursing code of ethics and yield countless implications that guide our nursing practice.

Beneficence is a moral action and ethical principle to promote good. This means that we are only performing interventions and making recommendations that we believe are in the best interest of the patient. As nurses, beneficence is extremely valuable because it encourages critical thinking and to consider the outcomes of our care to ensure it is in the patient’s best interest. Beneficence holds us to the highest standard of practice. To put it simply, beneficence “emphasizes compassionate care and advocates for continual striving toward excellence” (Bernstein, 2017). Nurses are encouraged to always act with beneficence in mind, which should come as no surprise since the core of the profession’s goals is to promote the well-being of others. Doing no harm is directly tied to the nurse's duty to protect the patient's safety. Born out of the Hippocratic Oath, this principle dictates that we do not cause injury to our patients (Silva, 1999).

Examples of beneficence in nursing are numerous. One simple example is that a nurse knows it is in the best interest of a severely injured patient to receive pain medication as soon as possible when he/she arrives at the emergency room. They should receive this medication before other non-urgent aspects of their care are dealt with. In other situations, beneficence can be difficult and complex. One example that I have witnessed myself and we have discussed in class is when an Arabic mother was giving birth and would only allow female doctors in the room. The birth was traumatic and the baby needed a neonatologist immediately, but there were only male neonatologists working that day. The nurse knew that it was in the best interest of the patient to get the baby the help she needed and allowed the male doctor in the room. Another complex instance of beneficence could be when a patient denies medical care due to religion or cultural preferences and then later becomes unconscious in an emergent situation. The nurse then gave the medical care anyways in the emergency. It can be said that the nurse took away the patient’s autonomy and right to choose, but she has also acted with beneficence because the intervention saved the patient’s life.   Problems may arise between a patient’s desires when competent and the essential care that was given when they were deemed incompetent. In cases like this where a patient is unable to make decisions, medical staff is expected to act with both nonmaleficence and beneficence.  

Next, there is nonmaleficence, which can be defined as a medical professional’s duty to “do no harm.” This principle must be followed closely by nurses with the best interest of the patients in mind (Timko, 2001). In many critical care situations, treatments and interventions that are done often may result in unintentional short-term or long-term harm. The decision on whether or not to perform an action is decided by weighing the risks and benefits. No action should do anything to knowingly harm patients without the action having desired equal or greater benefits. In other words, the dangers of a procedure must be understood and weighed against the prospective benefits (Pantilat, 2008). When conscious and able to make the decision, it is the patient’s right to decide if they believe the procedure is worth the risk of potential harm.  

In conclusion, comprehensive and patient centered care that follows our moral code must demonstrate a balance between beneficence and nonmaleficence when weighing treatment decisions for our patients.

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